Summary: Higher levels of inflammation linked to lower survival rates are two to three times more likely in lung cancer patients with depression.
Source: Ohio State University
Lung cancer patients with moderate to severe depression are two to three times more likely to have levels of inflammation that predict poor survival rates, a new study has found.
The findings may help explain why a significant portion of lung cancer patients do not respond to new immunotherapy and targeted treatments that have led to significantly longer survival for many people with the disease.
“These patients with high levels of depression are at much higher risk for poor outcomes,” said Barbara Andersen, one of the study’s lead authors and professor of psychology at Ohio State University.
“Levels of depression may be as important, if not more important, than other factors that have been linked to how well people fare with lung cancer.”
The study was published online recently in the journal PLOS ONE.
Andersen and colleagues at Ohio State’s College of Medicine and Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute studied 186 patients newly diagnosed with advanced lung cancer (stage IV). They were interested in how levels of depression were related to levels of systemic inflammation ratio (SIR) biomarkers at the time of diagnosis.
SIRs include three biomarkers associated with inflammation in the body. Higher inflammation is more dangerous and linked to lower survival rates.
All participants also completed a depression measure. The results showed that a large proportion of patients – 35% – had moderate to severe depressive symptoms.
“Of all cancer patients, those with lung cancer have some of the highest rates of depression, which makes our study results even more concerning,” Andersen said.
The results showed an association between higher depression scores and higher inflammation scores, but the main finding was that patients with higher levels of depression drove the relationship, Andersen said. .
Take for example the platelet/lymphocyte ratio, one of the biomarkers of the study. For those with no or mild depressive symptoms, 56% of patients were above the threshold for dangerous levels of inflammation, compared to 42% who were below.
But for those with high levels of depression, 77% were above the threshold for high levels of inflammation and only 23% were below.
“It was the patients with high levels of depression who had surprisingly higher levels of inflammation, and that’s what really led to the correlation we saw,” she said.
These severely depressed patients were 1.3 to 3 times more likely to have elevated levels of inflammation, even after controlling for other factors related to inflammation biomarker levels, including demographics and smoking status.
And analyzes had shown that baseline levels of all three biomarkers predicted overall survival. Specifically, patients with high neutrophil to lymphocyte ratios (one of the inflammatory biomarkers) were about twice as likely to die at any time over the next two years as those with a lower inflammation ratio.
Andersen noted that this study measured the link between depression and inflammation when patients were first diagnosed and not yet treated.
But in a previous study by Andersen and colleagues, they controlled for levels of depression at diagnosis and found that the trajectory of ongoing depressive symptoms predicted survival. This was the first examination of the survival risk posed when depressive symptoms persist during treatment and thereafter.
The accumulating data suggests the importance of measuring and treating depression in patients with lung cancer, Andersen said.
She noted that there were more patients in this study with high depression/high inflammation than those with other indicators associated with low survival in cancer patients: high school or lower education, state overweight and a poor score on a test of ability to perform daily tasks. activities.
Some doctors may think it’s normal for cancer patients to be depressed, but that’s not true, she said.
“It’s normal to be upset, sad and anxious about a cancer diagnosis, but it’s not normal to have major depression,” Andersen said.
See also
“Depression should not be ignored. This study shows the strong link between depression and inflammation, both of which are linked to poor outcomes.
About this cancer and depression research news
Author: Jeff Grabmeier
Source: Ohio State University
Contact: Jeff Grabmeier – Ohio State University
Picture: Image is in public domain
Original research: Free access.
“Depression in Association with Neutrophil to Lymphocyte, Platelet to Lymphocyte, and Advanced Lung Cancer Inflammation Index Biomarkers Predicting Lung Cancer Survival” by Barbara L. Andersen et al. PLOS ONE
Abstract
Depression in association with neutrophil-to-lymphocyte, platelet-to-lymphocyte, and advanced lung cancer inflammation index biomarkers predicting lung cancer survival
Lung cancer is the product of inflammation and a dysfunctional immune system, and depression exhibits a similar dysregulation. Depression disproportionately affects lung cancer patients, having the highest rates of all cancers.
Both systemic inflammation and depression are predictive of non-small cell lung cancer (NSCLC) survival, but the existence and extent of any co-occurrence is unknown. The association between levels of systemic inflammation ratio (SIR) biomarkers and patients’ depressive symptoms is studied, with the hypothesis that the severity of depression would be significantly associated with poor prognosis inflammation.
Newly diagnosed stage IV non-small cell lung cancer; NOT = 186) patients were enrolled (ClinicalTrials.gov Identifier: NCT03199651) and blood samples and self-reports of depression (Patient Health Questionnaire-9) were obtained. For SIRs, neutrophil (N), lymphocyte (L), and platelet (P) cell counts were extracted for ratio (R) calculations for NLR, PLR, and advanced index. lung cancer inflammation (ALI). Patients were followed and biomarkers were tested as predictors of overall survival (OS) at 2 years to confirm their relevance.
Next, multivariate linear regressions tested the associations of depression with NLR, PLR, and ALI. Overall 2-year mortality was 61% (113/186). Cox model analyzes confirmed higher NLR (relative risk (HR) = 1.91; p = 0.001) and PLR (HR = 2.08; p<0.001), as well as lower ALI ( HR = 0.53; p = 0.005), as predictive of OS worsening. Adjusting for covariates, depression was reliably associated with biomarker levels (p ≤ 0.02).
Patients with moderate/severe depressive symptoms were 2-3 times more likely to have poor prognosis biomarker levels. New data show that patients’ depressive symptoms were reliably associated with lung-relevant biomarkers of systemic inflammation, all assessed at diagnosis/pretreatment.
The same SIRs were found prognostic for patients’ 2-year OS. Intensive study of depression, combined with measurements of cell biology and inflammation, is needed to extend these findings to uncover the mechanisms of toxicity of depression for treatment responses and survival in patients with AD. NSCLC.