Is your patient with bladder cancer blessed with long telomeres? If so, you can expect him to live many years with the disease – as long as he is not depressed, that is.
An intriguing observational study from the department of epidemiology at the University of Texas M.D. Anderson Cancer Center in Houston found that a magic combination of euthymia and telomere length translated into a staggering sixfold increase in survival in 464 patients with bladder cancer.
To put actual numbers to that, it means that depressed patients with short telomeres lived an average of 31.3 months – about 2.5 years – while those with no depression and long telomeres lived an astonishing 199.8 months, or 16.6 years.
Patients with short telomeres and high levels of depression had a threefold risk of mortality.
"This is the first study of its kind that analyzes bladder cancer outcomes," said Meng Chen, Ph.D., a coinvestigator on the study presented during the annual American Association for Cancer Research international conference on frontiers in cancer prevention research.
She continued, "Psychological factors are not usually included in epidemiologic studies," which, given the study results, begs the question, "Why not?"
Short telomeres have been previously identified as likely suspects in several biomarker studies of aging and diseases, including cancer. A press release from M.D. Anderson explained, "As people grow older, telomeres on the tips of chromosomes, which protect chromosomes from unraveling as cells replicate, shorten, and eventually fail, leading to cell death."
Are short telomeres the egg, presaging a bad outcome in bladder cancer patients, or the chicken, telegraphing damage already done? No one knows for sure. The jury isn’t in on the precise role telomeres play in disease progression, much less on how to alter the picture.
Stress has also been associated with shortened telomeres, prompting coauthor Jie Lin, Ph.D., to recommend that enhanced stress management be incorporated into cancer treatment.
It certainly makes sense.
Until telomere enhancement procedures become the rage, it seems prudent to me to identify the risk we now know exists – depression – and treat it well, in patients with bladder cancer and other forms of the disease.
Dr. Freed is a psychologist in Santa Barbara, Calif., and a medical journalist.