Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey

Quality of life three months and one year after first treatment for early stage breast cancer: influence of treatment and patient characteristics

This paper reports the quality of life (QoL) of a large cohort of Australian women three and twelve months after surgery for early stage breast cancer (ESBC), and shows that the impact of disease and treatment on QoL differed by age, education and marital status. Eighty-three percent of eligible patients were recruited; 86% had breast conserving surgery and 14% mastectomy. Response rates were 93% (n = 305) at three months and 88% (n = 291) at one year. Quality of life was measured with the EORTC core questionnaire (QLQ-C30) and an ESBC-specific questionnaire. Multilevel analysis was used to estimate the effects and interactions of time, treatment and patient characteristics. Most symptoms declined between three months and one year, but arm and menopausal symptoms persisted. Emotional, social and role functioning improved over time, and fear of disease recurrence diminished. Younger women faired worse than older women on a broad range of QoL dimensions. Single women and those with less education faired worse on a number of dimensions. The negative impact of mastectomy on body image was greatest among married women, particularly young married women. These sociodemographic distinctions are relevant when discussing treatment options with women facing a diagnosis of ESBC.

Predicting mood disorders in breast cancer patients

Prediction of delayed psychiatric disorders in breast cancer patients by using a screening procedure was investigated. Two questionnaires, the Psychological Distress Inventory and the Hospital Anxiety and Depression Scale, were administered before and during chemotherapy, and at the first follow-up visit. A psychiatric diagnosis was assigned to 50 of the 132 patients (38%) evaluated at follow-up. Including a set of clinical and demographic variables in a logistic regression, increasing age (P=0.001) and psychiatric history (P<0.001) were associated with psychiatric morbidity at follow-up. The accuracy of the two questionnaires in predicting delayed psychiatric disorders increased from the evaluation before chemotherapy to the evaluation during chemotherapy. The most accurate prediction was observed for the concurrent evaluation at follow-up. The accuracy of three predictive models developed for each evaluation point by including age, psychiatric history and psychological distress measured with each of the two questionnaires was not significantly better than that observed using only the questionnaires' scores as predictors.

Anxiety in cancer patients

Anxiety is common in cancer patient populations, and must often initially be recognized and managed by cancer care professionals. This article reviews the recent oncology and mental health literature on anxiety. The aim is to help those involved in cancer patient care who are not specialists in mental health to understand the nature of anxiety, and discriminate morbid from normal anxiety. We review recent research into the association of anxiety with events during diagnosis and management of cancer, highlighting the importance of the meaning of events to an individual as an important factor in making people anxious. Lastly we review management strategies which might be used by cancer care professionals, in particular the importance of an awareness of specific patterns of communication which may alleviate or maintain anxiety for some cancer patients.

Prevalence of psychological distress and use of support services by cancer patients at Sydney hospitals

OBJECTIVE

The study aimed to estimate the prevalence of anxiety and depression within a cross section of cancer patients in the Sydney region, and to assess the use of and degree of satisfaction with available support services.

METHOD

A survey was conducted at oncology outpatient departments of four Sydney hospitals. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a questionnaire seeking information on their use of patient support services, as well as demographic and clinical information.

RESULTS

A total of 504 valid questionnaires were returned. Using a cut-off score of 11 on the HADS, the prevalence of clinically significant anxiety and depression was 11.5% and 7.1% respectively; 17% of patients had received individual counselling while 6.5% had attended support groups. The majority of patients who had attended counselling or support groups reported them to have been 'extremely' or 'reasonably' helpful (86% and 83% respectively). Of the patients who were experiencing clinically significant anxiety or depression, 75% had not received any counselling or psychological treatment. The main factors which predicted clinically significant anxiety or depression were: restricted activity levels, advanced disease, a non-English-speaking background and being female.

CONCLUSIONS

While the prevalence of clinically significant anxiety or depression detected by the HADS was reasonably low, a substantial number of possible cases were identified. The majority of affected patients were not accessing counselling or psychological treatment. Systematic screening of oncology patients at hospital entry might enable more immediate identification of clinically affected patients, who could then be referred for further testing or psychological treatment.

Psychotherapies in psycho-oncology. An exciting new challenge

BACKGROUND

There is ample scope to devise forms of psychotherapy in consultation-liaison psychiatry, including the newly evolving area of psycho-oncology.

AIMS

To highlight the development of psychotherapy in psycho-oncology, providing two illustrations.

METHOD

We report on conceptual and clinical research in the context of oncology and palliative care, focusing on (a) an approach for families at risk of maladaptive bereavement; and (b) a group programme for women newly diagnosed with early-stage breast cancer.

RESULTS

We were able to introduce new forms of psychological treatment for specific clinical groups, and anecdotal evidence points to useful benefits for participants.

CONCLUSIONS

Psychotherapists should grasp the opportunity to bring their skills to the medical arena, but need to subject newly devised interventions to well-designed and methodologically rigorous research.

The emerging role of the breast care nurse in Australia

It is well documented that educated breast care nurses can provide essential support and information to empower a woman with breast cancer to participate in treatment decisions and take more control over her health and life. An evaluation of Breast Cancer Support Services, a dynamic unit within the Anti-Cancer Council of Victoria, Australia, conducted in 1994, recommended that breast cancer support service nurses should increase their knowledge of breast cancer treatment and management throughout the whole continuum from diagnosis to death. Greater knowledge would enhance the nurse's role as a vital member of a multidisciplinary team and a resource to women experiencing breast cancer at any stage in their journey. Acting on these recommendations, the Anti-Cancer Council of Victoria, in conjunction with La Trobe University, designed and developed the first national, tertiary-level training program for breast care nurses. The Breast Cancer Distance Education program, which has graduates from all states in Australia, has been accredited by the Royal College of Nursing and positively evaluated by the Centre for Behavioural Research in Cancer. The evaluation found that students rated the course highly, and many planned to change their nursing practice as a result of taking the course. Accredited breast care nurses are taught to use accurate and up-to-date information in combination with advanced communication skills. They do not hesitate to confer with other members of the multidisciplinary team to ensure that women with breast cancer receive the individualized support and continuity of care they deserve.