Treatment Type and Demographic Characteristics As Predictors for Cancer Adjustment: Prospective Trajectories of Depressive Symptoms in a Population Sample

Objective: Prospectively identifying individuals at heightened risk for depression can alleviate the disease burden of distal physical and mental health consequences after cancer onset. Our objective was to identify heterogeneous trajectories of adjustment in cancer patients, using treatment-type as a predictor.

Methods: Participants were followed for 6 years within the Health and Retirement Study (HRS), a prospective population-based cohort study. The sample consisted of 1,294 middle-aged participants who were assessed once before and 3 time points after their report of an initial cancer diagnosis. In addition to self-reported depressive symptoms, subjects indicated receipt of surgical, radiological, or chemical interventions as part of their usual oncological care.

Results: Four symptom trajectories were identified with Latent Growth Mixture Modeling: an increasing depression (10.5%), chronic depression (8.0%), depressed-improved (7.8%), and stable-low depression (73.7%). A conditional model using participants with available predictor data (n = 545) showed individuals in the emerging depression class were significantly more likely to have received chemo/medication therapy when compared with the remitting depression, stable-low, and chronic depression classes. Participants in the chronic and depressed-improved classes generally had worse baseline health, and the depressed-improved were also younger in age.

Conclusion: Patients who exhibited increasing depressive symptoms had a greater probability of receiving chemo/medication therapy than any other adjustment trajectory group, although the majority of chemotherapy patients did not exhibit depressive symptom changes. These data underscore the diversity of ways that patients adjust to cancer, and suggest cancer treatment, baseline health, and age may influence long-term patterns of psychological adjustment.