Depressive symptom trajectories in older breast cancer survivors: The Thinking and Living with Cancer Study Journal Article

   


Authors: Nakamura, Z. M.; Small, B. J.; Zhai, W.; Ahles, T. A.; Ahn, J.; Artese, A. L.; Bethea, T. N.; Breen, E. C.; Cohen, H. J.; Extermann, M.; Graham, D.; Irwin, M. R.; Isaacs, C.; Jim, H. S. L.; Kuhlman, K. R.; McDonald, B. C.; Patel, S. K.; Rentscher, K. E.; Root, J. C.; Saykin, A. J.; Tometich, D. B.; Van Dyk, K.; Zhou, X.; Mandelblatt, J. S.; Carroll, J. E.
Article Title: Depressive symptom trajectories in older breast cancer survivors: The Thinking and Living with Cancer Study
Abstract: PurposeTo identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories.MethodsRecently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores >= 16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories.ResultsSurvivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms.ConclusionsFifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes.Implications for Cancer SurvivorsOur results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.
Keywords: breast cancer; prevalence; age; social support; depression; anxiety; geriatric assessment; women; quality-of-life; cancer survivorship; elderly-patients; older adults; frailty; deficit-accumulation
Journal Title: Journal of Cancer Survivorship
Volume: 19
Issue: 2
ISSN: 1932-2259
Publisher: Springer  
Date Published: 2025-04-01
Start Page: 568
End Page: 579
Language: English
ACCESSION: WOS:001102009300001
DOI: 10.1007/s11764-023-01490-2
PROVIDER: wos
PMCID: PMC11068856
PUBMED: 37924476
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Source: Wos
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MSK Authors
  1. Tim A Ahles
    182 Ahles
  2. James Charles Root
    113 Root
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