Depression, shortened telomeres increase mortality in bladder cancer patients

ScienceDaily (Oct. 18, 2012) — Low depressive symptoms and a longer telomere length are compelling factors that contribute to a prolonged life for bladder cancer patients, according to researchers at The University of Texas MD Anderson Cancer Center.

In an observational study, a team of MD Anderson researchers analyzed clinical and behavioral data collected from 464 bladder cancer patients, according to research presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research.

"This is the first study of its kind that analyzes bladder cancer outcomes," said Meng Chen, Ph.D., an instructor in MD Anderson's Department of Epidemiology. "Psychological factors are not usually included in epidemiologic studies"

The patients observed were enrolled in an ongoing study of bladder cancer that provides extensive genetic, epidemiologic and psychological data. The collaboration of MD Anderson epidemiologists and psychologists is led by the study's principal investigator, Xifeng Wu, M.D., Ph.D., professor and chair of the epidemiology department.

Patients' information was analyzed according to four different groups. The first group involved patients with long telomeres and no depressive symptoms; the second identified patients who had long telomeres with depressive symptoms; the third had shortened telomeres and no depressive symptoms, while the fourth group had shortened telomeres and depressive symptoms.

Bladder cancer is the fourth most common cancer of men and is usually diagnosed in people over the age of 60. The American Cancer Society estimates 56,000 men and 18,000 women will have a bladder cancer diagnosis in 2012.

Research has identified shortened telomere length as an aging-associated biomarker in several diseases, including cancer. As people grow older, telomeres on the tips of chromosomes, which protect chromosomes from unraveling as cells replicate, shorten and eventually fail, leading to cell death. MD Anderson researchers analyzed blood samples to measure telomere length.

Depressive symptoms were analyzed using the Center for Epidemiologic Studies Depression Scale (CES-D). The self-report scale -- one of the most common screening tests used for finding levels of depression -- revealed patients who scored at high levels of depressive symptoms have a 1.89-fold risk of dying compared to those with lower levels of depression, who will live a little over three times longer -- 200 months vs. 58 months.

The study also revealed the combination of factors, longer telomeres and low levels of depressive symptoms, increased survival for bladder cancer patients by more than six-fold -- 31.3 months vs 199.8 months. Those with short telomeres and high levels of depression had a three-fold risk of mortality.

A certain level of stress, which has also been associated with shortened telomere length, is a dominating factor with many cancer patients. "People are not treating the depression directly, but mainly focused on coping with cancer,"said Chen. "This leads to additional stress that increases mortality."

Enhanced stress management should be an integral part of cancer treatment, "Lifestyle behaviors including a healthy diet, regular exercise and smoking-cessation are factors for reducing stress and ultimately depression in cancer patients." " said co-author Jie Lin, Ph.D., assistant professor in the Department of Epidemiology.

Lin also said the new risk factors such as psychological risk factors identified by the team could be included in future risk prediction models. The team is optimistic that this study will encourage clinicians to incorporate behavioral factors into risk models so interventions can be developed to prolong survival for bladder cancer patients.

Contributing authors to the work include Jan Blalock, Ph.D., Paul Cinciripini, Ph.D. from the Department of Behavioral Science, and Lorenzo Cohen, Ph.D., from the Department of General Oncology.

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The above story is reprinted from materials provided by University of Texas M. D. Anderson Cancer Center, via Newswise.

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Depression, DNA Linked to Higher Death Risk in Bladder Cancer Patients

THURSDAY, Oct. 18 (HealthDay News) -- People with significant symptoms of depression and shortened telomeres -- pieces of DNA that protect the ends of chromosomes from deterioration -- are at greater risk of death from bladder cancer, new research suggests.

The findings were scheduled for presentation Wednesday at the annual cancer prevention conference of the American Association for Cancer Research, in Anaheim, Calif.

"We found that patients with bladder cancer with shorter telomeres and high levels of depression symptoms have a threefold increased risk for mortality," Meng Chen, an epidemiologist at the University of Texas MD Anderson Cancer Center, in Houston, said in an association news release.

In conducting the study, the researchers analyzed medical and psychological information on nearly 500 patients with bladder cancer. The participants' level of depression was rated on a standard scale: Patients without symptoms of depression had a score below 16 and those with a score of 16 or greater were considered depressed.

Patients who scored as depressed had an average survival time of 58 months, the study found. In comparison, patients with scores below 16 had an average survival time that exceeded 200 months. Depressed patients had a 1.89 times higher risk of death from all causes than those who were not depressed.

The researchers used patients' blood samples to measure the length of the their telomeres, a marker of aging that is linked to cancer. Patients with depression symptoms and short telomeres had more than a three times higher risk for death and a much shorter period of disease-free survival.

Although the study authors said more research is needed to further investigate their findings, they suggested that psychological factors may play an important role in the survival of people with cancer, along with lifestyle factors that could slow the shortening of telomeres, such as exercise and weight loss.

"In terms of building a prediction model for bladder cancer mortality, current models only focus on clinical variables, such as treatment and tumor stage and grade," Chen said. "Our study suggests that psychological factors and perhaps lifestyle changes could be included in this prediction model."

The study found an association between depression, DNA changes and death after bladder cancer. It did not prove a cause-and-effect relationship. The data and conclusions should be viewed as preliminary until published in a peer-reviewed medical journal.

-- Mary Elizabeth Dallas Copyright © 2012 HealthDay. All rights reserved. SOURCE: American Association for Cancer Research, news release, Oct. 17, 2012

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Depression and shortened telomeres increased bladder cancer mortality

ScienceDaily (Oct. 17, 2012) — The combination of shortened telomeres, a biological marker of aging associated with cancer development, and elevated depression significantly impacted bladder cancer mortality, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held in Anaheim, Calif. Oct. 16-19, 2012.

"We found that patients with bladder cancer with shorter telomeres and high levels of depression symptoms have a threefold increased risk for mortality," said Meng Chen, Ph.D., an epidemiologist at The University of Texas MD Anderson Cancer Center in Houston.

As part of an ongoing, large-scale epidemiologic study of bladder cancer, Chen and colleagues collected clinical and mental health information on 464 patients with bladder cancer. They assessed patients' depression levels with the Center for Epidemiologic Studies Depression Scale (CES-D).

Depression symptoms alone affected mortality: Patients with CES-D scores of 16 or greater had a median survival time of 58 months, while those with scores below 16 had a median survival time longer than 200 months. In addition, patients with CES-D scores of 16 or greater had a 1.89-fold increased risk for all-cause mortality compared with patients with CES-D scores less than 16.

Telomere length was measured from patient blood samples. Univariate analysis revealed that long telomeres were associated with improved survival, but this finding was not significant in a multivariate analysis.

When evaluating the combination of depression and telomere length, the researchers found that compared with patients without depression symptoms (i.e., CES-D scores less than 16) and long telomeres, patients with depression symptoms (i.e., CES-D scores of 16 or greater) and short telomeres demonstrated more than a threefold increased risk for mortality and significantly shorter disease-free survival (31.3 months versus 199.8 months).

Although the mechanisms behind these findings need to be furthered studied, "these results suggest the potential important role of psychological factors to improve survival in cancer patients," Chen said.

In addition, the researchers pointed to evidence that smoking cessation, weight loss and increased physical activity can slow telomere shortening and potentially improve survival.

"In terms of building a prediction model for bladder cancer mortality, current models only focus on clinical variables, such as treatment and tumor stage and grade," Chen said. "Our study suggests that psychological factors and perhaps lifestyle changes could be included in this prediction model."

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The above story is reprinted from materials provided by American Association for Cancer Research (AACR).

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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