Cancer-related inflammation and depressive symptoms: Systematic review and meta-analysis

• Type of Material: Article
• Authors: Andrew Miller, Emory University; Daniel C McFarland, Department of Medicine, Northwell Health/Lenox Hill Hospital, New York, NY; Meredith Doherty, University of Pennsylvania; Thomas M Atkinson, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Robin O'Hanlon, Medical Library, Memorial Sloan Kettering Cancer Center. New York, NY; William Breitbart, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Christian J Nelson, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Andrew H Miller, Emory University
• Language: English
• Date: 2022-04-13
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.34193
• Title of Journal or Parent Work: CANCER
• Volume: 128
• Issue: 13
• Start Page: 2504
• End Page: 2519
• Grant/Funding Information: P30 Cancer Center Grant: Craig Thompson Memorial Sloan Kettering National Institutes of Health Loan Repayment Grant
• Keywords: Science & Technology; FATIGUE; interleukin-6; Oncology; depression; ANXIETY; Life Sciences & Biomedicine; IL-6; inflammation; NECROSIS-FACTOR-ALPHA; CYTOKINES; C-REACTIVE PROTEIN; tumor necrosis factor; PREVALENCE; IMMUNE-SYSTEM; PERFORMANCE; depressive symptoms; meta-analysis; ASSOCIATIONS; cancer; C-reactive protein
• Research Categories: Health Sciences, Oncology; Psychology, Behavioral; Health Sciences, Medicine and Surgery

Abstract

Background: Depressive symptoms in patients with cancer are associated with poor quality of life and decreased survival. Although inflammation is reliably associated with depression in otherwise healthy individuals, the association in patients with cancer remains unclear. Given the high prevalence of cancer-related inflammation, the authors aimed to establish the relationship between inflammation and depression in cancer patients based on extant literature. Methods: A systematic review and meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered under Prospero ID CRD42021226743. Three databases were searched including PubMed, the Cochrane Library, and PsycINFO using the following criteria for inclusion: 1) measurement of a peripheral inflammatory marker, 2) use of a validated tool/scale to measure depression, and 3) a cancer diagnosis. Risk of publication bias was assessed by Funnel plot and Egger test. Results: Seventy-three studies were included in the systematic review and 54 studies (n = 5017) were included in meta-analyses. Associations with depressive symptoms were significant for peripheral blood interleukin (IL)-6 (standardized mean difference [SMD] = 0.59; 95% confidence interval [CI], 0.35-0.82), I2 = 57.9%; tumor necrosis factor (TNF) (SMD = 0.73; 95% CI, 0.35-1.11), I2 = 74.1%; and C-reactive protein (CRP) (SMD = 0.57; 95% CI, 0.27-0.87), I2 = 0%. IL-5, IL-13, albumin, and neutrophil-to-lymphocyte ratio were associated with depressive symptoms but based on fewer studies. Most cancer settings were represented; the number of studies per inflammatory marker varied from 1 to 52. Conclusions: Although peripheral inflammatory markers were unevenly studied, the most studied markers (IL-6, TNF, and CRP) were associated with depressive symptoms in cancer patients and may be useful for management of depressive symptoms in the cancer setting. Lay Summary: Peripheral blood inflammatory markers (IL-6, TNF, and CRP) were associated with depressive symptoms in various cancer settings. Although further studies are warranted, these findings may help identify and manage depressive symptoms in patients with cancer.