Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study

Zev M Nakamura; Brent J Small; Wanting Zhai; Tim A Ahles; Jaeil Ahn; Ashley L Artese; Traci N Bethea; Elizabeth C Breen; Harvey J Cohen; Martine Extermann; Deena Graham; Michael R Irwin; Claudine Isaacs; Heather S L Jim; Kate R Kuhlman; Brenna C McDonald; Sunita K Patel; Kelly E Rentscher; James C Root; Andrew J Saykin; Danielle B Tometich; Kathleen Van Dyk; Xingtao Zhou; Jeanne S Mandelblatt; Judith E Carroll

doi:10.1007/s11764-023-01490-2

Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study

J Cancer Surviv. 2023 Nov 4:10.1007/s11764-023-01490-2. doi: 10.1007/s11764-023-01490-2. Online ahead of print.

Authors

Zev M Nakamura¹, Brent J Small², Wanting Zhai^{3

4}, Tim A Ahles⁵, Jaeil Ahn^{3

4}, Ashley L Artese⁶, Traci N Bethea⁴, Elizabeth C Breen^{7

8}, Harvey J Cohen⁶, Martine Extermann⁹, Deena Graham¹⁰, Michael R Irwin^{7

8}, Claudine Isaacs⁴, Heather S L Jim¹¹, Kate R Kuhlman^{8

12

13}, Brenna C McDonald¹⁴, Sunita K Patel¹⁵, Kelly E Rentscher¹⁶, James C Root⁵, Andrew J Saykin¹⁴, Danielle B Tometich¹¹, Kathleen Van Dyk^{7

17}, Xingtao Zhou^{3

4}, Jeanne S Mandelblatt⁴, Judith E Carroll^{7

8}

Affiliations

¹ Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Campus Box #7160, Chapel Hill, NC, 27599, USA. zev_nakamura@med.unc.edu.
² School of Aging Studies, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA.
³ Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA.
⁴ Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁶ Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
⁷ Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
⁸ Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA.
⁹ Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
¹⁰ John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
¹¹ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
¹² Department of Psychological Science, University of California, Irvine, CA, USA.
¹³ Institute for Interdisciplinary Salivary Bioscience Research, School of Social Ecology, University of California, Irvine, CA, USA.
¹⁴ Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁵ City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
¹⁶ Department of Psychiatry and Behavioral Medicine, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁷ Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.

PMID: 37924476
PMCID: PMC11068856 (available on 2025-05-04)
DOI: 10.1007/s11764-023-01490-2

Abstract

Purpose: To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories.

Methods: Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories.

Results: Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms.

Conclusions: Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes.

Implications for cancer survivors: Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.

Keywords: Breast cancer; Cancer survivorship; Depression; Frailty; Older adults; Social support.

Abstract

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