Spiegel David, Giese-Davis Janine
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305, USA.
Biol Psychiatry. 2003 Aug 1;54(3):269-82. doi: 10.1016/s0006-3223(03)00566-3.
Depression and cancer commonly co-occur. The prevalence of depression among cancer patients increases with disease severity and symptoms such as pain and fatigue. The literature on depression as a predictor of cancer incidence is mixed, although chronic and severe depression may be associated with elevated cancer risk. There is divided but stronger evidence that depression predicts cancer progression and mortality, although disentangling the deleterious effects of disease progression on mood complicates this research, as does the fact that some symptoms of cancer and its treatment mimic depression. There is evidence that providing psychosocial support reduces depression, anxiety, and pain, and may increase survival time with cancer, although studies in this latter area are also divided. Psychophysiological mechanisms linking depression and cancer progression include dysregulation of the hypothalamic-pituitary-adrenal axis, especially diurnal variation in cortisol and melatonin. Depression also affects components of immune function that may affect cancer surveillance. Thus, there is evidence of a bidirectional relationship between cancer and depression, offering new opportunities for therapeutic intervention.
抑郁症与癌症常常同时出现。癌症患者中抑郁症的患病率会随着疾病严重程度以及疼痛和疲劳等症状而增加。关于抑郁症作为癌症发病率预测因素的文献结果不一，尽管慢性和重度抑郁症可能与癌症风险升高有关。虽然抑郁症预测癌症进展和死亡率的证据存在分歧但更为有力，不过，区分疾病进展对情绪的有害影响使这项研究变得复杂，癌症及其治疗的一些症状与抑郁症相似这一事实也同样如此。有证据表明，提供心理社会支持可减轻抑郁、焦虑和疼痛，并可能延长癌症患者的生存时间，尽管这后一领域的研究也存在分歧。将抑郁症与癌症进展联系起来的心理生理机制包括下丘脑 - 垂体 - 肾上腺轴失调，尤其是皮质醇和褪黑素的昼夜变化。抑郁症还会影响免疫功能的组成部分，而免疫功能可能会影响癌症监测。因此，有证据表明癌症与抑郁症之间存在双向关系，这为治疗干预提供了新机会。
