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The chemotherapy blues: How depression impacts treatment efficacy

January 13, 2017

    Depression is a well-known side effect of cancer: 15-25% of cancer patients experience some degree of depression following their diagnosis. While depression undoubtedly has a negative impact on a patient's quality of life, a new study suggests even more dire consequences—that depression can hinder the effectiveness of cancer treatment.

    Depression increases the severity of chemo-induced side effects and reduces progression-free survival

    This study evaluated the effect of depression on patients with small cell lung cancer (SCLC). A total of 186 participants enrolled in the study and completed a Self-Rating Depression Scale (SRDS) and quality of life (QOL) assessment the day before their first round of chemotherapy.

    The authors found that patients who had reported higher levels of depression had lower tolerance for chemotherapy. These patients experienced adverse side effects, such as chemotherapy-induced nausea and vomiting (CINV) and lower white blood cell count, the latter of which can lead to chemotherapy resistance. Even more impactful, patients who reported moderate to severe depression at the beginning of the study had reduced progression-free survival (PFS) and overall survival (OS).

    A neuropathic factor associated with depression may be to blame

    Previous studies have shown that quality of life can have an effect on cancer patients' PFS and OS, but few studies have demonstrated why this occurs. The authors of this article hypothesize that the correlation between depression and effectiveness of chemotherapy can be attributed to the decreased levels of brain-derived neurotrophic factor (BDNF) in the blood of depressed patients.

    Lower levels of BDNF are well-documented in people with depression, but this is one of the first studies linking this factor to cancer patients' response to chemotherapy. Patients with higher levels of depression had lower levels of BDNF and also lower PFS and OS. Through an in-vitro experiment, the authors found that cells treated with higher levels of BDNF were more receptive to chemotherapy. Conversely, this suggests that the lower levels of BDNF found in patients with depression may hinder the effectiveness of chemotherapy.

    Distress screening and management are critical for patient care

    These findings highlight just how much of an impact depression can have on patients' survival. Assessing and treating patients' depression early on can have a critical impact on the quality of their care and the effectiveness of their treatment. Explore our guidance outlined below to learn how you can improve distress screening and management at your organization.

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