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. 2022 Sep 20:12:980197.
doi: 10.3389/fonc.2022.980197. eCollection 2022.

Risk of developing depression from endocrine treatment: A nationwide cohort study of women administered treatment for breast cancer in South Korea

Jooyoung Oh  1   2 , Hye Sun Lee  3 , Soyoung Jeon  3 , Dooreh Kim  4 , Jeong-Ho Seok  1   2 , Woo-Chan Park  4 , Jae-Jin Kim  1   2 , Chang Ik Yoon  4
Affiliations

Risk of developing depression from endocrine treatment: A nationwide cohort study of women administered treatment for breast cancer in South Korea

Jooyoung Oh et al. Front Oncol. .

Abstract

Background: Although previous studies demonstrated no association between depression and tamoxifen in patients with breast cancer, there is still a limited amount of long-term follow-up data. This study aimed to evaluate the relationship between endocrine treatment and the risk of depression.

Methods: This nationwide population-based cohort study used data obtained over a 14-year period (January 2007 to December 2021) from the Korean National Health Insurance claims database. All female patients with breast cancer were included. We examined the incidence of depression in patients who underwent endocrine treatment, and those who did not undergo endocrine treatment constituted the control group.

Results: The data from 11,109 patients who underwent endocrine treatment and 6,615 control patients between 2009 and 2010 were analyzed. After performing matching for comorbidities and age, both groups comprised 6,532 patients. The median follow-up were 119.71 months. Before and after matching was performed, the endocrine treatment was not a significant risk factor for developing depression (p=0.7295 and p=0.2668, respectively), nor was it a significant factor for an increased risk for suicide attempt (p=0.6381 and p=0.8366, respectively).

Conclusions: Using a real-world population-based cohort, this study demonstrated that there is no evidence that the endocrine treatment increases the risk of depression.

Keywords: aromatase inhibitor; breast cancer; depression; endocrine treatment; tamoxifen.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for the selection and enrollment of eligible patients in this study.
Figure 2
Figure 2
Kaplan–Meier analysis of the incidence of depression in breast cancer patients according to endocrine treatment. Before matching, there was no significant difference between the patients who underwent endocrine treatment and those who did not undergo endocrine treatment (A, p = 0.729, log-rank test). After matching, there was still no significant difference between the two groups of patients (B, p = 0.267).
Figure 3
Figure 3
Subgroup analysis of incidence of depression in breast cancer patients according to the use of tamoxifen. Before matching, there was no difference in the incidence (only diagnosis) between the patients administered tamoxifen and those not administered tamoxifen (A, p = 0.248, log-rank test). After matching, there was still no significant difference between these two groups (B, p = 0.207). When the incidence of depression (diagnosis + anto-depressant) analyzed in patients, there was no difference in the risk of depression according to tamoxifen use, both before matching (C, p = 0.642) and after matching (D, p = 0.100).
Figure 4
Figure 4
Subgroup analysis of incidence of depression in breast cancer patients according to the use of aromatase inhibitors. Before matching, patients administered aromatase inhibitors was exhibited a higher incidence of depression (only diagnosis) than those not administered aromatase inhibitors (A, p = 0.007). However, there was no significant difference between these two groups after matching (B, p = 0.635). When the incidence of depression (diagnosis + anto-depressant) was analyzed in the patients, the patients administered aromatase inhibitors had a signficantly increased risk of depression than those not administered aromatase inhibitors (C, p = 0.049). However, there was no significant difference between these two groups after matching (D, p = 0.533).
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