Depression, anxiety in ovarian cancer patient

Authors: P. Halada 1,2;  V. Doničová 1,2;  I. Práznovec 1,2;  V. Pidrman 3;  J. Špaček 1,2
Authors‘ workplace: Porodnická a gynekologická klinika FN, Hradec Králové, přednosta prof. MUDr. Špaček J., Ph. D., IFEPAG 1;  Lékařská fakulta Univerzity Karlovy, Hradec Králové 2;  Soukromá psychiatrická ordinace, Hradec Králové 3
Published in: Čes. Gynek.2019, 84, č. 4 s. 309-317


Objective: A summary article, which is concluding available data about the psychological alterations, especially depression and anxiety, in ovarian cancer patients.

Design: Revue article.

Setting: Department of Obstetrics and Gynaecology, University Hospital in Hradec Králove.

Discussion: Depressive symptoms could arise as a consequence of the stress, which is the response to oncological diagnosis, treatment or relapse of the oncological disease. This depressive condition is raising concerns in patients, family and health care professionals because it is significantly contributing to morbidity and at the same time is leading to the increase of the health care costs. In general the alteration of the physical and mental functions is reducing the average life expectancy. The patients with serious gynecological cancer diagnosis are requiring psychological support, which is not always satisfactory from their family. It would therefore be desirable to establish professional centers or clinics providing counseling and psychotherapy.

Conclusion: The summary of the available research data about depression in a women with gynaecological cancer has pointed out not only connection between depression and ovarian cancer, but has also underlined the importance of this problematic for daily praxis and further intensive research.


depression – ovarian cancer – depression treatment in oncological diseases – depression and imunity


1. Aaronson, NK., Meyerowitz, BE., Morton, B., et al. Quality of life research in oncology – past achievement and future priorities. Cancer, 1991, 67, p. 839–843.

2. Andersen, BL., Farrar, WB., Golden-Kreutz, DM., et al. Psychological, behavioral, and immune changes after a psychological intervention: a clinical trial. J Clin Oncol, 2004, 22, p. 3570–3580.

3. Andoh, A., Tsujikawa, T., Fujiyama, Y. Role of dietary fiber and short-chain fatty acids in the colon. Curr Pharm Des, 2003, 9, p. 347–358.

4. Arden-Close, E., Gidron, Y., Moss-Morris, R. Psychological distress and its correlates in ovarian cancer: a systematic review. Psychooncology, 2008, 17, p. 1061–1072.

5. Bailey, RK., Geyen, DJ., Scott-Gurnell, K., et al. Understanding and treating depression among cancer patients. Intern J Gynecol Cancer, 2005, 15, p. 203–208.

6. Bodurka-Bevers, D., Basen-Engquist, K., Carmack, CL., et al. Depression, anxiety, and quality of life in patients with epithelial ovarian cancer. Gynecol Oncol, 2000, 78, p. 302–308.

7. Bower, JE. Cancer-related fatigue-–mechanisms, risk factors, and treatments. Nat Rev Clin Oncol, 2014, 11, p. 597–609.

8. Bruera, E., Neumann, CM. The uses of psychotropics in symptom management in advanced cancer. Psychooncology, 1998, 7, p. 346–358.

9. Cankurtaran, ES., Ozalp, E., Soygur, H., et al. Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 2008, 16, p. 1291–1298.

10. Cella, DF., Tulsky, DS. Measuring quality of life today: methodological aspects. Oncology (Williston Park), 1990, 4, p. 29–38; discussion 69.

11. Cella, DF., Tulsky, DS. Quality of life in cancer: definition, purpose, and method of measurement. Cancer Invest, 1993, 11, p. 327–336.

12. Chrousos, GP., Gold, PW. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA, 1992, 267, p. 1244–1152.

13. Cullum, JL., Wojciechowski, AE., Pelletier, G., Simpson, JS. Bupropion sustained release treatment reduces fatigue in cancer patients. Can J Psychiatry, 2004, 49, p. 139–144.

14. Davis, MP., Khawam, E., Pozuelo, L., Lagman, R. Management of symptoms associated with advanced cancer: olanzapine and mirtazapine. A World Health Organization project. Expert Rev Anticancer Ther, 2002, 2, p. 365–376.

15. Dinan, TG., Cryan, JF. The impact of gut microbiota on brain and behaviour: implications for psychiatry. Curr Opin Clin Nutr Metab Care, 2015, 18, p. 552–558.

16. Domenici, L., Palaia, I., Giorgini, M., et al. Sexual health and quality of life assessment among ovarian cancer patients during chemotherapy. Oncology, 2016, 91, p. 205–210.

17. Dwight-Johnson, M., Ell, K., Lee, PJ. Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer. Results from a randomized pilot study. Psychosomatics, 2005, 46, p. 224–232.

18. Eileen, H. Shinn PDACC. Depression treatment and screening in ovarian cancre patients.

19. Elenkov, IJ., Chrousos, GP., Wilder, RL. Neuroendocrine regulation of IL-12 and TNF-alpha/IL-10 balance. Clinical implications. Ann N Y Acad Sci, 2000, 917, p. 94–105.

20. Fisch, M. Treatment of depression in cancer. J Natl Cancer Inst Monogr, 2004, p. 105–111.

21. Ganz, PA., Hirji, K., Sim, MS., et al. Predicting psychosocial risk in patients with breast cancer. Med Care, 1993, 31, p. 419–431.

22. Ginsburg, A. Cancer-related depression and potential pharmacologic therapies. Proc (Bayl Univ Med Cent), 2008, 21, p. 439–441.

23. Glaser, R., MacCallum, RC., Laskowski, BF., et al. Evidence for a shift in the Th-1 to Th-2 cytokine response associated with chronic stress and aging. J Gerontol A Biol Sci Med Sci, 2001, 56, p. M477–482.

24. Greer, JB., O‘Keefe, SJ. Microbial induction of immunity, inflammation, and cancer. Front Physiol, 2011, 1, p. 168.

25. Gustinetti, G., Mikulska, M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence, 2016, 7, p. 280–297.

26. Hansmanová, L., Obereignerů, R., Šmahaj, J. Psycho­somatické aspekty zhoubného nádoru těla děložního. Čes Gynek, 2007. s. 304–308.

27. Heilig, M., Irwin, M., Grewal, I., Sercarz, E. Sympathetic regulation of T-helper cell function. Brain Behav Immun, 1993, 7, p. 154–163.

28. Holland, JC., Romano, SJ., Heiligenstein, JH., et al. A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psychooncology, 1998, 7, p. 291–300.

29. Howren, MB., Lamkin, DM., Suls, J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med, 2009, 71, p. 171–186.

30. Huang, T., Poole, EM., Okereke, OI., et al. Depression and risk of epithelial ovarian cancer: Results from two large prospective cohort studies. Gynecol Oncol, 2015, 139, p. 481–486.

31. Hughson, AV., Cooper, AF., McArdle, CS., Smith, DC. Psychological impact of adjuvant chemotherapy in the first two years after mastectomy. Br Med J (Clin Res Ed), 1986, 293, p. 1268–1271.

32. Irwin, M. Immune correlates of depression. Adv Exp Med Biol, 1999, 461, p. 1–24.

33. Irwin, M. Psychoneuroimmunology of depression: clinical implications. Brain Behav Immun, 2002, 16, p. 1–16.

34. Iżycki, D., Woźniak, K., Iżycka, N. Consequences of gynecological cancer in patients and their partners from the sexual and psychological perspective. Prz Menopauzalny, 2016, 15, p. 112–116.

35. Kautio, AL., Haanpää, M., Saarto, T., Kalso, E. Amitriptyline in the treatment of chemotherapy-induced neuropathic symptoms. J Pain Symptom Manage, 2008, 35, p. 31–39.

36. Kemp, RA., Ronchese, F. Tumor-specific Tc1, but not Tc2, cells deliver protective antitumor immunity. J Immunol, 2001, 167, p. 6497–6502.

37. Kenne Sarenmalm, E., Browall, M., Gaston-Johansson, F. Symptom burden clusters: a challenge for targeted symptom management. A longitudinal study examining symptom burden clusters in breast cancer. J Pain Symptom Manage, 2014, 47, p. 731–741.

38. Kesler, S., Janelsins, M., Koovakkattu, D., et al. Reduced hippocampal volume and verbal memory performance associated with interleukin-6 and tumor necrosis factor-alpha levels in chemotherapy-treated breast cancer survivors. Brain Behav Immun, 2013, 30 Suppl., p. S109–S116.

39. Klein, GL., Petschow, BW., Shaw, AL., Weaver, E. Gut barrier dysfunction and microbial translocation in cancer cachexia: a new therapeutic target. Curr Opin Support Palliat Care, 2013, 7, p. 361–367.

40. Koenigsberg, HW., Teicher, MH., Mitropoulou, V., et al. 24-h monitoring of plasma norepinephrine, MHPG, cortisol, growth hormone and prolactin in depression. J Psychiatr Res, 2004, 38, p. 503–511.

41. Koga, C., Itoh, K., Aoki, M., et al. Anxiety and pain suppress the natural killer cell activity in oral surgery outpatients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2001, 91, p. 654–658.

42. Kudela, M., Hansmanová, L. Psychosomatické aspekty a léčba psychofarmaky v etiopatogenezi karcinomu endometria. Čes Gynek, 2014. s. 378–381.

43. Luppino, FS., de Wit, LM., Bouvy, PF., et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry, 2010, 67, p. 220–229.

44. Lutgendorf, SK., Lamkin, DM., DeGeest, K., et al. Depressed and anxious mood and T-cell cytokine expressing populations in ovarian cancer patients. Brain Behav Immun, 2008, 22, p. 890–900.

45. Martinucci, I., Blandizzi, C., de Bortoli, N., et al. Genetics and pharmacogenetics of aminergic transmitter pathways in functional gastrointestinal disorders. Pharmacogenomics, 2015, 16, p. 523–539.

46. Massie, MJ., Holland, JC. Depression and the cancer patient. J Clin Psychiatry, 1990, 51, Suppl., p. 12–7; discussion p. 8–9.

47. McCorkle, R., Pasacreta, J., Tang, ST. The silent killer: psychological issues in ovarian cancer. Holist Nurs Pract, 2003, 17, p. 300–308.

48. Meraner, V., Gamper, EM., Grahmann, A., et al. Monitoring physical and psychosocial symptom trajectories in ovarian cancer patients receiving chemotherapy. BMC Cancer, 2012, 12, p. 77.

49. Mielcarek, P., Nowicka-Sauer, K., Kozaka, J. Anxiety and depression in patients with advanced ovarian cancer: a prospective study. J Psychosom Obstet Gynaecol, 2016, 37, p. 57–67.

50. Nishimura, T., Iwakabe, K., Sekimoto, M., et al. Distinct role of antigen-specific T helper type 1 (Th1) and Th2 cells in tumor eradication in vivo. J Exp Med, 1999, 190, p. 617–627.

51. Olver, S., Groves, P., Buttigieg, K., et al. Tumor-derived interleukin-4 reduces tumor clearance and deviates the cytokine and granzyme profile of tumor-induced CD8+ T cells. Cancer Res, 2006, 66, p. 571–580.

52. Pasquini, M., Biondi, M. Depression in cancer patients: a critical review. Clin Pract Epidemiol Ment Health, 2007, 3, p. 2.

53. Pasquini, M., Biondi, M., Costantini, A., et al. Detection and treatment of depressive and anxiety disorders among cancer patients: feasibility and preliminary findings from a liaison service in an oncology division. Depress Anxiety, 2006, 23, p. 441–448.

54. Poole, EM., Lee, IM., Ridker, PM., et al. A prospective study of circulating C-reactive protein, interleukin-6, and tumor necrosis factor alfa receptor 2 levels and risk of ovarian cancer. Am J Epidemiol, 2013, 178, p. 1256–1264.

55. Raison, CL., Rutherford, RE., Woolwine, BJ., et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry, 2013, 70, p. 31–41.

56. Reiche, EM., Nunes, SO., Morimoto, HK. Stress, depression, the immune system, and cancer. Lancet Oncol, 2004, 5, p. 617–625.

57. Richards, S., Umbreit, JN., Fanucchi, MP., et al. Selective serotonin reuptake inhibitor-induced rhabdomyolysis associated with irinotecan. South Med J, 2003, 96, p. 1031–1033.

58. Roy, A., Pickar, D., De Jong, J., et al. Norepinephrine and its metabolites in cerebrospinal fluid, plasma, and urine. Relationship to hypothalamic-pituitary-adrenal axis function in depression. Arch Gen Psychiatry, 1988, 45, p. 849–857.

59. Scheppach, W. Effects of short chain fatty acids on gut morphology and function. Gut, 1994, 35, p. S35–S38.

60. Schouten, LJ., Rivera, C., Hunter, DJ., et al. Height, body mass index, and ovarian cancer: a pooled analysis of 12 cohort studies. Cancer Epidemiol Biomarkers Prev, 2008, 17, p. 902–912.

61. Segerstrom, SC., Miller, GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull, 2004, 130, p. 601–630.

62. Slovacek, L., Slanska, I., Slovackova, B., et al. Screening for depression in survivors of metastatic ovarian cancer in a programme of palliative cancer care. Bratislavske Lek Listy, 2009, 110, p. 655–659.

63. Smitka, K., Papezova, H., Vondra, K., et al. The role of „mixed“ orexigenic and anorexigenic signals and autoantibodies reacting with appetite-regulating neuropeptides and peptides of the adipose tissue-gut-brain axis: relevance to food intake and nutritional status in patients with anorexia nervosa and bulimia nervosa. Int J Endocrinol, 2013, 2013, p. 483145.

64. Sood, AK., Bhatty, R., Kamat, AA., et al. Stress hormone-mediated invasion of ovarian cancer cells. Clin. Cancer Res, 2006, 12, p. 369–375.

65. Spiegel, D. Cancer and depression. Brit J Psychiatry, 1996. p. 109–116.

66. Sudo, N., Chida, Y., Aiba, Y., et al. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J Physiol, 2004, 558, p. 263–275.

67. Tabano, M., Condosta, D., Coons, M. Symptoms affecting quality of life in women with gynecologic cancer. Semin Oncol Nurs, 2002, 18, p. 223–230.

68. Thaker, PH., Han, LY., Kamat, AA., et al. Chronic stress promotes tumor growth and angiogenesis in a mouse model of ovarian carcinoma. Nat Med, 2006, 12, p. 939–944.

69. Theobald, DE., Kirsh, KL., Holtsclaw, E., et al. An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. J Pain Symptom Manage, 2002, 23, p. 442–447.

70. Thompson, DS. Mirtazapine for the treatment of depression and nausea in breast and gynecological oncology. Psychosomatics, 2000, 41, p. 356–359.

71. Thornton, LM., Andersen, BL., Crespin, TR., Carson, WE. Individual trajectories in stress covary with immunity during recovery from cancer diagnosis and treatments. Brain Behav Immun, 2007, 21, p. 185–194.

72. Touchefeu, Y., Montassier, E., Nieman, K., et al. Systematic review: the role of the gut microbiota in chemotherapy – or radiation–induced gastrointestinal mucositis – current evidence and potential clinical applications. Aliment Pharmacol Ther, 2014, 40, p. 409–421.

73. Valentine, AD. Cancer pain and depression: management of the dual-diagnosed patient. Curr Pain Headache Rep, 2003, 7, p. 262–269.

74. Wang, XS., Shi, Q., Williams, LA., et al. Inflammatory cytokines are associated with the development of symptom burden in patients with NSCLC undergoing concurrent chemoradiation therapy. Brain Behav Immun, 2010, 24, p. 968–974.

75. Wang, Y., Kasper, LH. The role of microbiome in central nervous system disorders. Brain Behav Immun, 2014, 38, p. 1–12.

76. Watson, M., Haviland, JS., Greer, S., et al. Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet, 1999, 354, p. 1331–1336.

77. Whooley, MA., Simon, GE. Managing depression in medical outpatients. N Engl J Med, 2000, 343, p. 1942–1950.

78. Williams, AM., Shah, R., Shayne, M., et al. Associations between inflammatory markers and cognitive function in breast cancer patients receiving chemotherapy. J Neuroimmunol, 2018, 314, p. 17–23.

79. Williams, S., Dale, J. The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Brit J Cancer 2006, 94, p. 372–390.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account