title: Predictors of depression in breast cancer patients treated with radiation: role of prior chemotherapy and nuclear factor kappa B.
abstract: BACKGROUND
  Depression is common during and after breast cancer treatment. However, the role of specific therapeutic modalities and related biologic mechanisms remains unclear. Radiation is an essential component of breast-conserving therapy and may contribute to depression in patients with breast cancer through the activation of inflammatory pathways.
  
  
  METHODS
  Depressive symptoms and inflammatory mediators, including nuclear factor kappa B (NF-κB), were assessed at baseline (before radiation), during radiation, and 6 weeks after radiation in 64 women who had stage 0 through IIIA breast cancer.
  
  
  RESULTS
  No significant increases in depressive symptoms occurred during or after radiation, although a number of patients exhibited moderate-to-severe depression throughout the study. Multivariate analyses of baseline factors predictive of depression revealed that educational status, perceived stress, prior chemotherapy, and peripheral blood NF-κB DNA binding all were independent predictors of persistent depressive symptoms after radiation (all P < .05). Of these factors, only prior chemotherapy was associated with inflammatory mediators, including NF-κB DNA binding, soluble tumor necrosis factor-alpha receptor 2, and interleukin-6, which, in univariate analyses predicted depressive symptoms after radiation (all P < .05). Chemotherapy-treated patients also exhibited an over-representation of gene transcripts regulated by NF-κB.
  
  
  CONCLUSIONS
  Radiation was not associated with increased depressive symptoms in the current study, but of disease and treatment-related factors, prior chemotherapy predicted significant depression after radiation. Longitudinal studies are warranted to investigate the relationship among prior chemotherapy, inflammation, and persistent depression after breast cancer treatment.
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA 30322, USA. matorre@emory.edu
authors.forename: Mylin A
authors.initials: MA
authors.lastname: Torres
authors.forename: Thaddeus W
authors.initials: TW
authors.lastname: Pace
authors.forename: Tian
authors.initials: T
authors.lastname: Liu
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Felger
authors.forename: Donna
authors.initials: D
authors.lastname: Mister
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Doho
authors.forename: Jordan N
authors.initials: JN
authors.lastname: Kohn
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Barsevick
authors.forename: Qi
authors.initials: Q
authors.lastname: Long
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000378:metabolism / Q000523:psychology* / Q000532:radiotherapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003863:Depression / Q000209:etiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood / Q000378:metabolism; D007375:Interleukin-1 / Q000097:blood / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D008875:Middle Aged; D016328:NF-kappa B / Q000097:blood / Q000378:metabolism; D011832:Radiation Injuries / Q000523:psychology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000378:metabolism
chemical_list: D018836:Inflammation Mediators; D007375:Interleukin-1; D015850:Interleukin-6; D016328:NF-kappa B; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha