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Psychologic Distress Is Associated with Cancer-Specific Mortality among Patients with Cervical Cancer
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavík, Iceland.ORCID iD: 0000-0002-4186-8661
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden.ORCID iD: 0000-0003-3046-3447
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, United States.
Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-6865-0224
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2019 (English)In: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 79, no 15, p. 3965-3972Article in journal (Refereed) Published
Abstract [en]

Emerging evidence suggests a role of psychologic factors in the progression of different cancer types. However, it is unclear whether psychologic distress around the time of diagnosis of invasive cervical cancer places patients at a higher risk of cancer-specific mortality, independently of tumor characteristics and treatment modalities. We conducted a nationwide cohort study, including 4,245 patients with newly diagnosed cervical cancer during 2002-2011 in Sweden. Psychologic distress was indicated by a clinical diagnosis of depression, anxiety, or stress reaction and adjustment disorders, or the experience of a stressful life event, including death or severe illness of a family member, divorce, or between jobs, from one year before cancer diagnosis and onwards. We calculated the HRs of cancer-specific mortality among the patients exposed to psychologic distress, compared with unexposed patients, controlling for socioeconomic characteristics and other known prognostic indicators such as tumor and treatment characteristics. We found that patients exposed to psychologic distress had an increased risk of cancer-specific mortality (HR 1.33; 95% CI, 1.14-1.54). The association was primarily driven by distress experienced within one year before or after diagnosis (HR 1.30; 95% CI, 1.11-1.52), but not thereafter (HR 1.12; 95% CI, 0.84-1.49). In summary, our study shows that psychiatric disorders and stressful life events around cancer diagnosis are associated with increased cancer-specific mortality among patients with cervical cancer, independent of tumor characteristics and treatment modality.

Significance: These findings support the integration of psychologic screening and intervention in the clinical management of patients with cervical cancer, particularly around the time of cancer diagnosis.

Place, publisher, year, edition, pages
American Association for Cancer Research Inc. , 2019. Vol. 79, no 15, p. 3965-3972
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-75786DOI: 10.1158/0008-5472.CAN-19-0116ISI: 000478017700017PubMedID: 31253667Scopus ID: 2-s2.0-85070082661OAI: oai:DiVA.org:oru-75786DiVA, id: diva2:1343350
Funder
Swedish Cancer Society, CAN 2017/322Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00531The Karolinska Institutet's Research FoundationAvailable from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-16Bibliographically approved

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Fall, Katja

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