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From Department of Clinical and Social Sciences in Psychology (K.W.B.), University of Rochester, Rochester, New York; Centre for Health Evaluation and Outcome Sciences (A.R.L.), St. Paul’s Hospital and Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia; Division of Psychology (Z.R., L.E.), Sir Mortimer B. Davis-Jewish General Hospital, Montreal; and Departments of Psychology, Psychiatry, and Oncology (Z.R.), McGill University, Montreal, Quebec, Canada.
Kirk W. Brown, PhD, CSP, Meliora Hall, RC Box 270266, University of Rochester, Rochester, NY 14627-0266. E-mail: kirk{at}prodigal.psych rochester.edu
Received for publication May 10, 2002; revision received November 24, 2002.
OBJECTIVE: This study tested the predictive role of psychological distress in cancer survival, while attempting to overcome several important methodological and statistical limitations that have clouded the issue.
METHODS: Measures collected on a range of emotional and cognitive factors in the early postdiagnostic period and at 4-month intervals up to 15 months after diagnosis were used to predict survival time up to 10 years among 205 cancer patients heterogeneous in disease site, status, and progression.
RESULTS: With the use of both baseline and repeated measures, depressive symptomology was the most consistent psychological predictor of shortened survival time, after controlling for several known demographic and medical risk factors.
CONCLUSIONS: Given the importance of depressive symptoms to cancer survival, discussion focuses on the possible mechanisms mediating this relationship, the importance of psychological screening of cancer patients, and need for further research.
Key Words: depressive symptoms, • survival, • time dependence.
Abbreviations: CES-D = Center for Epidemiological Studies Depression scale;; CI = confidence interval;; HR = hazard ratio;; MI = multiple imputation
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