Depression and inflammation: a study finds lung cancer patients with both face increases in depression

Even if they have access to new, promising therapies, recent research shows that lung cancer patients who have a combination of elevated levels of depression and inflammation at diagnosis have continuing levels of depression during the next eight months, suggests data just published online in the journal Biopsychosocial Science and Medicine.

In the research, Barbara Andersen, PhD, professor of psychology at The Ohio State University, and colleagues at The Ohio State University College of Medicine and The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James), expand the understanding of the interplay between mental and physiological health. And they add to existing evidence that shows that individuals with significant depressive symptoms or major depressive disorder may also have elevated systemic inflammation.

“Inflammation is an 'enabling’ characteristic that is key to cancer onset and progression,” Dr. Andersen says. “Lung cancer is a product of a dysfunctional immune system, as evidenced by tobacco/smoking-induced inflammation, an inflammatory tumor microenvironment and robust, systemic inflammatory responses.”

Depression is influenced by a combination of genetic and environmental factors which impact DNA methylation, a biological process by which methyl groups are added to the DNA molecule. Methylation can change the activity of a DNA segment without changing the sequence and provide a mechanistic framework for the integration of both factors.

“Systemic inflammation, as studied here, is a marker of lung cancer progression. If coupled with a depression marker, that may provide added predictive value,” Dr. Andersen says. “What this suggests is that there may be an additive effect or perhaps a synergy between inflammation and depression that can lead to worse outcomes with depression.”

Co-authors on the study, all from Ohio State, are Kylie Park, MS, PhD candidate in psychology; Peter Shields, MD, Professor Emeritus in the College of Medicine and a medical oncologist specializing in the care of patients with lung cancer; John Myers, MS, statistics and biostatistics analyst at the College of Medicine and Sarah Reisinger, PhD, program director at the OSUCCC – James.

Their examination considered a wide variety of other factors that could affect the results, including age, race, partner status, education, employment status, lifetime smoking and any cancer treatments the patients received. Dr. Anderson says they studied 182 patients who were newly diagnosed with advanced lung cancer (stage IV) and were followed with monthly depression assessments for eight months.

Examining interactions among biomarkers is a topic of significant importance in lung cancer research. The Advanced Lung Cancer Inflammation Index used to assess systemic inflammation provided data suggesting that a depression biomarker may add predictive power to measures of systemic inflammation.

“It’s critically important for oncology providers to screen cancer patients at diagnosis and relevant timepoints thereafter to determine the severity of depression symptoms when they are present,” Dr. Andersen says. “The next challenge is to provide evidence-based interventions, such as cognitive behavioral therapy, for depression treatment.”