Depression May Affect Survival in Metastatic Renal Cancer
(HealthDay News) – For patients with metastatic renal cell carcinoma (RCC), depressive symptoms may be a predictor of survival, with potential links to cortisol dysregulation and expression of pro-inflammatory and pro-metastatic genes.
Lorenzo Cohen, PhD, from the University of Texas MD Anderson Cancer Center in Houston, and colleagues examined the clinical effects of psychosocial factors and cortisol dysregulation and associated transcription control pathways in 217 patients with metastatic RCC. Psychological factors were assessed by self-completed questionnaires. To identify potential alterations in circadian rhythms and genomic pathways, cortisol levels and whole genome transcription profiles were assessed.
After controlling for disease risk category the researchers found that the Centers for Epidemiologic Studies-Depression (CES-D) scores and cortisol slope correlated with decreased survival (hazard ratio, 1.5 [95% confidence interval, 1.00–2.23; P=0.05] and 1.9 [P=0.002], respectively). In a complete model, only cortisol slope and risk category remained significant. In functional genomic analyses, depressive symptoms were linked to increased expression of pro-inflammatory and pro-metastatic genes in circulating leukocytes. In patients with high CES-D, 116 transcripts were upregulated and 57 transcripts were downregulated by an average of at least 50%. In a subset of patients, these changes were also found in the tumor.
"Our findings, and those of others, suggest that mental health and social well-being can affect biological processes, which influence cancer-related outcomes," Cohen said in a statement. "They also suggest that screening for mental health should be part of standard care because there are well accepted ways of helping people manage distress, even in the face of a life-threatening illness."