Patients with depression may have a higher risk of receiving breast cancer treatment that is not in accordance with national guidelines, ultimately contributing to poorer overall and breast cancer-specific survival, a study published in the Journal of Clinical Oncology has shown.1
To determine whether women treated for depression before a diagnosis of primary early-stage breast cancer are at an increased risk for receiving nonguideline treatment, investigators analyzed data from 45,325 women with early breast cancer diagnosed in Denmark between 1998 and 2011.
Of those, 744 women had been seen as an inpatient or outpatient by a health care provider for depression and another 6068 had been treated with antidepressants.
Researchers found that tumor stage was not associated with a delay in diagnosis of breast cancer in women previously treated for depression; however, patients given antidepressants prior to cancer diagnosis had a 14% higher risk of receiving nonguideline treatment (odds ratio [OR], 1.14; 95% CI, 1.03-1.27).
The study also showed that women treated with antidepressants have a 21% higher risk of all-cause mortality (hazard ratio [HR], 1.21; 95% CI, 1.14-1.28) and an 11% increased risk of breast cancer-specific death (HR, 1.11; 95% CI, 1.03-1.20).
There was no significant difference in risk of receiving nonguideline treatment in women with previous hospital contacts for depression and those without.
Subgroup analyses further demonstrated that the association of depression with poor survival was particularly strong among women who did not receive the recommended adjuvant systemic treatment.
The findings underscore the importance of identifying women with a previous medical history of depression in order to increase initiation of adjuvant systemic breast cancer therapy and monitoring compliance to therapy.
1. Suppli NP, Johansen C, Kessing LV, et al. Survival after early-stage breast cancer of women previously treated for depression: a nationwide Danish cohort study. J Clin Oncol. 2016 Nov 14. doi: 10.1200/JCO.2016.68.8358. [Epub ahead of print]