Dual Eligibility, Comorbidity, and Anxiety Predict Late Depression in Cancer Survivors: JAMA
Late-onset depression is increasingly recognized as a major challenge in older cancer survivors, who show a higher prevalence of depression compared with the general population. As long-term survivorship continues to rise, identifying those at the highest risk becomes crucial for ensuring continuous psychological care. In a recent study, researchers found that Medicare–Medicaid dual eligibility, higher comorbidity burden, and preexisting anxiety independently increased the likelihood of late-onset depression, and this conclusion highlights the need to integrate these risk indicators into survivorship planning from the outset. The study was published in JAMA Network Open by Melissa T. and colleagues.
Researchers evaluated long-term survivors of breast, prostate, and colorectal cancer aged 66 years or older using linked SEER-Medicare data. Survivors were diagnosed between 2007 and 2012, and their outcomes were ascertained through 2020. The study examined sociodemographic factors, cancer-specific characteristics, comorbidities, and treatment exposures to estimate the risk of depression occurring 5-10 years after cancer diagnosis, identified via a validated claims-based algorithm.
This retrospective cohort study included 53,769 survivors enrolled in fee-for-service Medicare, representing 13,265 breast, 26,979 prostate, and 13,525 colorectal cancer survivors. All had no prior diagnosis of depression at baseline. Variables to be examined in this analysis include cancer type, treatment modalities (radiotherapy and androgen deprivation therapy), sociodemographics, comorbidities within one year before diagnosis, and any prior diagnosis of anxiety. Fine–Gray subdistribution hazard regression models were used to take into consideration competing mortality risk, and performed analyses separately for each cancer type. Analyses were done between August 2024 and July 2025.
Results
• The mean age of the study population was 74.1 years (SD 5.8); 61.9% were men, and the racial/ethnic distribution was: 4.4% Asian or Pacific Islander, 5.0% Hispanic, 7.3% non-Hispanic Black, 81.8% non-Hispanic White, and 1.5% other/unknown survivors.
The 5-year risk of late-onset depression varied according to cancer type:
• Breast cancer survivors: 13.3% (1768 of 13,265)
• Prostate cancer survivors: 8.7% (2360 of 26,979)
• Colorectal cancer survivors: 11.8% (1591 of 13,525)
• Whereas older age increased risk for some groups, including the prostate survivors aged ≥90 years of age (HR 1.57; 95% CI 1.10–2.24), in others it had no apparent association, such as colorectal survivors aged ≥90 years of age (HR 1.02; 95% CI 0.84–1.24).
The same three risk factors predicted late-onset depression across cancer types:
• Dual eligibility: HR 1.38 in breast survivors, 95% CI 1.22–1.57
• Previous anxiety: HR 2.82 in prostate survivors (95% CI 2.47–3.22)
• High comorbidity burden: HR 1.33 in breast survivors (95% CI 1.12–1.57)
• In survivors of prostate cancer, radiotherapy combined with or without androgen deprivation therapy also contributed to a higher risk of depression: HR 1.22; 95% CI 1.10–1.36.
This large population-based cohort study found that dual eligibility, high comorbidity burden, and pre-existing anxiety were independent predictors of late-onset depression in long-term cancer survivors, especially 5-10 years after the diagnosis of breast, prostate, or colorectal cancer.
Reference:
Taylor M, Westvold SJ, Long JB, et al. Risk of Late-Onset Depression in Long-Term Survivors of Breast, Prostate, and Colorectal Cancer. JAMA Netw Open. 2025;8(11):e2544812. doi:10.1001/jamanetworkopen.2025.44812
