Predictors of depression in breast cancer patients treated with radiation: Role of prior chemotherapy and nuclear factor kappa B

• Type of Material: Article
• Authors: Mylin Torres, Emory University; Thaddeus W. Pace, Emory University; Tian Liu, Emory University; Jennifer Felger, Emory University; Donna Mister, Emory University; Gregory H. Doho, Emory University; Jordan N. Kohn, Emory University; Andrea M. Barsevick, Thomas Jefferson University; Qi Long, Emory University; Andrew H Miller, Emory University
• Language: English
• Date: 2013-06-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 American Cancer Society
• Final Published Version (URL): http://onlinelibrary.wiley.com/doi/10.1002/cncr.28003/abstract
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 119
• Issue: 11
• Start Page: 1951
• End Page: 1959
• Grant/Funding Information: The Cooper Family Foundation Breast Cancer Initiative, The Robbins Scholar Award from Winship Cancer Institute, The Cancer Control and Population Sciences Pilot Project Grant from the Winship Cancer Institute, and the Radiation Therapy Oncology Group(RTOG) also provided support for this study.; This study was supported by the Loan Repayment Program Award L30 CA171103 and the Exploratory/Development Grant 1R21 CA155511-01A1 from the National Institutes of Health, National Cancer Institute.
• Keywords: Radiation; Breast Cancer; Depression; Nuclear Factor Kappa B; Inflammation; Chemotherapy
• Research Categories: Health Sciences, Oncology; Biology, Biostatistics; Health Sciences, Mental Health

Abstract

Background Depression is common during and after breast cancer treatment. However, the role of specific therapeutic modalities and related biological mechanisms remains unclear. Radiation is an essential component of breast conserving therapy and may contribute to depression in breast cancer patients through activation of inflammatory pathways. Methods Depressive symptoms and inflammatory mediators including nuclear factor kappa B (NF-kB) were assessed at baseline (before radiation), during, and 6 weeks after radiation in 64 women with Stage 0–IIIA breast cancer. Results No significant increases in depressive symptoms occurred during or after radiation, although a number of patients exhibited moderate-to-severe depression throughout the study. Multivariate analyses of baseline factors predictive of depression revealed that educational status, perceived stress, prior chemotherapy and peripheral blood NF-kB DNA binding were all independent predictors of persistent depressive symptoms following radiation (all p<0.05). Of these factors, only prior chemotherapy was associated with inflammatory mediators including NF-kB DNA binding, soluble tumor necrosis factor-alpha receptor 2 and interleukin-6, which in univariate analyses predicted depressive symptoms following radiation (all p<0.05). Chemotherapy-treated patients also exhibited an overrepresentation of gene transcripts regulated by NF-KB. Conclusions Radiation was not associated with increased depressive symptoms, but of disease and treatment-related factors, prior chemotherapy predicted significant depression following radiation. Longitudinal studies are warranted to investigate the relationship among prior chemotherapy, inflammation, and persistent depression following breast cancer treatment.