If you’re already depressed, you may need help to make good decisions

In a rather less that surprising finding, a new paper in the Journal of Clinical Oncology reports that men with existing depressive disorders at the time of diagnosis with prostate cancer “are less likely to undergo definitive treatment and experience worse overall survival.”

Prasad et al. conducted a retrospective, population-based, observational cohort study based on data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data set to look into the impact of previously diagnosed depression on the outcomes of men with newly diagnosed prostate cancer.

Here are their base findings:

  • They identified 41,275 men in the SEER-Medicare data set who were diagnosed with clinically localized prostate cancer between 2004 and 2007.
  • 1,894/41,275 of these men (4.6 percent) had been diagnosed with a depressive disorder within the 2 years immediately preceding the diagnosis of prostate cancer.
  • Compared to non-depressed patients, men previously diagnosed with a depressive disorder were generally
    • Older, white or Hispanic, and unmarried
    • Lived in non-metropolitan areas and areas of lower median income
    • Had more co-morbidities
    • Were more likely to undergo expectant management for low-, intermediate-, and high-risk disease
    • Were less likely to undergo definitive therapy (surgery or radiation) across all risk strata
    • Experienced worse overall mortality across all risk strata
      • For low-risk disease, relative risk (RR) = 1.86
      • For intermediate-risk disease, RR = 1.25
      • For high-risk disease, RR = 1.16

A pre-existing diagnosis of depression is commonly associated with a less assertive response on the part of the patient to treatment for any serious disorder. There would appear to be a certain inevitability to this response unless there is some strong intervention from a family member or other care-giver who has the time and patience to “motivate” an already depressed patient.

We are actually a little surprised to see that the percentage of men being diagnosed with prostate cancer who had a previous diagnosis of a depressive disorder was as low as 4.6 percent.

One Response

  1. An interesting study would be to examine how many men with previously diagnosed depression consider it to be a co-morbidity of longer term ADT.

    For many men, depression is a crippling side effect of ADT — I suggest this is less the case for men who are already familiar with depression.

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