Older adults with cancer and depression who started talk therapy within four weeks of their diagnosis had a 21% lower risk of dying from their cancer, according to an analysis of 265,639 Medicare patients presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting in Boston. Only 3% of the depressed patients got therapy that early.
The practical point is simple. If you or someone in your family has just been diagnosed with cancer and feels low, hopeless or unable to enjoy things, you can ask the cancer team for a referral to a therapist or counselor in the first few weeks, not months later. This study does not show that therapy treats cancer, and it is not a reason to change or delay any cancer treatment. It is a reason not to write off depression as “just the chemo.”
Whether talk therapy or pills work better for depression is its own question, and in people with heart failure, the two were tested head to head.
Key takeaways
- About 1 in 5 seniors with a common cancer (22%) also had major depression, and they had an 11% higher risk of dying from their cancer.
- Talk therapy started within four weeks of diagnosis was tied to a 21% lower risk of cancer death; the link shrank when therapy started at eight or 12 weeks.
- This was an observational study, so it cannot prove therapy caused the benefit.
What the study found
Researchers led by Edmund M. Qiao, MD, a radiation oncology resident at the University of California San Diego, studied SEER-Medicare records of people aged 66 or older diagnosed from 2010 to 2017 with breast, colorectal, prostate, bladder, kidney or non-small cell lung cancer. More than one in five (22%) also had a diagnosis of major depressive disorder.
Patients with depression had an 11% higher risk of cancer death than those without it. In raw numbers, 29% of patients with depression had died from their cancer one year after diagnosis, compared with 21% of those without depression. At five years, it was 43% versus 35%.
Among patients with depression, therapy started within four weeks of diagnosis was tied to a 21% lower risk of cancer death after the researchers adjusted for measured differences between patients. The link was smaller for therapy at eight weeks (13% lower risk) and 12 weeks (12% lower risk). Five-year cancer death was 31% among patients who got therapy and 44% among those who did not, a raw comparison before any adjustment.
Few people got that help. Only 3% of depressed patients had a therapy session within four weeks, rising to just 4.6% by 12 weeks. Antidepressants were used by 32.5% within four weeks, but they were not tied to lower cancer deaths at any time point across the whole group. The one exception was prostate cancer, where antidepressants were linked to lower cancer death.
Depression was most common in lung cancer (27%) and least common in prostate cancer (13%). The therapy link reached statistical significance in prostate, breast and kidney cancer.
Dr. Kumar’s take
I am working from ASTRO’s press release here; the full paper was not available to me.
The biggest caveat is who gets to a therapist within four weeks of a cancer diagnosis. That person has to be well enough to attend and organized enough to book it, and those traits predict better cancer outcomes on their own. The researchers used statistical weighting to balance the groups on what the records captured, but claims data do not record how sick someone feels, how much support they have, or how motivated they are. The release itself says the study cannot show therapy caused the drop in deaths.
The adjusted 21% can only correct for what the records measured.
The release also notes that its figures are updated from the posted abstract and asks reporters to use the release.
None of that undoes the practical point. Depression after a cancer diagnosis is common, and it hides well: fatigue, poor focus and loss of interest look a lot like the effects of cancer and its treatment. And only 3% got early therapy. Treating depression is worth doing for its own sake, whether or not it changes survival.
What it means for you
If you or a loved one has a new cancer diagnosis and the low mood, hopelessness or loss of interest goes beyond tiredness, say so to the cancer team and ask for a counseling or therapy referral in the first few weeks.
What this does not license: skipping, delaying or swapping any cancer treatment, or stopping an antidepressant you already take. Those are decisions for you and your doctor. If you already take an antidepressant, adding therapy on top of it may lower the chance of depression coming back.
Source: American Society for Radiation Oncology press release, via EurekAlert!