Navari Rudolph M, Brenner Marie C, Wilson Megan N
Walther Cancer Research Center, University of Notre Dame, Notre Dame, IN 46556, USA.
Breast Cancer Res Treat. 2008 Nov;112(1):197-201. doi: 10.1007/s10549-007-9841-z. Epub 2007 Dec 7.
Studies have shown that there is a high prevalence of depression in cancer patients. Women with breast cancer may have an even higher risk of depression particularly in a postmenopausal or estrogen deficiency state. A small number of randomized controlled trials have examined the efficacy of antidepressants compared to that of a placebo in cancer patients, but some results have been difficult to interpret due to a heterogeneous patient group. In the current investigation, we screened newly diagnosed early stage breast cancer patients for depressive symptoms prior to the initiation of adjuvant therapy and investigated whether the oral antidepressant fluoxetine affected depressive symptoms, completion of adjuvant treatment, and quality of life.
Patients with newly diagnosed early stage breast cancer were screened for depressive symptoms prior to the initiation of adjuvant therapy. Patients with depressive symptoms were randomized to a daily oral fluoxetine or a placebo. Patients were then followed for 6 months and evaluated for quality of life, completion of adjuvant treatment, and depressive symptoms.
A high percentage of patients with newly diagnosed early stage breast cancer were found to have depressive symptoms prior to the initiation of adjuvant therapy. The use of fluoxetine for 6 months resulted in an improvement in quality of life, a higher completion of adjuvant treatment (chemotherapy, hormonal therapy, chemotherapy plus hormonal therapy), and a reduction in depressive symptoms compared to patients who received placebo.
An antidepressant should be considered for early stage breast cancer patients with depressive symptoms who are receiving adjuvant treatment.
研究表明癌症患者中抑郁症的患病率很高。乳腺癌女性患抑郁症的风险可能更高，尤其是在绝经后或雌激素缺乏状态下。少数随机对照试验研究了抗抑郁药与安慰剂相比在癌症患者中的疗效，但由于患者群体异质性，一些结果难以解释。在当前的研究中，我们在辅助治疗开始前对新诊断的早期乳腺癌患者进行了抑郁症状筛查，并研究了口服抗抑郁药氟西汀是否会影响抑郁症状、辅助治疗的完成情况和生活质量。
在辅助治疗开始前，对新诊断的早期乳腺癌患者进行抑郁症状筛查。有抑郁症状的患者被随机分为每日口服氟西汀组或安慰剂组。然后对患者进行6个月的随访，并评估其生活质量、辅助治疗的完成情况和抑郁症状。
发现高比例的新诊断早期乳腺癌患者在辅助治疗开始前有抑郁症状。与接受安慰剂的患者相比，使用氟西汀6个月可改善生活质量，提高辅助治疗（化疗、激素治疗、化疗加激素治疗）的完成率，并减轻抑郁症状。
对于接受辅助治疗且有抑郁症状的早期乳腺癌患者，应考虑使用抗抑郁药。
