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Originally published as JCO Early Release 10.1200/JCO.2009.23.6968 on August 3 2009 © 2009 American Society of Clinical Oncology.
Reply to A. Saini et alInstitute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark We thank Saini et al1 for their interest in and useful comments on our results.2 We agree that antineoplastic treatment might have long-term effects on risk for affective disorders and also that these effects might differ according to age at time of cancer diagnosis as well as to treatment type received. As indicated by Saini et al,1 we observed that risk for hospitalization with depression among patients with hormone-related cancers increased approximately two-fold in the first year after diagnosis.2 Saini et al commented that the risk trajectory seemed to be different in men and women; in men with prostate cancer, there was an 81% increased risk 10 or more years after diagnosis, whereas in women with hormone-related cancers, the risk increase leveled out, although it was still significant at 15% after 10 or more years. We did not specifically address this sex difference, and we would like to take this opportunity to point out that the confidence intervals overlapped between sexes for estimates reporting relative risk by time since diagnosis. Thus, we would still be careful not to put too much emphasis on the actual risk estimate; instead, we would rather focus on the consistent risk elevation many years after diagnosis of hormone-related cancers in both men and women. Saini et al1 raised the question of whether there might be differences in risk for depression because of different responses to antineoplastic treatment and that these differences might even be additionally modified by age. First, with regard to antineoplastic treatment, unfortunately we do not have access to valid data on treatment provided. These data have not been systematically collected in the Danish Cancer Registry, and thus we are not able to address directly depression as a function of a late effect caused by specific treatment. However, the points made by Saini et al are indeed plausible and would definitely warrant additional exploration in studies in which data on treatment are available in combination with long-term follow-up to fully clarify a possible causal role played by specific antineoplastic treatment in risk for developing depression after cancer diagnosis.
Second, we had the opportunity to carry out age-stratified analyses for prostate cancer in men and breast cancer in women, thus addressing whether age could have been a risk-modifying factor (Table 1). Contrary to the suggestion by Saini et al,1 it seems that it was actually the oldest women with breast cancer who were at continuous high risk for first-time depression throughout the full study period compared with cancer-free women, whereas for the two younger age groups (< age 50 years and between age 50 to 64 years), risk for depression was no different from that in cancer-free women after 9 years of follow-up. For prostate cancer, risk estimates were higher for the group younger than age 70 years for the period up to 9 years after diagnosis; however, the problem of small numbers because of stratification of analysis is reflected in the wider confidence intervals. Furthermore, no observations were seen in the period of 10 or more years since diagnosis among these men, whereas for the oldest age group (
We agree that age is important in a patient facing cancer; treatment regimen and adverse and late effects of cancer treatment differ according to age, and the challenges—psychologic and social—of facing a possibly life-threatening illness probably also differ according to stage of life. However, in this population-based nationwide study,2 it seems that age did not modify risk for depression after hormone-related cancer diagnosis. Whether the patient was younger, middle aged, or older when diagnosed with breast or prostate cancer, this was not reflected in risk for depression after cancer diagnosis; when measured as severe depression leading to hospitalization, risk increased similarly for all age groups. We are thankful for the opportunity to clarify this important issue and add to the overall findings of increased risk for depression after a wide spectrum of cancer diseases and for years after cancer diagnosis. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES
1. Saini A, Ostacoli L, Gorzegno G, et al: Risk of depressive events in long-term surviving patients affected by hormone-related cancer according to time after diagnosis. J Clin Oncol 27:e91–e92, 2009. 2. Dalton SO, Laursen TM, Ross L, et al: Risk for hospitalization with depression after a cancer diagnosis: A nationwide, population-based study of cancer patients in Denmark from 1973 to 2003. J Clin Oncol 27:1440–1445, 2009.
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Copyright © 2009 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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age 70 years), risk increased approximately 65% after 10 or more years. 
