McFarland Daniel C, Riba Michelle, Grassi Luigi
Department of Medicine, Hofstra University, Northwell Health, Lenox Hill Hospital, New York, NY.
Department of Psychiatry, University of Michigan, Ann Arbor, MI.
Clin Pract Epidemiol Ment Health. 2021 Dec 31;17(1):287-294. doi: 10.2174/1745017902117010287. eCollection 2021.
Neuropsychiatric symptoms are problematic in cancer settings. In addition to poor quality of life, depression is associated with worsened survival. Patients who develop depression that responds to treatment have the same cancer-related survival as those patients who never had depression. Although depression in patients with cancer is common, it is often unrecognized, untreated, or at best, undertreated. There remains untapped potential for underlying cancer-related biology associated with depression to help clinicians correctly identify depressed cancer patients and orchestrate appropriate treatments to address cancer-related depression. Biologically, inflammation has been most vigorously described in its association with depression in otherwise healthy patients and to a significant extent in patients with medical illness. This association is especially relevant to patients with cancer since so many aspects of cancer induce inflammation. In addition to cancer itself, its treatments (., surgery, radiation, chemotherapy, and systemic therapies) and associated factors (., smoking, obesity, aging) are all associated with increased inflammation that can drive immunological changes in the brain followed by depression. This critical review investigates the relationship between depression and cancer-related inflammation. It investigates several hypotheses that support these relationships in cancer patients. Special attention is given to the data that support certain inflammatory markers specific to both cancer and depression, the neurobiological mechanisms by which inflammation can impact neurotransmitters and neurocircuits in the brain, and the data addressing interventions that reduce inflammation and depression in cancer patients, and future directions.
神经精神症状在癌症患者中是个难题。除了生活质量差之外，抑郁症还与生存率降低有关。接受治疗且病情有所缓解的抑郁症患者与从未患过抑郁症的患者具有相同的癌症相关生存率。虽然癌症患者中的抑郁症很常见，但往往未被识别、未得到治疗，或者充其量只是治疗不足。与抑郁症相关的潜在癌症相关生物学机制仍有未被挖掘的潜力，可帮助临床医生正确识别患有抑郁症的癌症患者，并精心安排适当的治疗方法来解决癌症相关的抑郁症问题。从生物学角度来看，炎症在健康人群的抑郁症中已有大量描述，在患有疾病的患者中也有很大程度的关联。这种关联对癌症患者尤为重要，因为癌症的许多方面都会引发炎症。除了癌症本身，其治疗方法（如手术、放疗、化疗和全身治疗）以及相关因素（如吸烟、肥胖、衰老）都与炎症增加有关，炎症会导致大脑中的免疫变化，进而引发抑郁症。这篇综述探讨了抑郁症与癌症相关炎症之间的关系。它研究了支持癌症患者中这些关系的几种假设。特别关注支持癌症和抑郁症特有的某些炎症标志物的数据、炎症影响大脑神经递质和神经回路的神经生物学机制、关于减少癌症患者炎症和抑郁症的干预措施的数据以及未来的研究方向。
