Abstract
Objectives: To investigate the prevalence of, and risk factors for psychological distress following first recurrences of breast cancer.
Patients and methods: The sample was drawn consecutively from the inpatient and outpatient populations of the National Cancer Center Hospital in Japan during an 18-month period from July 1996 to December 1997. Of the 56 eligible patients, 55 women aged 30–73 year with recurrent breast cancer participated in the study. The prevalence of psychological distress, including major depressive disorder and adjustment disorders was evaluated according to the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Third edition-revised (DSM-III-R). Risk factors for psychological distress were analyzed with a logistic regression model.
Results: Of the 55 subjects, 42 met the DSM-III-R criteria for major depressive disorder or adjustment disorders. Major depressive disorder was seen in 4 (7%), and adjustment disorders in 19 (35%). Logistic regression analysis showed that a disease-free interval of less than 24 months significantly predicted a diagnosis of major depressive disorder or adjustment disorders (odds ratio 5.28, 95% confidence interval; 1.28–21.8, p=0.02).
Conclusions: These results suggest that it is important for all oncology staff to pay careful attention to the psychological health of patients who have been informed of their cancer recurrence, and that some psychosocial intervention is necessary for preventing distress in patients facing early recurrence.
Similar content being viewed by others
References
Baile WF, Bilbertini M, Scott L, Endicott J: Depression and tumor stage in cancer of the head and neck. Psycho Oncol 1: 15–24, 1992
Burkberg J, Penman D, Holland JC: Depression in hospitalized cancer patients. Psychosom Med 46: 199–212, 1984
Chochinov HM, Wilson KG, Enns M, Lander S: Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgements. Am J Psychiatry 151: 537–540, 1994
Devlen J, Maguire P, Phillips P, Crowther D, Chamblers H: Psychological problems associated with diagnosis and treatment of lymphomas, I: retrospective study. BMJ 295: 953–954, 1987
Fallowfield LJ, Hall A, Maguire GP, Baum M: Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ 301: 575–580, 1990
Goldberg JA, Scott RN, Davidson PM, Murray GD, Stallard S, George WD, Maguire GP: Psychological morbidity in the first year after breast surgery. Eur J Surg Oncol 18: 327–331, 1992
Hopwood P, Howell A, Maguire P: Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer 64: 349–352, 1991
Lynch ME: The assessment and prevalence of affective disorders in advanced cancer. J Palliative Care 11: 10–18, 1995
Alexander PJ, Dinesh N, Vidyasagar MS: Psychiatric morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome. Acta Oncol 32: 623–626, 1993
Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CLM: The prevalence of psychiatric disorders among cancer patients. JAMA 249: 751–757, 1983
Okamura H, Akechi T, Kugaya A, Mikami I, Okuyama T, Nakano T, Kagaya A, Yamawaki S, Uchitomi Y: Depression in patients with advanced cancer. In: Eguchi K, Klastersky J, Feld R (eds) Current Perspectives and Future Directions in Palliative Medicine. Springer-Verlag, 1998, pp 67–76
Cella DF, Mahon SM, Donovan MI: Cancer recurrence as a traumatic event. Behav Med 16: 15–22, 1990
Mahon SM, Cella DF, Donovan MI: Psychosocial adjustment to recurrent cancer. Oncol Nurs Forum 17: 47–52, 1990
Jenkins PL, May VE, Hughes LE: Psychological morbidity associated with local recurrence breast cancer. Int J Psychiatry in Medicine 21: 149–155, 1991
Silberfarb PM, Maurer LH, Crouthamel CS: Psychosocial aspects of neoplastic disease: I. Functional status of breast cancer patients during different treatment regimens. Am J Psychiatry 137: 450–455, 1980
Breitbart W: Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer 3: 45–60, 1995
Weisman AD, Worden JW: The existential plight in cancer: significance of the first 100 days. Int J Psychiatry in Medicine 7: 1–15, 1976- 77
Maunsell E, Brisson J, Deschenes L: Social support and survival among women with breast cancer. Cancer 76: 631–637, 1995
Spitzer RL, Williams JBW, Gibbon M, First MB: Structured Clinical Interview for DSM-III-R (SCID). American Psychiatric Press, Washington, DC, 1990
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Revised Edition. American Psychiatric Press, Washington, DC, 1987
McNair DM, Lorr M, Droppleman LF: Manual for the Profile of Mood States (POMS). Educational and Industrial Testing Service, San Diego, 1971
Yokoyama K, Araki S, Kawakami N, Takeshita T: Production of the Japanese edition of profile of mood states (POMS): assessment of reliability and validity (in Japanese). Jpn J Public Health 37: 913–918, 1990
Robertson JF, Dixon AR, Nicholson RI, Ellis IO, Elston CW, Blamey RW: Confirmation of a prognostic index for patients with metastatic breast cancer treated by endocrine therapy. Breast Cancer Res Treat 22: 221–227, 1992
Yamamoto N, Watanabe T, Katsumata N, Omuro Y, Ando M, Fukuda H, Tokue Y, Narabayashi M, Adachi I, Takashima S: Construction and validation of a practical prognostic index for patients with metastatic breast cancer. J Clin Oncol 16: 2401–2408, 1998
Ibbotson T, Maguire P, Selby P, Priestman T, Wallace L: Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 30A: 37–40, 1994
Zabora JR, Smith-Wilson R, Fetting JH, Enterline JP: An ef-ficient method for psychosocial screening of cancer patients. Psychosomatics 31: 192–196, 1990
Cella DF, Jacobsen PB, Orav EJ, Holland JC, Silberfarb PM, Rafla S: A brief POMS measure of distress for cancer patients. J Chronic Dis 40: 939–943, 1987
McNair DM, Lorr M, Droppleman LF: Manual for the Profile of Mood States (POMS), Revised. Educational and Industrial Testing Service, San Diego, 1992
Shacham S: A shortened version of the Profile ofMood States. J Pers Assess 47: 305–306, 1983
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Okamura, H., Watanabe, T., Narabayashi, M. et al. Psychological distress following first recurrence of disease in patients with breast cancer: prevalence and risk factors. Breast Cancer Res Treat 61, 131–137 (2000). https://doi.org/10.1023/A:1006483214678
Issue Date:
DOI: https://doi.org/10.1023/A:1006483214678