Researchers at The University of Texas MD Anderson Cancer Center have found that symptoms of depression in patients with newly diagnosed metastatic kidney cancer are associated with worse outcomes, a link that may be explained by inflammatory gene regulation.
"Our findings... suggest that mental health and social well-being can affect biological processes, which influence cancer-related outcomes," said lead author Lorenzo Cohen, PhD, professor in the Departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program at MD Anderson.
The study, published in the journal PLoS ONE, explores the interplay between patient psychological condition, stress hormone regulation, and the role of inflammatory gene expression.
Although previous research has linked depression to worse outcomes in patients with cancer, the authors said "these findings provide the first evidence that levels of depressive symptoms are associated with survival time among patients with newly diagnosed advanced renal cell carcinoma, controlling for disease-and treatment-related factors."
"We were particularly interested in examining psychosocial factors as predictors of survival," said Cohen. "Our findings indicate that we're now able to understand some of the possible biological pathways that explain the association between depression and survival."
The researchers examined 217 patients with newly diagnosed metastatic renal cell carcinoma over a period of 67 months. At study entry, patients provided blood samples and completed questionnaires and surveys designed to measure depressive symptoms, general quality of life, social support, coping, religiosity, and spirituality.
Participants also provided five saliva samples per day for three days to evaluate fluctuations of cortisol (the stress hormone that should be high in the morning and diminish during the course of the day). Increased cortisol levels have been found in patients with depressive symptoms and are linked to cellular alterations, Cohen explained.
At the time of analysis, 64 percent of patients were deceased, with the average time from diagnosis to death 1.8 years. Overall, 23 percent of patients reported symptoms of clinical depression, which was associated with shorter survival time. A "flattened" cortisol slope from morning to evening was also related to shorter survival time.
Whole-genome profiling was conducted on tissue samples from an equal number of patients with the highest depressive symptoms and risk-matched patients with the lowest depressive symptom scores to determine whether the increased mortality risk in patients with higher depressive symptoms might stem from pro-inflammatory gene expression.
"We know specific signaling pathways like NF-ĸB play a critical role in regulating inflammation within cells," said co-author Anil Sood, MD, of MD Anderson's Department of Gynecologic Oncology. "Our goal was to determine if these pathways were expressed at greater levels in patients with depressive symptoms and we found data indicating they were." These findings suggest the association between patient psychological condition and survival time may stem from a dysregulation in inflammatory biology and cortisol slope.
Researchers say the next step is to conduct clinical trials to evaluate whether management of depression using behavioral techniques or pharmacologic interventions can influence survival in patients with mild, moderate, or severe mood disorders and a cancer diagnosis. Meanwhile, said Cohen, the present findings "suggest that screening for mental health should be part of standard care because there are well accepted ways of helping people manage distress, even in the face of a life threatening illness."
Is screening for mental health part of the standard of care at your center? What is the role of the oncology nurse in the process?
- UT MD Anderson study finds link between depressive symptoms and cancer survival. Available at http://www.mdanderson.org/newsroom/news-releases/2012/depression-and-cancer.html.
- Cohen L, Cole SW, Sood AK, Prinsloo S, Kirschbaum C, et al. Depressive symptoms and cortisol rhythmicity predict survival in patients with renal cell carcinoma: role of inflammatory signaling. PLoS One. 2012;7(8):e42324. Epub 2012 Aug 1. Available at