Study: Does prior antidepressant use affect the treatment breast cancer patients receive?
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This study is about:
Whether women with a history of depression before their initial breast cancer diagnosis are more likely to have breast cancer treatment that does not follow national guidelines and also whether they have poorer survival compared to women without a history of depression.
Why is this study important?
To identify groups of patients who may not be getting standard of care treatment that improves their chances of surviving breast cancer.
- Women from Denmark who were diagnosed with primary breast cancer and had a history of depression that was treated with antidepressants had increased risk of:
- receiving breast cancer treatment that did not follow national guidelines.
- having worse overall survival.
- While these risks were increased, the overall differences were small between women who were treated with antidepressants and those who were not.
What does this mean for me?
This study suggests that women who had breast cancer diagnoses and previous treatment for depression were more likely have cancer treatments that did not adhere to national guidelines and also have worse overall survival. A serious limitation of the study is that it could not address why these treatments did not follow national guidelines. While more work needs to be done to understand why this may be occurring, all breast cancer patients should feel comfortable asking their health care providers about their treatments, so that they can understand the reasons for the treatment and any other available options. Oncologists recommend breast cancer treatment based on many different pieces of information, including cancer , subtype of breast cancer (e.g. , , , etc.), and sometimes the results of prognostic tests or testing for inherited mutations in or other genes that increase cancer risk. In the United States, the National Comprehensive Cancer Network publishes versions of the national breast cancer treatment guidelines to help patients understand the current standard of care treatments and facilitate shared decision making with their physicians.
This is an interesting study that generates ideas for further research, but it should not cause alarm for patients who face both depression and cancer. People who are being actively treated for depression at the time of a cancer diagnosis or who have a history of depression should let their oncologists and other health care providers know so that their physicians can provide appropriate care or referrals. Everyone should inform their health care provider of all medications and supplements they are taking.
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Suppli NP, Johansen C, Kessing LV, et al. “Survival after breast cancer of women previously treated for depression: a nationwide Danish cohort study.” Journal of Clinical Oncology. Published online first on November 14, 2016.
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This article is relevant for:
Women diagnosed with breast cancer who have received antidepressants
This article is also relevant for:
Breast cancer survivors
Women under 45
Women over 45
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IN DEPTH REVIEW OF RESEARCH
Previous studies found an association between depression and survival after breast cancer, with people who have a history of depression experiencing worse rates of survival than those who do not. Nis Suppli and colleagues from the Danish Cancer Society Research Center published work in the Journal of Clinical Oncology in January 2017 to try to understand this association.
Researchers of this study wanted to know:
Do women who have previously been prescribed antidepressants receive different breast cancer treatments than women who have not taken antidepressants?
Population(s) looked at in the study:
This study included 45,325 women from Denmark who were diagnosed with breast cancer between April 1998 through December 2011: 6,068 (13%) of the women had previously used antidepressants. Women with a previous cancer diagnosis or other major psychiatric disorders were excluded. The study authors used national cancer treatment guidelines and clinical data from the Danish Breast Cancer Group. Information on which women had been prescribed antidepressants was retrieved from the Danish Psychiatric Central Research Register.
- Women in Denmark who were diagnosed with breast cancer and who had previously taken antidepressants had increased risk of:
- receiving cancer treatment that did not follow national guidelines.
- having worse overall survival.
- having worse breast cancer-specific survival.
- While these risks were increased, the overall differences were small between women who were treated with antidepressants and those who had not.
Because the researchers used existing data from registries and did not collect it themselves, they were unable to differentiate between women who had undiagnosed or untreated depression and those who had depression but only had psychotherapy without antidepressants. (The registry information was collected over a 13½-year period during which treatment for both breast cancer and depression has evolved.) Nor did researchers take into account lifestyle factors such as alcohol use, smoking, and access to care. Another problem was the use of antidepressant prescriptions as a measure of the women with depression—this number could include patients who didn’t necessarily have depression, as antidepressants are often prescribed to treat anxiety, pain and other conditions; the number may have also missed people with depression who chose to treat it with other methods. Finally, because of the study design, researchers were unable to understand why treatment for patients who had been prescribed antidepressants was less likely to follow recommended national guidelines. Several reasons are possible, including patient preference, health care providers not offering guideline-based treatments, patients may not have been compliant, or a combination of these and/or other reasons.
It is also important to note that this study was conducted in the Danish health care system and does not necessarily reflect what is happening in the United States.
This study suggests that breast cancer patients who were previously treated for depression are more likely to receive cancer treatment other than treatment that is recommended by national guidelines. This is an interesting study that generates ideas for further research, but it should not cause alarm for patients who face both depression and cancer. Breast cancer patients or survivors with depression or a history of depression should discuss any concerns with their health care providers.
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- What treatments are available to treat my breast cancer?
- Do I need chemotherapy?
- How does depression affect breast cancer?
- I take medication to treat depression. Can I continue during cancer treatment?
- I have struggled with depression in the past. Are there resources for cancer patients dealing with depression?
The following studies on the emotional effects of cancer are enrolling patients:
- NCT04739696: Developing a Virtual Stress Management Intervention for Spousal/Partnered Caregivers of Solid Tumor Cancer Patients. This study will look at the ability of a stress management program for employed caregivers to improve psychological distress in spouses or partners who are caregivers for people diagnosis with a solid tumor cancer of any .
- NCT03581357: Mobile Mindfulness Meditation Intervention for Cancer Survivors. This will study the impact and satisfaction of Mobile Mindfulness Meditation on anxiety, pain, fatigue, trauma, and sleep in cancer survivors.
- NCT03611309: Perioperative Surrounding Cancer Surgery for Patients & Their Family Members (PERIOP-PC). The study goal is to compare surgeon-palliative care team co-management, versus surgeon alone management, of patients and family members preparing for major upper gastrointestinal cancer surgery.
- NCT04604158: Evaluating the Effect of a Mobile Audio Companion (Elly) to Reduce Anxiety in Cancer Patients. This is a study in cancer patients to examine the feasibility of a mobile health application, Elly (Elly Health Inc.), to reduce levels of anxiety, stress, loneliness, and social isolation.
- NCT03344757: Health Gatherings - For Your Health After Cancer. look at the effects of a 10-week stress management in-person group program. The program will study emotions, stress, and stress management techniques (such as relaxation and coping techniques) on quality of life, distress, depression, and physical health in Spanish- speaking, Hispanic/Latino men diagnosed with Cancer (PC).
- NCT05364450: Studying Types of Therapy for Coping With Fear of Recurrence Among Breast Cancer Survivors. Fear of breast cancer recurrence (FCR) is common. This study will test three types of online, group therapy for breast cancer survivors with FCR.
- NCT04583891: Mobile Apps to Reduce Distress in Breast Cancer Survivors Using an Adaptive Design. This project will look at using a mobile health app to address emotional distress in women with breast cancer, and test the impact of coaching as a way to increase engagement with the app.
- NCT02871752: Reducing the Effects of Active Surveillance Stress, Uncertainty and Rumination Thru Engagement in Mindfulness Education (REASSUREME). This study examines how well a couples-based mindfulness-based stress reduction (MBSR) works on positive and negative psychological responses to active surveillance (AS) and AS adherence.
- NCT03344757: Health Gatherings - For Your Health After Cancer. This study will look at the effects of a 10-week stress management in-person group program. The program will study the effects of stress, and stress management techniques on quality of life, distress, depression, and physical health in Spanish- speaking, Hispanic/Latino men diagnosed with cancer.
The following organizations offer peer support services for people with, or at high risk for breast cancer:
- FORCE peer support:
- Our Message Boards allow people to connect with others who share their situation. Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Connect online with our Private Facebook Group.
- Join our virtual and in-person support meetings.
- Other organizations that offer breast cancer support:
Who covered this study?
Also published in:
The same article was also covered by Fox News.
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