Depression and Anti-depressant Therapy Effects on Quality of Life and Patient Satisfaction Outcome Measures in Breast Cancer Using the BREAST-Q
Kevin M. Klifto, PharmD, Pathik Aravind, Michele A. Manahan, MD, Kristen P. Broderick, MD, Damon S. Cooney, MD, PhD, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
The Johns Hopkins University, Baltimore, MD, USA.
Purpose: Depression prior to breast cancer and its effect on post-diagnosis quality of life in women undergoing breast reconstruction is relatively unknown. The BREAST-Q has become widely used to assess pre- and post-operative patient-reported outcomes. There are no studies evaluating the impact of a pre-cancer diagnosis of depression or anti-depressant use on BREST-Q scores. We investigated if depression or anti-depressant use may alter the results of the BREAST-Q.
Methods: This study is a single-center, retrospective analysis of 300 patients with completed BREAST-Q data who underwent breast reconstruction from November 2013 to 2016 following a diagnosis of breast cancer. Patients completed the BREAST-Q at four time points: pre-operatively, 6-weeks following tissue expander insertion, and 6- and 12-months following final reconstruction. We reviewed medical records to identify patients who had a pre-cancer diagnosis of clinical depression and anti-depressant medication use. Patients were stratified into a depression and no depression group. The depression group was defined as a pre-cancer diagnosis of depression. The no depression group was defined as no pre-cancer clinical diagnosis of depression and no anti-depressant use. BREAST-Q scores were compared between depression (n=50) and no depression (n=250) patients; the depression group was further stratified by anti-depressant (n=36) and no anti-depressant (n=14) use. The Mann-Whitney U test was used for continuous variables, based on the non-parametric distribution of the data. The same statistical guidelines were used for the sub-group analysis.
Results: Sexual well-being scores at the 6-week tissue expander follow up for patients in the depression group (median=37, IQR = 25–47) were significantly lower (p<0.01) than scores for patients in the no depression group (median=47, IQR = 39-60). Patients in both
groups showed a decrease from baseline in BREAST-Q scores across all domains at the 6-week tissue expander follow-up. However, the scores after final reconstruction (6 and 12-month follow-ups) were higher than baseline for both groups of patients. There were no statistically significant differences in BREAST-Q scores in other domains. The sub-group analysis comparing the depression group on anti-depressant medication (n=36, 72%) to those on no anti-depressant medication (n=14, 28%) did not show any statistically significant differences in BREAST-Q scores across all domains. Six (17%) of the 36 patients with a prior diagnosis of depression were currently taking either bupropion or mirtazapine, two medications that have shown to have minimal effects on sexual function. These patients had clinically higher sexual well-being BREAST-Q scores at baseline (median=61) compared to patients taking anti-depressants that cause sexual dysfunction (median=53).
Conclusion: Patients with a diagnosis of depression prior to breast cancer had lower BREAST-Q sexual well-being scores at the 6-week tissue expander follow-up, regardless of anti-depressant medication use. While at 6-weeks there is a difference in scores between the patients with depression and no depression, by 12 months no other differences are noted.
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