Advanced NSCLC Survival May Be Impacted by Depression and Anxiety, Highlighting the Need for Mental Health Care

As treatments for NSCLC improve survival, this benefit may be affected by depression and anxiety, which is common in patients with the disease and may require patients to advocate for cognitive behavioral therapy among other approaches.

Depression and anxiety during and after treatment for stage 4 non-small cell lung cancer (NSCLC) may negatively impact survival, highlighting the need for mental health care throughout one’s cancer journey, study results demonstrated.

“My hope is that it provides a compelling empirical demonstration of the importance of reducing patients’ depressive symptoms from the time of diagnosis going forward,” said Barbara L. Andersen, a professor of psychology and distinguished university professor at The Ohio State University in Columbus, in an interview with CURE®.

Andersen explained that she and her colleagues conducted this study to learn more about what happens with depression and anxiety when a patient with NSCLC undergoes treatment. Their previous data demonstrated that patients with lung cancer often have depression and anxiety, with approximately 40% of patients having moderate-to-severe depressive symptoms after diagnosis and before treatment. Other studies have shown that depressive and anxiety symptoms when patients are diagnosed with lung cancer may predict survival after treatment.

“That was already known, but there was nothing known about literally what occurs in the middle,” Andersen said. “Is it the fact that depressive symptoms at baseline were so bad and after that they fell away, or was there a continuing course of symptoms? … What's important about the finding is that, yes, the baseline values predicted survival, but above and beyond that, it was this trajectory, the continuation of depressive symptoms that added risk for premature death.”

Two Years of Tracking Depression and Anxiety Symptoms

Researchers analyzed data pertaining to depressive and anxiety symptoms in 157 patients with stage 4 NSCLC. Assessments were performed through questionnaires, which patients completed every one to two months for 24 months. Survival was also monitored in these patients throughout follow-up.

The findings from the questionnaires demonstrated that depression and anxiety significantly decreased as time passed since the cancer diagnosis.

“I’m a medical oncologist. In my career, I focus on medical treatments that improve outcomes, but this study suggests that specifically targeting depressive symptoms in these patients may also help improve outcomes,” Dr. David P. Carbone, a professor of medicine at The Ohio State University and director of the James Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center in Columbus, told CURE®.

A trajectory of depressive symptoms during a two-year period was significantly linked with cancer survival after taking several factors into consideration including smoking status and treatment received.

“The fundamental finding was that the trajectory of symptoms is an important thing to follow,” Carbone said. “The implication is that you should intervene and have them seek professional counseling while they're getting their medical therapies.”

Symptoms related to anxiety were associated with cancer survival, although not significantly when other control variables were included.

Andersen noted that there may be a link between lung cancer and depression/anxiety.

“It may well be a synergy between the inflammation that is caused by the disease, and that's primarily due to smoking and the effects of nicotine in depressing immunity,” she explained. “We also have other data that show that higher depressive symptoms are associated with depressed immunity. When you put those two together, it would appear that there may be a synergy — inflammation from depression in the context of inflammation from the disease.”

Hesitation to Seek Mental Health Care

Although it is known that the most effective treatment for anxiety or depression is cognitive behavior therapy, sometimes that isn’t the first approach health care professionals take with patients.

“It is not helpful to say, ‘Well, of course you're depressed, you have lung cancer.’ Such comments discount a patient's effort to talk about their psychological health, which is something many patients already have difficulty disclosing,” Andersen said. “Many of the symptoms of depression may be consistent with having a progressive disease, such as problems with sleep or one's appetite. However, personal feelings of failure or worthless, hopeless or little interest or pleasure are not a part of cancer; those are symptoms of depression. It's important to acknowledge that, yes, this is an extremely difficult circumstance, but one doesn't want cancer to sap all enjoyment of life, cause feelings of poor self worth or withdraw from friends and family.”

Even with effective treatment strategies for anxiety and depression, some patients may not be as eager to seek mental health care.

“It is a difficult thing for many people, especially (in those age 60 and older),” Carbone explained. “They tend not to want to seek that sort of help. But the way I do it is I start out just saying that it's completely natural to feel depressed when you have the diagnosis. This depression affects the entire family, the spouse who sees the mortality of their loved one at a time when they should be traveling the world and enjoying life. It impacts the entire family. I try to start by explaining that it's a normal reaction, but that there are treatments for these feelings as well, and that can help improve the quality of their life as well as me treating the cancer.”

Andersen mentioned that psychosocial issues associated with lung cancer may become more important as treatment for lung cancer is improving.

“Treatment (for lung cancer) is turning survival rates upside down,” she explained. “Five years ago, the median survival was four months. In this study, the median was eight months, and there are some living longer than two years. As people with lung cancer survive much longer, it is all the more important that they feel well psychologically.”

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