Depression, immunity, and survival in patients diagnosed with hepatobiliary carcinoma

Abstract

18525 Background: Depression has been found to be associated with increased morbidity and mortality in healthy adults. The prevalence of depression in patients diagnosed with cancer, and in particular hepatobiliary carcinoma (HBC), is significantly higher than the general population. The aims of the present study were to: (1) examine the prevalence of depressive symptoms in patients with HBC, (2) test the relationship between depressive symptoms and survival, and (3) begin to explore underlying mechanisms that explain the relationship between depression and survival in patients with HBC. Methods: 101 patients diagnosed with HBC were administered a battery of questionnaires which included the Center for Epidemiological Studies-Depression (CES-D) questionnaire. Disease-specific data was gathered from medical charts and survival was measured from the date of diagnosis to death. Immune markers (NK cell, IL-4 and 5, TNF, and IFN) were collected in 24 patients. Results: At diagnosis, 39% of the sample reported a score of 16 or greater (clinical range). Using Cox Regression, demographic (age, gender, ethnicity) and disease specific variables (diagnosis, treatment, hepatitis, cirrhosis, tumor location, tumor number, tumor size, vascularity of lesion, and portal vein invasion) variables, as well as CES-D score at diagnosis were analyzed. CES-D scores >16 [Wald = 4.0, p = 0.05] and portal vein invasion (PVI) [Wald = 9.0, p = 0.003] significantly predicted survival. Using Kaplan Meier Survival analysis (Breslow test) and stratifying for PVI, a trend was found [Chi-Square = 3.1, p = 0.08] in which patients with PVI and CES-D scores >16, survived 7.4 months whereas patients with CES-D scores <16 survival 13 months. Patients without PVI and CES-D scores >16 survived 18.2 months whereas those with CES-D scores <16 survived 24.7 months. In a sample of 24 patients, those who reported CES-D scores >16 had significantly lower Natural Killer cell numbers than patients with CES-D scores <16 while covarying age, gender, stress, social support, and coping style [F(1,21) = 9.39, p = 0.003]. Conclusions: Depression may be an important prognostic factor for patients diagnosed with HBC. No significant financial relationships to disclose.