OBJECTIVES : Depressive symptoms and quality of life may adversely affect cancer treatment and survival in patients’ diagnosed with cancer. Co-morbid depression in older adults may contribute to lower initiation or adherence to treatment, leading to increased mortality. We evaluated the association between pre-cancer depressive symptoms and mortality in older patients diagnosed with non-Hodgkin lymphoma.

METHODS : A retrospective cohort study was conducted using the SEER-MHOS linked database. The study included adults ≥65 years diagnosed with first primary NHL between 1998 and 2014 that completed one survey within 5-years prior to diagnosis. A positive screen for depressive symptoms was determined using MHOS responses. Depressive symptoms were defined as a positive response to at least 1 of 3 depression screening questions and a mental health component summary score £42. We used multi-variable Cox-proportional hazards models to estimate risk of cancer-specific mortality in adults with baseline depressive symptoms relative to adults without depressive symptoms.

RESULTS : In a cohort of 1,308 patients, 81% were non-Hispanic white and 51% were female with a mean age of 76 years, consisting of primarily diffuse large B-cell lymphomas (75%). Prior to cancer diagnosis, 135 (10%) subjects reported depressive symptoms. Compared to patients without baseline depressive symptoms, patients with depressive symptoms reported lower education (less than high school: 39% vs. 25%, p <0.01), lower annual household income (less than $30,000: 81% vs. 62%, p<0.01) and had a higher number of co-morbidities (mean of 3 vs. 2, p<0.01). In multi-variable analyses, depressive symptoms were not associated with cancer-specific mortality risk (HR 1.09, 95% 0.80-1.38, p=0.60).

CONCLUSIONS : Our findings provide little evidence to support the hypothesis that depressive symptoms adversely affect cancer-specific survival in older patients with NHL. However, the high prevalence of depressive symptoms among older lymphoma patients is consistent with that of other critically ill older adults and deserves clinical attention.