Global prevalence of depression among breast cancer patients: a systematic review and meta-analysis

What are the effects of free dance and dance therapy on self-esteem, anxiety, body image and depressive symptoms of women undergoing breast cancer surgery? A randomized clinical trial

OBJECTIVE

To analyze the effect of two 12-week interventions with free dance and dance therapy compared to the control group on self-esteem, body image anxiety and depressive symptoms in women undergoing breast cancer surgery.

METHODS

Randomized clinical trial, with two different interventions (free dance and dance therapy) carried out at different periods, consisting of 23 female breast cancer survivors (58.7 ± 9.9 years), divided into two groups, the intervention group (IG - n = 11) who received different interventions at different times and the control group (CG -n = 12) who maintained their routine activities. The interventions lasted 12 weeks, with 60-min sessions, held twice a week and with a washout period of 35 days between them. The outcomes assessed were self-esteem (Self-Esteem Scale), anxiety (Beck Anxiety Inventory), body image (Body Image after Breast Cancer), and depressive symptoms (Beck Depression Inventory).

RESULTS

There was an improvement within the free dance group in depressive symptoms (p = 0.013) and within the dance therapy group in anxiety (p ≤ 0.001). Difference between the free dance group in the variable depressive symptoms (p ≤ 0.001) and difference between the dance therapy group in anxiety (p ≤ 0.001). In body image, the limitations domain showed an intragroup difference (p = 0.039) due to a worsening post-intervention in the CG compared to the dance therapy group.

CONCLUSION

Women survivors of breast cancer showed improvement in anxiety and depressive symptoms after performing 12 weeks of free dance and dance therapy.

REGISTRATION

Clinical registry: Brazilian Clinical Trials Registry (ReBEC) (nº 0RBR-772ktp).

Social support, social constraint, and psychological adjustment in patients with colorectal cancer

Cancer patients' social networks, particularly their spouses or romantic partners, can promote or undermine their psychological adjustment. This study examined the relative associations of partner social support and social constraint with patients' psychological adjustment and further tested gender's moderating role in these associations. Participants were 124 patients newly diagnosed with colorectal cancer (M age = 56.6 years, 34% female), who completed questionnaires on perceived spousal social support and social constraint, depressive symptoms, and life satisfaction. Findings revealed that greater social constraint was significantly associated with lower life satisfaction regardless of gender; however, greater social constraint was only associated with greater depressive symptoms in male patients. No significant associations or interactions with social support were found. Findings highlight the importance for patients-especially male patients-with cancer to feel able to disclose cancer-related thoughts and feelings to their partners and call for more consistent operationalization and measurement when studying patients' social functioning.

Effect of breast cancer surgery on levels of depression and anxiety: a systematic review and meta-analysis

BACKGROUND

Breast cancer surgery is a critical intervention with potentially significant psychological impacts. This systematic review and meta-analysis investigate the effect of different surgical approaches on levels of depression and anxiety in breast cancer patients.

METHODS

Following the PRISMA 2020 guidelines, we conducted a comprehensive search of international bibliometric databases including PubMed, Scopus, Web of Science, and Embase, up to March 21, 2024.

RESULTS

From 1576 identified articles, 13 studies were included after screening and eligibility assessments. Meta-analysis results indicated a significant reduction in depression (SMD: -0.14; 95% CI: -0.25 to -0.02) and anxiety (SMD: -0.42; 95% CI: -0.56 to -0.28) following breast cancer surgery. Subgroup analysis revealed that mastectomy patients experienced a notable decrease in both depression and anxiety, while results for breast-conserving surgery and reconstruction were more varied.

CONCLUSIONS

Breast cancer surgery is associated with a decrease in depression and anxiety, particularly following mastectomy. Further research should focus on long-term psychological effects and the development of tailored interventions for different surgical types.

Molecular mechanisms and clinical value of the correlation between depression and cancer

According to the World Health Organization, cancer remains the primary cause of death of millions of individuals annually and the foremost cause of mortality worldwide. Cancer imposes substantial economic and mental challenges on patients and their families and strains healthcare systems. Depression, one of the most prevalent mental health conditions, affects approximately 3.8% of the global population and is a significant global health challenge. Research indicates increasing incidence rates of depression among patients with cancer. Depression also appears to influence cancer development and progression, worsening patient prognosis and quality of life, thereby creating additional challenges for clinical treatment. Correlation of depression and cancer is a complicated yet promising field with fast-paced progression and vital clinical values. Therefore, we discussed in this review the associations between depression and cancer and their potential mechanisms by analyzing the specific role of depression in the development and progression of tumors from the perspective of suppressing tumor immunity, inhibiting tumor cell apoptosis, inducing DNA damage, promoting tumor cell mesenchymal transition, enhancing tumor cell stemness, and promoting tumor angiogenesis. This review also discusses how tumors influence the development of depression via inflammatory factors and the significance of identifying and treating depression to enhance the quality of life and prognosis of patients with cancer. Promising biomarkers and effective treatments are also highlighted. Despite available data, limited research exists on how treating depression affects cancer prognosis, and whether timely treatment can reduce cancer risk remains unclear, which necessitates further investigation. This review summarizes the molecular mechanisms involved in the relationship between cancer and depression to help identify new biomarkers and provide precise medical care for patients with depression. We hope this review will lay the foundation for future research, advancing new biomarkers and therapies for early diagnosis of cancer and depression comorbidity.

Regulation of inflammation by Chaihu-Shugan-San: Targeting the IL-17/ NF-κB pathway to combat breast cancer-related depression

BACKGROUND

Breast cancer-related depression (BCRD) is one of the severest comorbidities, affecting the quality of life and the treatment efficacy in BC patients. Chaihu-Shugan-San (CSS), a traditional Chinese medicine presents a potential therapeutic method in BCRD.

PURPOSE

The main purpose of the research was to investigate the effects of CSS on BCRD in a mouse model and to elucidate its mechanisms, particularly its impact on microglial polarization through the IL-17/ NF-κB pathway.

METHODS

A mouse BCRD model was constructed and treated with CSS. Behavioral testing, biochemical parameters, H&E staining, and small animal imaging were used to assess the depressive-like behaviors and tumor growth in mice. RNA sequencing analysis was performed, and the data were authenticated by Western blot as well as quantitative qRT-PCR to explore the mechanisms of CSS treatment in BCRD. The BV2 microglia were stimulated with LPS in vitro and intervened by IL-17 protein, IL-17 antagonist, IMD-0354, and CSS. In addition, western blot was utilized to confirm the expression of IL-17/ NF-κB pathway-related factors. Molecular docking technique and UPLC-Q-TOF/MS were used to find out the key active components of CSS.

RESULTS

CSS treatment significantly improved depression-like behaviors and retarded tumor growth in mice. Through RNA sequencing analysis, it was indicated that the improvement of BCRD by CSS was highly associated with the regulation of the IL-17/ NF-κB pathway. Western blot and qRT-PCR outcomes suggested that CSS inhibited the IL-17/ NF-κB pathway, facilitating the transformation from pro-inflammatory M1 microglial phenotype to anti-inflammatory M2 phenotype, contributing to the reduction of neuroinflammation. In vitro experiments demonstrated that CSS modulated the immune reaction through the induction of phenotypic transformation of microglia from M1 toward M2 phenotype, hence reducing neuroinflammation. Notably, this therapeutic effect of CSS was highly similar to the effects of IL-17 antagonists, thus suggesting that CSS alleviates the symptoms of BCRD by targeting IL-17. Molecular docking revealed that the major bioactive compounds in CSS were Saikosaponin A, Saikosaponin C, and Saikosaponin D.

CONCLUSION

This study systematically demonstrates that CSS ameliorates BCRD by suppressing the IL-17/ NF-κB pathway as well as modulating microglial polarization and elucidates the dual function of IL-17. These results point to a new multi-target intervention strategy for BCRD treatment and fully reflect the holistic effects of CSS by its multi-component as well as multi-target actions.

Breast cancer and suicide: A comprehensive systematic review and meta-analysis of suicidal behaviours mortality and risk factors among women with breast cancer

BACKGROUND

Suicidal behaviours, including ideation, attempts, and mortality, are significant yet often overlooked concerns among women with breast cancer. While the psychological burden of breast cancer has been studied, comprehensive data on the prevalence and risk factors of suicidal behaviours in this population remain limited.

OBJECTIVE

This systematic review and meta-analysis aim to assess the prevalence, incidence, and risk factors associated with suicidal behaviours among women with breast cancer.

METHODS

A literature search was conducted using Embase, MEDLINE, CINAHL, Web of Science, and Academic Search Complete for studies published up to June 2024. Search terms included 'breast cancer,' 'suicidal behaviour,' 'suicide ideation,' 'suicide attempts,' 'self-harm,' and 'self-injury.' Eligible studies included primary data on suicidal ideation, attempts, or completed suicides among women with breast cancer. Meta-analyses were performed using random-effects models, and heterogeneity was assessed with the I2 statistic.

RESULTS

Twenty studies comprising 3450,022 participants were included. The pooled prevalence of suicidal ideation was 10 % (95 % CI 0.01-0.63, p < 0.001), while suicide attempts were reported at 2 % (95 % CI 0.01-0.03, p < 0.001). Suicide mortality was observed in 0.001 % (95 % CI 0.001-0.002, p < 0.001). Younger age (18-45 years), advanced cancer stages (stage IV), and unmarried status were significant risk factors.

CONCLUSION

Suicidal behaviours are prevalent among women with breast cancer, particularly in younger, unmarried patients with advanced cancer stages. Comprehensive mental health support is crucial in reducing suicide risk.

The role of emotion regulation difficulties on anxiety and depressive symptoms among patients with breast cancer

The co-morbid anxiety and depressive symptoms among patients with breast cancer has been linked with adaptation problems and poor quality of life. This study investigated the effect of emotion regulation difficulties on anxiety and depressive symptoms in patients with breast cancer. The study was conducted with a cross-sectional correlational design. The study included 140 patients with breast cancer. Data were collected using the Socio-demographic Characteristics Questionnaire, Difficulties in Emotion Regulation Scale Short Form, and the Hospital Anxiety Depression Scale. Descriptive statistics, and multivariate regression analyses were used. Goals (β = 0. 294, p = 0.026) and strategies (β = 0.223, p = 0.038) were associated with anxiety, explaining 12.6% of the variance for anxiety. Regarding depressive symptoms, impulse (β = 0.250, p = 0.003), strategies (β = 0.231, p = 0.035), and goals (β = 0.222, p = 0.022) were associated with depressive symptoms. The model explained 25.2% of the variance for depressive symptoms. Patients with breast cancer who have difficulty in goal-directed behavior and limited access to emotion regulation strategies when emotionally distressed are associated with a risk of anxiety and depressive symptoms. It is recommended that emotion regulation difficulties of patients with breast cancer should be assessed in terms of anxiety and depression risk. Psychosocial interventions focused on adaptive emotion regulation strategies could be implemented in cancer care.

Feasibility and acceptability of a remote physical activity intervention coupled with short text messages in women with breast cancer and severe depressive or anxiety symptoms

PURPOSE

To test the feasibility and acceptability of a remote physical activity (PA) intervention coupled with motivational text messages among women experiencing severe depressive and/or anxiety symptoms during or after breast cancer (BC) treatment.

METHODS AND MATERIALS

A three-phase-single-case experimental study design (16-week) was conducted among 18 women diagnosed with BC reporting high levels of depressive and anxiety symptoms. Our intervention included behaviour change techniques (BCTs) and 2-3 supervised PA sessions per week, for at least 30 min, coupled with 4-7 weekly personalised text messages. Feasibility (satisfaction and drop-out rates), acceptability (participation rates, therapeutic alliance, and qualitative data), fidelity (quality of BCTs delivered), and the efficacy on PA level and physical fitness were assessed.

RESULTS

Participants expressed high satisfaction and reported an excellent working alliance with their kinesiologist. Notably, there was a very high participation rate (90%) along with a low dropout rate (11%). However, only 3 patients significantly increased their PA post-intervention.

CONCLUSION

This study highlighted the importance to personalise remote PA interventions for women with BC and severe depressive or anxiety symptoms. The combination of a remote PA intervention with daily text messages appears to be very suitable to increase their adherence.

Changes in health behaviors and risk of depression after breast cancer diagnosis and treatment: a nationwide cohort study

PURPOSE

Protective lifestyle behaviors could potentially mitigate the risk of depression in breast cancer survivors. This study examined the association between changes in key health behaviors and depression risk after breast cancer diagnosis and treatment.

METHODS

This nationwide cohort study assessed 30,523 breast cancer survivors without a prior history of depression, focusing on changes in weight, smoking habits, alcohol consumption, and physical activity from pre- to post-cancer diagnosis. The primary outcome was incident depression, with adjusted hazard ratios and confidence intervals calculated to consider potential confounders.

RESULTS

During an average follow-up of 5.3 years (160,755 person-years), lifestyle changes post-diagnosis included decreases in smoking (2.8% to 0.9%) and alcohol consumption (24.9% to 7.5%) and an increase in physical activity (18.9% to 32.1%). Substantial weight gain (> 10%) was associated with a 27% elevated risk of depression compared to those who maintained weight. Both continuation and cessation of smoking were associated with increased depression risk compared to sustained non-smokers. Changes in alcohol consumption, either initiation or cessation, were associated with increased depression risk compared to sustained non-drinkers. Conversely, breast cancer survivors who became inactive post-diagnosis had a reduced risk of depression compared to those who remained inactive. Our exploratory analysis showed that regular physical activity prior to diagnosis was associated with a 7% lower risk of depression compared to inactivity.

CONCLUSION

We observed that post-diagnosis weight gain exceeding 10%, sustaining or quitting smoking, starting or stopping alcohol consumption, and pre-diagnosis physical inactivity were all associated with an increased risk of depression in breast cancer survivors. Healthcare providers should support healthy behaviors to mitigate depression risk after breast cancer diagnosis and treatment.

Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study

PURPOSE

To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories.

METHODS

Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories.

RESULTS

Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms.

CONCLUSIONS

Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.

Impact of major depressive disorder on breast cancer outcomes: a national retrospective cohort study

BACKGROUND

Establishing whether women with major depressive disorder who develop breast cancer have poor outcomes is key to optimizing care for this population. To this end, we examined associations between major depressive disorder and breast cancer recurrence and mortality.

METHODS

Using medical record data from the US Department of Veterans Affairs health-care system, we established a retrospective cohort of women with local or regional stage invasive breast cancer between 2010 and 2019 and followed them through 2022. We used a 2-year window to identify women diagnosed with major depressive disorder before breast cancer diagnosis. We used multivariable Cox-proportional hazards regression to estimate associations between major depressive disorder and breast cancer recurrence and mortality while accounting for competing risks and adjusting for sociodemographic, clinical, lifestyle, and tumor characteristics.

RESULTS

We identified 6051 women with breast cancer, of whom 1754 (29%) had major depressive disorder. The mean (SD) age at breast cancer diagnosis was 57 (11) years. In multivariable analyses, women with major depressive disorder had a 37% (hazard ratio = 1.37, 95% CI = 1.19 to 1.57) higher risk of recurrence and a 30% (hazard ratio = 1.30, 95% CI = 1.02 to 1.64) higher risk of breast cancer mortality. The association between major depressive disorder and recurrence was stronger among women with estrogen receptor-positive breast cancer. In secondary analyses, there were statistically significant interactions between major depressive disorder and multiple exposures with respect to recurrence, including current smoking, substance abuse, and nonreceipt of screening mammography.

CONCLUSIONS

Women with major depressive disorder had inferior breast cancer outcomes compared with women without a history of major depressive disorder. Research is needed to investigate underlying mechanisms linking depression to breast cancer progression and evaluate interventions to improve outcomes in this high-risk population.

Association between the Chinese Dietary Balance Index-based dietary quality and depressive symptoms in breast cancer patients

PURPOSE

This cross-sectional study explored the association between dietary quality and the risk of depressive symptoms in breast cancer patients.

METHODS

Dietary intake was assessed by 3-day, 24-h dietary recall, followed by dietary quality evaluation by the Chinese Dietary Balance Index-16 (DBI-16). Depressive symptoms were assessed by Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

A total of 160 breast cancer patients with a mean age of 53.07 ± 9.50 years were recruited. Fifty of these patients had a CES-D score higher than 16 and were defined as depressed. Compared with non-depressed patients, depressed patients had significantly inadequate fruit intake (P = 0.002). A higher proportion of depressed patients had moderately inadequate dietary intake (lower bound scores, LBS, between 25 ~ 36) compared with non-depressed patients (14.0% vs. 0.9%), and there was a significant difference in the distribution of inadequate intake levels between the two groups (P = 0.003). The depressed patients also had a significantly lower diet variety (P = 0.009). Logistic regression analysis showed that after controlling for age, menopausal status, and employment, LBS was positively associated with depressive symptoms (OR = 1.086; 95% CI 1.005-1.174; P = 0.036), whereas the fruit score (OR = 0.674; 95% CI 0.522-0.871; P = 0.003) and diet variety score (OR = 0.637; 95% CI 0.462-0.878; P = 0.006) were both negatively associated.

CONCLUSION

Diet might be one of the determinants of depressive symptoms in breast cancer patients. A balanced diet with more fruits, increased diet variety, and adequate nutrients might be a promising strategy to prevent or treat depressive symptoms in breast cancer patients.

Intervening in the Cancer Care System: An Analysis of Equity-Focused Nurse Navigation and Patient-Reported Outcomes

BACKGROUND

Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes.

METHOD

We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient's behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators' clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health.

RESULTS

Twelve percent of navigators' clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants.

DISCUSSION

The term system-facing support highlights navigators' role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity.

Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses

INTRODUCTION

Depression and anxiety are prevalent psychological disorders that significantly affect physical, emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especially challenging for cancer survivors, complicating treatment management, affecting adherence, and potentially impacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, and anxiety, as well as their determinants among cancer patients.

METHOD

An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants of pain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses. The review involved a thorough search of multiple databases and included studies published in English up to July 2024 that reported on these symptoms. The process involved screening and selecting studies based on specific criteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determine overall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understanding of these psychological issues in cancer survivors and guide future research and interventions.

RESULT

The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59-38.74), while anxiety had a prevalence of 30.55% (95% CI 24.04-37.06). Pain prevalence after treatment was 39.77% (95% CI 31.84-47.70). Before treatment, 65.22% (95% CI 62.86-67.57) of cancer patients reported pain, which persisted in 51.34% (95% CI 40.01-62.67) during treatment. The analysis also found that during the COVID-19 pandemic, depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI 41.25-45.26) and 52.93% (95% CI 50.91-54.96), respectively.

CONCLUSION

The umbrella review found that depression and anxiety prevalence among cancer survivors was 33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factors contributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxiety was significantly linked to advanced cancer stage and poor sleep quality.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of Rosenthal effect-based nursing intervention on self-care ability and hope level in patients undergoing breast surgery

OBJECTIVE

To investigate the impact of Rosenthal effect-based nursing intervention on self-care ability and hope level in patients undergoing breast surgery.

METHODS

A total of 200 patients with breast disease admitted to the First Affiliated Hospital of Wenzhou Medical University for treatment from January 2022 to January 2023 were randomly divided into the observation group (n = 100) and the control group (n = 100). The control group was given routine nursing care, while the observation group was additionally given Rosenthal effect-based nursing intervention. Afterward, the psychological status, self-care ability, hope level, and quality of life were compared between the 2 groups pre-and post-intervention.

RESULTS

After the intervention, the observation group saw lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores than the control group. Meanwhile, the post-intervention scores of health knowledge, management skills, responsibility, management concept, positive action, close relationship with others, attitude towards the present and future, social function, psychological function, physical function, and material lifewere higher in the observation group compared with those in the control group, with statistically significant differences (p < 0.05).

CONCLUSION

Rosenthal effect-based nursing intervention is beneficial for improving the psychological status, self-care ability, hope level, and quality of life of patients undergoing breast surgery. The findings suggest that this intervention should be considered for integration into standard care protocols for breast surgery patients to optimize their post-surgical outcomes and well-being. Future research should focus on evaluating the long-term effectiveness and feasibility of implementing this intervention in diverse clinical settings.

Experiences of rehabilitation one year after breast cancer diagnosis-A focus group study from the ReScreen randomized controlled trial

BACKGROUND

Treatment for breast cancer poses major challenges and leads to a variety of side-effects and problems that affect life for a long time. Experiences and symptoms vary, and research indicates a lack of structures for ensuring individualized rehabilitation. This qualitative focus group study aims to explore the experience of women with BC after participating in a complex randomized controlled trial (RCT) (Clinicaltrials.gov NCT03434717) focusing on cancer rehabilitation from a comprehensive perspective.

METHOD

Nine semi-structured focus group interviews with women (n = 30) who participated in the Rescreen RCT were conducted. The women were interviewed divided into three RCT groups (intervention, control, or observation group). Data were initially analyzed inductively using conventional content analysis, followed by a deductive approach, guided by the result from the inductive analysis.

RESULTS

The inductive analysis resulted in two categories and four sub-categories and showed a great variation in experiences and needs. Some women described a well-functioning process, while others described lack of individualized information, continuity with healthcare providers, and clear pathways for support. After the deductive analysis, a variation between the groups appeared. Women in the intervention group expressed that a proactive and individualized approach facilitated rehabilitation and they experienced a feeling of being recognized as a person, which they highlighted as important. On the contrary, women from the control group described feelings of being abandoned from healthcare, hindering rehabilitation. The observation group expressed that their needs had been fulfilled within the healthcare system.

CONCLUSIONS

This study adds important knowledge to the evaluation of the ReScreen model and contributes to existing research on how individualized rehabilitation after breast cancer can be applied in clinical practice. A proactive, person-centered approach in rehabilitation, aimed at those with extended needs, would potentially optimize rehabilitation and facilitate the recovery process after breast cancer treatment.

Depression decreases immunity and PD-L1 inhibitor efficacy via the hypothalamic-pituitary-adrenal (HPA) axis in triple-negative breast cancer

BACKGROUND

Depression weakens antitumor immunity, yet the underlying mechanisms linking depression and tumor growth remain unclear. This study examines the influence of depression on the hypothalamic-pituitary-adrenal (HPA) axis, immunological function, and effectiveness of immunotherapy in triple-negative breast cancer (TNBC) patients.

METHODS

A mouse model of comorbid TNBC and depression was established via chronic restraint stress (CRS) and 4T1 tumor transplantation. A programmed cell death ligand 1 (PD-L1) inhibitor was used to manage mice with TNBC, and the ability of metyrapone to reverse the immune system changes induced by HPA axis activation in depression was evaluated. Mouse peripheral blood was used to measure HPA axis activity, immune cell numbers and cytokine levels.

RESULTS

Depression activates the HPA axis, leading to increased levels of glucocorticoids. Depression led to an increase in the B-cell number and a reduction in the CD4+ T-cell and CD8+ T-cell numbers, without a statistically significant difference in the regulatory T (Treg) cell number. Furthermore, depression increased the levels of the cytokines interferon-gamma (IFN-γ), interleukin (IL)-1β, IL-4, IL-6, IL-8, and tumor necrosis factor (TNF)-α while decreasing the levels of IL-2 and IL-10. Similar results were observed in the context of PD-L1 inhibitor therapy. The depressed mice presented an increased tumor burden and a poor response to the PD-L1 inhibitor. The application of metyrapone during PD-L1 inhibitor treatment resulted in partial restoration of these depression-related alterations.

CONCLUSIONS

Depression reduces the effectiveness of PD-L1 inhibitors by altering the number of immune cells and the levels of cytokines through activation of the HPA axis.

TRANSLATIONAL RELEVANCE

Depression is common in breast cancer patients and is associated with reduced antitumor immunity. There is limited knowledge regarding the specific mechanisms through which depression impairs antitumor immunity. Immunotherapy, which promotes the restoration of antitumor immunity, represents a promising treatment strategy for TNBC patients. However, the efficacy of immunotherapy can be compromised by depressive symptoms and the administration of glucocorticoids during treatment. It is still uncertain whether increasing glucocorticoid levels can reduce the efficacy of immunotherapy in patients with depression. The potential benefits of combining immunotherapy with glucocorticoid inhibitors compared with immunotherapy alone need to be evaluated for TNBC patients with concurrent depressive symptoms. Therefore, further clarification of the specific mechanisms by which depression impairs antitumor immunity is needed to inform future optimization of immunotherapy strategies.

Differences in Emotional Awareness Moderate Cytokine-Symptom Associations Among Breast Cancer Survivors

Cancer survivors have elevated levels of proinflammatory cytokines, which could be associated with cancer-related symptoms. Given that proinflammatory cytokines heighten negative affect by directly affecting the brain, we explored these direct associations and whether differences in levels of emotional awareness moderate the associations between proinflammatory cytokines and cancer-related symptoms. This cross-sectional, secondary analysis of baseline data was collected from 162 female breast cancer survivors (aged 36-70 years), who were enrolled 6 ± 4 months after completing cancer treatment. We tested cytokines in serum (IL-1β, IL-6, IL-8, TNF-α, IL-4, IL-10, and TGF-β) and assessed depression, cancer-related fatigue, pain intensity, and pain interference. Emotional awareness was assessed using a performance measure, the Levels of Emotional Awareness Scale. In participants with high but not average or low levels of emotional awareness, positive associations were found for IL-1β, IL-6, and TNF-α with depression and between IL-6 and TNF-α with pain intensity. In addition, IL-6 had a positive association with pain intensity at average levels of emotional awareness. These results suggest that women with high or in some cases average, but not low, emotional awareness reported depression and pain as being positively associated with their cytokine levels. By using emotional awareness as a cognitive resource to promote emotion regulation and distress transformation, interventions may be able to counteract heightened sensitivity to the mood-altering effects of cytokines.

The mediating effect of intrusive rumination on the relationship between illness uncertainty and fear of cancer recurrence in breast cancer survivors

BACKGROUND

Recently, increased awareness of early diagnosis and treatment options has led to an increase in the number of breast cancer survivors. Psychosocial interventions to increase the quality of life in this group are gaining importance. One of the most common psychological problems in breast cancer survivors is fear of cancer recurrence (FCR). It is essential to elucidate the mechanisms of FCR.

AIMS

This study aimed to examine the mediating effect of intrusive rumination on the relationship between illness uncertainty and FCR in breast cancer survivors.

METHODS

The study was designed to be cross-sectional, and 204 breast cancer survivors were included. Participants were given the Mishel Uncertainty in Illness Scale-Community form (MUIS-C), the severity subscale of the Fear of Cancer Recurrence Inventory, and the Event-Related Rumination Inventory-intrusive rumination subscale. Correlation analyses were conducted, and the structural equation method evaluated the mediation effect.

RESULTS

Most participants (74%) reported some degree of FCR. A significant positive relationship was found between illness uncertainty and FCR (r = 0.325; p ≤ 0.001). The path analysis showed that intrusive rumination partially mediates this relationship.

CONCLUSIONS

This study's results shed light on the relationship between illness uncertainty, rumination, and FCR. Planning psychoeducation programs during follow-up to reduce illness uncertainty may positively affect FCR. In addition, metacognitive therapies that can functionalize the ruminative thinking style can also effectively intervene in FCR.

Physical Activity and Depression in Breast Cancer Patients: Mechanisms and Therapeutic Potential

Breast cancer is a significant traumatic experience that often leads to chronic stress and mental health challenges. Research has consistently shown that physical activity-especially exercise-can alleviate depressive symptoms; however, the specific biological mechanisms underlying these antidepressant effects remain unclear. In this review, we comprehensively summarize the biological mechanisms of depression and the antidepressant mechanisms of physical activity and explore the biological processes through which exercise exerts its antidepressant effects in breast cancer patients. We focus on the impact of physical activity on inflammation, the endocrine system, glutamate, and other aspects, all of which play crucial roles in the pathophysiology of depression. Moreover, we discuss the heterogeneity of depression in breast cancer patients and the complex interactions between its underlying mechanisms. Additionally, we propose that a deeper understanding of these mechanisms in the breast cancer population can guide the design and implementation of exercise-based interventions that maximize the antidepressant benefits of physical activity. Finally, we summarize the current research and propose future research directions.

Psychometric properties of the Swedish version of the Patient Health Questionnaire-9: an investigation using Rasch analysis and confirmatory factor analysis

Depression is one of the most common psychiatric conditions. Given its high prevalence and disease burden, accurate diagnostic procedures and valid instruments are warranted to identify those in need of treatment. The Patient Health Questionnaire-9 (PHQ-9) is one of the most widely used self-report measures of depression, and its validity and reliability has been evaluated in several languages. However, the Swedish translation has yet not been subject to psychometric evaluation, and no previous psychometric evaluation of the instrument have used both Rasch analysis and classic test theory. The aim of this study was to investigate validity and reliability of the PHQ-9 in a Swedish sample of individuals with self-reported current or past mental health problems using Rasch analysis and confirmatory factor analysis. A sample of 4958 participants was recruited from an online survey covering different aspects of covid-19 and mental health targeted towards individuals with mental health problems. Results showed that a one-factor solution fit the data after removing one item and that some items had a different response pattern for older respondents. Furthermore, after removing item 2 and merging the two middle response categories for item 9, the Swedish translation of PHQ-9 showed adequate psychometric properties. The findings suggests that the Swedish translation of PHQ-9 may need to be adapted in order to make adequate interpretations of an individual score and to differentiate between populations. Further tests of its validity and reliability in other Swedish samples are needed to fully understand the properties of the Swedish version of PHQ-9.

Detection of differences in physical symptoms between depressed and undepressed patients with breast cancer: a study using K-medoids clustering

BACKGROUND

To detect the differences in physical symptoms between depressed and undepressed patients with breast cancer (BC), including common symptoms, co-occurring symptoms, and symptom clusters based on texts derived from social media and expressive writing.

METHODS

A total of 1830 texts from social media and expressive writing were collected. The Chi-square test was used to compare the frequency of physical symptoms between depressed and undepressed patients with BC. Symptom lexicon of BC and K-medoids Clustering were used for mining physical symptoms and cluster analysis.

RESULTS

The common physical symptoms reported by texts included general pains (59.38%), fatigue (26.60%), vomiting (24.82%), swelling of limbs (21.69%), difficulty sleeping (21.56%), nausea (16.78%), alopecia (15.14%), loss of appetite (13.78%), dizziness (11.60%), and concentration problems (11.19%). The frequency of difficulty sleeping (depressed 28.40%; undepressed 18.16%; P = 0.002) in depressed patients was higher than undepressed patients with BC. High co-occurrence was observed in both commonly mentioned symptoms and those less commonly mentioned but frequently co-occurring with them. There were 5 symptom clusters identified in depressed patients and 6 symptom clusters in undepressed patients. Pain-related symptom cluster and gastrointestinal symptom cluster were both identified in the depressed and undepressed patients. The novel immune system impairment symptom cluster consisting of bleeding and fever was found in the undepressed patients.

CONCLUSIONS

This study found that difficulty sleeping was reported more frequently, and identified difficulty sleeping-pain symptom cluster in depressed patients. The novel immune system impairment symptom cluster in undepressed patients was detected. Healthcare providers can provide targeted care to depressed and undepressed patients based on these differences. These findings demonstrate that social media can provide new perspectives on symptom experiences. The combination of digital tools and traditional clinical tools for symptom management in follow-up has great potential in the future.

CLINICAL TRIAL NUMBER

Not applicable.

Changes over time in self-efficacy to cope with cancer and well-being in women with breast cancer: a cross-cultural study

OBJECTIVE

This study aimed to examine whether self-efficacy to cope with cancer changes over time in patients with breast cancer and whether these potential changes are similar across patients. It also aimed to examine whether these trajectories are related to patient psychological well-being and overall quality of life.

METHODS

Participants (N = 404) from four countries (i.e. Finland, Israel, Italy, and Portugal) were enrolled in the study few weeks after breast surgery or biopsy. Self-efficacy to cope with cancer was assessed at baseline, six and 12 months later. Well-being indices were assessed at baseline, 12 and 18 months later.

RESULTS

Using Latent Class Growth Analysis, two groups of patients were identified. The majority of patients reported high levels of self-efficacy to cope, which increased over time. For almost 15% of the patients, however, self-efficacy declined over time. Diminishing levels of self-efficacy to cope predicted worse levels of well-being. The pattern of self-efficacy changes and their relationships to well-being was consistent across countries.

CONCLUSION

Monitoring self-efficacy to cope with cancer is probably important in order to detect alarming changes in its levels, as a declining self-efficacy to cope may serve as a signal of the need for intervention to prevent adaptation difficulties.

Depression risk among breast cancer survivors: a nationwide cohort study in South Korea

BACKGROUND

Depression among breast cancer survivors is a significant concern affecting their long-term survivorship and quality of life. This study investigates the incidence of depression among breast cancer survivors and identifies associated risk factors.

METHODS

This retrospective cohort study used data from the Korean National Health Insurance Service database and included 59,340 breast cancer patients without a history of depression who underwent surgery between January 1, 2010, and December 31, 2016. They were individually matched 1:2 by age with a general population without cancer (n = 99,834). The mean follow-up period was 6.4 ± 2.6 years. Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) were calculated considering death as a competing risk and adjusting for sociodemographic factors and comorbidities.

RESULTS

Breast cancer survivors with a mean (standard deviation) age of 51.5 (9.2) years had a 39% increased risk of depression compared to non-cancer controls (sHR 1.39, 95% CI 1.36-1.42). During the first year post-diagnosis, breast cancer survivors across all ages exhibited a significantly elevated risk of depression, with a sHR of 3.23 (95% CI 3.08-3.37). Notably, younger survivors had a sHR of 4.51 (95% CI 4.19-4.85), and older survivors had a sHR of 2.56 (95% CI 2.42-2.71). One year post-surgery, younger survivors (age ≤ 50 years) showed a 1.16-fold increase in depression risk (sHR 1.16, 95% CI 1.11-1.20), while older survivors (age > 50 years) showed no significant change in risk, which decreased over time. Use of anthracycline, taxane, or endocrine therapy was associated with an increased depression risk (sHR 1.17, 95% CI 1.13-1.22; sHR 1.12, 95% CI 1.07-1.16; and sHR 1.27, 95% CI 1.14-1.41, respectively), with endocrine therapy showing a 41% increased depression risk in older survivors (sHR 1.41, 95% CI 1.23-1.61).

CONCLUSION

This study demonstrates a significant association between breast cancer and depression, with a particularly heightened risk in younger survivors within the first year post-diagnosis. Special attention is needed to meticulously screen for depressive symptoms during the early follow-up years for breast cancer survivors who are premenopausal or have undergone chemotherapy and endocrine therapy.

Heart rate variability and insomnia in depressed patients with breast cancer

OBJECTIVES

Depression is associated with unhealthy autonomic regulation. However, whether patients with breast cancer (BC) with different degrees of depression can be identified from linear and non-linear dynamics in the autonomic nervous system is unclear. We aimed to evaluate the differences in linear and non-linear heart rate variability (HRV) parameters in patients with BC with different degrees of depression and the relationship between HRV parameters and depression and sleep disorders.

METHODS

A total of 115 patients with BC were enrolled. According to their Self-Rating Depression Scale (SDS) scores, the patients were divided into a non-depressed group, a mildly depressed group and a moderately to severely depressed group. The Pittsburgh Sleep Quality Index (PSQI), HRV, linear index (including time and frequency domains) and non-linear index (including Poincare plot, approximate entropy (ApEn) and short-term fluctuation slope (DFAα1)) were evaluated.

RESULTS

Compared with patients without depssion, patients with mild depression and moderate-to-severe depression had significant differences in the time domain, frequency domain index, the SD perpendicular to the line-of-identity (SD1) and DFAα1 of non-linear HRV and sleep quality. SDS and PSQI scores were correlated with HRV parameters.

CONCLUSIONS

The severity of depression in patients with BC is associated with reduced variability, complexity of cardiac dynamics and sleep disturbance.

Depression, anxiety and associated factors among cancer patients in Africa; a systematic review and meta-analysis study

BACKGROUND

Depression and anxiety are the most common types of mental disorders among cancer patients. Many research studies carried out in African countries indicate that anxiety and depression are highly prevalent, but the results vary across regions. Thus, this study aimed to estimate the pooled prevalence and associated factors of depression and anxiety among cancer patients in Africa.

METHODS

The databases EMBASE, PubMed, African Journals Online, and Google Scholar were used to identify articles. This systematic review and meta-analysis included 32 (31 for depression and 25 for anxiety) original articles from 11 African countries. To detect publication bias, Egger regression tests and funnel plot analysis were employed. A sensitivity analysis and a subgroup analysis were carried out.

RESULTS

The pooled prevalence of depression and anxiety among cancer patients was found to be 53.21% (95% CI: 47.47-58.94) and 53.32% (95% CI: 46.85, 59.80) respectively. Across regions, the prevalence of depression among cancer patients was 60.03 (95% CI: 55.85-64.21), 53.59 (95% CI: 45.31-61.87), and 43.92 (95% CI: 36.17-51.67) in North, East, and West Africa, respectively. The pooled prevalence of anxiety among cancer patients was 64.85 (95% CI: 54.81-74.88) in North Africa, 49.53 (95% CI: 40.72-58.33) in East Africa, and 46.23 (95% CI: 38.98-53.48) in West Africa. Advanced stages of cancer (AOR = 3.8; 95% CI: 1.73, 8.42), less educated (AOR = 2.57; 95% CI: 1.28-5.14), and having no financial support (AOR = 2.03; 95% CI: 1.12, 3.67) were factors associated with depression. Advanced stages of cancer (AOR = 5.44; 95% CI: 1.95, 15.18) and no financial assistance (AOR = 2.88; 95% CI: 1.79, 4.63) were factors associated with anxiety.

CONCLUSION

Depression and anxiety among cancer patients are highly prevalent in Africa. Being at an advanced stage of cancer, low educational attainment, and not having financial support were all associated with depression symptoms; in addition, having advanced cancer and not having financial support were also associated with anxiety symptoms. Therefore, it is critical to screen cancer patients for anxiety and depression and provide them with appropriate interventions when these conditions arise.

Association between sleep duration, depression and breast cancer in the United States: a national health and nutrition examination survey analysis 2009-2018

OBJECTIVE

Breast cancer is the most common cancer in women, threatening both physical and mental health. The epidemiological evidence for association between sleep duration, depression and breast cancer is inconsistent. The aim of this study was to determine the association between them and build machine-learning algorithms to predict breast cancer.

METHODS

A total of 1,789 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the study, and 263 breast cancer patients were identified. Sleep duration was collected using a standardized questionnaire, and the Nine-item Patient Health Questionnaire (PHQ-9) was used to assess depression. Logistic regression yielded multivariable-adjusted breast cancer odds ratios (OR) and 95% confidence intervals (CI) for sleep duration and depression. Then, six machine learning algorithms, including AdaBoost, random forest, Boost tree, artificial neural network, limit gradient enhancement and support vector machine, were used to predict the development of breast cancer and find out the best algorithm.

RESULTS

Body mass index (BMI), race and smoking were statistically different between breast cancer and non-breast cancer groups. Participants with depression were associated with breast cancer (OR = 1.99, 95%CI: 1.55-3.51). Compared with 7-9h of sleep, the ORs for <7 and >9 h of sleep were 1.25 (95% CI: 0.85-1.37) and 1.05 (95% CI: 0.95-1.15), respectively. The AdaBoost model outperformed other machine learning algorithms and predicted well for breast cancer, with an area under curve (AUC) of 0.84 (95%CI: 0.81-0.87).

CONCLUSIONS

No significant association was observed between sleep duration and breast cancer, and participants with depression were associated with an increased risk for breast cancer. This finding provides new clues into the relationship between breast cancer and depression and sleep duration, and provides potential evidence for subsequent studies of pathological mechanisms.

Prevalence of subthreshold depression in older adults: A systematic review and meta-analysis

BACKGROUND

The prevalence of subthreshold depression (StD) in older adults shows considerable variation across studies. This study aimed to determine the prevalence of subthreshold depression in elderly people.

METHODS

We conducted a thorough literature search across multiple databases, including PubMed, Web of Science, Medline, Cochrane Library, SinoMed, Wan Fang Data, CNKI, and VIP. Statistical analyses were carried out using STATA version 16.0. Our study was prospectively registered with PROSPERO (CRD42023494210).

RESULTS

Seventy-seven studies involving 225,232 individuals were included in this meta-analysis. The overall prevalence of subthreshold depression was 18.6 % (95 % CI: 16.0 %-21.2 %, I2 =99.8 %, p<0.001. Subgroup analyses showed the prevalence of StD in older adults varied depending on the screening tools used and the continent of the study. Funnel plots and Egger's test did not reveal any significant publication bias (Egger's test: p = 0.057).

CONCLUSION

The prevalence of subthreshold depression in older adults is high, suggesting attention needs to be paid to the mental health of the elderly. To prevent a larger public health issue, it is imperative to implement timely and effective preventive measures and interventions, focusing on early detection and intervention.

The complexity of needs and roles of family members during breast cancer rehabilitation: a qualitative study

BACKGROUND

Family members play a crucial role in supporting women with breast cancer during their recovery. In the complex situation of being an informal caregiver, their own health and ability to support the patient needs to be acknowledged. The aim was to explore the experiences, needs and roles of family members throughout the rehabilitation process of women with breast cancer.

METHODS

A qualitative study was conducted, involving semi-structured individual telephone interviews with 20 purposefully selected family members of women with breast cancer (13 men aged 24-79 years, 7 women aged 19-76 years). Data analysis utilized conventional content analysis and used "casing" as the analysis technique. The study is part of the ReScreen randomized controlled trial and all participants gave informed consent.

RESULTS

The interviews revealed significant variation among family members, leading to the emergence of different typologies based on their reactions and specific preconditions. These typologies included: 1) The case of the assertive and confident team leader, 2) The case of the frustrated but persistent guardian, 3) The case of the reassured bystander, and 4) The case of the neglected outsider. While not mutually exclusive, the cases demonstrated clear similarities and differences in whether individuals felt secure or insecure in the rehabilitation process and their level of involvement in this process. Some described feelings of being involved and active in the process while others experienced not being involved and described feelings of abandonment. However, regardless of their role, family members reported that their own health was seldom considered by healthcare professionals.

CONCLUSIONS

This study sheds light on the concept of "we-disease," where the role of a family member is interrelated with factors such as their health literacy, supporting role, level of involvement, relationship, and identity during the patient's rehabilitation process. This highlights significant divergence in whether family members perceive the rehabilitation process as a collaborative effort or an individual challenge. These perceptions greatly impact their own well-being and ability to support women with breast cancer, underscoring the importance of recognizing family members as informal caregivers and offering tailored support from healthcare professionals when needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03434717. Registered February 15, 2018.

Closing the Loop on Revision: The Impact of Emotional Well-being on Elective Revision After Breast Reconstruction

BACKGROUND

A diagnosis of breast cancer has a significant impact on a patient's physical and emotional health. Breast reconstruction improves quality of life and self-esteem following mastectomy. However, many patients undergo additional elective revision procedures after reconstruction.

OBJECTIVES

The aim of this study was to assess the relationship between perioperative emotional well-being and elective revisions in breast reconstruction.

METHODS

A retrospective review was performed of patients who underwent breast reconstruction with a single surgeon between January 2007 and December 2017. Revision procedures were defined as additional operations that fall outside the index reconstructive plan. Medical records were reviewed for a history of generalized anxiety disorder (GAD) and/or major depressive disorder. Multivariate analysis was performed to identify factors associated with revision.

RESULTS

A total of 775 patients undergoing breast reconstruction were included, of whom 121 (15.6%) underwent elective revision. Overall, a history of any psychiatric history (P < .001), depression alone (P = .001%), and GAD and depression together (P = .003) were significantly associated with revision surgery. On multivariate logistic regression controlling for comorbidities and reconstruction modality, depression alone, and GAD and depression together were significantly associated with an increased likelihood of revision surgery (odds ratio, 3.20, P < .001; odds ratio, 2.63, P < .001).

CONCLUSIONS

Perioperative emotional well-being and reconstruction modality impact the rate of secondary revision surgery. An understanding of the surgical and patient-related risk factors for revision can provide more informed patient-decision making and improve surgical planning.

LEVEL OF EVIDENCE: 3

Assessment of psycho-oncology in the Middle East and North Africa region: a systematic review and meta-analysis

BACKGROUND

The Middle East and North Africa (MENA) region is expected to witness a significant increase in the burden of cancer. Contrary to Western literature, the burden of psycho-oncology is yet to be established within the MENA region. This study reviews all available evidence characterizing the psychological burden among patients with cancer across the MENA region.

METHODS

We systematically explored the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science (WoS) databases for reports on the psychiatric burden among patients with cancer residing within the MENA region from January 2000 until January 2023. Raw proportion were extracted and analyzed using a random-effects model.

FINDINGS

Eighty-three studies comprised of 16 810 participants, representing 14 countries, met our inclusion criteria. Across the MENA region, the prevalence of depression, anxiety, and distress were 44% (95% CI, 39%-50%), 47% (95% CI, 40%-54%), and 43% (95% CI, 30%-56%), respectively. Prevalence of depression was significantly different across countries, with Palestine (73%; 95% CI, 42%-91%) reporting the highest rate while Morocco (23%; 95% CI, 7%-56%) reported the lowest. Similarly, anxiety significantly differed across MENA nations ranging from 64% (95% CI, 3%-99%) in Morocco to 28% (95% CI, 18%-42%) in Tunisia. Rates of depression and anxiety were significantly different across measurement tools but not between Arabic-speaking versus Persian/Farsi-speaking countries. Meta-regression models showed that neither publication year nor age affected the prevalence of both anxiety and depression (P = .374 and .091 for depression and P = .627, and .546 for anxiety, respectively).

INTERPRETATION

We report an abnormally high rate of psychiatric burden among patients with cancer in the MENA region. Thus, establishing appropriate psycho-oncologic interventions within the MENA region is of utmost importance.

Distress and inflammation are independently associated with cancer-related symptom severity

Objective

To evaluate longitudinal associations of distress and inflammation with somatic and depressive symptom severity in breast cancer patients, from before to six months after neoadjuvant chemotherapy. We also explored feasibility and effects of an early mindfulness-based intervention for preventing or reducing somatic and depressive symptoms.

Methods

Longitudinal pilot study with a randomized waitlist-controlled intervention design. Women with breast cancer were randomized to receive access to a smartphone application offering meditation exercises, either immediately after baseline testing (intervention group) or after study completion (control group) in a 1:1 ratio. Assessments (self-report questionnaires and a blood draw when feasible) were completed before, halfway through, immediately after, and 6 months after completing neoadjuvant chemotherapy.

Results

Fifty evaluable women were enrolled. Somatic symptom severity increased during chemotherapy, whereas depressive symptom severity was at its peak before treatment and declined gradually thereafter. Distress was positively associated with depressive symptom severity. Only Distress Thermometer-results were positively associated with somatic symptom severity. Inflammation was positively associated with both types of symptoms, and distress did not moderate the associations between inflammation and symptom severity. Intervention adherence was low and no intervention effect on symptom experience was observed.

Conclusion

Inflammation and distress are independently associated with somatic and depressive symptoms experienced during breast cancer treatment.

Breast Cancer and Mental Health: Incidence and Influencing Factors-A Claims Data Analysis from Germany

BACKGROUND/OBJECTIVES

With breast cancer (BC) survival improving due to optimized therapy, enhancing quality of life has become increasingly important. Both diagnosis and treatment, with their potential side effects, pose risks to mental well-being. Our study aimed to analyze the incidence and potential risk factors for mental disorders in BC patients.

METHODS

This retrospective analysis used claims data from AOK Baden-Wuerttemberg, including 11,553 BC patients diagnosed via ICD code C50 between 2010 and 2020 and 31,944 age-matched controls. Patients with mental disorders in the 12 months prior to diagnosis were excluded. Mental disorders were categorized into eight groups based on ICD codes: anxiety, obsessive compulsive disorder, adjustment disorder, dissociative disorder, hypochondriac disorder, affective disorder, mania, and other neuroses.

RESULTS

Mental disorders were significantly more common in BC patients than in controls (64.2% vs. 38.1%, p < 0.01, OR 2.91, 95%CI [2.79, 3.04]). In particular, hypochondriac, anxiety, affective, and adjustment disorders occurred significantly more often in BC patients. No differences were found for mania, bipolar disease, other neuroses, obsessive compulsive-, or dissociative disorders. Furthermore, endocrine therapy was associated with psychological comorbidities (OR 1.69, p < 0.001, 95%CI [1.53, 1.86]), while primarily metastasized patients (stage C) had a lower risk than adjuvant patients in stage A (OR 0.55, p < 0.0001, 95%CI [0.49, 0.61]). Regarding surgical treatment, mastectomy patients showed lower rates of mental illnesses (61.2%) than those with breast-conserving treatment (71.6%), or especially breast reconstruction (78.4%, p < 0.01). Breast reconstruction was also associated with more hypochondriac (p < 0.01) and adjustment disorders (p < 0.01).

CONCLUSIONS

So, BC patients experience significantly more mental disorders than controls, particularly when treated with endocrine therapy and breast reconstructive surgery.

Efficacy comparison of five antidepressants in treating anxiety and depression in cancer and non-cancer patients

Introduction

Cancer patients have a heightened susceptibility to anxiety and depressive disorders, which significantly impact the effectiveness of cancer treatments and long-term quality of life. This study aimed to compare the efficacy of different antidepressants in cancer and non-cancer patients.

Methods

A total of 610 patients diagnosed with depressive episodes and/or anxiety disorders were retrospectively included and divided into a cancer group and a non-cancer control group. Antidepressants used included escitalopram, duloxetine, sertraline, venlafaxine, and vortioxetine, combined with trazodone or not. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire-7 (GAD-7) scores were used to evaluate the efficacy after 4 weeks and 8 weeks of systematic antidepressants treatment.

Results

Compared to the non-cancer group, the cancer group had higher proportions of females, older individuals, and patients with poor sleep quality, while reporting fewer somatic symptoms at baseline (all p < 0.05). PHQ-9 and GAD-7 scores in cancer patients treated with antidepressants were significantly lower than baseline at week 4 and week 8 (all p < 0.05). The sertraline group demonstrated significantly less improvement in GAD-7 scores at week 4 and in both GAD-7 and PHQ-9 scores at week 8 compared to the escitalopram group, while duloxetine, venlafaxine, and vortioxetine showed comparable efficacy to escitalopram. Antidepressants combined with trazodone showed significant improvement in PHQ-9 scores at week 4 compared to those without trazodone. The gynecological cancer group showed significantly more improvement in GAD-7 and PHQ-9 scores at week 4 and 8 compared to breast cancer patients.

Conclusion

Antidepressant treatment in cancer patients with anxiety and depression is as effective as in non-cancer patients. The efficacy of escitalopram is comparable to duloxetine, venlafaxine, and vortioxetine, all of which outperformed sertraline in cancer patients.

The effects of Tai Chi and Baduanjin on breast cancer patients: systematic review and meta-analysis of randomized controlled trials

Background

Tai Chi and Baduanjin are nonpharmacological interventions that are widely applied among cancer patients.

Objective

This meta-analysis aimed to assess the effect of Tai Chi and Baduanjin on breast cancer patients by summarizing and pooling the results of previous studies.

Methods

The PubMed, Embase, Web of Science, Scopus and Cochrane Library and several databases were searched up to December 1, 2023, to identify high-quality RCTs. Relevant terms such as Tai Chi and Baduanjin were used as keywords. Stata 15.0 software and Review Manager (version 5.3; Cochrane Training) were used to screen the studies, extract the data, code the data, and perform the meta-analysis. The mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. The PICOS framework was used to develop the following eligibility criteria: (i) population - breast cancer patients; (ii) intervention - Tai Chi and Baduanjin intervention; (iii) comparison - Tai Chi and Baduanjin group and different intervention (e.g., regular intervention, routine rehabilitation training, waiting list, sham Qigong, usual care, no intervention); (iv) outcomes - cognitive ability, shoulder joint function, anxiety, depression, fatigue, sleep quality, quality of life; and (v) study design - randomized controlled trial.

Results

From January 2013 to December 2023, we included a total of 16 RCTs involving 1247 patients. A total of 647 patients were in the experimental group and were treated with Tai Chi and Baduanjin, while 600 patients were in the control group and were treated with traditional methods. The results of our meta-analysis indicate that Tai Chi and Baduanjin yield outcomes that are comparable to those of traditional treatment methods. Specifically, Tai Chi and Baduanjin significantly increased cognitive function, increased shoulder joint function, improved sleep quality indicators and improved quality of life indicators. Furthermore, Tai Chi and Baduanjin significantly reduced anxiety symptoms, depression symptoms, and fatigue symptoms among breast cancer patients. Sensitivity analysis was performed, a funnel plot was constructed. No publication bias was indicated by Egger's or Begg's test.

Conclusion

Overall, Tai Chi and Baduanjin are viable and effective nonpharmacological approaches for treating breast cancer patients, as they yield better results than traditional treatment methods. However, these findings should be interpreted with caution due to the limited number of controlled trials, small sample sizes, and low quality of the evidence.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023469301.

Emotional awareness amplifies affective sensitivity to social support for women with breast cancer

Emotional awareness (EA) is thought to facilitate psychological health by aiding emotion regulation in oneself and garnering social support from others. This study tested these potential relationships within a one-year longitudinal study of 460 women (age 23-91 years, mean 56.4 years) recently diagnosed with breast cancer (i.e., within four months). The women completed measures of emotional awareness, social support, social stress, affective symptoms, and well-being. Linear models tested EA as a moderator of social support and stress on affective symptoms and well-being. In those with higher EA, low social support was associated with greater depression and lower optimism. There was some evidence that higher EA predicted greater depression at baseline but lower depression at nine-month follow-up. These results support the idea that EA increases sensitivity to available social support and facilitates emotional adjustment over time, suggesting that assessment of EA could help guide clinicians in identifying those at greatest risk of adverse mental health outcomes in this population.

Depression and associated factors among adult breast cancer patients attending at selected public hospital in Addis Ababa, Ethiopia

Background

Depression is a major public health problem among adult breast cancer patients. Although there are few studies on depression, data were mainly from a single center and the potential risk factors were not exhaustively addressed. Thus, we aimed to investigate the prevalence of depression and risk factors among adult breast cancer patients at two big hospitals in Addis Ababa.

Objective

To assess depression and its associated factors among breast cancer patients attending public hospitals in Addis Ababa, Ethiopia, in 2021.

Methods

An institution-based cross-sectional study was conducted among adult patients with breast cancer attending at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College from June to July 2021. Simple random sampling was used to obtain a sample size of 318. Data were collected using the standard Patient Health Questionnaire-9, structured questionnaire interviews, and chart reviews. SPSS version 25 was used for analysis; the correlation between independent and dependent variables was evaluated using a logistic regression model. Each analysis regarded a p-value less than 0.05 as statistically significant.

Result

The mean age of the participants was 43.1 ± 11.3 years. The prevalence of depression among adult breast cancer patients was 33 (10.6%), and according to the patient health questionnaires (PHQ)-9 score categorization, 116 (37.3%) were minor, 28 (9%) were moderate, and 5 (1.6%) had moderate severity. The duration of diagnosis was <12 months and stage 2 breast cancer was more protective against depression than stage 4 breast cancer. A lower monthly income and poor social support were significantly associated with depression.

Conclusion

The prevalence of depression was moderate among adult patients with breast cancer; the stage of cancer, duration of diagnosis, income, and poor social support were significantly associated with depression, emphasizing the value of counseling.

Associations between plasma markers and symptoms of anxiety and depression in patients with breast cancer

BACKGROUND AND PURPOSE

Among patients with solid tumors, those with breast cancer (BC) experience the most severe psychological issues, exhibiting a high global prevalence of depression that negatively impacts prognosis. Depression can be easily missed, and clinical markers for its diagnosis are lacking. Therefore, this study in order to investigate the diagnostic markers for BC patients with depression and anxiety and explore the specific changes of metabolism.

METHOD AND RESULTS

Thirty-eight BC patients and thirty-six matched healthy controls were included in the study. The anxiety and depression symptoms of the participants were evaluated by the 17-item Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA). Plasma levels of glial fibrillary acidic protein (GFAP) and lipocalin-2 (LCN2) were evaluated using enzyme linked immunosorbent assay, and plasma lactate levels and metabolic characteristics were analyzed.

CONCLUSION

This study revealed that GFAP and LCN2 may be good diagnostic markers for anxiety or depression in patients with BC and that plasma lactate levels are also a good diagnostic marker for anxiety. In addition, specific changes in metabolism in patients with BC were preliminarily explored.

The mechanism of cancer-depression comorbidity

Cancer and depression are closely interrelated, particularly in patients with advanced cancer, who often present with comorbid anxiety and depression for various reasons. Recently, there has been a growing interest in the study of depression in cancer patients, with the aim of assessing the possible triggers, predictors, adverse events, and possible treatment options for depression in several common cancers. The objective of this narrative review is to synthesize the extant literature on the relationship between the occurrence and progression of depression in several common patient categories. The authors conducted a comprehensive review of 75 articles published in PubMed over the past five years. This review was further evaluated in the present paper. Ultimately, it was determined that depression is a prevalent and detrimental phenomenon among cancer patients, particularly those with advanced disease. Consequently, there is a pressing need to prioritize research and interventions aimed at improving the quality of life and psychosocial well-being of cancer patients, including those with advanced disease. The relationship between cancer and depression has been evolving dynamically in recent times. The current research findings indicate a strong association between cancer and depression. However, the direction of causality remains unclear. Focusing on depression in cancer patients may, therefore, be beneficial for these patients.

Association between depressive symptoms and second primary cancer in cancer survivors: Insights from a nationally representative study

OBJECTIVE

The purpose of this study was to investigate the association between depressive symptoms and second primary cancer (SPC) in U.S. cancer survivors.

METHODS

Cancer survivors from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study, and depressive symptoms were defined by the Patient Health Questionnaire 9 (PHQ-9). The association between depressive symptoms and SPC was assessed via multiple logistic regression, restricted cubic spline (RCS), sensitivity, and subgroup analyses.

RESULTS

This study involved 2315 participants representing >15 million noninstitutionalized U.S. residents. Multivariate logistic regression fully adjusted for confounders revealed that cancer survivors with a PHQ-9 score ≥ 10 had a greater risk of developing SPC than those with a PHQ-9 score of 0-4 ([OR] = 1.88, 95% [CI] = 1.20-2.89, p = 0.005). The RCS showed a linear positive correlation between the PHQ-9 score and SPC (p for overall = 0.017). The robustness of this association was subsequently confirmed via multiple interpolation of missing data and different cluster-level methods (namely weighted linear regression) as sensitivity analyses. Furthermore, subgroup analyses confirmed this correlation was stronger in participants with sleep duration <7 h (p for interaction = 0.036).

CONCLUSION

Moderate to severe depressive symptoms in cancer survivors were associated with an increased risk of developing SPC, especially at <7 h of sleep.

Effectiveness of a theory-based tailored mHealth physical activity intervention for women undergoing chemotherapy for breast cancer: A quasi-experimental study

Objectives

This study aimed to explore the effectiveness of the theory-based tailored mHealth physical activity (PA) intervention among patients with breast cancer undergoing chemotherapy.

Methods

A quasi-experimental study design was adopted. A total of 60 breast cancer patients were selected from two tertiary hospitals in Shanghai and Hangzhou City from September 2019 to August 2021. According to the admission order, 30 patients were first included in the control group, followed by 30 patients in the intervention group. A smartphone application (app) named "Breast Care" was developed based on social cognitive theory, self-efficacy theory, and the theory of planned behavior. The app integrated various functions, including information browsing, PA monitoring and feedback, symptom reporting, and social interaction. Patients in the intervention group received three months of personalized online PA guidance in addition to routine care. The control group received routine care. Baseline and post-intervention investigations after three months were conducted in two groups using the Short Form of International Physical Activity Questionnaire, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Breast cancer.

Results

After three months of intervention, compared to the control group, breast cancer patients in the intervention group showed significant improvements in walking, moderate PA, and overall PA (P < 0.05). Compared to the baseline data, breast cancer patients in the intervention group had significant improvements in walking and overall PA after three months (P < 0.05), whereas the control group experienced significant declines in walking, moderate PA, and overall PA after three months (P < 0.05). There were statistically differences between the two groups in scores for anxiety, overall quality of life, and its dimensions, such as physical well-being, emotional well-being, and additional breast cancer well-being (P < 0.05).

Conclusions

The theory-based tailored mHealth PA intervention has demonstrated a positive impact on promoting PA behavior change and emotional management among breast cancer patients. The 'Breast Care' app integrated various practical behavior change strategies, offering valuable guidance for personalized remote rehabilitation support for cancer patients.

Comparative effect of different mindfulness-based intervention types and deliveries on depression in patients with breast cancer: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Breast cancer has become the most common cancer worldwide. Various types of mindfulness-based interventions (e.g., mindfulness-based cognitive therapy, mindfulness-based stress reduction) have been conducted in different delivery methods (including face to face and internet delivered) to help patients with breast cancer mitigate their depression. However, at present, there are no studies that compare the effectiveness of all these types and deliveries of mindfulness-based interventions. Therefore, this protocol aims to conduct a systematic review and network meta-analysis to assess the effectiveness of various types and deliveries of mindfulness-based interventions in mitigating depression in patients with breast cancer.

METHODS

This protocol is according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The electronic databases, including PubMed, Web of Science, the Cochrane Library, Embase, Google Scholar, The China National Knowledge Infrastructure and OpenGrey, will be comprehensively retrieved for related randomised controlled trials (RCTs) from inception to December 2023. Two reviewers will independently assess the risk of bias using the Cochrane Risk of Bias Tool for Randomised Trials 2.0 (RoB 2.0). The network meta-analysis will be performed using the STATA V.16.0, and the assessment of heterogeneity, inconsistency, publication bias, evidence quality, subgroup analyses and sensitivity analyses will be conducted.

ETHICS AND DISSEMINATION

This protocol does not require approval from an ethics committee as it is based on previous research findings. The results will be disseminated via peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42024495996.

Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey-National Death Index Linked Study

Breast cancer (BC) and depression are globally prevalent problems. Numerous reviews have indicated the high prevalence of depression among BC survivors. However, the long-term impact of depression on survival among BC survivors has not been well explored. For this investigation, we aimed to explore the relationship between BC, depression, and mortality from a national random sample of adult American women. Data from the U.S. National Health and Nutrition Examination Survey (years 2005-2010) were linked with mortality data from the National Death Index up to December 31st, 2019. A total of 4719 adult women (ages 45 years and older) were included in the study sample with 5.1% having breast cancer and more than a tenth (12.7%) having depression. The adjusted hazard ratio (HR) for all-cause mortality risk among those with BC was 1.50 (95% CI = 1.05-2.13) compared to those without BC. In the adjusted analysis, the risk of all-cause mortality was highest among women with both depression and BC (HR = 3.04; 95% CI = 1.15-8.05) compared to those without BC or depression. The relationship between BC and mortality was moderated by cardiovascular diseases, anemia, smoking, age, PIR, and marital status. Our analysis provides vital information on factors that could be helpful for interventions to reduce mortality risk among those with BC and depression. In addition, given the higher risk of mortality with co-occurring BC and depression, collaborative healthcare practices should help with widespread screening for and treatment of depression among BC survivors.

Effect of exercise on fatigue and depression in breastcancer women undergoing chemotherapy: a systematic review and meta-analysis

This meta-analysis examined the effectiveness of exercise interventions in reducing fatigue and depression among women undergoing chemotherapy for breast cancer. The study followed PRISMA guidelines and analysed seven randomized controlled trials between 2016 and 2022. The results showed that exercise can substantially reduce fatigue levels (MD: -0.40, CI: -0.66, -0.14, P: 0.003), a common side effect of chemotherapy. Although depression did not significantly change (MD: -0.39, CI: -0.98, 0.20, P: 0.19), this study highlights the positive impact of exercise on mental health outcomes. The control group also experienced decreased quality of life (MD: 0.18, CI: 0.01-0.35, P: 0.03), emphasizing the importance of incorporating exercise interventions to improve overall well-being during breast cancer treatment. In addition to primary outcomes, the study revealed that exercise positively affected secondary aspects such as cognitive fatigue, social function, physical function, constipation, and dyspnoea.

The relationship between psychological distress and cognitive failure among breast cancer survivors: a network analysis

Background

Psychological distress is highly prevalent and has a severe impact on the quality of life among breast cancer survivors. This type of distress is associated with cognitive failure. However, previous studies have focused solely on the total scale scores of these two concepts while ignoring the unique relationship between specific components. In the present study, we utilized network analysis to explore the relationship between psychological distress and cognitive failure in breast cancer survivors.

Methods

The network analysis approach was adopted to estimate the regularized partial correlation network in a cross-sectional sample of 409 breast cancer survivors. All participants were assessed using the Depression Anxiety Stress Scale and the Cognitive Failure Questionnaire. The Gaussian Graphical Model was employed to estimate the network, centrality indices, and edge weights, providing a description of the characteristics of the network.

Results

The results indicated that anxiety-stress and depression-stress were the strongest edges in the community of psychological distress. Distractibility-memory was the strongest edge in the community of cognitive failure. Distractibility and memory were the most central nodes, with the highest expected influence in the network. Depression and motor coordination acted as important bridge nodes with the highest bridge expected influence.

Conclusion

Distractibility and memory in cognitive failure played important roles in activating and maintaining the relationship network. Motor coordination was identified as the crucial pathway for the impact of cognitive failure on psychological distress. Interventions targeting these specific issues might be more effective in improving cognitive failure and reducing psychological distress among breast cancer survivors.

Breast cancer survivorship

Breast cancer survivorship care transitions from active treatment to focus on surveillance and health maintenance. This review article discusses the crucial aspects of breast cancer survivorship, which include cancer surveillance, management of treatment side effects, implementation of a healthy lifestyle, and psychosocial support.

Quality of Life Determinants among Breast Cancer Women Undergoing Treatment in Indonesia: A Cross-Sectional Study

Objectives

Breast cancer affects millions of women worldwide, including Indonesia and brings a burden on many aspects, especially quality of life. This study investigated the influence of demographic characteristics, psychological distress and physical activity levels on quality of life among breast cancer women undergoing therapy in Indonesia.

Materials and Methods

This cross-sectional study was conducted among 200 breast cancer women. We used the Indonesian version of depression, anxiety, stress scales, international physical activity questionnaires and World Health Organization Quality of Life-BREF to evaluate psychological distress, physical activity levels and quality of life. Descriptive, bivariate and multiple linear regressions were applied.

Results

Study participants had moderate quality of life scores. Approximately 22% of the variance in physical health was explained by family history, depression and physical activity. Having a family history is associated with better psychological health (ß = 5.32, P = 0.04). In contrast, experienced moderate to severe depressive symptoms contributed to lower environment domains (ß = -6.30, P = 0.02). Furthermore, having a low level of physical activity was the only significant factor influencing all domain scores, including physical health (β = -24.82, P < 0.001), psychological health (β = -19.72, P < 0.001), social relation (β= -16.91, P < 0.001) and environment (β = -13.91, P < 0.001).

Conclusion

Physical activity levels are the strongest determinant of quality of life among breast cancer women in Indonesia. Nurses should not only widen information access regarding breast cancer, especially for patients with genetic risk, but also should early screen for depressive symptoms and develop strategies to motivate patients to increase their physical activity to escalate breast cancer patient's quality of life.

Racial and Ethnic Differences in Psychosocial Care Use Among Adults With Metastatic Breast Cancer: A Retrospective Analysis Across Six New York City Health Systems

PURPOSE

A metastatic breast cancer (mBC) diagnosis can affect physical and emotional well-being. However, racial and ethnic differences in receipt of outpatient psychosocial care and supportive care medications in adults with mBC are not well described.

METHODS

Adults with mBC were identified in the INSIGHT-Clinical Research Network, a database inclusive of >12 million patients receiving care across six New York City health systems. Outpatient psychosocial care was operationalized using Common Procedure Terminology codes for outpatient psychotherapy or counseling. Psychosocial/supportive care medications were defined using Rx Concept Unique Identifier codes. Associations between race/ethnicity and outpatient care and medication use were evaluated using logistic regression.

RESULTS

Among 5,429 adults in the analytic cohort, mean age was 61 years and <1% were male; 53.6% were non-Hispanic White (NHW), 21.4% non-Hispanic Black (NHB), 15.9% Hispanic, 6.1% Asian/Native Hawaiian/Pacific Islander (A/NH/PI), and 3% other or unknown. Overall, 4.1% had ≥one outpatient psychosocial care visit and 63.4% were prescribed ≥one medication. Adjusted for age, compared with NHW, Hispanic patients were more likely (odds ratio [OR], 2.14 [95% CI, 1.55 to 2.92]) and A/NH/PI patients less likely (OR, 0.35 [95% CI, 0.12 to 0.78]) to have an outpatient visit. NHB (OR, 0.59 [95% CI, 0.51 to 0.68]) and Asian (OR, 0.36 [95% CI, 0.29 to 0.46]) patients were less likely to be prescribed medications.

CONCLUSION

Despite the prevalence of depression, anxiety, and distress among patients with mBC, we observed low utilization of psychosocial outpatient care. Supportive medication use was more prevalent, although differences observed by race/ethnicity suggest that unmet needs exist.

Non-pharmaceutical interventions for depressive symptoms in patients with breast cancer: protocol for a systematic review and network meta-analysis

INTRODUCTION

Patients with breast cancer often suffer from depressive symptoms throughout various stages of cancer, significantly impacting their quality of life and treatment outcomes. Non-pharmaceutical interventions such as psychotherapy, mind-body therapies and physical exercise have shown effectiveness in addressing cancer-related depression. However, the efficacy and safety of different non-pharmacological interventions remain a topic of debate. Therefore, to provide an objective assessment and comparison of the impact of different non-pharmaceutical interventions on depression, we will conduct a network meta-analysis (NMA) to explore the effects of different non-pharmaceutical interventions on reducing depressive symptoms among patients with breast cancer.

METHODS AND ANALYSIS

We will search nine Chinese and English-language databases, from database inception to 31 July 2023, for randomised controlled trials published in Chinese or English. The English-language databases are PubMed, Medline, Embase, Web of Science and Cochrane Central Register of Controlled Trials, and the Chinese databases are CBM, CNKI, VIP and Wanfang. Two independent researchers will perform information extraction from eligible articles. The primary outcome will be the changes in depressive symptoms, while the secondary outcome will include adverse events. STATA V.15.0 will be used to conduct paired meta-analysis and NMA. Grading of Recommendations Assessment, Development and Evaluation will be used to assess the quality of evidence, and the Cochrane tool for assessing the risks of bias in randomised trials V.2 will be used for risk of bias assessment.

ETHICS AND DISSEMINATION

The study does not require ethical approval as it will analyse data from existing studies. It is expected that the results of the study will be published in peer-reviewed journals and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42023450494.

Depression promotes breast cancer progression by regulating amino acid neurotransmitter metabolism and gut microbial disturbance

INTRODUCTION

Breast cancer (BC) is the most prevalent type of cancer and has the highest mortality among women worldwide. BC patients have a high risk of depression, which has been recognized as an independent factor in the progression of BC. However, the potential mechanism has not been clearly demonstrated.

METHODS

To explore the correlation and mechanism between depression and BC progression, we induced depression and tumor in BC mouse models. Depression was induced via chronic unpredictable mild stress (CUMS) and chronic restraint stress (CRS). Amino acid (AA) neurotransmitter-targeted metabonomics and gut microbiota 16S rDNA gene sequencing were employed in the mouse model after evaluation with behavioral tests and pathological analysis.

RESULTS

The tumors in cancer-depression (CD) mice grew faster than those in cancer (CA) mice, and lung metastasis was observed in CD mice. Metabonomics revealed that the neurotransmitters and plasma AAs in CD mice were dysregulated, namely the tyrosine and tryptophan pathways and monoamine neurotransmitters in the brain. Gut microbiota analysis displayed an increased ratio of Firmicutes/Bacteroides. In detail, the abundance of f_Lachnospiraceae and s_Lachnospiraceae increased, whereas the abundance of o_Bacteroidales and s_Bacteroides_caecimuris decreased. Moreover, the gut microbiota was more closely associated with AA neurotransmitters than with plasma AA.

CONCLUSION

Depression promoted the progression of BC by modulating the abundance of s_Lachnospiraceae and s_Bacteroides_caecimuris, which affected the metabolism of monoamine neurotransmitters in the brain and AA in the blood.