Anxiety, Depression at Lymphoma Diagnosis May Affect Outcomes

Patients with diffuse large B-cell lymphoma, a type of non-Hodgkin lymphoma, who have existing depression or anxiety at diagnosis tend to have a higher risk of dying from their disease compared to those without a mental health diagnosis, according to recent research.

These findings, which were published in The Lancet Hematology, highlight the importance of patients talking to their health care team if they are experiencing depression or anxiety, according to lead study author, Dr. Oreofe O. Odejide.

“Speak up; do not to stay in isolation,” Odejide, who is also a physician in the adult lymphoma and division of population sciences at the Dana-Farber Cancer Institute in Boston, said in an interview with CURE®. “Bring this up to their care providers, so these things can be addressed with their resources, their psychosocial experts, psychological experts and practical resources as well.”

To better understand the effects of depression and anxiety in patients with diffuse large B-cell lymphoma, Odejide and her team analyzed data from 13,244 patients who were diagnosed at the age of 67 years or older between the years 2001 and 2013. The researchers took note of which patients had preexisting anxiety or depression, and then tracked the date and cause of death, noting how long patients lived after being diagnosed.

A total of 16% patients had preexisting anxiety and/or depression. Findings showed that patients with depression tended to have the worst outcomes, with a 37% higher risk of dying from their lymphoma, compared with those who did not have anxiety or depression. The data also demonstrated that patients with anxiety had worse survival.

While the study did not investigate the reason why patients with anxiety and depression tend to have poorer outcomes, Odejide has a few theories, one of which involves the timing of treatment.

“One of the hypotheses we have is that the diagnosis of lymphoma or any cancer in general is overwhelming. It's a lot to deal with,” Odejide said. “So if someone is already struggling from depression or anxiety, the ability to initiate treatment in a timely fashion — and all the work of the resources that need to be mobilized for that — may be more challenging for this population.”

Additionally, patients with anxiety and depression may face barriers to health care, including limited social support of financial barriers, which could impact adherence to their treatment plan, according to Odejide.

“So even when people start treatment in a timely fashion, we know that the treatment for diffuse large B-cell lymphoma and many other lymphomas is not a one-time treatment. It's multiple cycles of treatment, managing the side effects of treatment. So the ability to adhere to this, given all the other barriers that are faced, may be another potential hypothesis,” Odejide said, mentioning that a prior study found that patients with depression had a three times higher risk of not being able to adhere to their cancer treatment.

Finally, Odejide explained that stigma still exists around mental health, even in the health care setting.

“The health care system is not necessarily immune from stigma,” she said. “So that might also be a factor that might play into treatment, what type of treatment and that might impact overall outcomes of the treatment.”

Looking forward, Odejide mentioned that more research is needed to better determine how mental health issues can impact cancer outcomes and develop interventions to decrease — and ideally eliminate — this disparity.

“Where we hope the field eventually gets to is not just uncover the mechanisms but to actually develop interventions that can be widely disseminated to help patients with the symptoms of depression and anxiety,” Odejide said.

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