Abstract
Depression and cancer commonly co-occur. The prevalence of depression among cancer
patients increases with disease severity and symptoms such as pain and fatigue. The
literature on depression as a predictor of cancer incidence is mixed, although chronic
and severe depression may be associated with elevated cancer risk. There is divided
but stronger evidence that depression predicts cancer progression and mortality, although
disentangling the deleterious effects of disease progression on mood complicates this
research, as does the fact that some symptoms of cancer and its treatment mimic depression.
There is evidence that providing psychosocial support reduces depression, anxiety,
and pain, and may increase survival time with cancer, although studies in this latter
area are also divided. Psychophysiological mechanisms linking depression and cancer
progression include dysregulation of the hypothalamic-pituitary-adrenal axis, especially
diurnal variation in cortisol and melatonin. Depression also affects components of
immune function that may affect cancer surveillance. Thus, there is evidence of a
bidirectional relationship between cancer and depression, offering new opportunities
for therapeutic intervention.
Keywords
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References
- Stress and immune responses after surgical treatment for regional breast cancer.J Natl Cancer Inst. 1998; 90: 30-36
- A biobehavioral model of cancer stress and disease course.Am Psychol. 1994; 49: 389-404
Antoni M, Carver CS (2003): Cognitive behavioral stress management intervention effects on benefit finding in breast cancer patients. Psychosocial and physiological correlates. Presented at: Society of Behavioral Medicine Twenty-fourth Annual Meeting; Salt Lake City, UT, March 19–22, 2003
- Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. A controlled study.Arch Gen Psychiatry. 1988; 45: 859-864
- Influence of mood and adjustment to cancer on compliance with chemotherapy among breast cancer patients.J Psychosom Res. 1994; 38: 393-402
- Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research.Acta Neurol. 1991; 13: 315-327
- Cognitive Therapy of Depression. Guilford Press, New York1991
- Stress increases metastatic spread of a mammary tumor in rats.Brain Behav Immun. 1991; 5: 193-205
- Illness, the mind, and the body.Theor Med. 1994; 15: 337-347
- Personality factors and breast cancer development.J Natl Cancer Inst. 1996; 88: 1478-1482
- Psychoneuroimmunology and Cancer.in: Holland J.C. Rowland J.H. Handbook of Psychooncology: Psychological Care of the Patient with Cancer. Oxford University Press, New York, NY1989: 727-734
- Depression in hospitalized cancer patients.Psychosom Med. 1984; 46: 199-212
- Psychological distress and pain significantly increase before death in metastatic breast cancer patients.Psychosom Med. 2003; 65: 416-426
- Hormone specific regulation of natural killer cells by cortisol.FEBS Lett. 1991; 285: 108-110
- Will to live in the terminally ill.Lancet. 1999; 354 ([see comments]): 816-819
- Desire for death in the terminally ill.Am J Psychiatry. 1995; 152: 1185-1191
- Psychological factors in illness and recovery.N Z Med J. 1998; 111: 410-412
- Supportive-expressive group therapy and distress in patients with metastatic breast cancer.Arch Gen Psychiatry. 2001; 58: 494-501
- Coping styles associated with psychological adjustment to advanced breast cancer.Health Psychol. 1996; 15: 434-437
- The association between treatment-specific optimism and depressive symptomatology in patients enrolled in a Phase I cancer clinical trial.Cancer. 2001; 91: 1949-1955
- Use of alternative medicine by women with breast cancer.N Engl J Med. 1999; 341 ([letter; comment]): 1155-1157
- Psychiatric symptomatology among hospitalized cancer patients.Am J Psychiatry. 1974; 131: 1323-1327
- Cognitive-behavioral stress management reduces serum cortisol by enhancing benefit finding among women being treated for early stage breast cancer.Psychosom Med. 2000; 62: 304-308
- A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer.Psychooncology. 1998; 7: 508-517
- Depression and cancer risk.Am J Epidemiol. 2002; 155: 1088-1095
- Night shift work, light at night, and risk of breast cancer.J Natl Cancer Inst. 2001; 93: 1557-1562
- Do psychological factors predict survival in breast cancer?.J Psychosom Res. 1989; 33: 561-569
- Psychological coping mechanisms and survival time in metastatic breast cancer.JAMA. 1979; 242: 1504-1508
- Diurnal activity and pulsatility of the hypothalamus-pituitary-adrenal system in male depressed patients and healthy controls.J Clin Endocrinol Metab. 1997; 82: 234-238
- A meta-analysis of the efficacy of cognitive therapy for depression.J Consult Clin Psychol. 1989; 57: 414-419
- Effects of group CBT on the survival time of patients with metastatic breast cancer.Psychooncology. 1999; 8: 474-481
Ehlers SL, Christiensen AJ (2003): Effects of depression symptomatology and substance use on head and neck cancer mortality. Presented at: Society for Behavioral Medicine Twenty-fourth Annual Meeting; Salt Lake City, UT, March 19–22, 2003
- Trends in alternative medicine use in the United States, 1990-1997.JAMA. 1997; 280: 1569-1575
- Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers.JAMA. 2000; 284: 2460-2468
- Depression in the medical setting.J Clin Psychiatry. 1999; 60: 40-56
- Hopelessness and risk of mortality and incidence of myocardial infarction and cancer.Psychosom Med. 1996; 58: 113-121
- Malignant melanoma.Arch Gen Psychiatry. 2003; 60: 100-103
- A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance.Arch Gen Psychiatry. 1990; 47: 720-725
- Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later.Arch Gen Psychiatry. 1993; 50: 681-689
- Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.Am J Prev Med. 1998; 14: 245-258
- Noradrenergic sympathetic innervation of the spleen.J Neurosci Res. 1987; 18: 37-48
- Psychoneuroimmunology and cancer.Adv Neuroimmunol. 1996; 6: 179-190
- Host circadian clock as a control point in tumor progression.J Natl Cancer Inst. 2002; 94: 690-697
- Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy.J Consult Clin Psychol. 2002; 70: 916-925
- Suppression, repressive-defensiveness, restraint, and distress in metastatic breast cancer.J Pers. 2001; 69: 417-449
- Emotional expression and cancer progression.in: Davidson R.J. Scherer K. Hill Goldsmith H. Handbook of Affective Sciences. Oxford University Press, Oxford2003: 1053-1082
- Clinical and biochemical manifestations of depression. Relation to the neurobiology of stress (2).N Engl J Med. 1988; 319 ([published erratum appears in N Engl J Med 1988 Nov 24;319(21):1428]): 413-420
- The effect of group psychosocial support on survival in metastatic breast cancer.N Engl J Med. 2001; 345: 1719-1726
- Psycho-oncology.Psychooncology. 1993; 3: 87-102
- Psychological attributes of women who develop breast cancer.J Psychosom Res. 1975; 19: 147-153
- Diagnostic groups and depressed mood as predictors of 22-month mortality in medical inpatients.Psychosom Med. 1998; 60: 570-577
- A randomized controlled trial of psychotherapeutic intervention in cancer patients.Ann R Coll Physicians Surg Can. 1994; 27: 93-96
- Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy.Cancer. 2000; 88: 615-619
- Depression and cancer mortality and morbidity.J Behav Med. 1988; 11: 1-13
- Depression and chronic medical illness.J Behav Med. 1990; 11: 3-11
- Psychological morbidity and quality of life in Australian women with early-stage breast cancer.Med J Aust. 1998; 169: 192-196
- Elevated lung cancer risk among persons with depressed mood.Am J Epidemiol. 1996; 144: 1096-1103
- Effects of medical and psychotherapeutic treatment on the survival of women with metastatic breast carcinoma.Cancer. 1997; 80: 225-230
- Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery.Hepatogastroenterology. 1999; 46: 322-335
- Changes of immunoregulatory cells induced by psychological and physical stress.Clin Exp Immunol. 1984; 58: 127-135
- Absence of major depressive disorder in female cancer patients.J Clin Oncol. 1985; 3: 1553-1560
- Younger women at increased risk for breast cancer.J Natl Cancer Inst Monogr. 1994; 16: 171-176
- Correlation of stress factors with sustained depression of natural killer cell activity and predicted prognosis in patients with breast cancer.J Clin Oncol. 1987; 5: 348-353
- Correlation of stress factors with sustained depression of natural killer cell activity and predicted prognosis in patients with metastatic breast cancer.J Clin Oncol. 1987; 5: 348-353
- Mastectomy versus breast conservation surgery.Health Psychol. 1992; 11 ([see comments]): 349-354
- Estrogen receptor concentration and social factors as predictors of natural killer cell activity in early-stage breast cancer patients. Confirmation of a model.Nat Immun Cell Growth Regul. 1990; 9: 313-324
- Immunological and psychosocial predictors of disease recurrence in patients with early-stage breast cancer.Behav Med. 1991; 17: 67-75
- Prognostic risk assessment in primary breast cancer by behavioral and immunological parameters.Health Psychol. 1985; 4: 99-113
- A molecular mechanism for stress-induced alterations in susceptibility to disease.Lancet. 1995; 346: 104-106
- Depressed mood and development of cancer.Am J Epidemiology. 1990; 132: 962-972
- Effects of counseling for late stage cancer.Cancer. 1982; 49: 1048-1055
- Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases.J Clin Oncol. 2002; 20: 2118-2126
- A specialized home care intervention improves survival among older post-surgical cancer patients.J Am Geriatr Soc. 2000; 48 ([see comments]): 1707-1713
- Depression in patients with cancer. Diagnosis, biology, and treatment.Arch Gen Psychiatry. 1995; 52: 89-99
- Influences of hormones and neuroactive substances on immune function.in: Cotman C.W. Briton R.E. Galaburda A. McEwen B. Schneider D.M. The Neuro-Immune-Endocrine Connection. Raven, New York1987
- Psychosocial factors and the development of breast cancer.Health Psychol. 1999; 18: 520-531
- Cortisol diurnal variation in blood and saliva of patients with metastatic colorectal cancer.Anticancer Res. 2002; 22: 1243-1250
- Assessment and treatment of depression in the cancer patient.J Psychosom Res. 1998; 45: 215-237
- Screening for anxiety and depression in women with breast cancer. Psychiatry and medical oncology gear up for managed care.Psychosomatics. 1999; 40: 64-69
- Chronically depressed mood and cancer risk in older persons.J Natl Cancer Inst. 1998; 90: 1888-1893
- Personality and risk of cancer.Psychosom Med. 1987; 49: 435-449
- UK and USA breast cancer deaths down 25% in year 2000 at ages 20-69 years.Lancet. 2000; 355: 1822
Pirl WF, Roth AJ (1999): Diagnosis and treatment of depression in cancer patients. Oncology (Huntingt) 13:1293–1302, 1305–1306
- Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer.J Clin Oncol. 1992; 10: 1292-1298
- The effect of compliance with treatment on survival among patients with hematologic malignancies.J Clin Oncol. 1990; 8: 356-364
- Depression in the medically ill.Am J Psychiatry. 1986; 143: 696-705
- A possible mechanism by which stress accelerates growth of virally-derived tumors.Proc Natl Acad Sci U S A. 1992; 89: 11084
- Endocrine mediation of psychosocial stressor effects on mouse mammary tumor growth.Cancer Lett. 1992; 65: 85-93
- Vulnerability to stress-induced tumor growth increases with age in rats.Endocrinology. 1985; 117: 662-666
- Rotating night shifts and risk of breast cancer in women participating in the Nurses' Health Study.J Natl Cancer Inst. 2001; 93: 1563-1568
- Diurnal cortisol rhythm as a predictor of breast cancer survival.J Natl Cancer Inst. 2000; 92: 994-1000
- Melatonin in Psychiatric and Neoplastic Disorders. American Psychiatric Press, Inc, Washington, DC2000
- Psychological depression and 17-year risk of death from cancer.Psychosom Med. 1981; 43 (xxiii, 314): 117-125
- Attitude toward alternative therapy, compliance with standard treatment, and need for emotional support in patients with melanoma.Arch Dermatol. 1997; 133 ([see comments]): 316-321
- Anti-tumor immune mechanisms.in: Lewis C.E. O'Sullivan C. Barraclough J. The Psychoimmunology of Cancer Mind and Body in the Fight for Survival. Oxford Press, Oxford1994: 267-290
- Health caring.Cancer. 1994; 74: 1453-1457
- Cancer and depression.Br J Psychiatry. 1996; 168: 109-116
- Mind matters—group therapy and survival in breast cancer.N Engl J Med. 2001; 345 ([letter; comment]): 1767-1768
- Effects of psychotherapy on cancer survival.Nat Rev Cancer. 2002; 2: 383-389
- Group therapy and hypnosis reduce metastatic breast carcinoma pain.Psychosom Med. 1983; 45: 333-339
- Pain in metastatic breast cancer.Cancer. 1983; 52: 341-345
- Effect of psychosocial treatment on survival of patients with metastatic breast cancer.Lancet. 1989; 2: 888-891
- Group support for patients with metastatic cancer. A randomized outcome study.Arch Gen Psychiatry. 1981; 38: 527-533
- Pain and depression in patients with cancer.Cancer. 1994; 74: 2570-2578
- Re.J Natl Cancer Inst. 2002; 94: 530
- Measuring the quality of life of cancer patients.J Chronic Dis. 1981; 34: 585-597
- Depression and functional status as predictors of death among cancer patients.Cancer. 2002; 94: 2719-2727
- Prediction of survival for older hospitalized patients.J Am Geriatr Soc. 2000; 48: S16-S24
- Neuroendocrine aspects of primary endogenous depression.Psychoneuroendocrinology. 1992; 17: 507-515
- Prospective investigation of emotional control and cancer risk in men (the Zutphen Elderly Study) (The Netherlands).Cancer Causes Control. 2000; 11: 589-595
- Rhythm alteration in patients with metastatic breast cancer and poor prognostic factors.J Cancer Res Clin Oncol. 1995; 121: 181-188
- Psychological symptoms and disease-free and overall survival in women with stage II breast cancer. Cancer and Leukemia Group B.J Natl Cancer Inst. 1996; 88 ([see comments]): 661-667
- Elevated basal cortisol levels and attenuated ACTH and cortisol responses to a behavioral challenge in women with metastatic breast cancer.Psychoneuroendocrinology. 1996; 21: 361-374
- Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients.J Psychosom Res. 1997; 42: 453-466
- Psychological sequelae of cancer diagnosis.Psychosom Med. 1997; 59: 280-293
- Self-esteem, depression and anxiety among Swedish children and adolescents on and off cancer treatment.Acta Paediatr. 2000; 89: 229-236
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- Relationships between emotional control, adjustment to cancer and depression and anxiety in breast cancer patients.Psychol Med. 1991; 21: 51-57
- Influence of psychological response on survival in breast cancer.Lancet. 1999; 354 ([see comments]): 1331-1336
- The construct validity of the repressive coping style.in: Singer J.L. Repression and Dissociation: Implications for Personality Theory, Psychopathology, and Health. University of Chicago Press, Chicago1990: 337-386
- Low-anxious, high-anxious, and repressive coping styles to stress.J Abnorm Psychol. 1979; 88: 369-380
- Relationship between quality of life and mood in long-term survivors of breast cancer treated with mastectomy.Support Care Cancer. 1997; 5: 241-248
- Psychosocial outcomes of breast cancer therapies.Psychosomatics. 1991; 32: 177-186
- Depression and cancer.Psychol Med. 1979; 9: 747-752
- Cortisol regulation in posttraumatic stress disorder and major depression.Biol Psychiatry. 1996; 40: 79-88
- Glucocorticoids can promote androgen-independent growth of prostate cancer cells through a mutated androgen receptor.Nat Med. 2000; 6: 703-706
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- Depression as a risk for cancer morbidity and mortality in a nationally representative sample.JAMA. 1989; 262 ([see comments]): 1191-1195
Article Info
Publication History
Accepted:
June 3,
2003
Received in revised form:
April 2,
2003
Received:
November 12,
2002
Identification
Copyright
© 2003 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
