Abstract
BackgroundDepression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors.MethodsAbout 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression.ResultsCompared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression.ConclusionsLong‐term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care.
Highlights
Depression is more prevalent in breast cancer (BC) survivors than in the general population
In comparison to the general population, cancer survivors
Recurrence in BC is associated with distress, hopelessness, and impairments in physical, functional, and emotional well-being.[16,17]. These factors can be related to depression. The objectives of this population-based study are to compare the prevalence of depression in (1) BC long-term survivors vs female general population controls, (2) BC long-term survivors who remained disease-free after treatment vs those with self-report of recurrence, and (3) to assess potential factors associated with depression in BC survivors and controls
Summary
Breast cancer (BC) is the most commonly diagnosed cancer in women, with more than 2 million new cases worldwide in 2018.1 Better prognosis and demographic aging lead to a steadily increasing number of long-term cancer survivors (≥5 years post-diagnosis).[2]. Being overweight or obese are reciprocally associated with depression.[12] in women with BC shortly after treatment, personal factors (eg, partnership, having children) and social factors (socioeconomic status, social contact),[13] treatment-related variables,[13] and poor body image were associated with depression, with the latter factor even more so when the partner shows little empathy.[14] It is of interest to identify which factors are associated with depression in long-term BC survivors and whether these factors differ in same-aged controls Such information will assist to determine whether specific prevention strategies are needed for BC survivors. The objectives of this population-based study are to compare the prevalence of depression in (1) BC long-term survivors (stage I to III at primary diagnosis) vs female general population controls, (2) BC long-term survivors who remained disease-free after treatment vs those with self-report of recurrence, and (3) to assess potential factors associated with depression in BC survivors and controls
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