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    Psychosocial correlates of cancer survival: a subsequent report 3 to 8 years after cancer diagnosis. Cassileth B R,Walsh W P,Lusk E J Journal of clinical oncology : official journal of the American Society of Clinical Oncology Professional and public interest in possible relationships between psychosocial factors and disease outcome continues to increase. Published research in this area, however, is marked by contradictory results. Positive relationships between a variety of psychosocial factors and length of survival from cancer are reported, but other studies uncover no such associations. In a previously reported prospective investigation of 359 patients with newly diagnosed malignant diseases, we found no relationship between clinical outcome and any psychosocial factor studied. We have continued to observe these patients, who are now up to 8 years post-diagnosis, and report here additional data on their disease outcomes as they relate to psychosocial factors assessed at diagnosis. Two groups of patients were studied: 204 patients with advanced, prognostically poor malignant disease at diagnosis; and 155 patients with intermediate or high-risk melanoma or breast cancer. Shortly after diagnosis, patients completed a self-report questionnaire that assessed seven psychosocial factors previously reported to predict longevity in the general population. Factors included social ties and marital history, job satisfaction, use of psychotropic drugs, general life satisfaction, subjective view of adult health, hopelessness, and perception of amount of adjustment required to cope with the new diagnosis. Clinical factors--performance status and extent of disease at diagnosis--predicted clinical outcome. No psychosocial factor consistently was associated with length of survival or remission. Results of additional exploratory analyses also are reported. 10.1200/JCO.1988.6.11.1753
    Psychosomatic factors in the process of cancerogenesis. Theoretical models and empirical results. Grossarth-Maticek R,Kanazir D T,Schmidt P,Vetter H Psychotherapy and psychosomatics The core of the authors' research program consists in the assumption that complex statistical interactions of sociological and psychological factors with pathophysiological and standard risk factors are more important for the early detection, prediction and prevention of cancer than one or just a few medical risk factors, e.g. the relationship between smoking and lung cancer. As the analysis of these relationships can only be done in interdisciplinary research, interpretation and discussion of social scientific, molecular biological and epidemiological aspects was attempted. In the first part we explicate a model of relevant propositions from the psychosomatic literature to explain the relationship between psychosocial factors of carcinogenesis. A discussion of the authors' research program contains additional variables and propositions. It appears to the authors that among the psychosocial and sociological factors of carcinogenesis, the molecular biological variables are especially relevant, as they form the intervening link between the social science variables and cancer. Discussion of the methodology and the sampling of the authors' empirical studies follows. Two prospective studies, carried out in Yugoslavia and West Germany, are described in detail. The data of these studies are used in the empirical analysis. In the next part the empirical results of different multivariate analyses are presented: The effects of the sociological and psychological variables on carcinogenesis are described; standard risk factors and biochemical-molecular biological factors are brought together, special attention being given to the interaction between these two groups of variables. 10.1159/000287636
    Standard risk factors for lung cancer, cardiac infarct, apoplexy, diabetes mellitus and, their changes in psychosocial context. Grossarth-Maticek R,Jankovic M,Vetter H Psychotherapy and psychosomatics In a prospective study, 1,353 persons were administered a psychosocial questionnaire. At the same time, smoking, weight, and blood pressure were measured. 3 years later these variables were measured again. Another 7 years later the whole group was checked for clinical diagnoses that had occurred in the meantime. The main results were: (1) the 3-year changes of the somatic risk factors were almost as good predictors as their values themselves; (2) psychosocial variables were considerably better predictors of the diseases, and they also predicted the changes of the somatic risk factors about as well as the diseases. 10.1159/000287550
    Psychosocial stress as a risk for breast cancer. Forsén A Psychotherapy and psychosomatics Life events, important emotional losses, difficult life situations, and psychological characteristics were investigated in a case-control study of 87 breast cancer patients and their controls. In a second part, the effect of stressful life events preceding cancer diagnosis on survival was studied in an 8-year follow-up of the breast cancer group. The control group was selected from the general female population and matched for sex, age, number of child-births, and language. The findings showed that breast cancer patients had significantly more life events, important losses, and difficult life situations prior to the discovery of the breast tumor than controls. The analysis indicated that important losses during a 6-year prodromal period and life event scores prior to examination on both the 12-month and modified 6-year Social Readjustment Rating Scale were associated with subsequent development of breast cancer. The association persisted after adjustment for marital status, education, and social class. The findings of the survival analyses indicated that life events in the 12 months preceding the onset of breast cancer and lower social class were associated with a smaller chance of disease-free and overall survival after controlling for clinical factors. 10.1159/000288427
    Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. Hopwood P,Stephens R J Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:To evaluate self-reported depression rates in patients with inoperable lung cancer and to explore demographic, clinical, and quality-of-life (QOL) factors associated with depression and thus identify patients at risk. PATIENTS AND METHODS:Nine hundred eighty-seven patients from three palliative treatment trials conducted by the Medical Research Council Lung Cancer Working Party formed the study sample. 526 patients (53%) had poor prognosis small-cell lung cancer (SCLC) and 461 patients (47%) had good prognosis non-small-cell lung cancer (NSCLC). Hospital Anxiety and Depression Scale data and QOL items from the Rotterdam Symptom Checklist were analyzed, together with relevant demographic and clinical factors. RESULTS:Depression was self-rated in 322 patients (33%) before treatment and persisted in more than 50% of patients. SCLC patients had a three-fold greater prevalence of case depression than those with NSCLC (25% v 9%; P <.0001). An increased rate for women was found for good performance status (PS) patients (PS of 0 or 1) but the sex difference reduced for poor PS patients (PS of 3 or 4) because of increased depression rates for men (chi(2) for trend, P <.0001). Multivariate analysis showed that functional impairment was the most important risk factor; depression increased by 41% for each increment on the impairment scale. Pretreatment physical symptom burden, fatigue, and clinician-rated PS were also independent predictors, but cell type was not. CONCLUSION:Depression is common and persistent in lung cancer patients, especially those with more severe symptoms or functional limitations. Psychologic screening and appropriate intervention is an essential part of palliative care. 10.1200/JCO.2000.18.4.893
    Psychosomatic factors involved in the process of cancerogenesis. Preliminary results of the Yugoslav prospective study. Grossarth-Maticek R,Kanazir D T,Vetter H,Schmidt P Psychotherapy and psychosomatics In a Yugoslav village, psychosocial, anamnestic medical, and pathophysiological data were recorded for 1,353 persons in a longitudinal study. The role of psychosocial stress in carcinogenesis, as far as we have investigated it, may be described as follows: (1) Psychosocial stress in terms of high hopelessness, high antiemotionality, etc. has a strong relevance for cancer incidence which does not act via one of our physiological variables associated with cancer. This follows from the results of our multivariate analysis. (2) Psychosocial stress is substantially associated with a low lymphocyte percentage, which in turn is a relatively strong risk factor for cancer. (3) Psychosocial stress is relatively weakly associated with the cholesterol minimum; but apart from the fact that the cholesterol characteristics of cancer subjects are more marked descriptively under stress conditions, psychosocial stress significantly enhances the efficacy of the most important physiological risk variables for cancer. 10.1159/000287767
    Depression and anxiety symptoms in women at high risk for breast cancer: pilot study of a group intervention. Wellisch D K,Hoffman A,Goldman S,Hammerstein J,Klein K,Bell M The American journal of psychiatry OBJECTIVE:The psycho-oncology literature to date contains only one outcome study based on a group model for high-risk relatives of breast cancer patients. The authors set out to study the effects of group intervention in high-risk relatives of breast cancer patients. METHOD:Thirty-three high-risk relatives of breast cancer patients participated in a six-session, 12-hour group intervention model that consisted of educational and psychosocial components. RESULTS:There was a significant reduction of depression symptoms as reported on the Center for Epidemiologic Studies Depression Scale. Similarly, there was a significant reduction of anxiety symptoms as reported on the State-Trait Anxiety Inventory state scale. CONCLUSIONS:In this pilot study, the investigators found the group intervention model effective at reducing symptoms of depression and reactive (not chronic) anxiety. 10.1176/ajp.156.10.1644
    Psychosocial predictors of cancer and internal diseases. An overview. Grossarth-Maticek R Psychotherapy and psychosomatics In 1965, questionnaire data were obtained for 1,353 inhabitants of a Yugoslavian town on the following variables: blocked expression of feelings and needs; psychosocial stress in the form of either lasting depression and hopelessness or lasting anger and irritation; harmonization and idealization, with negation of self; rational orientation with repression of emotions; psychopathological symptoms; "explosive behavior", including exposure to adverse environmental conditions, abuse of medicines etc, ignoring signs of illness, hyperactivity. These variables were related to the incidence of cancer and internal diseases over the next 10 years.A discriminant analysis yielded 93% correct predictions. The results, beyond their theoretical significance, open up substantive possibilities of early recogninition as well as preventive and curative sociopsychotherapy of cancer and internal diseases. 10.1159/000287422
    Self reported stress and risk of breast cancer: prospective cohort study. Nielsen Naja Rod,Zhang Zuo-Feng,Kristensen Tage S,Netterstrøm Bo,Schnohr Peter,Grønbaek Morten BMJ (Clinical research ed.) OBJECTIVE:To assess the relation between self reported intensity and frequency of stress and first time incidence of primary breast cancer. DESIGN:Prospective cohort study with 18 years of follow-up. SETTING:Copenhagen City heart study, Denmark. PARTICIPANTS:The 6689 women participating in the Copenhagen City heart study were asked about their perceived level of stress at baseline in 1981-3. These women were followed until 1999 in the Danish nationwide cancer registry, with < 0.1% loss to follow-up. MAIN OUTCOME MEASURE:First time incidence of primary breast cancer. RESULTS:During follow-up 251 women were diagnosed with breast cancer. After adjustment for confounders, women with high levels of stress had a hazard ratio of 0.60 (95% confidence interval 0.37 to 0.97) for breast cancer compared with women with low levels of stress. Furthermore, for each increase in stress level on a six point stress scale an 8% lower risk of primary breast cancer was found (hazard ratio 0.92, 0.85 to 0.99). This association seemed to be stable over time and was particularly pronounced in women receiving hormone therapy. CONCLUSION:High endogenous concentrations of oestrogen are a known risk factor for breast cancer, and impairment of oestrogen synthesis induced by chronic stress may explain a lower incidence of breast cancer in women with high stress. Impairment of normal body function should not, however, be considered a healthy response, and the cumulative health consequences of stress may be disadvantageous. 10.1136/bmj.38547.638183.06
    Depression and anxiety in women with early breast cancer: five year observational cohort study. Burgess Caroline,Cornelius Victoria,Love Sharon,Graham Jill,Richards Michael,Ramirez Amanda BMJ (Clinical research ed.) OBJECTIVE:To examine the prevalence of, and risk factors for, depression and anxiety in women with early breast cancer in the five years after diagnosis. DESIGN:Observational cohort study. SETTING:NHS breast clinic, London. PARTICIPANTS:222 women with early breast cancer: 170 (77%) provided complete interview data up to either five years after diagnosis or recurrence. MAIN OUTCOME MEASURES:Prevalence of clinically important depression and anxiety (structured psychiatric interview with standardised diagnostic criteria) and clinical and patient risk factors, including stressful life experiences (Bedford College life events and difficulties schedule). RESULTS:Nearly 50% of the women with early breast cancer had depression, anxiety, or both in the year after diagnosis, 25% in the second, third, and fourth years, and 15% in the fifth year. Point prevalence was 33% at diagnosis, falling to 15% after one year. 45% of those with recurrence experienced depression, anxiety, or both within three months of the diagnosis. Previous psychological treatment predicted depression, anxiety, or both in the period around diagnosis (one month before diagnosis to four months after diagnosis). Longer term depression and anxiety, were associated with previous psychological treatment, lack of an intimate confiding relationship, younger age, and severely stressful non-cancer life experiences. Clinical factors were not associated with depression and anxiety, at any time. Lack of intimate confiding support also predicted more protracted episodes of depression and anxiety. CONCLUSION:Increased levels of depression, anxiety, or both in the first year after a diagnosis of early breast cancer highlight the need for dedicated service provision during this time. Psychological interventions for women with breast cancer who remain disease free should take account of the broader social context in which the cancer occurs, with a focus on improving social support. 10.1136/bmj.38343.670868.D3
    Depression in cancer patients. Chochinov H M The Lancet. Oncology Clinical depression is a relatively common, and yet frequently overlooked, source of suffering among patients with cancer. All patients who face a life-threatening diagnosis such as cancer experience a normal albeit painful emotional reaction, but a substantial minority will become clinically depressed. This article reviews some basic information that oncology practitioners may find helpful in identifying patients at risk of experiencing a major depression. A brief overview of the epidemiology, diagnostic criteria, screening approaches, and special issues, such as depression in the elderly, high-risk populations, and suicide is also provided. 10.1016/S1470-2045(01)00456-9
    American Cancer Society Award lecture. Psychological care of patients: psycho-oncology's contribution. Holland Jimmie C Journal of clinical oncology : official journal of the American Society of Clinical Oncology The centuries-old stigma attached to cancer precluded patients' being told their diagnoses, and thus, delayed any exploration of how they dealt with their illness. This situation changed in the United States in the 1970s when patients began to be told their cancer diagnosis, permitting the first formal study of the psychological impact of cancer. However, a second and equally long-held stigma attached to mental illness has been another barrier and this has kept patients from being willing to acknowledge their psychological problems and to seek counseling. This "double stigma" has slowed the development of psycho-oncology. However, we began to see rapid changes occurring in the last quarter of the 20th century. Valid assessment instruments were developed which were used in well-designed studies. Data from these studies and clinical observations led to increased recognition that psychosocial services are needed by many patients and provide significant assistance in coping with illness. Psycho-oncology has two dimensions: first, the study of the psychological reaction of patients at all stages of the disease, as well as of the family and oncology staff; second, exploring the psychological, social, and behavioral factors that impact on cancer risk and survival. Psycho-oncology now has a recognized role within the oncologic community through clinical care, research, and training as it relates to prevention of cancer through lifestyle changes, evaluation of quality of life, symptom control, palliative care and survivorship. Presently, there are sufficient research studies from which standards of care have been established. Both evidence and consensus-based clinical practice guidelines have been promulgated. It now possible to monitor the quality of existing psychosocial services by using these benchmarks of quality that have evolved in recent years. 10.1200/JCO.2003.09.133
    Side effects and cancer-related stress determine quality of life in long-term survivors of testicular cancer. Mykletun Arnstein,Dahl Alv A,Haaland Carl Fredrik,Bremnes Roy,Dahl Olav,Klepp Olbjørn,Wist Erik,Fosså Sophie D Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:The prevalence of long-term survivors after treatment for testicular cancer (TC) is increasing, and most studies display normal or only slightly reduced quality of life (QOL) in TC survivors (TCSs). Impaired QOL is claimed to be associated with treatment modality and its side effects, although most studies in this field can be criticized for various methodologic shortcomings. We wanted to examine variation in long-term QOL in TCSs in relation to TC treatment modality, side effects, and TC-related stress in a large population. PATIENTS AND METHODS:QOL, side effects, and TC-related stress were self-rated by a questionnaire at a mean of 11 years of follow-up in 1,409 TCSs treated from 1980 to 1994. Norm data was obtained from 2,678 males who were representative of the general population. QOL was measured with the Short Form-36 (SF-36), and TC-related stress was measured with the Impact of Event Scale. RESULTS:There were no clinically relevant differences in QOL between TCSs and age-adjusted norm data, although there was a slightly lowered SF-36 Physical Component Summary Score in TCSs. Variation of QOL in TCSs was related to self-reported side effects and TC-related stress but not to TC treatment modality. A significant association was found between side effects and TC-related stress. CONCLUSION:TCSs do not suffer long term from reduced QOL, and only minor differences in QOL were found between different treatment modalities. TCSs who report more side effects or TC-related stress have increased risk for reduced QOL, but these associations are not explained by TC treatment modalities. Further QOL research in this area should explore vulnerability factors for side effects and TC-related stress. 10.1200/JCO.2005.08.048
    Health psychology: psychosocial and biobehavioral aspects of chronic disease management. Schneiderman N,Antoni M H,Saab P G,Ironson G Annual review of psychology Psychosocial factors appear to impact upon the development and progression of such chronic diseases as coronary heart disease, cancer, and HIV/AIDS. Similarly, psychosocial interventions have been shown to improve the quality of life of patients with established disease and seem to influence biological processes thought to ameliorate disease progression. Small-scale studies are useful for specifying the conditions under which psychosocial factors may or may not impact quality of life, biological factors, and disease progression. They are also useful for informing us about the conditions under which psychosocial interventions can serve as adjuvants (e.g. adherence training) to medical treatments. Only large-scale clinical trials, however, can determine the extent to which these psychosocial interventions may impact morbidity and mortality. 10.1146/annurev.psych.52.1.555
    Study of anxiety disorder and depression in long-term survivors of testicular cancer. Dahl Alv A,Haaland Carl Fredrik,Mykletun Arnstein,Bremnes Roy,Dahl Olav,Klepp Olbjørn,Wist Erik,Fosså Sophie D Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:To increase our knowledge of the prevalence of anxiety disorder and depression in long-term testicular cancer survivors (TCSs), and to identify variables associated with such caseness. PATIENTS AND METHODS:Participants were 1,408 TCSs treated between 1980 and 1994 in Norway. Participants provided information about their medical, social, and familial situation on a questionnaire. They also completed the Hospital Anxiety and Depression Scale (HADS). Anxiety disorder and depression were defined by a score >/= 8 on the HADS subscales. The prevalence rates were compared with age-adjusted norm data. RESULTS:HADS-defined anxiety disorder was more prevalent in TCSs (19.2%; 95% CI, 17.2% to 21.3%) than in the norm sample (13.5%; 95% CI, 13.1% to 13.9%; P < .001), whereas the prevalence of HADS-defined depression did not differ from the norm (TCSs, 9.7%; 95% CI, 8.1% to 11.2% v norm, 10.1%, 95% CI, 9.5 to 10.5; P = .56). The relative risk for anxiety disorder was 1.49 (95% CI, 1.31 to 1.69) and for depression the relative risk was 0.96 (95% CI, 0.81 to 1.14) in TCSs compared with norm. In multivariate analyses, HADS-defined anxiety disorder in TCSs was associated with young age, peripheral neuropathy, economic problems, alcohol problems, sexual problems, relapse anxiety, and having been treated for mental problems. CONCLUSION:Long-term TCSs have an increased risk of HADS-defined anxiety disorder that warrants clinical attention. Checking easily available demographic and TC-related data and use of a simple screening test such as HADS assists the identification of TCSs with anxiety disorder. 10.1200/JCO.2005.05.061
    Depression and risk of cancer progression: an elusive link. Irwin Michael R Journal of clinical oncology : official journal of the American Society of Clinical Oncology 10.1200/JCO.2007.10.7292
    Stress, depression, the immune system, and cancer. Reiche Edna Maria Vissoci,Nunes Sandra Odebrecht Vargas,Morimoto Helena Kaminami The Lancet. Oncology The links between the psychological and physiological features of cancer risk and progression have been studied through psychoneuroimmunology. The persistent activation of the hypothalamic-pituitary-adrenal (HPA) axis in the chronic stress response and in depression probably impairs the immune response and contributes to the development and progression of some types of cancer. Here, we overview the evidence that various cellular and molecular immunological factors are compromised in chronic stress and depression and discuss the clinical implications of these factors in the initiation and progression of cancer. The consecutive stages of the multistep immune reactions are either inhibited or enhanced as a result of previous or parallel stress experiences, depending on the type and intensity of the stressor and on the animal species, strain, sex, or age. In general, both stressors and depression are associated with the decreased cytotoxic T-cell and natural-killer-cell activities that affect processes such as immune surveillance of tumours, and with the events that modulate development and accumulation of somatic mutations and genomic instability. A better understanding of the bidirectional communication between the neuroendocrine and immune systems could contribute to new clinical and treatment strategies. 10.1016/S1470-2045(04)01597-9
    Psychological distress in men with breast cancer. Brain Kate,Williams Buddug,Iredale Rachel,France Liz,Gray Jonathon Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:This article reports the first United Kingdom study to examine the prevalence of psychological distress in men with breast cancer and the factors associated with increased distress. PATIENTS AND METHODS:One hundred and sixty-one men with breast cancer completed a cross-sectional questionnaire that included measures of anxiety and depressive symptoms, cancer-specific distress, body image, coping, information and support needs, and clinical and demographic variables. RESULTS:Clinical levels of anxiety and depressive symptoms were reported by 6% and 1% of men, respectively, while 23% reported high levels of cancer-specific distress. Anxiety was most strongly associated with avoidance coping and fear and uncertainty about the future (42% of the variance in anxiety scores, P < .001). Depressive symptoms were associated with altered body image (35% of the variance, P < .001). Body image, avoidance coping, referral to the study by a clinician, fear and uncertainty, and wanting to receive more gender-specific information together explained 51% of the variance in cancer-related distress (P < .001). Clinical and demographic factors did not account for a significant proportion of the variance in any of the distress measures. CONCLUSION:Although the prevalence of clinical anxiety and depressive symptoms were low in this sample, almost a quarter of men experienced traumatic stress symptoms specific to breast cancer. Potential risk factors for distress include the use of avoidant coping strategies, negative body image, feelings of fear and uncertainty in relation to breast cancer, and unmet information needs. Suggestions are made for improving the information and support available to men with breast cancer. 10.1200/JCO.2006.10.064
    Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116,000 European men and women. Heikkilä Katriina,Nyberg Solja T,Theorell Töres,Fransson Eleonor I,Alfredsson Lars,Bjorner Jakob B,Bonenfant Sébastien,Borritz Marianne,Bouillon Kim,Burr Herman,Dragano Nico,Geuskens Goedele A,Goldberg Marcel,Hamer Mark,Hooftman Wendela E,Houtman Irene L,Joensuu Matti,Knutsson Anders,Koskenvuo Markku,Koskinen Aki,Kouvonen Anne,Madsen Ida E H,Magnusson Hanson Linda L,Marmot Michael G,Nielsen Martin L,Nordin Maria,Oksanen Tuula,Pentti Jaana,Salo Paula,Rugulies Reiner,Steptoe Andrew,Suominen Sakari,Vahtera Jussi,Virtanen Marianna,Väänänen Ari,Westerholm Peter,Westerlund Hugo,Zins Marie,Ferrie Jane E,Singh-Manoux Archana,Batty G David,Kivimäki Mika, BMJ (Clinical research ed.) OBJECTIVE:To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers. DESIGN:Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116,056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake RESULTS:A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer. CONCLUSIONS:These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers. 10.1136/bmj.f165
    Risk for hospitalization with depression after a cancer diagnosis: a nationwide, population-based study of cancer patients in Denmark from 1973 to 2003. Dalton Susanne O,Laursen Thomas Munk,Ross Lone,Mortensen Preben Bo,Johansen Christoffer Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:As more people survive cancer, it is necessary to understand the long-term impact of cancer. We investigated whether cancer survivors are at increased risk for hospitalization for depression. METHODS:We linked data on all 5,703,754 persons living in Denmark on January 1, 1973, or born thereafter to the Danish Cancer Registry and identified 608,591 adults with a diagnosis of cancer. Follow-up for hospitalization for depression in the Danish Psychiatric Central Register from 1973 through 2003 yielded 121,227,396 person-years and 121,304 hospitalizations for depression. The relative risk (RR) for depression among cancer survivors relative to the cancer-free population was estimated by Poisson regression analysis with adjustment for age and period and stratified by sex, site of cancer, and extent of disease. RESULTS:The risk for depression in the first year after a cancer diagnosis was increased, with RRs ranging from 1.16 (95% CI, 0.90 to 1.51) in women with colorectal cancer to 3.08 (95% CI, 1.88 to 5.02) in men with brain cancer. Decreasing but still significant excess risks during subsequent years were observed for most specific cancers. The risk remained increased throughout the study period for both men and women surviving hormone-related cancers, for women surviving smoking-related cancers, and for men surviving virus- and immune-related cancers. CONCLUSION:This study confirms an increased risk for depression in patients facing a disruptive event like cancer. Early recognition and effective treatment are needed to prevent admission of cancer survivors for depression. 10.1200/JCO.2008.20.5526
    Exercise, tea consumption, and depression among breast cancer survivors. Chen Xiaoli,Lu Wei,Zheng Ying,Gu Kai,Chen Zhi,Zheng Wei,Shu Xiao Ou Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE To examine the association of lifestyle factors and supplement use with depression among breast cancer survivors. PATIENTS AND METHODS In a population-based cohort study conducted between April 2002 and December 2006 in Shanghai, China, a total of 1,399 women who were diagnosed with stage 0 to III breast cancer completed 6-month and 18-month postdiagnosis, in-person interviews. Information on sociodemographic, clinical, and lifestyle factors were collected through the interviews and through review of medical charts at approximately 6 months postdiagnosis. A metabolic equivalent (MET) score was calculated from reported exercise activities. Quality of life (QOL) was evaluated by the Medical Outcomes Short Form-36 Health Survey at 6 months postdiagnosis. Depressive symptoms were measured by using a 20-item Center for Epidemiological Studies-Depression Scale at approximately 18 months postdiagnosis. Results Overall, 26% of women reported depressive symptoms and 13% met the criteria of clinical depression at 18 months postdiagnosis. Women with a higher exercise level (ie, >/= 8.3 MET h/wk) were less likely to have depression than nonexercisers; the multivariate adjusted odds ratios (ORs) were 0.71 (95% CI, 0.47 to 1.07) for mild depression and 0.56 (95% CI, 0.35 to 0.88) for clinical depression in analyses controlled for sociodemographic and clinical factors and baseline QOL. Women who increased their exercise level had lower risk for depression. Regular tea consumption (ie, > 100 g dried tea leaves/mo) was inversely associated with overall depression (OR, 0.39; 95% CI, 0.19 to 0.84). No associations were found for dietary intake or supplement use with depression. CONCLUSION Regular exercise participation and tea consumption may play an important role in the prevention of depression among breast cancer survivors. 10.1200/JCO.2009.23.0565
    Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. Russ Tom C,Stamatakis Emmanuel,Hamer Mark,Starr John M,Kivimäki Mika,Batty G David BMJ (Clinical research ed.) OBJECTIVE:To quantify the link between lower, subclinically symptomatic, levels of psychological distress and cause-specific mortality in a large scale, population based study. DESIGN:Individual participant meta-analysis of 10 large prospective cohort studies from the Health Survey for England. Baseline psychological distress measured by the 12 item General Health Questionnaire score, and mortality from death certification. PARTICIPANTS:68,222 people from general population samples of adults aged 35 years and over, free of cardiovascular disease and cancer, and living in private households in England at study baseline. MAIN OUTCOME MEASURES:Death from all causes (n = 8365), cardiovascular disease including cerebrovascular disease (n = 3382), all cancers (n = 2552), and deaths from external causes (n = 386). Mean follow-up was 8.2 years (standard deviation 3.5). RESULTS:We found a dose-response association between psychological distress across the full range of severity and an increased risk of mortality (age and sex adjusted hazard ratio for General Health Questionnaire scores of 1-3 v score 0: 1.20, 95% confidence interval 1.13 to 1.27; scores 4-6: 1.43, 1.31 to 1.56; and scores 7-12: 1.94, 1.66 to 2.26; P<0.001 for trend). This association remained after adjustment for somatic comorbidity plus behavioural and socioeconomic factors. A similar association was found for cardiovascular disease deaths and deaths from external causes. Cancer death was only associated with psychological distress at higher levels. CONCLUSIONS:Psychological distress is associated with increased risk of mortality from several major causes in a dose-response pattern. Risk of mortality was raised even at lower levels of distress. 10.1136/bmj.e4933