Cancer incidence and mortality rates in Hungary are the highest in the Central-Eastern European region. Our investigative study examined associations of cancer-prone behavioral risk factors, psychosocial variables and demographic characteristics with cancer treatment on a population level. Data were obtained from the Hungarostudy 2002, a cross-sectional, representative survey of the adult Hungarian population (n=12643). Controlling for all other study variables in a binary logistic regression model, results revealed that the odds of having been treated for cancer were almost twice as high among persons with depression and respondents who experienced negative life events than for those who were not depressed and reported no negative life events. These results send a warning signal to the Hungarian health care system regarding the widespread need for education, prevention, psycho-social screening programs and treatment of depression.
Keywords: depression, negative life events, cancer treatment, population study
In Hungary, cancer incidence (772.24 per 100 000) and cancer mortality (263.81 per 100 000) rates are the highest in the Central-Eastern European region and among the highest in international comparative analyses based on epidemiological data (Gárdos, 2002; WHO, 2006). Also, prevalence of clinical depression (score 19 and higher on the Beck Depression Inventory) in the Hungarian population has been increasing since 1988 when it was 7.5%. The prevalence rose to 14.1% in 1995 and 16.5% in 2002 (Balo & Purebl, 2008). While the associations between psychosocial variables and cancer have been relatively thoroughly-studied in general, no research has specifically addressed these relationships within the Hungarian population. The national representative survey (Hungarostudy 2002) provided a valuable resource to allow the examination of the psychosocial aspects of cancer.
Psychosocial variables and their relationship to cancer incidence and progression are discussed in several recent reviews (Balog & Degi, 2005; Bleiker & Ploeg, 1999; Butow et al., 2000; DeBoer, Ryckman, Pruyn, & VandenBorne, 1999; Denollet, 1999; Garssen, 2004; Kállay, Degi, & Vincze, 2007; McKenna, Zevon, MCorn, & Rounds 1999; Petticrew, Fraser, & Regan, 1999). Although evidence is mixed and opinions divided, Garssen (2004) concluded that 70% of the prospective studies reviewed showed an association between psychosocial aspects and cancer outcomes. An even larger number of studies found that these aspects affected cancer progression in particular.
Depression in cancer patients is associated with non-disclosure of cancer diagnosis (Degi, 2009), lower quality of life (Grassi et al., 1996; Koller et al., 1996), high suicide rate (Henriksson, Isometsa, Hietanen, Aro, & Lonnqvist, 1995), poorer adjustment to the disease (Watson, Haviland, Greer, Davidson, & Bliss, 1991), poor adherence to medical treatment (Pirl & Roth, 1999), and less optimism about treatment effectiveness (Cohen, de Moor, & Amato, 2001). Further, depression affects many bodily functions such as endocrine and immune functioning, which persistently activate the hypothalamic-pituitary-adrenal (HPA) axis, affects and compromises immune surveillance of tumors and resistance to cancer progression, increases DNA damage and inhibits apoptosis (Gidron, Russ, Tissarchondou, & Warner, 2006; Irie, Miyata, & Kasai, 2005; Levy, Herberman, Lippman, D'Angelo, & Lee, 1991). In general depression is associated with decreased number and cytotoxicity of T and NK (natural killer) cells which influence cancer progression (Levy et al., 1991). Recently it has been suggested that depression is correlated with cancer-related oxidative DNA damage, as levels of 8-OH-dG (8-hydroxydeoxyguanosine) in depressed cancer patients were higher than in controls (Gidron et al., 2006; Irie et al., 2005).
It is also important to note that the relationship between depression and cancer is associated with cigarette smoking (Knekt et al. …