MedicalResearch.com Interview with:
Dr. Eileen H. Shinn PhD
Assistant Professor, Department of Behavioral Science
Cancer Prevention and Population Sciences
MD Anderson Cancer Center
The University of Texas
Medical Research: What is the background for this study? What are the main findings?
Dr. Shinn: Recent studies with leukemia, breast, lung, renal and liver cancer patients have shown that patients with depression have worsened survival. These effect sizes are small, but independent of any of the traditional factors that are known to impact survival, such as extent of cancer, types of treatment administered and baseline health and age of the patient. The current thinking is that cancer patients who are depressed have chronically heightened responses to stress; the constant release of stress hormones trigger changes in the tumor itself (such as noradrenergically-driven tumor angiogenesis) or may weakens the body’s immune function and ability to resist tumor growth.
When we measured depression in newly diagnosed patients with oropharyngeal cancer (cancer of the base of tongue and tonsil), we found that those patients who scored as depressed were 3.5 times more likely to have died within the five year period after their diagnosis, compared to nondepressed patients. We also found that patients who were depressed were also 3.8 times more likely to have their cancer recur within the first five years after diagnosis. We also found that patients who continued to smoke after diagnosis were more likely to recur within the first five years. These effect sizes were larger than those typically found in recent studies. We believe that the larger effect size may be due to the tight eligibility criteria ( e.g., we did not include patients who already had recurrent disease, we only included patients with one specific type of head and neck cancer, oropharyngeal) and also due to controlling other known factors (all patients completed individualized treatment regimens of radiation/ chemoradiation at a comprehensive cancer center and patients with more advanced disease stage were more likely to have received treatment intensification compared to patients with early stage disease). In all, we had 130 patients, one of the largest prospective studies with oropharyngeal cancer to examine the effect of depression on cancer outcome.
Medical Research: What should clinicians and patients take away from your report?
Dr. Shinn: With important factors, such as careful diagnosis, staging and individualized multidisciplinary treatment plans, being equal, depression status may impact patient recurrence and survival in oropharyngeal cancer.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Shinn: These results need to be replicated in a larger study, with particular attention paid to repeated measures of depression as well as possible biobehavioral markers of tumor growth and chronic stress.
Depression and Oropharynx Cancer Outcome.
Shinn, Eileen H. PhD; Valentine, Alan MD; Jethanandani, Amit MPH; Basen-Engquist, Karen PhD, MPH; Fellman, Bryan MS; Urbauer, Diana MS; Atkinson, Emma BA; Yusuf, Syed Wamique MD; Lenihan, Daniel MD; Woods, Myrshia L. PA; Kies, Merrill S. MD; Sood, Anil K. MD; Carmack, Cindy PhD; Morrison, William H. MD; Gillenwater, Ann MD; Sturgis, Erich M. MD, MPH; Garden, Adam S. MD
Depression and Smoking Linked To Worse Prognosis in Oral Cancer (2015). Depression and Smoking Linked To Worse Prognosis in Oral Cancer