Psychological characteristics and subjective symptoms as determinants of psychological distress in patients prior to breast cancer diagnosis

The Effect of Targeted Ultrasound as Primary Imaging Modality on Quality of Life in Women with Focal Breast Complaints: A Comparative Cohort Study

Background: The high diagnostic performance of modern breast ultrasound (US) opens the possibility to shift toward targeted US as initial imaging test in women with breast complaints. This comparative cohort study investigates the effects of starting with US followed by digital breast tomosynthesis (DBT), as practiced in the breast ultrasound study (BUST), on women's health-related quality of life (QoL). Methods: Fifty BUST participants and 50 "controls" who underwent DBT and US in regular order filled out the EQ-5D-3L three times during their visit: BUST participants before US (T1), after US (T2), and after DBT (T3) and non-BUST participants before DBT (T1), after DBT (T2), and after US (T3). Changes in QoL from baseline to T2 and T3 were assessed using generalized least squares, also taking into account the effects of biopsy, age, and complaint type. Results: Participants' mean age was 50.6 years (BUST: SD = 12.1, controls: SD = 11.5). At T2 the overall QoL was higher [t(102.9) = 2.4, p = 0.017] and anxiety levels were lower [t(98.7) = -2.4, p = 0.020] in BUST participants compared with controls. However, from T2 to T3 these effects equalize, resulting in similar performances in QoL and anxiety at T3, respectively [t(97.6) = -2.3, p = 0.023] and [t(97.2) = 3.1, p = 0.002]. Compared with BUST participants, controls show a clear decrease in pain after US [t(106.5) = -2.8, p = 0.006]. Women undergoing biopsy had lower QoL [t(167.1) = -2.4, p = 0.017] and pain [t(154.1) = -2.1, p = 0.038], and more anxiety [t(187.4) = 4.3, p = 0.000]. Conclusions: The results suggest that changing the radiological order by starting with US has a short-term positive effect on overall QoL, anxiety, and DBT pain experience in symptomatic women. Owing to its negative impact, biopsies should be performed cautiously. In conclusion, the moment of reassurance for women advances by reversing the radiological order according to the BUST, showing the high importance of human interaction in diagnostic care in addition to the clinical performance of imaging modalities.

Prevalence of depression, trait anxiety, and social support during the diagnostic phases of breast cancer

Objective

This study aims to determine the prevalence of depression, trait anxiety, and social support among women suspected of breast cancer (BC) and to investigate the association of these factors with the diagnosis of BC.

Methods

A cross-sectional study was conducted on 745 women who presented with breast symptoms in a university breast clinic in Malaysia. Participants were instructed to respond to self-report questionnaires on depression, trait anxiety, and social support while they were waiting for assessment of their suspected BC. The final diagnoses of these patients were traced one month after examining their medical records. Descriptive statistics were performed to examine the socio-demographic and clinical characteristics of all participants. A multiple regression analysis was carried out to determine the association of the abovementioned factors with the diagnosis of BC.

Results

The analysis showed that BC was diagnosed in 109 (14.6%), benign breast disease (BBD) in 550 (73.8%), and healthy breast (HB) in 86 (11.5%) women. The prevalence of depression was 53.2% in women with BC, 53.6% in women with BBD, and 60.5% in women with HB prior to diagnosis. The prevalence of trait anxiety was 33%. Mean scores for trait anxiety were 42.2 ± 9.0 and 41.8 ± 9.1 for the BC group and BBD group, respectively. The level of perceived social support was similar in all three groups.

Conclusion

We found no significant difference in depression, trait anxiety, and social support among women with newly diagnosed BC, BBD, and HB in women with breast symptoms while undergoing diagnostic evaluation. A longitudinal study is essential to establish the association between chronic mental stress and BC.

Psychometric properties of the Chinese version of the Courtauld Emotional Control Scale in women newly diagnosed with breast cancer

PURPOSE

Emotional control, the attempt to suppress the expression of negative effects, is an essential factor in the prevalence of psychological distress in women with breast cancer. The Courtauld Emotional Control Scale (CECS) is a commonly used self-report tool for assessing emotional suppression in both clinical and general groups. This study aimed to validate the Chinese version of the Courtauld Emotional Control Scale (CECS) in women newly diagnosed with breast cancer.

METHODS

The study involved 680 women newly diagnosed with breast cancer aged 25 to 76 (mean age = 48.19, standard deviation (SD) = 8.57) from Changsha (China). Data analysis included Cronbach's alpha coefficients, the intraclass correlation coefficient (ICC), Pearson's correlations, Independent-Samples T test, confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were conducted to determine the optimal model. For the best fitting model stability was assessed with tests for invariance across age, educational level, and employment status.

RESULTS

Internal consistency (α = 0.987) and test-retest reliability (ICC = 0.715) of the CECS were presented. Results confirm the structure of the Chinese version of the CECS with 21 items divided into three dimensions, anger suppression (CECS_AG), depression suppression (CECS_MD), and anxiety suppression (CECS_AX). Convergent and known-groups validity were acceptable. Additionally, this model remained invariant across age, educational levels, and employment status.

CONCLUSIONS

The Chinese version of the CECS has good psychometric properties in terms of reliability and validity, remaining invariant across age, educational levels, and employment status in women newly diagnosed with breast cancer.

Depression and anxiety in pet owners after a diagnosis of cancer in their pets: a cross-sectional study in Japan

OBJECTIVE

To determine the presence and predictors of depression and anxiety in pet owners after a diagnosis of cancer in their pets.

DESIGN

Cross-sectional study.

SETTING

A veterinary medical centre specialised in oncology for dogs and cats and two primary veterinary clinics in Japan.

PARTICIPANTS

The participants for analysis were 99 owners of a pet with cancer diagnosis received in the past 1-3 weeks and 94 owners of a healthy pet.

MAIN OUTCOME MEASURES

Self-reported questionnaires were used to assess depression and anxiety. Depression was assessed using the Center of Epidemiologic Studies Depression Scale, and anxiety was measured by using the State-Trait Anxiety Inventory-Form JYZ.

RESULTS

Depression scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders (p<0.001). Within the owners of a pet with cancer, depression was significantly more common in those who were employed than those who were unemployed (p=0.048). State anxiety scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders, including trait-anxiety scores (p<0.001). Furthermore, in owners of a pet with cancer, state anxiety was higher in owners with high trait anxiety (p<0.001) and in owners whose pets had a poor prognosis (p=0.027).

CONCLUSION

The results indicate that some owners tended to become depressed and anxious after their pets had received a diagnosis of cancer. Employment may be a predictor of depression. High trait anxiety and a pet with a poor prognosis may increase owners' state anxiety. Including the pet in a family genogram and attention to the pet's health condition may be important considerations for family practice.

The level of emotion control, anxiety, and self-efficacy in the elderly in Bialystok, Poland

PURPOSE

The aim of the study was to assess the level of emotion control, anxiety, and self-efficacy in the inhabitants of Bialystok (Poland) aged above 60.

PATIENTS AND METHODS

The study included 300 people above the age of 60, inhabitants of Bialystok and its neighborhoods: 100 residents of public nursing home, 100 participants of the University of the Third Age in Bialystok, and 100 students of the University of Healthy Senior. The three standardized psychometric scales were used in the study: Courtauld Emotional Control Scale (CECS), State-Trait Anxiety Inventory (STAI), and General Self-Efficacy Scale (GSES).

RESULTS

The median of the overall score of CECS equaled 54 points, which is considered average in terms of negative emotions acceptance. The mean score of perceiving anxiety as the condition of STAI (X1) was 48 points, while anxiety as a trait of STAI (X2) was 49 points. The overall score for GSES proved that respondents had a subjective feeling of self-efficacy at the level of 29 points out of 40 points possible, which means that their self-efficacy was rather at the high level in their self-assessment. In women, a negative correlation was revealed between the sense of self-efficacy and age (r=-0.320, P<0.001). Analyzing the study group affiliation of respondents, a negative correlation was reported between the sense of self-efficacy and age among the elderly residents of public nursing home (r=-0.408, P<0.001). Taking into consideration the study group affiliation of respondents, a positive correlation between anger control (CECS) and the sense of anxiety as a trait of STAI (X2) was found among participants of the University of Healthy Senior (r=0.307, P=0.002).

CONCLUSION

The social and demographic features (gender, group affiliation, age) analyzed in the study were found to be correlated significantly with the control of negative emotions, the level of anxiety, and self-efficacy. The study group affiliation was a key variable conditioning the relations between the analyzed features. The elderly residents of public nursing home belonged to the group distinguishing negatively compared to other two study groups. The study respondents were characterized by the relatively high perception of anxiety, which may be as a result of the health and social problem present in this age group. In order to improve the quality of life, the study population should reduce level of perceived anxiety and increase the control of negative emotions and self-efficacy by social integration of seniors. The study scores in the scale of CECS, STAI, and GSES do not deviate from the world norms obtained by other researchers in the rest of the world.

Using qualitative methods to access the pain experience

Qualitative methods provide us with techniques to access the pain experience of patients in ways that provide explanation for apparent contradictions and idiosyncrasies that are difficult to access. In this article, I review three such strategies and the application of qualitative research to practice: (1) the analysis of the ways participants speak about agonizing pain using narrative inquiry, (2) comparisons of childbirth pain in two cultural groups using ethnography and (3) present a qualitative theory, the Praxis Theory of Suffering. This theory provides a theoretical explanation for behaviours that presently confound the understanding of distress using the Distress Thermometer. An alternative approach, 'reading' patients' behavioural manifestations of distress, is recommended.

Emotional suppression and depressive symptoms in women newly diagnosed with early breast cancer

Background

Patients with breast cancer usually present varying levels of depressive symptoms. Emotional suppression, as a coping style, refers to an individual’s ability to consciously control expression of negative emotions. Thus, emotional suppression is an important psychological factor related to depressive symptoms in patients with breast cancer. It has long been considered that compared to European and American women, Chinese women are more likely to ascribe to norms of negative emotion control for smooth social interaction. However, there is paucity of research focusing on emotional suppression among Chinese women with breast cancer. Thus the aims of the current study were (1) to investigate the incidence of depressive symptoms in women newly diagnosed with early breast cancer in Mainland China, and (2) to examine the relationships between emotional suppression and depressive symptoms in these patients.

Methods

The Center for Epidemiological Studies Depression Scale (CES-D), the Beck Anxiety Inventory (BAI) and the Chinese version of the Courtauld Emotional Control Scale (CECS) were used to assess the level of depressive symptoms, anxiety symptoms and emotional suppression respectively in 247 women with early breast cancer and 362 healthy women. Analyses of variance were conducted to investigate group differences on depressive symptoms and emotional suppression. Bivariate correlations and Hierarchical regression analyses were performed to examine the effect of emotional suppression on depressive symptoms in participants after controlling the impact of group membership and anxiety level.

Results

(1) The incidence rates of clinical and severe depressive symptoms in patients were 36.4 and 36.0 % respectively. (2) Patients scored significantly higher than healthy women on CECS. (3) The scores on CECS were significantly associated with the total CES-D scores in all participants; Anger suppression significantly predicted the total CES-D scores.

Conclusions

The majority of women newly diagnosed with early breast cancer reported clinical or severe depressive symptoms. As well, these patients presented a controlled emotion coping style. Emotional suppression was associated with the level of depressive symptoms in women newly diagnosed with breast cancer. Anger suppression might play a unique role in the depressive symptoms among women newly diagnosed with breast cancer.

The impact of outpatient chemotherapy-related adverse events on the quality of life of breast cancer patients

The objective of our study was to clarify the impact of adverse events associated with the initial course of outpatient chemotherapy on the quality of life of breast cancer patients. We conducted a survey to assess the quality of life in 48 breast cancer patients before and after receiving their first course of outpatient chemotherapy at Gifu Municipal Hospital. Patients completed the European Quality of Life 5 Dimensions and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs before and after 1 course of outpatient chemotherapy. European Quality of Life 5 Dimensions utility value and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs total score decreased significantly after chemotherapy (p<0.001 and p = 0.018, respectively). The mean scores for the activity, physical condition, and psychological condition subscales of the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs decreased significantly after chemotherapy (p = 0.003, p<0.001, and p = 0.032, respectively), whereas the social relationships score increased significantly (p<0.001). Furthermore, in the evaluation of quality of life according to individual adverse events, the decrease in quality of life after chemotherapy in terms of the European Quality of Life 5 Dimensions utility value and the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs total score was greater in anorexic patients than in non-anorexic patients (p = 0.009 and p<0.001, respectively). This suggests that anorexia greatly reduces quality of life. Our findings reveal that anticancer drug-related adverse events, particularly anorexia, reduce overall quality of life following the first course of outpatient chemotherapy in current breast cancer patients. These findings are extremely useful and important in understanding the impact of anticancer drug-related adverse events on quality of life.

Predictive factors for psychological distress related to diagnosis of breast cancer

OBJECTIVE

The aims of the present study were as follows: (i) to clarify the proportion of women who experience psychological distress during breast cancer diagnosis and (ii) to identify the predictors of psychological distress related to the diagnostic process.

METHODS

This was a longitudinal prospective study of women who required further breast examination. Questionnaires were administered at pre-medical consultations (Time 1), after describing radiological examination (Time 2), and after explaining pathological findings (Time 3). All participants completed Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy--Breast, and Functional Assessment of Chronic Illness Therapy--Spiritual subscale at Time 1 to identify predictors. Participants also completed HADS at Times 2 and 3 to identify the presence or absence of psychological distress.

RESULTS

Of the 222 eligible patients, at Time 2, 31 (22.6%) participants with no clinical abnormalities and 39 (45.9%) participants with abnormal findings had HADS scores of ≥ 11 points (χ2 test, 13.14; p < 0.001). At Time 3, 14 (28.0%) participants with benign breast changes and 24 (68.6%) participants with breast cancer had scores of ≥ 11 (χ2 test, 13.71; p < 0.001). Higher HADS scores at Time 1 were associated with the presence of psychological distress at all stages of breast cancer diagnosis. Advanced tumor stage was a predictor of psychological distress for participants with breast cancer (odds ratios = 3.314, 95% confidence interval = 1.033-9.509; p = 0.044).

CONCLUSION

These results suggest that intensive psychological intervention is necessary for breast cancer patients with large tumors, as well as for women with suspected breast cancer with high HADS scores at pre-consultation.

What do you mean, a spot?: A qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules

BACKGROUND

More than 150,000 Americans each year are found to have a pulmonary nodule. Even more will be affected following the publication of the National Lung Screening Trial. Patient-doctor communication about pulmonary nodules can be challenging. Although most nodules are benign, it may take 2 to 3 years to rule out cancer. We sought to characterize patients’ perceptions of communication with their providers about pulmonary nodules.

METHODS

We conducted four focus groups at two sites with 22 adults with an indeterminate pulmonary nodule. Transcripts were analyzed using principles of grounded theory.

RESULTS

Patients described conversations with 53 different providers about the pulmonary nodule. Almost all patients immediately assumed that they had cancer when first told about the nodule. Some whose providers did not discuss the actual cancer risk or explain the evaluation plan experienced confusion and distress that sometimes lasted for months. Patients were frustrated when their providers did not address their concerns about cancer or potential adverse effects of surveillance (eg, prolonged uncertainty, radiation exposure), which in some cases led to poor adherence to evaluation plans. Patients found it helpful when physicians used lay terms, showed the CT image, and quantified cancer risk. By contrast, patients resented medical jargon and dismissive language.

CONCLUSIONS

Patients commonly assume that a pulmonary nodule means cancer. What providers tell (or do not tell) patients about their cancer risk and the evaluation plan can strongly influence patients’ perceptions of the nodule and related distress. We describe simple communication strategies that may help patients to come to terms with an indeterminate pulmonary nodule.

Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age

BACKGROUND

Reported prevalence of emotional distress in cancer patients varies widely across studies. The present study determined prevalence of anxiety and depression (separated for presence of symptoms versus clinical levels) in a large, representative sample of cancer patients after diagnosis.

METHOD

During the years 2004-2009, 10,153 consecutive patients were routinely screened with the Psychosocial Screen for Cancer questionnaire at two major cancer centers.

RESULTS

Patients' mean age was 59 years and 45% were men. Across cancer types, 19.0% of patients showed clinical levels of anxiety and another 22.6% had subclinical symptoms. Further, 12.9% of patients reported clinical symptoms of depression and an additional 16.5% described subclinical symptoms. Analyses by cancer type revealed significant differences such that patients with lung, gynecological, or hematological cancer reported the highest levels of distress at the time point of cancer diagnosis. As expected, women showed higher rates of anxiety and depression, and for some cancer types the prevalence was two to three times higher than that seen for men. In some cancer types emotional distress was inversely related to age. Patients younger than 50 and women across all cancer types revealed either subclinical or clinical levels of anxiety in over 50% of cases.

LIMITATIONS

Findings describe levels of emotional distress after diagnosis but cannot inform about trajectories of anxiety and depression over time.

CONCLUSION

Given that levels of anxiety and depression varied widely by cancer type, gender, and age, these results inform which cancer patients are most likely in need of psychosocial support.

Determinants affecting quality of life: implications for pharmacist counseling for patients with breast cancer in Japan

Although pharmacist counseling assumes an important role in the clinical setting, oncology pharmacy practitioners worldwide currently lack adequate guidance. This study aimed to identify the determinants and causal relationships that affect quality of life (QOL) in breast cancer patients before adjuvant systemic therapy for improving pharmacist counseling and guidance. This study analyzed 93 postoperative patients with breast cancer before pharmacist counseling for adjuvant systemic therapy. Patients were asked to complete questionnaires to assess QOL (the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 [EORTC QLQ-C30] and its breast cancer module [EORTC QLQ-BR23]) before pharmacist counseling. We analyzed factors affecting QOL by stepwise multiple linear regression analysis and evaluated causal association using path analysis. In the multiple linear regression model using variables selected by stepwise analysis, the factors affecting global health status (GHS)/QOL included fatigue, emotional functioning, systemic therapy side effects, future perspectives, and appetite loss. In the path analysis model, GHS/QOL were strongly influenced by fatigue directly; and emotional functioning, directly and indirectly via other factors. Our results indicated that fatigue and emotional functioning are strong factors affecting QOL. These factors may be able to predict poor QOL before initiating adjuvant systemic therapy. Thus, our findings suggest that these factors may be potentially useful for pharmacist counseling at the beginning of adjuvant systemic therapy.

High-anxious individuals show increased chronic stress burden, decreased protective immunity, and increased cancer progression in a mouse model of squamous cell carcinoma

In spite of widespread anecdotal and scientific evidence much remains to be understood about the long-suspected connection between psychological factors and susceptibility to cancer. The skin is the most common site of cancer, accounting for nearly half of all cancers in the US, with approximately 2-3 million cases of non-melanoma cancers occurring each year worldwide. We hypothesized that a high-anxious, stress-prone behavioral phenotype would result in a higher chronic stress burden, lower protective-immunity, and increased progression of the immuno-responsive skin cancer, squamous cell carcinoma. SKH1 mice were phenotyped as high- or low-anxious at baseline, and subsequently exposed to ultraviolet-B light (1 minimal erythemal dose (MED), 3 times/week, 10-weeks). The significant strengths of this cancer model are that it uses a normal, immunocompetent, outbred strain, without surgery/injection of exogenous tumor cells/cell lines, and produces lesions that resemble human tumors. Tumors were counted weekly (primary outcome), and tissues collected during early and late phases of tumor development. Chemokine/cytokine gene-expression was quantified by PCR, tumor-infiltrating helper (Th), cytolytic (CTL), and regulatory (Treg) T cells by immunohistochemistry, lymph node T and B cells by flow cytometry, adrenal and plasma corticosterone and tissue vascular-endothelial-growth-factor (VEGF) by ELISA. High-anxious mice showed a higher tumor burden during all phases of tumor development. They also showed: higher corticosterone levels (indicating greater chronic stress burden), increased CCL22 expression and Treg infiltration (increased tumor-recruited immuno-suppression), lower CTACK/CCL27, IL-12, and IFN-γ gene-expression and lower numbers of tumor infiltrating Th and CTLs (suppressed protective immunity), and higher VEGF concentrations (increased tumor angiogenesis/invasion/metastasis). These results suggest that the deleterious effects of high trait anxiety could be: exacerbated by life-stressors, accentuated by the stress of cancer diagnosis/treatment, and mediate increased tumor progression and/or metastasis. Therefore, it may be beneficial to investigate the use of chemotherapy-compatible anxiolytic treatments immediately following cancer diagnosis, and during cancer treatment/survivorship.

Reflexology for the symptomatic treatment of breast cancer: a systematic review

The objective of this review was to assess the effectiveness of reflexology as a symptomatic treatment for breast cancer. In all, 12 databases were searched from the time of their inception through July 2010. Prospective, controlled clinical trials of reflexology in patients with breast cancer that included an assessment of clinical outcome measures were reviewed. Study selection, data extraction, and validations were performed independently by 2 reviewers. One randomized clinical trial (RCT) and three nonrandomized controlled clinical trials (CCTs) met our inclusion criteria. One large RCT showed significant differences in quality of life and mood when reflexology was compared with self-initiated support. Three CCTs tested reflexology compared with no treatment or simple rest. All of them suggested favorable effects of reflexology on pain, nausea, and vomiting. However, they had a high risk of bias. Collectively, the existing evidence does not convincingly show that reflexology is effective for breast cancer care. Future studies seem warranted; they should be of high methodological quality, and include adequate control interventions.