Depression is common among cancer patients, impacting roughly 1 in 4 people diagnosed with the disease. It can strike patients at different stages, as well, including after treatment is over. A new study shows this common experience may also significantly impact mortality risk.

Research recently published in the journal Brain Sciences investigated how depression may impact breast cancer survivors long-term. Using data from the U.S. National Health and Nutrition Examination Survey and the National Death Index, the study showed that having either condition increased the risk of dying, but the risk was even higher if a person had both breast cancer and depression. The research team says this shows a need for a more collaborative and comprehensive treatment regimen for cancer.

Jagdish Khubchandani, lead researcher and professor of public health sciences at New Mexico State University, says, “The combination is what makes the risk of death increase tremendously and leads to thousands of years of life lost. We found in our study that the co-occurrence of depression further reduces survival among women with breast cancer. Unfortunately, many women with breast cancer do not get timely or quality care for mental health issues such as depression.”

Of the more than 4,700 women aged 45 older included in the study, 5.1% had breast cancer and 12.7% had depression. After a follow-up period of about 7.5 years, the researchers found that those with only breast cancer or depression were about 1.5 times more likely to die than those without either. However, when a patient had both conditions, their risk of dying was more than three times higher than their unimpacted peers. This was true even after accounting for possible contributing factors.

The researchers did find, though, that certain characteristics were more common in those with breast cancer and depression who had died. Those included lower income and education levels, being a racial or ethnic minority, and having other chronic diseases or behaviors that can already contribute to mortality risk.

The team says their findings show that screening for depression in breast cancer survivors, and treating it if found, may be helpful. It also highlights the importance of addressing both physical and psychosocial health needs in high-risk breast cancer patients.

Khubchandani says, “We all know or will know someone with breast cancer in our lifetimes. Most likely, they will have poor psychological health or lower quality of life. It is in part because we do not have a comprehensive approach to health care for women with cancer.”

If you’re a cancer patient dealing with depression, the American Cancer Society says you should be honest with your care team about how you’re feeling. They may be able to refer you to someone who can provide therapy or medication that can help. Read more here.