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Psychological morbidity and quality of life in women with advanced breast cancer: A cross-sectional survey

Published online by Cambridge University Press:  29 June 2006

BRENDA GRABSCH ,
DAVID M. CLARKE ,
ANTHONY LOVE ,
DEAN P. McKENZIE ,
RAYMOND D. SNYDER ,
SIDNEY BLOCH ,
GRAEME SMITH  and
DAVID W. KISSANE
BRENDA GRABSCH
Affiliation:
University of Melbourne Centre for Palliative Care, Departments of Medicine and Psychiatry, St. Vincent's Hospital and Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
DAVID M. CLARKE
Affiliation:
Monash University Department of Psychological Medicine, Monash Medical Centre, Clayton, Victoria, Australia
ANTHONY LOVE
Affiliation:
School of Psychological Sciences, LaTrobe University, Bundoora, Victoria, Australia
DEAN P. McKENZIE
Affiliation:
Monash University Department of Epidemiology & Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australia
RAYMOND D. SNYDER
Affiliation:
Department of Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
SIDNEY BLOCH
Affiliation:
University of Melbourne Centre for Palliative Care, Departments of Medicine and Psychiatry, St. Vincent's Hospital and Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
GRAEME SMITH
Affiliation:
Monash University Department of Psychological Medicine, Monash Medical Centre, Clayton, Victoria, Australia
DAVID W. KISSANE
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
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Abstract

Objective: Our purpose was to determine the frequency of psychiatric morbidity and to assess the quality of life of women with advanced breast cancer.

Methods: The 227 women in the sample were recruited in Melbourne, Australia, and were interviewed (prior to intervention) for a randomized controlled trial of supportive-expressive group therapy. The main outcome measures were DSM–IV psychiatric diagnoses plus quality of life data based on the EORTC QLQ-C30 (core) and QLQ-BR23 (breast module) instruments.

Results: Forty-two percent of the women (97/227) had a psychiatric disorder; 35.7% (81) of these had depression or anxiety or both. Specific diagnoses were minor depression in 58 women (25.6%), major depression in 16 (7%), anxiety disorder in 14 (6.2%), and phobic disorder in 9 (4%). Seventeen (7.5%) women had more than one disorder. In terms of quality of life, one-third felt less attractive, one-quarter were dissatisfied with their body image, and, in most, sexual interest had waned. Menopausal symptoms such as hot flashes affected less than one-third, whereas symptoms of lymphedema were experienced by 26 (11.5%).

Significance: Women with advanced breast cancer have high rates of psychiatric and psychological disturbance. Quality of life is substantially affected. Clinicians need to be vigilant in monitoring psychological adjustment as part of a comprehensive biopsychosocial approach.

Keywords

Advanced breast cancerDepressionAnxietyPsychosocial morbidityQuality of life
Type
Research Article
Information
Palliative & Supportive Care , Volume 4 , Issue 1 , March 2006 , pp. 47 - 56
Copyright
© 2006 Cambridge University Press

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References

REFERENCES

Aaronson, N.K., Ahmedzai, S., Bergman, B., et al. (1993). The European Organization for the Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365–376.Google Scholar
Altman, D.G., Machin, D., Bryant, T.N., et al. (eds). (2000). Statistics with confidence, 2nd ed. London: British Medical Journal.
American Joint Committee on Cancer. (1992). Manual for staging of cancer. In Manual for Staging of Cancer. Beahrs, O., Hensen, D., & Huttin, R. (eds.), p. 149. Philadelphia: Lippincott.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association Press.
Australian Bureau of Statistics. (1998). Mental health and wellbeing profile of adults: Australia 1997. Canberra: AGPS.
Australian Institute of Health and Welfare (AIHW) & Australasian Association of Cancer Registries (AACR). (2003). Cancer in Australia 2000. AIHW cat. no. CAN 18. Canberra: AIHW.
Beck, A.T. & Beck, R.W. (1972). Screening depressed patients in family practice: A rapid technic. Postgraduate Medicine, 52, 81–85.Google Scholar
Berard, R.M.F., Boermeester, F., & Viljoen, G. (1998). Depressive disorders in an out-patient oncology setting: Prevalence, assessment, and management. Psycho-Oncology, 7, 112–120.Google Scholar
Bryant, T. (2000). Confidence Interval Analysis Version 2 [Computer program]. Southampton: University of Southampton.
Bukberg, J., Penman, D., & Holland, J.C. (1984). Depression in hospitalized cancer patients. Psychosomatic Medicine, 46, 199–212.Google Scholar
Burgess, C.C., Ramirez, A.J., Richards, M.A., et al. (2002). Does the method of detection of breast cancer affect subsequent psychological morbidity? European Journal of Cancer, 38, 1622–1625.Google Scholar
Clarke, D.M., Smith, G.C., Herrman, H.E., et al. (1998). Monash Interview for Liaison Psychiatry (MILP): Development, reliability, and procedural validity. Psychosomatics, 39, 318–328.Google Scholar
Cull, A., Sprangers, M., Bjordal, K., et al. (2003). EORTC QLQ-C30 Reference Values. Brussels: The European Organization for the Research and Treatment of Cancer. Available at: http://www.eortc.be/home/qol/Manuals1.htm.
Dean, C. (1987). Psychiatric morbidity following mastectomy: Preoperative predictors and types of illness. Journal of Psychosomatic Research, 31, 385–392.Google Scholar
Derogatis, L.R. (1992). The Affects Balance Scale. Baltimore: Clinical Psychometric Research.
Derogatis, L.R., Morrow, G.R., Fetting, J., et al. (1983). The prevalence of psychiatric disorders among cancer patients. JAMA, 249, 751–757.Google Scholar
Devine, E.C. & Westlake, S.K. (1995). The effects of psychoeducational care provided to adults with cancer: Meta-analysis of 116 studies. Oncology Nursing Forum, 22, 1369–1381.Google Scholar
Ellman, R. & Thomas, B.A. (1995). Is psychological wellbeing impaired in long-term survivors of breast cancer? Journal of Medical Screening, 2, 5–9.Google Scholar
Epstein, N.B., Baldwin, L.M., & Bishop, D.S. (1983). The McMaster Family Assessment Device. Journal of Marital Family Therapy, 9, 171–180.Google Scholar
Feifel, H., Strack, S., & Nagy, V.T. (1987). Coping strategies and associated features of medically ill patients. Psychosomatic Medicine, 49, 616–625.Google Scholar
Foot, G. & Sanson-Fisher, R. (1995). Measuring the unmet needs of people living with cancer. Cancer Forum, 19, 131–135.Google Scholar
Fulton, C. (1998). The prevalence and detection of psychiatric morbidity in patients with metastatic breast cancer. European Journal of Cancer Care, 7, 232–239.Google Scholar
Hakamies-Blomqvist, L., Luoma, M.L., Sjostrom, J., et al. (2000). Quality of life in patients with metastatic breast cancer receiving either docetaxel or sequential methotrexate and 5-fluorouracil. A multicentre randomised phase III trial by the Scandinavian Breast Group. European Journal of Cancer, 3, 1411–1417.Google Scholar
Hall, A., Fallowfield, L., & A'Hern, R. (2000). When breast cancer recurs: A three year prospective study of psychological morbidity. Breast, 2, 197–203.Google Scholar
Hopwood, P., Howell, A., & Maguire, P. (1991). Screening for psychiatric morbidity in patients with advanced breast cancer: Validation of two self-report questionnaires. British Journal of Cancer, 64, 353–356.Google Scholar
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective distress. Psychosomatic Medicine, 41, 209–218.Google Scholar
Hughson, A.V.M., Cooper, A.F., McArdle, C.S., et al. (1988). Psychosocial consequences of mastectomy: Levels of morbidity and associated factors. Journal of Psychosomatic Research, 32, 383–391.Google Scholar
Jenkins, P.L., May, V.E., & Hughes, L.E. (1991). Psychological morbidity associated with the local recurrence of breast cancer. International Journal of Psychiatry in Medicine, 21, 149–155.Google Scholar
Kissane, D.W. & Bloch, S. (2002). Family Focused Grief Therapy: A Model of Family-Centred Care During Palliative Care and Bereavement. Buckingham: Open University Press.
Kissane, D.W., Bloch, S., Burns, W.I., et al. (1994). Perceptions of family functioning and cancer. Psycho-Oncology, 3, 259–269.Google Scholar
Kissane, D.W., Clarke, D.M., Ikin, J., et al. (1998). Psychological morbidity and quality of life in Australian women with early breast cancer: A cross-sectional survey. Medical Journal of Australia, 169, 192–196.Google Scholar
Kramer, J.A., Curran, D., Piccart, M., et al. (2000). Randomised trial of paclitaxel versus doxorubicin as first-line chemotherapy for advanced breast cancer: Quality of life evaluation using the EORTC QLQ-C30 and the Rotterdam Symptom Checklist. European Journal of Cancer, 36, 1488–1497.Google Scholar
McLachlan, S.A., Devins, G.M., & Goodwin, P.J. (1998). Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) as a measure of psychological functioning in breast cancer. European Journal of Cancer, 34, 510–517.Google Scholar
Meyer, T.J. & Mark, M.M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomised experiments. Health Psychology, 14, 101–108.Google Scholar
National Breast Cancer Centre Advanced Breast Cancer Working Group. (2001). Clinical Practice Guidelines for the Management of Advanced Breast Cancer. Canberra: National Health and Medical Research Council.
National Breast Cancer Centre and National Cancer Control Initiative. (2003). Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer. Camperdown, NSW: National Breast Cancer Centre.
Newcombe, R.G. (1998). Two-sided confidence intervals for the single proportion: Comparison of seven methods. Statistics in Medicine, 17, 857–872.Google Scholar
Pinder, K.L., Ramirez, A.J., Black, M.E., et al. (1993). Psychiatric disorder in patients with advanced breast cancer: Prevalence and associated factors. European Journal of Cancer, 29A, 524–527.Google Scholar
Ramirez, A.J., Richards, M.A., Jarrett, S.R., et al. (1995). Can mood disorder in women with breast cancer be identified preoperatively? British Journal of Cancer, 72, 1509–1512.Google Scholar
Razavi, D., Delvaux, N., Farvacques, C., et al. (1990). Screening for adjustment disorder and major depressive illness in cancer in-patients. British Journal of Psychology, 156, 79–83.Google Scholar
Riccardi, A., Tinelli, C., Brugnatelli, S., et al. (2000). Doubling of the epirubicin dosage within the 5-fluorouracil, epirubicin and cyclophosphamide regimen: A prospective, randomized, multicentric study on antitumor effect and quality of life in advanced breast cancer. International Journal of Oncology, 16, 769–776.Google Scholar
Roberts, C.S., Cox, C.E., Reintgen, D.S., et al. (1994). Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making. Cancer, 74, 336–341.Google Scholar
Sheard, T. & Maguire, P. (1996). The effect of psychological interventions on anxiety and depression in oncology: Results of two meta-analyses. Psycho-Oncology, 5, 19.Google Scholar
Spiegel, D., Bloom, J.R., Kraemer, H.C., et al. (1989). Effect of psychosocial treatments on survival of patients with metastatic breast cancer. Lancet, 2, 888–891.Google Scholar
Sprangers, M.A.G., Groenvold, M., Arraras, J.L., et al. (1996). The European Organization for the Research and Treatment of Cancer breast cancer specific quality-of-life questionnaire module: First results from a three country field study. Journal of Clinical Oncology, 14, 2756–2768.Google Scholar
SPSS Inc. (1999). SPSS for Windows Version 9.0.1 [Computer program]. Chicago: SPSS Inc.
Toms, J.R. (ed.) (2004). Cancer Stats Monograph. London: Cancer Research UK.
U.S. Cancer Statistics Working Group. (2005). United States Cancer Statistics: 1999–2002. Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Available at: www.cdc.gov/cancer/npcr/uscs.
Watson, M., Greer, S., & Bliss, J.M. (1989). Mental Adjustment to Cancer (MAC) Scale Users' Manual. Surrey, UK: CRC Psychological Medicine Research Group.
Watson, M., Law, M., dos Santos, M., et al. (1994). The Mini-MAC: Further development of the Mental Adjustment to Cancer Scale. Journal of Psychsocial Oncology, 12, 33–46.Google Scholar
Wilson, E.B. (1927). Probable inference, the law of succession, and statistical inference. Journal of the American Statistical Association, 22, 209–212.Google Scholar
Wilson, K.A., Dowling, A.J., Abdolell, M., et al. (2000). Perception of quality of life by patients, partners and treating physicians. Quality of Life Research, 9, 1041–1052.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar