The role of baseline and persistent depression in adjuvant cancer therapy: impact on toxicity and quality of life

Abstract

Introduction: Depression is common among cancer patients, adversely affecting treatment adherence, toxicity, and quality of life (QoL). However, its course during adjuvant therapy and its impact on outcomes in resected cancer remain poorly understood. This study evaluated changes in depression from treatment initiation (T1) to six months later (T2) and examined associations with demographic, clinical, and psychological factors, treatment-related toxicities, and QoL. Methods: In this multicenter, prospective observational study, 927 patients with resected, non-metastatic cancer receiving adjuvant treatment were enrolled. Depressive symptoms were measured using the Brief Symptom Inventory-18 (BSI-18) at T1 and T2. Patients were classified as “never” (no symptoms at T1 or T2), “new-onset” (absent at T1, present at T2), “remission” (present at T1, absent at T2), or “persistent” (present at both time points). Treatment-related toxicities were evaluated according to CTCAE v4.0, and QoL was assessed with the EORTC QLQ-C30. Results: At T2, 50.8% of patients remained asymptomatic, 12.3% experienced remission, 23.4% exhibited persistent depression, and 13.5% developed new-onset depression. Persistent depression was more common among women, younger patients, those without a partner, and breast cancer patients. Patients with persistent symptoms showed significantly higher toxicities—including hematologic, digestive, and neuropathic events, as well as increased asthenia (p < .001)—and poorer functioning with greater symptom burden, resulting in markedly reduced overall QoL. In multivariate analyses, baseline depression and ECOG performance status were the main predictors of depressive symptoms at six months, while age predicted changes over time; other sociodemographic or clinical factors were not significant. Logistic regression confirmed that younger age, female sex, breast cancer, and poorer ECOG were associated with higher odds of persistent depression compared with never-depressed patients. Conclusion: Both baseline depression and functional impairment (ECOG) are independent predictors of depressive symptoms during adjuvant therapy. Persistent depression is significantly associated with increased treatment toxicity and poorer QoL in patients with early-stage resected cancer, highlighting the need for routine screening and early psychological intervention during adjuvant treatment.