title: Post-surgical depressive symptoms and long-term survival in non-metastatic breast cancer patients at 11-year follow-up.
abstract: Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up.
  
  
  
  From 1998 to 2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2-10weeks post-surgery for non-metastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8-15-year follow-up.
  
  
  
  A total of 95 women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival (M=13.56years; SE=0.26) than those in the mild/moderate depressed group (M=11.45years; SE=0.40), Log-rank χ2(1)=4.41, p=0.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p=0.027. Similar results were observed in a subsample with invasive disease (n=191). Depression category did not predict disease-free survival in the overall or invasive sample.
  
  
  
  Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida.|Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.|Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.affiliation: Massachusetts General Hospital Cancer Center, Center for Psychiatric Oncology and Behavioral Sciences and Cancer Outcomes Research Program, Boston, Massachusetts.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Jacobs
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Bouchard
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.|Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Lechner
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida.
authors.forename: Devika R
authors.initials: DR
authors.lastname: Jutagir
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Gudenkauf
authors.affiliation: Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.|Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Blomberg
authors.affiliation: Celgene Corporation.
authors.forename: Stefan
authors.initials: S
authors.lastname: Glück
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida.|Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Carver
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology / Q000601:surgery; D003863:Depression / Q000523:psychology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011184:Postoperative Period
keywords: Breast neoplasms; Depressive symptoms; Follow-up study; Recurrence; Survival