There is compelling evidence suggesting that depression is associated with elevated mortality in aging-related diseases, including cancer. Telomere shortening is a marker of biological aging and is involved in cancer development. Recent studies have shown that major depressive disorder with a chronic course is associated with shortened telomere length. Several conceptual models have been proposed to explain the underlying mechanism between depression and cancer; however, no study has evaluated depression and telomere length in modifying cancer outcomes. In a prospective study, we recruited 464 bladder cancer patients and collected demographic, clinical and depression data. Telomere length was measured from blood samples at baseline for each patient. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Multivariate cox regression was used to assess the association between depressive symptoms, telomere length, and bladder cancer mortality, as well as the joint effect of depressive symptoms and telomere length on bladder cancer mortality. The Kaplan-Meier plots and log rank tests were applied to compare survival time of subgroups by depressive symptoms and telomere length. During a median follow up of 21.6 months, 88 deaths occurred. Patients with CES-D scores ≥16 (clinical screening criteria) had a 1.89-fold (95%CI: 1.12-3.20, P=0.018) increased risk of all-cause mortality relative to patients with CES-D scores < 16. The Kaplan-Meier survival analysis showed shorter survival for those with CES-D scores ≥16 (CES-D scores ≥16 = 58.0 months vs. CES-D scores < 16 = >200 months, P log rank=0.004). In univariate analysis, long telomere length (dichotomized by median) was associated with significantly improved survival (HR=0.55; 95% CI=0.34 to 0.89. P=0.015), but the association was not significant in multivariate analysis. A joint effect of short telomere length and depressive symptoms was observed: compared to patients with CES-D scores < 16 and long telomere length, patients with CES-D scores ≥16 and short telomeres exhibited an over 3-fold increased risk of mortality (HR=3.19, 95% CI, 1.44-7.04, P=0.004) and significantly shorter disease-free survival (31.3 months vs. 199.8 months, P<0.001). Our study suggests that shortened telomere length and depressive symptoms influence bladder cancer mortality, individually and jointly. Findings highlight the need to provide interventions that address high levels of depressive symptoms, which may result in improved survival in bladder cancer patients.
Citation Format: Meng Chen, Jie Lin, Jan Blalock, Lorenzo Cohen, Paul M. Cinciripini, Xifeng Wu. Depression and short telomere length increased mortality in bladder cancer patients. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A88.