Link Between Previous Treatment for Depression and Increased Risk of Receiving Nonguideline Treatment in Early-Stage Breast Cancer
Women with early-stage breast cancer previously treated for depression were more likely to receive nonguideline treatment for breast cancer, “probably contributing to poorer overall and cancer-specific survival,” according to a nationwide Danish cohort study reported in the Journal of Clinical Oncology by Suppli et al.
The study included 45,325 women with early-stage breast cancer diagnosed from 1998 to 2011. Of them, 744 women (2%) had a previous hospital contact as an inpatient or outpatient for depression, and 6,068 (13%) had been treated with antidepressants.
Association With Treatment and Outcome
Tumor stage was not associated with a delay in diagnosis of breast cancer in women previously treated for depression. Women receiving antidepressants before a breast cancer diagnosis had a significantly increased risk of receiving nonguideline treatment for breast cancer (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.03–1.27), poorer breast cancer–specific survival (hazard ratio [HR] = 1.11, 95% CI = 1.03–1.20), and poorer overall survival (HR = 1.21, 95% CI = 1.14–1.28).
Among women with a previous hospital contact for depression, there were nonsignificantly increased risks for nonguideline treatment (OR = 1.32, 95% CI = 0.99–1.77) and being classified as having low-risk breast cancer (OR = 1.24, 95% CI = 0.98–1.58); no difference in breast cancer–specific mortality was observed between these women and those with no history of antidepressant use.
In a subgroup analysis among women with high-risk breast cancer who did not receive guideline adjuvant systemic therapy, overall survival was worse among those who had used antidepressants (HR = 1.51, 95% CI = 1.26–1.82) and nonsignificantly worse among those with previous hospital contact for depression (HR = 1.57, 95% CI = 0.99–2.49).
The investigators concluded: “Women previously treated for depression constitute a large subgroup of patients with breast cancer who are at risk for receiving non-guideline breast cancer treatment, which probably contributes to poorer overall and breast cancer–specific survival.”
This study was supported by the Danish Cancer Society and the University of Copenhagen.
Nis P. Suppli, MD, PhD, of the Danish Cancer Society Research Center, Copenhagen, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
