Major Depression in Breast Cancer Patients with Ovarian Function Suppression: A Cross-Sectional Study Comparing Ovarian Ablation and Gonadotropin-Releasing Hormone Agonists

Abstract Purpose: We examined whether there were differences in major depression outcomes and independent risk factors associated with gonadotropin-releasing hormone agonists (GnRHa) and ovarian ablation (OA) in premenopausal breast cancer patients. Methods: Premenopausal breast cancer patients from seven hospitals who received OFS participated in the study between June 2019 and June 2020. The independent variable was the type of ovarian suppression, categorized as either OA (n = 174) or GnRHa (n = 389). Major depression was evaluated using the Patient Health Questionnaire (PHQ-9), and the Female Sexual Function Index questionnaire was used to assess sexual function.Results: A total of 563 patients completed the surveys. The mean PHQ-9 sum score was slightly lower in the GnRHa cohort than in the OA cohort (11.4 ± 5.7 vs. 12.8 ± 5.8, P = 0.079). There were significantly fewer patients with major depression (PHQ-9 ≥ 15) in the GnRHa cohort (31.1% vs. 40.2%, P = 0.025). Further, the duration of OFS was closely correlated with major depression, indicating a time-dependent trend [duration of OFS > 2 years vs. duration of OFS ≤ 2 years: Exp (B) = 1.651, P = 0.031]. Sexual dysfunction was negatively correlated with major depression [sexual dysfunction vs. normal: Exp (B) = 0.769, P = 0.046].Conclusions: This is the first study to demonstrate that GnRHa results in more favorable depression outcomes than OA. Moreover, most patients preferred alternatives to their OFS treatment. These findings can contribute to improving and alleviating the adverse effects of OFS.