Depression does more than strike at the heart; it can compromise survival for patients with metastatic kidney cancer.
Researchers from the University of Texas M.D. Anderson Cancer Center in Houston found that patients with higher levels of cortisol – a stress hormone linked with depression – died significantly sooner than those with lower cortisol levels (hazard ratio, 1.9; P = .002).
The prospective study accrued 217 patients with newly diagnosed metastatic renal cell carcinoma (RCC) from 2000 to 2007. Participants completed psychosocial questionnaires; saliva and blood samples also were collected.
Nearly a quarter (23%) of the population had a score of 16 or greater on the CES-D (Centers for Epidemiologic StudiesDepression) scale, which met criteria for depressive symptoms and was also associated with shorter survival, compared with lower scores (HR, 1.5; P = .05).
Genomic analysis suggested a biological underpinning for the observed link, reported Lorenzo Cohen, Ph.D., a professor in M.D. Anderson’s departments of general oncology and behavioral science and director of the integrative medicine program, and his coauthors. Patients with high cortisol levels had marked up-regulation of proinflammatory genes.
"Collectively, the present data suggest that the association between RCC patient psychological condition and survival time may stem from systemic dysregulation of inflammatory biology resulting from blunted cortisol rhythmicity and subsequent de-repression of pro-inflammatory signaling pathways within the tumor microenvironment that subsequently contribute to disease progression and metastasis," wrote the investigators. (PLoS ONE 2012 Aug. 1 [doi:10.1371/journal.pone.0042324]).
Grants from the Dana Foundation, the Mary and David Wolff Family Foundation, the U.S. Department of Health and Human Services, the National Institutes of Health, and the M.D. Anderson Cancer Center supported the research.