title: Adjuvant treatments of breast cancer increase the risk of depressive disorders: A population-based study.
abstract: BACKGROUND
  Previous studies have posited conflicting results regarding depressive disorders among breast cancer survivors who received adjuvant therapies including chemotherapy, radiotherapy, selective estrogen receptor modulator (e.g. tamoxifen), third-generation aromatase inhibitors (AIs; e.g. anastrozole, letrozole or exemestane), and monoclonal antibody (e.g. trastuzumab). We therefore performed a population-based study with a defined breast cancer cohort to investigate the risk of depressive disorders in breast cancer patients who received adjuvant therapies.
  
  
  METHODS
  We conducted a retrospective study of a breast cancer cohort of 36,586 participants who were selected from the National Health Insurance Research Database(NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidences of newly onset depressive disorders. Kaplan-Meier and Cox regression analyses were used to identify the risk factors associated with depressive disorders in breast cancer patients who underwent adjuvant therapies
  
  
  RESULTS
  Of the total 36,586 patients, 1342 (3.7%) were ascertained with depressive disorders. The Cox multivariate proportional hazards analysis showed that age of 40-59 (adjusted hazard ratio (aHR) 1.327, 95% CI 1.123-1.567, p=0.001), chemotherapy (aHR 1.555, 95% CI 1.387-1.743, p<0.001), radiotherapy (aHR 1.385 95% CI 1.220-1.571, p<0.001), tamoxifen (aHR 1.458, 95% CI 1.110-1.914, p=0.007), AIs (aHR 1.360, 95% CI 1.193-1.550, p<0.001), and trastuzumab (aHR 1.458, 95% CI 1.110-1.914, p=0.007) were independent risk factors for developing depressive disorders.
  
  
  CONCLUSIONS
  The dosage effect of adjuvant treatments, cancer staging, genetic or environmental confounders associated with the risk of depressive disorders were not comprehensively evaluated.
  
  
  CONCLUSIONS
  Developing depressive disorders are at higher risk in breast cancer survivors aged 40-59 who received adjuvant treatments including chemotherapy, radiotherapy, tamoxifen, AIs or trastuzumab. Psychological evaluation and support are necessarily needed in breast cancer survivors who received adjuvant therapies.
authors.affiliation: Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan, ROC; Institute of Clinical Medicine, China Medical University, Taichung, Taiwan, ROC; Sunshine Psychiatric Hospital, Taichung, Taiwan, ROC.
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan, ROC; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC; Institute of Medical Sciences, Tzu Chi university, Hualien, Taiwan, ROC.
authors.forename: Shaw-Ji
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: Biostatistical Consulting Lab, Institute of Nursing-Midwifery, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC. Electronic address: chiehyu@ntunhs.edu.tw.
authors.forename: Chieh-Yu
authors.initials: CY
authors.lastname: Liu
mesh_terms: D000328:Adult; D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D000077289:Letrozole; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use; D011159:Population Surveillance / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D013624:Taiwan / Q000453:epidemiology; D013629:Tamoxifen / Q000627:therapeutic use; D000068878:Trastuzumab / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000730:Androstadienes; D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000077289:Letrozole; C056516:exemestane; D000068878:Trastuzumab
keywords: Adjuvant treatments; Breast cancer; Depressive disorders