TY - JOUR

T1 - Survival After Early-Stage Breast Cancer of Women Previously Treated for Depression

T2 - A Nationwide Danish Cohort Study

AU - Suppli, Nis P

AU - Johansen, Christoffer

AU - Kessing, Lars V

AU - Toender, Anita

AU - Kroman, Niels

AU - Ewertz, Marianne

AU - Dalton, Susanne O

PY - 2017

Y1 - 2017

N2 - Purpose The aim of this nationwide, register-based cohort study was to determine whether women treated for depression before primary early-stage breast cancer are at increased risk for receiving treatment that is not in accordance with national guidelines and for poorer survival. Material and Methods We identified 45,325 women with early breast cancer diagnosed in Denmark from 1998 to 2011. Of these, 744 women (2%) had had a previous hospital contact (as an inpatient or outpatient) for depression and another 6,068 (13%) had been treated with antidepressants. Associations between previous treatment of depression and risk of receiving nonguideline treatment of breast cancer were assessed in multivariable logistic regression analyses. We compared the overall survival, breast cancer-specific survival, and risk of death by suicide of women who were and were not treated for depression before breast cancer in multivariable Cox regression analyses. Results Tumor stage did not indicate a delay in diagnosis of breast cancer in women previously treated for depression; however, those given antidepressants before breast cancer had a significantly increased risk of receiving nonguideline treatment (odds ratio, 1.14; 95% CI, 1.03 to 1.27) and significantly worse overall survival (hazard ratio, 1.21; 95% CI, 1.14 to 1.28) and breast cancer-specific survival (hazard ratio, 1.11; 95% CI, 1.03 to 1.20). Increased but nonsignificant estimated risks were also found for women with previous hospital contacts for depression. In subgroup analyses, the association of depression with poor survival was particularly strong among women who did not receive the indicated adjuvant systemic therapy. Conclusion Women previously treated for depression constitute a large subgroup of patients with breast cancer who are at risk for receiving nonguideline breast cancer treatment, which probably contributes to poorer overall and breast cancer-specific survival.

AB - Purpose The aim of this nationwide, register-based cohort study was to determine whether women treated for depression before primary early-stage breast cancer are at increased risk for receiving treatment that is not in accordance with national guidelines and for poorer survival. Material and Methods We identified 45,325 women with early breast cancer diagnosed in Denmark from 1998 to 2011. Of these, 744 women (2%) had had a previous hospital contact (as an inpatient or outpatient) for depression and another 6,068 (13%) had been treated with antidepressants. Associations between previous treatment of depression and risk of receiving nonguideline treatment of breast cancer were assessed in multivariable logistic regression analyses. We compared the overall survival, breast cancer-specific survival, and risk of death by suicide of women who were and were not treated for depression before breast cancer in multivariable Cox regression analyses. Results Tumor stage did not indicate a delay in diagnosis of breast cancer in women previously treated for depression; however, those given antidepressants before breast cancer had a significantly increased risk of receiving nonguideline treatment (odds ratio, 1.14; 95% CI, 1.03 to 1.27) and significantly worse overall survival (hazard ratio, 1.21; 95% CI, 1.14 to 1.28) and breast cancer-specific survival (hazard ratio, 1.11; 95% CI, 1.03 to 1.20). Increased but nonsignificant estimated risks were also found for women with previous hospital contacts for depression. In subgroup analyses, the association of depression with poor survival was particularly strong among women who did not receive the indicated adjuvant systemic therapy. Conclusion Women previously treated for depression constitute a large subgroup of patients with breast cancer who are at risk for receiving nonguideline breast cancer treatment, which probably contributes to poorer overall and breast cancer-specific survival.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antidepressive Agents/therapeutic use

KW - Breast Neoplasms/mortality

KW - Cause of Death

KW - Chemotherapy, Adjuvant

KW - Chi-Square Distribution

KW - Denmark/epidemiology

KW - Depression/diagnosis

KW - Disease-Free Survival

KW - Early Detection of Cancer

KW - Female

KW - Guideline Adherence

KW - Humans

KW - Logistic Models

KW - Medication Adherence

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasm Staging

KW - Practice Guidelines as Topic

KW - Practice Patterns, Physicians'

KW - Proportional Hazards Models

KW - Recurrence

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Suicidal Ideation

KW - Suicide/prevention & control

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1200/JCO.2016.68.8358

DO - 10.1200/JCO.2016.68.8358

M3 - Journal article

C2 - 28095267

VL - 35

SP - 334

EP - 342

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 3

ER -