Lifetime stressor exposure and depression among patients with pancreatic cancer: insights from the Florida Pancreas Collaborative.

BACKGROUND: Although depression is reported to be higher among patients with pancreatic cancer than in the general population, research on depression and stress levels in this population is limited. METHODS: To address this gap, we investigated the prevalence of self-reported depression and lifetime stressor exposure in a cohort of treatment-naïve patients with pancreatic ductal adenocarcinoma (PDAC) or other types of pancreatic tumors such as pancreatic neuroendocrine tumors and intraductal papillary mucinous neoplasms who received care at one of 15 institutions participating in the multi-institutional study Florida Pancreas Collaborative. Depression severity was assessed using the Edmonton Symptom Assessment System-revised (ESAS-r) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC), and acute and chronic stressor exposure was assessed with the Stress and Adversity Inventory (STRAIN). RESULTS: PDAC patients reported higher average depression symptom severity at the time of diagnosis and after 6 months compared to non-PDAC patients (p = 0.027 and p = 0.063, respectively). On the other hand, non-PDAC patients experienced a higher mean number and severity of lifetime stressors (p = 0.021 and p = 0.039, respectively) than PDAC patients. Across the sample, greater stressor exposure (measured by stressor count, severity, and event type) was associated with higher odds of clinically significant depressive symptoms. We also observed that chronic stressors were significantly associated with lower odds of advanced disease (OR = 0.896, p = 0.002). Among PDAC patients who completed both STRAIN and ESAS-r (n = 52), greater severity of acute life events was associated with a significant increase in ESAS-r depression scores between baseline and 6-month follow-up (p = 0.015). CONCLUSIONS: These findings highlight distinct patterns of depression and stress across pancreatic tumor types and reveal a robust association between lifetime stress exposure and depressive symptoms. Together, they underscore the need for systematic screening and integrated psychosocial support for patients with pancreatic cancer.