Receiving psychotherapy for depression early was associated with a lower risk for cancer-related death in patients with cancer.

In an analysis of more than 265,000 older adults with common cancers, patients with major depressive disorder (MDD) who received psychotherapy within 1 month of their diagnosis had a 21% reduced risk for cancer-specific mortality compared with those who didn’t receive psychotherapy. Early intervention with medications was more common among participants in this study, with only 3% of patients with depression receiving psychotherapy within 4 weeks of diagnosis.

The findings suggest that prompt referral for psychotherapy could address an important gap in comprehensive cancer care, lead author Edmund Qiao, MD, radiation oncology resident at the University of California, San Diego, said.

“As providers, we have a lot of things that we want to get through in a cancer consult visit. I would stress for us to take a pause, too, and think about the whole patient, mind-body, as well as their cancer treatment,” Qiao told Medscape Medical News. “Early recognition is potentially the most impactful way to help with managing depression in the setting of cancer care.”

The abstract was presented on September 28 at the American Society for Radiation Oncology (ASTRO) 2026 Annual Meeting.

Around 1 in 4 patients with cancer experience depression. Yet, research suggests that mental health treatment remains underutilized among patients with cancer and comorbid depression.

In the new study, the investigators set out to assess the association between preexisting depression and cancer-specific mortality, as well as mental health treatment outcomes.

Using data from Surveillance, Epidemiology, and End Results-Medicare, the investigators included 254,029 patients (mean age, 75.4 years) in their analysis. Patients had breast, prostate, colorectal, bladder, or non-small cell lung cancer from 2010 to 2017.

Cases of MDD were defined using International Classification of Diseases (ICD), Ninth and 10th Revision codes. Antidepressant therapy and psychotherapy were identified using Medicare Part D claims and Current Procedural Terminology codes, respectively.

Multivariate Fine-Gray competing risk models were used to assess the effect of depression on cancer-specific deaths. Subhazard distribution ratios were used to control for non-cancer mortality as a competing risk for cancer mortality. Multivariate Fine-Gray models were also used to evaluate the association between the timing of depression treatment and cancer-specific mortality.

Among the 22% of patients in the sample with diagnosed MDD, almost two thirds did not receive mental health treatment within 8 weeks of their cancer diagnosis.

Patients with depression had an 11% higher risk for cancer-specific mortality than those without depression (P < .001).

Early intervention, particularly with psychotherapy, was associated with a lower risk for death. Psychotherapy within 4 weeks of cancer diagnosis was linked to a 21% reduced risk for cancer-specific mortality compared with that among patients with depression who did not receive psychotherapy (P < .001).

This risk reduction lessened as the time taken for mental health treatment to be introduced increased. At 8 weeks, psychotherapy was associated with a 13% lower risk, and at 12 weeks, a 12% lower risk than that among those who did not receive psychotherapy.

Antidepressant therapy was not significantly associated with lower cancer-specific mortality at any timepoints, without adjusting for individual cancer types. Yet, pharmacotherapy was more commonly used — 32.5% of patients with depression received antidepressants within 4 weeks of diagnosis.

Depression was most common among patients with non-small cell lung cancer. Although depression was least common among patients with prostate cancer, these patients showed the highest risk for cancer-specific mortality.

Psychotherapy was significantly associated with a lower risk for death from prostate, breast, and kidney cancer. Antidepressant therapy was significantly associated with a lower cancer-specific mortality only among patients with prostate cancer.

The study was limited by its retrospective design. In addition, the analysis was limited to older patients, and unmeasured factors may have affected outcomes.

Fumiko Chino, MD, who was not involved in the study, said the findings highlight important next steps for improving cancer care to ensure patients are fully supported during their diagnosis.

“The key finding that I thought was fascinating was that psychotherapy seemed to have more positive effects across broader populations and that it was really underutilized compared to medications,” Chino, radiation oncologist at The University of Texas MD Anderson Cancer Center in Houston, told Medscape Medical News.

One potential reason is that those who received psychotherapy might have been more motivated to improve their mental health, she added.

“The take-home message is that we believe that a greater individualization of depression management in cancer is necessary,” Qiao said. The type of cancer, prognosis, and treatment course can affect a patient’s mental health needs as well as which interventions might be the most beneficial, he noted.

Qiao and Chino reported no relevant disclosures. This was a nonfunded study.