Beyond survival: the hidden impact of depression on life after cancer

Depression is common among patients with cancer and is associated with worse quality of life (QoL). However, less is known about how a history of depression affects QoL in long-term cancer survivors. This study examined whether cancer survivors with a history of depression report poorer QoL compared to those without.

Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, phone-based survey, were analyzed. Adults aged ≥ 18 years with a self-reported history of cancer were stratified by history of depression. Demographics and QoL indicators-including emotional support, social isolation, cognitive concerns, and functional independence-were compared using chi-square tests. Multivariable logistic regression analyses evaluated whether depression was independently associated with QoL outcomes after adjustment for demographic and socioeconomic factors.

Of 72,765 cancer survivors identified, 72,443 (99.6%) responded to the depression history item and were included. Compared with survivors without depression, those with depression were younger, less likely to be married, and more likely to report lower income, obesity, and smoking (all p < 0.001). Survivors with depression reported worse mental (35% vs. 6%) and physical health (34% vs. 15%), lower life satisfaction (15% vs. 3%), reduced emotional support (66% vs. 84%), and greater functional limitations (all p < 0.001). After adjustment for socioeconomic factors, depression remained independently associated with poorer QoL across multiple domains. Depression prevalence was highest among survivors of brain (38%) and gynecologic cancers (36%).

Depression among cancer survivors is independently associated with poorer quality of life across emotional, social, and functional domains, underscoring the importance of depression screening and intervention in survivorship care.

Integrating depression screening and psychosocial interventions into survivorship care is critical to improving long-term well-being and daily functioning.