Abstract
Previous studies on the association between mental health and mortality in patients with cancer have reported contradictory results. We conducted a population-based cohort study to determine whether pre-existing depression is associated with all-cause and cause-specific mortality after cancer diagnosis. We included 5-year cancer survivors, identified from the National Health Insurance Scheme Health Screening Cohort between January 1, 2004 and December 31, 2009. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals (CI) to assess the association between pre-existing depression and all-cause, cancer-related, and noncancer-related mortality among 5-year cancer survivors. After adjustment for sociodemographics, lifestyle, and clinical status, the multivariable adjusted hazard ratios (95% CIs) for all-cause, cancer-related, and noncancer-related mortality among 5-year cancer survivors with pre-existing depression were 1.52 (1.13–2.05), 1.17 (0.75–1.81), and 2.07 (1.38–3.10) compared with those without pre-existing depression, respectively. Significant associations between pre-existing depression and mortalities (all-cause and noncancer-related mortality) were only observed among male cancer survivors. Our findings suggest that depression is associated with all-cause mortality after cancer diagnosis and that greater efforts should be focused on the long-term survival of patients with cancer with pre-existing depression, especially in male cancer survivors.
Highlights
Previous studies on the association between mental health and mortality in patients with cancer have reported contradictory results
Between 2004 and 2009, 11,065 (6,023 men [54.4%] and 5,042 women [36.6%]) 5-year CS were identified from the National Health Insurance Service (NHIS)-Health Screening (HEALS) Cohort
Further adjusting for depression after cancer diagnosis in the multivariable Cox proportional hazards models did not alter the associations found in the main analysis. This population-based longitudinal study revealed a significant association between pre-existing depression and long-term mortality in 5-year CS
Summary
Previous studies on the association between mental health and mortality in patients with cancer have reported contradictory results. Our findings suggest that depression is associated with all-cause mortality after cancer diagnosis and that greater efforts should be focused on the long-term survival of patients with cancer with pre-existing depression, especially in male cancer survivors. Previous studies have suggested an association between mental and physical health[7,8,9], there is not enough evidence supporting the relationship between pre-existing depression and mortality among cancer survivors[6,10,11]. Several studies have investigated the outcomes of patients with cancer with depression in Western countries[6,22,23,24,25], our study focused on the effect of previously-diagnosed depression on 5-year survival of cancer patients In this nationally representative, population-based cohort study, we analyzed information regarding diverse health conditions, health behaviors, and biological risk factors. We hypothesized that cancer survivors who had depression before being diagnosed with cancer would have decreased survival rates compared with those without pre-existing depression
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