Moderate/severe Depression (MADRS) Can Affect the Quality of Life and Outcome Among Patients Admitted to Breast Cancer Diagnosis Unit

AIM: The Montgomery-Asberg Depression Rating Scale (MADRS) is one of the most widely used examiner rating instruments for screening, diagnosis and measuring the severity of depression. However, the long-term predictive value of the MADRS in patients admitted to the breast cancer diagnosis unit (BCDU) is unknown. PATIENTS AND METHODS: In the Kuopio Breast Cancer Study women with breast symptoms were evaluated for the total MADRS score before any diagnostic procedures. The relapse-free survival (RFS) was calculated from the time of diagnosis to the time of first relapse including local relapse, contralateral breast cancer (BC) or metastatic disease. The overall survival (OS) was assessed as the time from the date of diagnosis to the date of last follow-up or death of the patient. The effect of the MADRS on the RFS and on the OS were calculated by Kaplan-Meier survival analysis and the difference between groups was assessed by the log-rank test. The RFS and OS were estimated for the study groups with the low MADRS score (<25) versus the high MADRS score (≥25). The end-point of our study was to determine differences in long-term outcome and in MADRS score in breast cancer (BC), benign breast disease (BBD) and healthy study subjects (HSS). RESULTS: In the Cox proportional hazard model the total MADRS score significantly predicted the 25 year RFS and OS in the HSS, BBD and BC groups combined (HR=2.26, p=0.006; HR=2.46, p=0.008, respectively), and in the Kaplan-Meier survival analysis with the log-rank test the total MADRS score predicted the 25 year RFS and OS in the HSS, BBD and BC groups combined (p=0.005; p=0.006, respectively). CONCLUSION: The moderate/severe depression (MADRS) can affect the quality of life and outcome among patients admitted to the BCDU.