ASCO 2024 - Early screening for depressive symptoms in breast cancer

Villejuif, 3 June 2024

ASCO 2024 – Clinical science symposium

Early screening for depressive symptoms in breast cancer

Depressive symptoms are common among women with breast cancer. They lead to impaired quality of life, are associated with poorer treatment adherence and an increased risk of death. A survey presented to ASCO on 3 June 2024 by Dr. Antonio Di Meglio, medical oncologist at Gustave Roussy, breast cancer specialist and researcher in the “Après Cancer” (after cancer) team, looked at the determinants of depression in the course of breast cancer. His work identified a number of risk factors.

This oral presentation is one of the 135 presentations on the agenda for this 2024 edition of ASCO, in which Gustave Roussy’s research physicians took part, including 29 oral presentations. Gustave Roussy is present in many fields of expertise, attesting to the quality of the research carried out there and its international recognition.  

The aim of this work was to profile patients at risk of depression as soon as breast cancer was diagnosed in order to implement targeted strategies to prevent this risk.  

To carry out this work, Gustave Roussy’s team of researchers relied on the CANTO cohort, sponsored by Unicancer, launched in 2012 at 26 centres in France and comprised of 14,000 women with localised breast cancer. This cohort collects multiple data on patients’ clinical characteristics, socio-economic information, medical history, type of cancer, treatments, toxicity, and cancer-related disorders. 

The study conducted by Dr. di Meglio looked at the possible depressive disorders of 9,087 patients in this cohort. All were followed for six years after diagnosis. All of these women underwent surgery, approximately 90% received radiotherapy, 82% hormone therapy and 53% chemotherapy.

"This work enabled us to identify several groups of women based on their depressive symptoms, says Dr. Antonio di Meglio. In total, 70% had little or no depressive symptoms, at diagnosis and treatment, and during 6 years of follow-up. Nearly 7% of the patients in this study already had depressive disorders at the time of diagnosis, which resolved very quickly after active treatment (surgery, chemotherapy, radiation therapy). By contrast, 20% of these women developed depression during the treatment phase or six-year follow-up period, although they did not necessarily have depressive disorder before diagnosis." It also appeared that the active treatment phase presented the greatest risk for the onset and worsening of depressive symptoms. However, the type of treatment received did not appear to be a risk factor for depression.

Research into determinants associated with depression in this cohort of women precisely identified several risk factors. Thus, while this cohort covers women aged 20 to 85, it appears that older women have an increased risk of depression, as do those with a high body mass index (overweight or obese) and those with a lower socio-economic level.  Women with a history of psychiatric disorders, those already complaining of increased fatigue, anxiety problems, cognitive disorders, or poor self-image at the time of diagnosis were also more likely to have depressive symptoms.

These patients, who had presented with depressive disorders during breast cancer, also mentioned a greater impact of cancer in their lives: positive impact with more altruism, empathy for others, greater awareness of health; but also negative impact with more concern in general, in particular concerning employment and relationships with the partner. During the treatment phase, most often associated with the onset of depressive disorder, a change in lifestyle, with weight gain, reduced physical activity, increased alcohol consumption, was associated with more severe depressive symptoms.

This work will enable us to better identify, from the moment of diagnosis, those women with breast cancer who are most at risk of depression, so that we can implement prevention and treatment strategies. "Screening and monitoring for depressive symptoms is essential to intercept the psychological vulnerability of women diagnosed with breast cancer," concludes Dr Di Meglio. "Appropriate psychological support, along with interventions aimed at mitigating health-risking behaviours such as weight gain, sedentary behaviour and alcohol consumption, particularly during the treatment phase, could help reduce long-term depressive symptoms after breast cancer treatment".

Abstract no. 12009 - Patterns of depressive symptoms among survivors of early-stage breast cancer (BC) - Clinical science symposium – Monday, 3 June 2024 | 4:42 p.m. UTC-5.