Originally published as JCO Early Release 10.1200/JCO.2005.05.751 on August 8 2005

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Role of Depression As a Predictor of Mortality Among Cancer Patients After Stem-Cell Transplantation

From the Department of Psychiatry, Clinical Institute of Psychiatry and Psychology; and Stem-Cell Transplantation Unit, Department of Hematology, Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain

Address reprint requests to Jesús M. Prieto, MD, Espronceda 43 B, 17480 Roses, Spain; e-mail: jmprieto{at}comg.es

PURPOSE: To determine the association between depression and survival among cancer patients at 1, 3, and 5 years after stem-cell transplantation (SCT).

PATIENTS AND METHODS: This was a prospective cohort study of 199 hematologic cancer patients who survived longer than 90 days after SCT and who were recruited in a University-based hospital between July 1994 and August 1997. Patients received a psychiatric assessment at four consecutive time points during hospitalization for SCT, yielding a total of 781 interviews. Depression diagnoses were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

RESULTS: Eighteen (9.0%) and 17 patients (8.5%) met criteria for major and minor depression, respectively. Multivariate Cox regression models found major depression to be predictive of higher 1-year (hazard ratio [HR], 2.59; 95% CI, 1.21 to 5.53; P = .014) and 3-year mortality (HR, 2.04; 95% CI, 1.03 to 4.02; P = .041) but not 5-year mortality (HR, 1.48; 95% CI, 0.76 to 2.87; P = .249). Minor depression had no effect on any mortality outcome. Other multivariate significant predictors of higher mortality were higher regimen toxicity in the 1-, 3-, and 5-year models; older age and acute lymphoblastic leukemia in the 3- and 5-year models; chronic myelogenous leukemia in the 3-year model; and lower functional status and intermediate/higher risk status in the 5-year model. Use of peripheral-blood stem cells predicted lower mortality in the 5-year model.

CONCLUSION: After adjusting for multiple factors, major depression predicted higher 1- and 3-year mortality among cancer patients after SCT, underscoring the importance of adequate diagnosis and treatment of major depression.

Supported by research grant Nos. FIJC 98/QV-JMP and FIJC 03/QV-JMP from the Josep Carreras International Leukemia Foundation.

The Josep Carreras International Leukemia Foundation had no role in the design, conduct, interpretation, and analysis of the study and review or approval of the manuscript.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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  JCO 2005 23: 5878-5880 [Full Text]

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