New research shows that depression symptoms in patients with newly diagnosed metastatic kidney cancer are related to patient survival. Researchers believe inflammatory gene regulation may explain this association. The study, published in the journal PLoS ONE, explores the relationship between patient psychological condition, stress hormone regulation, and the role of inflammatory gene expression.
“Our findings, and those of others, suggest that mental health and social well-being can affect biological processes, which influence cancer-related outcomes,” said Lorenzo Cohen, PhD, professor in MD Anderson’s departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program. “They also suggest that screening for mental health should be part of standard care because there are well-accepted ways of helping people manage distress, even in the face of a life-threatening illness."
Cohen, the study’s lead author, continued, “Our findings indicate that we’re now able to understand some of the possible biological pathways that explain the association between depression and survival.”
Between April 2000 and November 2005, Cohen and colleagues assessed 217 MD Anderson patients newly diagnosed with metastatic renal cell carcinoma. Upon entering the study, patients completed a number of questionnaires measuring depressive symptoms, general quality of life, social support, coping, and religiosity and spirituality. Patients also provided blood samples.
To evaluate fluctuations of cortisol, participants provided 5 saliva samples per day for 3 days. According to Cohen, increased cortisol levels have been found in patients with depressive symptoms and are linked to cellular alterations.
At the time of analysis, 64% of patients were deceased. Overall, 23% of patients reported depressive symptoms within a clinical range. This was associated with shorter survival time, even after controlling for disease-related risk factors.
To determine whether the increased mortality risk associated with elevated depressive symptoms might result from proinflammatory gene expression, whole-genome profiling was conducted on tissue samples from 15 patients with the highest depressive symptoms and 15 risk-matched patients with the lowest depressive symptom scores.
According to the study, 116 genetic transcripts were found to be upregulated by an average of 50% or more in patients with high depressive symptoms. The data suggest that the association between patient psychological condition and survival time may stem from a dysregulation in inflammatory biology and cortisol slope.