Depressive symptoms and short telomere length are associated with increased mortality in bladder cancer patients
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Abstract
BACKGROUND: Depression is associated with an increased risk of mortality in patients with cancer; it has been hypothesized that depression-associated alterations in cell aging mechanisms, in particular, the telomere/telomerase maintenance system, may underlie this increased risk. We evaluated the association of depressive symptoms and telomere length to mortality and recurrence/progression in 464 patients with bladder cancer. METHODS: We used the Center for Epidemiologic Studies Depression Scale (CES-D) and Structured Clinical Interview for DSM-IV Disorder (SCID) to assess current depressive symptoms and lifetime major depressive disorder (MDD), respectively, and telomere length was assessed from peripheral blood lymphocytes. Multivariate Cox regression was used to assess the association of depression and telomere length to outcomes and the joint effect of both. Kaplan-Meier plots and log-rank tests were used to compare survival time of subgroups by depression variables and telomere length. RESULTS: Patients with depressive symptoms (CES-D ≥ 16) had a 1.83-fold [95% confidence interval (CI), 1.08-3.08; P = 0.024] increased risk of mortality compared with patients without depressive symptoms (CES-D < 16) and shorter disease-free survival time (P = 0.004). Patients with both depressive symptoms and lifetime history of MDD were at 4.88-fold (95% CI, 1.40-16.99; P = 0.013) increased risk compared with patients with neither condition. Compared to patients without depressive symptoms and long telomere length, patients with depressive symptoms and short telomeres exhibited a 4-fold increased risk of mortality (HR, 3.96; 95% CI, 1.86-8.41; P = 0.0003) and significantly shorter disease-free survival time (P < 0.001). CONCLUSION: Short telomere length and depressive symptoms are associated with bladder cancer mortality individually and jointly. IMPACT: Further investigation of interventions that impact depression and telomere length may be warranted in patients with cancer.
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A recent study found that the combination of short telomere length with depression was, compared with either measure alone, a strong prospective predictor of both cancer disease progression and mortality in a cohort of bladder cancer patients.
“For example, a recent study found that the combination of short telomere length with depression was (compared with either measure alone) a strong prospective predictor of both cancer disease progression and mortality in a cohort of bladder cancer patients (Lin et al., 2015).”
From Psychiatric disorders and leukocyte telomere length: Underlying mechanisms linking mental illness with cellular aging (2015) · cites this paper as Lin et al., 2015
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Systematic Review: Depression and Anxiety Prevalence in Bladder Cancer Patients
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- Authors
- Lin, J., Blalock, J. A., Chen, M., Ye, Y., Gu, J., Cohen, L., Cinciripini, P. M., & Wu, X.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Cohen, Lorenzo
- Venue
- Cancer Epidemiology, Biomarkers & Prevention
- Published
- 2015-02-01
- Volume
- 24
- Issue
- 2
- Pages
- 336-343
- ISSN
- 1055-9965 (ISSN-L)
- 1538-7755
- PMC
- PMC4332382
- OpenAlex
- W2113310671
- Cited by
- 42
- References
- 57
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 6 · 2017: 5 · 2016: 7 · 2015: 3
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cancer Epidemiology Biomarkers & Prevention (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (U01CA127615, P50CA091846, P50CA 91846, P30CA016672)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Physiology › Telomeres, Telomerase, and Senescence
- Keywords
- depressive symptoms, telomere length, bladder cancer, cancer mortality, major depressive disorder, disease-free survival, telomere shortening, cellular aging, telomerase, tumor recurrence
- MeSH terms
- Aged, Urinary Bladder Neoplasms, Cause of Death, Depressive Disorder, Female, Humans, Male, Middle Aged, Prospective Studies, Biomarkers, Telomere Shortening
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