Booster Shots

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Depression linked to earlier death when cancer is diagnosed

September 14, 2009 | 10:42 am

The image of the feisty optimist beating cancer and, conversely, the brooding pessimist being marched off by the grim reaper are commonly invoked when someone we know has gotten a cancer diagnosis. It's a cornerstone of America's can-do medical culture: with the right attitude and the tools at hand, we can lick it, yes we can.

"He's a fighter. He never loses hope. He'll beat it," we predict. "After her husband died, she seemed to have lost the will to live. So when the cancer came along, it just took her," we tell ourselves.

Sadly, the equation seems to be only half right -- bad news for those who go into cancer, or respond to a difficult diagnosis, with deep and persistent sadness, anxiety or irritability. A comprehensive analysis of past studies on cancer survival and depression has found that, all other things held equal, those who suffer depressive symptoms after they are diagnosed are about 25% more likely to die of their disease than those who do not show signs of depression. And for those who are actually diagnosed with major or minor depression in the course of their cancer treatment, the risk of dying from their disease increased by 39%.

The study, which is called a meta-analysis because it aggregates the findings of a large number of similarly designed studies, is published today in Cancer, the journal of the American Cancer Society. 

The latest study linking cancer outcomes to states of mind comes less than two years after another study -- this one also published in Cancer -- found that among a large population of clinical trial subjects with head and neck cancers, those who reported greater emotional well-being as they dealt with their illness were no more likely to live longer than those whose mental state was less positive.

That earlier study prompted its author, University of Pennsylvania psychologist James Coyne, to suggest that patients be allowed to deal with their diagnosis in their own fashion, rather than be prodded by loved ones to "think positive" in the hopes that such thinking would make the cancer yield.

The author of the latest study, as it happens, draws the same conclusion. The actual risk of death associated with death in cancer patients -- in other words, the additional contribution that depression makes to a cancer patient's risk of dying -- is very small, said the study authors, led by University of British Columbia graduate student Jillian Satin. Given that small effect, they concluded that cancer patients should not feel undue pressure to maintain a positive attitude to "beat" their disease.

After all, a cancer diagnosis is a major blow. Giving expression to feelings of anger, sadness, self-pity and anxiety would seem pretty natural. If you've been diagnosed with cancer or have a loved one who has, here's a place to find lots of resources for your and your loved one's social and emotional support.

But taking steps to recognize depression in patients battling cancer should be part of every physician's practice, the authors of the latest study said. Why? Because extensive evidence shows that cancer patients who have social and emotional supports as they deal with their illness have better quality of life.

-- Melissa Healy