Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Cancer Med. 2020 Nov;9(22):8713-8721. doi: 10.1002/cam4.3476. Epub 2020 Oct 6.
Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long-term survivors. Study objectives were: (1) to compare the age-specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease-free BC survivors vs BC survivors with self-reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors.
About 3010 BC survivors (stage I-III, 5-16 years post-diagnosis), and 1005 population controls were recruited in German multi-regional population-based studies. Depression was assessed by the Geriatric Depression Scale-15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression.
Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease-free survivors and controls, but prevalence in disease-free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression.
Long-term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care.
乳腺癌（BC）幸存者的抑郁发病率高于一般人群。然而，对于长期幸存者的抑郁情况知之甚少。本研究的目的是：（1）比较乳腺癌幸存者与女性人群对照组中，（a）特定年龄组的抑郁症状发生率，（b）无疾病生存的乳腺癌幸存者与报告复发的乳腺癌幸存者及对照组中，抑郁症状的发生率；（2）探讨乳腺癌幸存者抑郁的决定因素。
在德国多区域基于人群的研究中，招募了约 3010 例乳腺癌幸存者（I-III 期，诊断后 5-16 年）和 1005 名人群对照组。使用老年抑郁量表-15 评估抑郁情况。通过 logistic 回归控制年龄和教育程度，估计轻度/中度和重度抑郁的患病率。使用多分类 logistic 回归探索轻度和重度抑郁的决定因素。
与人群对照组相比，调整年龄和教育程度后，乳腺癌幸存者更有可能报告轻度/中度抑郁（30.4% vs 23.8%，p=0.0003）。在所有<80 岁的年龄组中，乳腺癌幸存者的轻度/中度和重度抑郁的患病率均显著更高，而≥80 岁的乳腺癌幸存者报告重度抑郁的频率低于对照组。报告复发的乳腺癌幸存者报告的轻度/中度抑郁的患病率明显高于无疾病幸存者和对照组，但无疾病幸存者和对照组之间的患病率相当。年龄、收入、独立生活、复发和 BMI 是乳腺癌幸存者轻度抑郁的显著决定因素。年龄、教育、就业、收入、复发和 BMI 是乳腺癌幸存者重度抑郁的显著决定因素。
<80 岁的长期乳腺癌幸存者报告的抑郁症状发生率显著高于对照组，这可能是由复发和个体因素导致的。研究结果表明，乳腺癌幸存者的抑郁较为常见，尤其是在乳腺癌复发后更为常见。临床医生应常规进行筛查，并将其转诊至心理护理中心。
