Screen Breast Cancer Patients for Depression: From the Annual Meeting of the American Psychiatric Association

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HONOLULU - Women whose depression improved during a 1-year treatment trial for metastatic breast cancer survived a median 2 years longer than women whose depression worsened, according to a long-term follow-up study.

"Our main finding is that the course of depression over the initial year of the study can be used to predict survival up to 14 years later," Dr. David Spiegel said at the meeting.

Therefore, screen patients with breast cancer for depression. Also, do not dismiss depressive symptoms as merely a normal component of a cancer diagnosis or treatment, he said. Another clinical implication is that psychotherapy intervention can make a significant positive difference. "There are ways of facing and living with this disease that may help patients to live longer as well as better.

"This is a tremendous opportunity for psychiatry to be a part of the mission that is now mandated at cancer centers - to help cancer patients live better with their illness," said Dr. Spiegel, director of the center on stress and health at Stanford (Calif.) University.

One-quarter of cancer patients meet the criteria for depression, Dr. Spiegel said. "The more serious your medical illness, the more likely you are to be depressed. It's 3% of the general population, 6% of outpatients, and 12% of medical inpatients - 1 out of 9 is depressed. But we often overlook the diagnosis; we misattribute the sadness to the prognosis of the disease; the disinterest in eating to the side effects of chemotherapy; the sleep disturbance to the worry about the illness. "All of these can be signs of depression," he said.

Therefore, more awareness of an association between depression and a cancer prognosis is warranted. "Somehow people get the idea that if you have depression, it can worsen your prognosis with heart disease. But they have a much more difficult time understanding that ... depression is just as lethal a comorbid factor with cancer," Dr. Spiegel said.

He and his associates found median survival was 53.6 months for women whose baseline scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) decreased over a period of 12 months, compared with a median 25.1-month survival for women whose CES-D scores increased. This 28.5-month difference in median survival was statistically significant.

The cohort included 101 women of 125 randomized to supportive-expressive group therapy or a control group with education materials who completed the CESD scale at base-line and at three assessment points during the year (J. …