Originally published as JCO Early Release 10.1200/JCO.2008.16.2784 on July 27 2009

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Major Depressive Disorder in Long-Term Cancer Survivors: Analysis of the National Comorbidity Survey Replication

From the Massachusetts General Hospital Cancer Center, Supportive Oncology Research Program; Massachusetts General Hospital, Department of Biostatistics; and the Departments of Society, Human Development and Health, and Epidemiology, Harvard School of Public Health, Boston, MA.

Corresponding author: William Pirl, MD, MPH, Massachusetts General Hospital, Yawkey 9A, 55 Fruit St, Boston, MA 02114; e-mail: wpirl{at}partners.org.

Purpose Prior research is mixed as to whether long-term cancer survivors (LCSs) have higher rates of depression than the general population. This is the first study to compare the rates of major depressive disorder (MDD) between LCSs and people without cancer histories in a nationally representative cross-sectional multistage cluster survey sample, the National Comorbidity Survey-Replication (NCS-R).

Methods Between 2001 and 2003, face-to-face interviews were conducted for the NCS-R in a national sample of 9,282 people, of whom 5,692 were assessed for a history of cancer. Participants with cancer diagnoses at least 5 years before the interview were considered LCSs. Survivors of childhood cancers were excluded. Comparing LCSs to those without a cancer history, odds ratios for having a MDD episode in the last 12 months before interview were obtained using multiple logistic regression controlling for demographic and medical variables. Differences in characteristics of those MDD episodes were also compared between groups.

Results Of participants age 23 years or older, 243 LCSs and 4,890 adults without a cancer history were identified in the sample. Adjusting for demographic variables and medical comorbidities, LCSs did not have increased odds of MDD in the last 12 months, with an odds ratio of (OR) 0.99 (95% CI, 0.55 to 1.79). LCSs reported higher mean levels of impairment from MDD in their home, social, and work life, but these differences were not significant.

Conclusion LCSs do not appear to have elevated rates of MDD. However, they may experience greater impairment from MDD compared to those without cancer. Longitudinal studies are needed to confirm these findings.

Supported by Grant No. K23 CA115908 from the National Institutes of Health/National Cancer Institute (W.F.P.).

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

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