The effects of major depression and phobia on stage at diagnosis of breast cancer

Psychometric Properties of the Patient Health Questionnaire-9 in Patients With Breast Cancer

OBJECTIVE

Due to the high frequency of depressive symptoms associated with breast cancer, it is crucial to screen for depression in breast cancer patients. While numerous screening tools are available for depression in this population, there is a need for a brief and convenient tool to enhance clinical use. This study aims to investigate the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) in patients with breast cancer.

METHODS

Patients with breast cancer (n=327) who visited the Breast Cancer Clinic were included in this study. The reliability of the PHQ-9 was analyzed by Cronbach's α, and the construct validity of the PHQ-9 was explored by factor analysis. The concurrent validity of the PHQ-9 was evaluated by Pearson correlation analysis with the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS).

RESULTS

The values of Cronbach's α ranged from 0.800 to 0.879 was acceptable. The exploratory factor analysis revealed that the one-factor model and two-factor model of the PHQ-9 explained 46% and 57% of the variance, respectively. The PHQ-9 were significantly correlated with those of HADS (r=0.702, p<0.001) and PSS (r=0.466, p<0.001). Consequently, the PHQ-9 demonstrated acceptable reliability and validity in breast cancer patients.

CONCLUSION

The findings of this study indicate that the PHQ-9 exhibits acceptable reliability and validity in patients with breast cancer. The convenience of this brief self-report questionnaire suggests its potential as a reliable and valid tool for assessing depression in breast cancer clinics.

Identifying and Reducing Barriers to Breast Imaging

Purpose of Review

The purpose of this review is to discuss disparities in breast health care access and outcomes related to race, gender, cultural diversity, sexual orientation, socioeconomic status, geographic location, and disability. The authors recognize the complexity of eliminating inequalities in health care but are optimistic that all patients will one day have equal access to care through dialogue, acknowledgment, recognition, and action.

Recent Findings

After lung cancer, breast cancer is the second leading cause of death among American women. Mammography as a preventative screening tool has resulted in significant reductions in breast cancer mortality. Despite existing breast cancer recommendations, it has been projected that 43,250 women will die from breast cancer in 2022.

Summary

Disparities in healthcare outcomes exist for many reasons including inequalities based on race, gender, cultural diversity, religion, sexual orientation, and socioeconomic status. Disparities, no matter how large or complex, are not insurmountable.

Impact of a pre-existing diagnosis of mental illness on stage of breast cancer diagnosis among older women

PURPOSE

Having a mental illness increases risk of mortality for women with breast cancer, partly due to barriers to accessing recommended care (e.g., cancer screening). Early detection is one important factor in breast cancer survival. To further understand this disparity in survival, we examined whether older women with mental illness are more likely to be diagnosed with later-staged breast cancers compared to women without mental illnesses.

METHODS

We used 2005-2015 SEER-Medicare data to identify AJCC stage I-IV breast cancer patients with and without a history of mental illness prior to cancer diagnosis. We used generalized ordinal regression to examine associations between mental illness diagnoses and stage at diagnosis, controlling for age, race/ethnicity, income, comorbidities, primary care use, rurality, and marital status.

RESULTS

Among 96,034 women with breast cancer, 1.7% have a serious mental illness (SMI), 19.9% depression or anxiety, and 7.0% other mental illness. Those with SMI have 40% higher odds of being diagnosed with AJCC Stages II, III than Stage I; women with depression/anxiety have 25% lower odds of being diagnosed with Stage IV cancer than Stage I; and women with other mental illnesses have similar odds of being diagnosed in later stages.

CONCLUSION

Women with SMI have higher odds of being diagnosed at later stages, which likely contributes to higher mortality after breast cancer. Surprisingly, women with depression and anxiety have a lower risk of being diagnosed with Stage IV cancer. Earlier breast cancer diagnosis in women with SMI is an important goal for reducing disparities breast cancer survival.

Crosstalk between Depression and Breast Cancer via Hepatic Epoxide Metabolism: A Central Comorbidity Mechanism

Breast cancer (BC) is a serious global challenge, and depression is one of the risk factors and comorbidities of BC. Recently, the research on the comorbidity of BC and depression has focused on the dysfunction of the hypothalamic–pituitary–adrenal axis and the persistent stimulation of the inflammatory response. However, the further mechanisms for comorbidity remain unclear. Epoxide metabolism has been shown to have a regulatory function in the comorbid mechanism with scattered reports. Hence, this article reviews the role of epoxide metabolism in depression and BC. The comprehensive review discloses the imbalance in epoxide metabolism and its downstream effect shared by BC and depression, including overexpression of inflammation, upregulation of toxic diols, and disturbed lipid metabolism. These downstream effects are mainly involved in the construction of the breast malignancy microenvironment through liver regulation. This finding provides new clues on the mechanism of BC and depression comorbidity, suggesting in particular a potential relationship between the liver and BC, and provides potential evidence of comorbidity for subsequent studies on the pathological mechanism.

Do breast cancer survivors with a recent history of clinical depression report worse experiences with care? A retrospective cohort study using SEER-CAHPS data

PURPOSE

We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity.

METHODS

Using the Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, getting care quickly, getting prescription drugs, specialist and overall care). We also assessed interactions of depression by race/ethnicity. All models were adjusted for demographics and cancer prognostic and treatment factors.

RESULTS

Of the 2271 survivors, 7.6% were clinically depressed. After adjusting for covariates, survivors with clinical depression had lower odds of reporting excellent ratings of their ability to get needed care, care by their specialist, and overall care, compared to those without depression (AOR = 0.58, 95% CI: 0.40-0.84; AOR = 0.40, CI: 0.31-0.76; and AOR = 0.61, CI: 0.42-0.89, respectively). Among Hispanics, having depression was associated with higher odds of excellent ratings of one's ability to get needed care (AOR: 5.42, 95% CI: 1.02-28.81). No other statistically significant associations by race/ethnicity were found.

CONCLUSIONS

Breast cancer survivors with depression report poorer patient experiences with care. Further research is needed to understand complexities of ratings of experiences with care among survivors of diverse backgrounds.

IMPLICATIONS

Survivors with a recent history of clinical depression may benefit from additional supportive care services.

End-of-life care for people with severe mental illness: mixed methods systematic review and thematic synthesis of published case studies (the MENLOC study)

OBJECTIVES

People with severe mental illness (SMI) have significant comorbidities and reduced life expectancy. The objective of the review reported in this paper was to synthesise material from case studies relating to the organisation, provision and receipt of care for people with SMI who have an end-of-life (EoL) diagnosis.

DESIGN

Systematic review and thematic synthesis.

DATA SOURCES

MEDLINE, PsycINFO, EMBASE, HMIC, AMED, CINAHL, CENTRAL, ASSIA, DARE and Web of Science from inception to December 2019. Supplementary searching for additional material including grey literature along with 62 organisational websites.

RESULTS

Of the 11 904 citations retrieved, 42 papers reporting 51 case studies were identified and are reported here. Twenty-five of the forty-two case study papers met seven, or more quality criteria, with eight meeting half or less. Attributes of case study subjects included that just over half were men, had a mean age of 55 years, psychotic illnesses dominated and the EoL condition was in most cases a cancer. Analysis generated themes as follows diagnostic delay and overshadowing, decision capacity and dilemmas, medical futility, individuals and their networks, care provision.

CONCLUSIONS

In the absence of high-quality intervention studies, this evidence synthesis indicates that cross disciplinary care is supported within the context of established therapeutic relationships. Attention to potential delay and diagnostic overshadowing is required in care provision. The values and preferences of individuals with severe mental illness experiencing an end-of-life condition should be recognised.

PROSPERO REGISTRATION NUMBER

CRD42018108988.

Selective serotonin reuptake inhibitors associated with increased mortality risk in breast cancer patients in Northern Israel

BACKGROUND

Approximately one in six women in the USA takes antidepressants and a third use selective serotonin reuptake inhibitors (SSRIs) after breast cancer diagnosis. Recent investigation demonstrated serotonin receptor (5-HTR2B) expression in the breast and serotonin production as an indicator of poor breast cancer prognosis. This study investigates the association between SSRI use at different time intervals relative to breast cancer diagnosis on survival.

METHODS

A population-based sample of 6959 consecutive, newly diagnosed breast cancer cases in Northern Israel was included. Patients were recruited from January 2000 and followed up through March 2020. Participants completed risk factor questionnaires regarding medical, reproductive and family history, medication use and health habits. Full prescription data were available through the Israeli national Clalit medical database. Multivariate Cox proportional hazard models were used to determine survival based on time of SSRI use.

RESULTS

Use of SSRIs in the 5 years prior to breast cancer diagnosis was associated with a 66% increase in overall mortality (HRadj = 1.66; CI: 1.05-2.63). SSRI use that initiated after breast cancer diagnosis was associated with an 81% increase in mortality (HRadj = 1.81; CI: 1.58-2.06). Use of SSRIs in the 5 years post-diagnosis was associated with a dose-response increase (P < 0.001) in long-term mortality (>5 years). Heavy SSRI use (≥24 prescription fills) after diagnosis was associated with nearly doubling in mortality (HR = 1.99; CI: 1.39-2.83).

CONCLUSION

SSRI use prior to and after breast cancer diagnosis is associated with increased mortality in breast cancer patients. Additional research is needed to better understand mechanisms mediating this association.

Associations between comorbidities and advanced stage diagnosis of lung, breast, colorectal, and prostate cancer: A systematic review and meta-analysis

Comorbidities and advanced stage diagnosis (ASD) are both associated with poorer cancer outcomes, but the association between comorbidities and ASD is poorly understood. We summarized epidemiological evidence on the association between comorbidities and ASD of selected cancers in a systematic review and meta-analysis. We searched PubMed and Web of Science databases up to June 3rd, 2021 for studies assessing the association between comorbidities and ASD of lung, breast, colorectal, or prostate cancer. Summary odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated using random-effects models. Also, potential variations in the associations between comorbidities and ASD by cancer type were investigated using random-effects meta-regression. Thirty-seven studies were included in this review, including 8,069,397 lung, breast, colorectal, and prostate cancer patients overall. The Charlson comorbidity index score was positively associated with ASD (stages III-IV) of breast cancer but was inversely associated with ASD of lung cancer (p_interaction = 0.004). Regarding specific comorbidities, diabetes was positively associated with ASD (OR = 1.17, 95%CI = 1.09-1.26), whereas myocardial infarction was inversely associated with ASD (OR = 0.84, 95%CI = 0.75-0.95). The association between renal disease and ASD differed by cancer type (p_interaction < 0.001). A positive association was found with prostate cancer (OR = 2.02, 95%CI = 1.58-2.59) and an inverse association with colorectal cancer (OR = 0.84, 95%CI = 0.70-1.00). In summary, certain comorbidities (e.g., diabetes) may be positively associated with ASD of several cancer types. It needs to be clarified whether closer monitoring for early cancer signs or screening in these patients is reasonable, considering the problem of over-diagnosis particularly relevant in patients with short remaining life expectancy such as those with comorbidities. Also, evaluation of the cost-benefit relationship of cancer screening according to the type and severity of comorbidity (rather than summary scores) may be beneficial for personalized cancer screening in populations with chronic diseases.

Extent of disease at first cancer presentation and previous anxiety and depressive symptoms: the HUNT study

BACKGROUND

Depressive symptoms are associated with higher cancer mortality, whereas anxiety symptoms are associated with lower than expected risk.

AIMS

This study aimed to investigate the prospective association between depressive/anxiety symptoms and the extent of disease (EOD) of first cancer at diagnosis.

METHOD

Prospective population-based study conducted from the second wave of the Nord-Trøndelag Health (HUNT) study. Of 65 000 residents comprehensively interviewed and examined for health status, 407 received first lifetime cancer diagnoses 1-3 years later, ascertained from the Cancer Registry of Norway, and had EOD recorded. Patients with localised disease or regional/distant spread at cancer diagnosis were analysed for earlier depressive/anxiety symptoms ascertained by the Hospital Anxiety and Depression Scale in HUNT.

RESULTS

Beyond-local EOD was present in 59.8% of those with neither anxiety nor depression, in 76.6% of those with depression alone (odds ratio, 2.20; 1.08-4.49), in 39.3% of those with anxiety alone (odds ratio, 0.44; 0.20-0.96) and in 57.7% of those with both anxiety and depression (odds ratio, 0.92; 0.41-2.06). After adjustment for demographic and health status, and cancer type, these associations were marginally stronger, but no longer statistically significant (odds ratios, 2.26; 0.84-6.11; 0.43; 0.15-1.26; and 1.00; 0.98-1.03, respectively).

CONCLUSIONS

In people who develop cancer, beyond-local EOD at diagnosis was more common in people with previous depression and less common in people with previous anxiety; however, independence from confounding factors could not be concluded.

Excess mortality from breast cancer in female breast cancer patients with severe mental illness

Women with a history of severe mental illness (SMI) have elevated breast cancer mortality. Few studies have compared cancer-specific mortality in women with breast cancer with or without SMI to reveal gaps in breast cancer treatment outcomes. We compared breast-cancer specific mortality in women with or without SMI and investigated effects of stage at presentation, comorbidity, and differences in cancer treatment. Women with their first breast cancer diagnosis in 1990-2013 (n = 80,671) were identified from the Finnish Cancer Registry, their preceding hospital admissions due to SMI (n = 4,837) from the Hospital Discharge Register and deaths from the Causes of Death Statistics. Competing risk models were used in statistical analysis. When controlling for age, year of cancer diagnosis, and comorbidity, breast cancer mortality was significantly elevated in patients with SMI. Relative mortality was highest in breast cancer patients with non-affective psychosis, partly explained by stage at presentation. Mortality was also significantly elevated in breast cancer patients with a substance use disorder and mood disorder. Patients with SMI received radiotherapy significantly less often than patients without SMI. Our findings emphasize the need to improve early detection of breast cancer in women with SMI and the collaboration between mental health care and oncological teams.

Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms

An earlier diagnosis is a key strategy for improving the outcomes of patients with cancer. However, achieving this goal can be challenging, particularly for the growing number of people with one or more chronic conditions (comorbidity/multimorbidity) at the time of diagnosis. Pre-existing chronic diseases might affect patient participation in cancer screening, help-seeking for new and/or changing symptoms and clinicians' decision-making on the use of diagnostic investigations. Evidence suggests, for example, that pre-existing pulmonary, cardiovascular, neurological and psychiatric conditions are all associated with a more advanced stage of cancer at diagnosis. By contrast, hypertension and certain gastrointestinal and musculoskeletal conditions might be associated with a more timely diagnosis. In this Review, we propose a comprehensive framework that encompasses the effects of disease-specific, patient-related and health-care-related factors on the diagnosis of cancer in individuals with pre-existing chronic illnesses. Several previously postulated aetiological mechanisms (including alternative explanations, competing demands and surveillance effects) are integrated with newly identified mechanisms, such as false reassurances, or patient concerns about appearing to be a hypochondriac. By considering specific effects of chronic diseases on diagnostic processes and outcomes, tailored early diagnosis initiatives can be developed to improve the outcomes of the large proportion of patients with cancer who have pre-existing chronic conditions.

Depression and quality of life in patients with breast cancer undergoing chemotherapy and monoclonal antibodies

Background

Depression is one of the major psychiatric morbidities in cancer patients. The purpose of our study was to evaluate the impact of depressive symptoms in the quality of life (QoL) of patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments.

Methods

Observational, cross-sectional study conducted between April and November 2016. To evaluate the QoL, the EORTC QLQ-C30 and QLQ-BR23 questionnaire were used. The patients were screened for depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) and those with a positive HADS-D positive questionnaire were referenced to the Psychiatry and Mental Health Department for further assessment and follow-up.

Results

We included 45 female patients. Sixteen (35.6%) patients had a positive HADS-D questionnaire and depressive symptoms confirmed by a psychiatric physician. Of those patients, 7 (15.6%) had a major depressive episode confirmed by psychiatric interview. There was a significant association of depressive symptoms with the future perspectives scale (p = 0.022), breast symptoms scale (p = 0.011) and arm symptom scale (p = 0.005). Significant differences were found in the fatigue (p = 0.024), pain (p = 0.037) and dyspnea (p = 0.009) subscales being worse in patients with depressive symptoms. The association between having depressive symptoms or not was shown to be significant or marginally significant for the variables stage of the tumour (p = 0.057), presence of distant metastasis (p = 0.072) and previous diagnosis of depression (p = 0.011). The patients treated with regimens containing monoclonal antibodies presented better outcomes in various subscales of the EORTC QLQ-C30 and QLQ-B23 questionnaires than those patients treated with chemotherapy regimens without monoclonal antibodies.

Conclusions

Despite the small sample of our study, this study provided evidence that depressive symptoms in patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments detrimentally reduced various aspects of QoL.

Personality and breast cancer screening in women of the GAZEL cohort study

The potential benefit of breast cancer screening is mitigated by the risk of false positives and overdiagnosis, thus advocating for a more personalized approach, based on the individual benefit-harm balance. Since personality might influence the women's appraisal of this balance, this prospective observational cohort study examined whether it could influence mammography use. A total of 2691 postmenopausal women of the GAZEL Cohort Study completed the Bortner Type A Rating Scale and the Buss and Durkee Hostility Inventory in 1993. Associations between personality scores and subsequent mammography use, self-reported through up to five triennial follow-up questionnaires, were estimated with Odds Ratio (OR) and 95% confidence interval (CI) with logistic mixed model regressions, adjusting for age, occupational grade, marital status, family history of breast cancer, age at menarche, age at first delivery, gynecological follow-up, hormone therapy use, and depressive symptoms. Individual propensity scores were used to weight the analyses to control for potential selection biases. More than 90% of the participants completed at least two follow-up questionnaires. Type A personality, but not hostility, was associated with mammography use in both univariate (crude OR [95% CI]: 1.62 [1.24-2.11], P < 0.001) and multivariate analyses (OR [95% CI]: 1.46 [1.13-1.90], P < 0.01). Type A personality traits (i.e., sense of time urgency, high job involvement, competitiveness) independently predicted mammography use among postmenopausal women. While paying more attention to the adherence of women with low levels of these traits, clinicians may help those with higher levels to better consider the risks of false positives and overdiagnosis.

Depression in Women with Breast Cancer: A Systematic Review of Cross-Sectional Studies in Iran

Objective: Breast cancer is one of the most common cancers in women and has more severe mental and emotional effects than other types. Depression as a mental disorder affects people’s mental well-being, physical symptoms, occupational performance, and finally quality of life. The aim of this study was to determine depression levels in Iranian women with breast cancer. Methods: A systematic review study was conducted in 2017. English and Persian databases (PubMed, SCOPUS, Web of Science, Google Scholar, SID, Magiran) were searched with key words such as Depression Or Depressive Disorders AND Women AND Breast Cancer OR Tumor OR Neoplasm OR Malignancy AND Iran. Inclusion criteria allowed for cross-sectional studies conducted in Iran (published in English or Persian language journals), studies that had key words in their keywords or their titles and standard instruments for measuring depression in patients. Of the 160 publications found, eight were selected after reviewing the title, abstract and full article. Results: Age of women with breast cancer in selected studies ranged from 43.8 (SD = 47.1) to 55.9 (SD = 14.6) years. Duration of cancer in most studies was about 1-2 years. In most studies, mild levels of depression for women with breast cancer were present. However, in one study it was stated that 69.4% of participants had serious levels of depression. Conclusions: There is increase in the risk of depression in women with breast cancer. Therefore, it seems necessary to plan preventive and therapeutic measures in order to improve the mental health and quality of life of the affected patients.

A case-control study of the association between psychosocial factors and the occurrence of laryngeal cancer

The aim of the present study was to investigate the association between social psychological factors and the occurrence of laryngeal cancer. A 1:1 matched case-control study was conducted. The participants completed questionnaires that included general information, such as the Life Event Scale, the Social Support Rating Scale, and the Eysenck Personality Questionnaire (EPQ). Scores were compared between the groups using paired t-tests and Wilcoxon's signed-rank tests. No significant difference in the psychoticism scale of the EPQ was observed between the two groups (P>0.05). However, significant differences were observed in scores on the life events and social support scales and in the remaining dimensions of the EPQ (all P-values <0.05). Positive life events may be protective factors for laryngeal cancer, whereas reduced utilization of social support may be a risk factor for laryngeal cancer.

Diagnosis and treatment delays among elderly breast cancer patients with pre-existing mental illness

PURPOSE

This study aimed to compare diagnosis and treatment delays in elderly breast cancer patients with and without pre-existing mental illness.

METHODS

A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare data including 16,636 women 68+ years, who were diagnosed with stage I-IIIa breast cancer in the United States from 2005 to 2007. Mental illness was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes recorded on inpatient and outpatient claims during the 3 years prior to breast cancer diagnosis. Patients were classified as having no mental illness, anxiety, depression, anxiety and depression, or severe mental illness (bipolar disorder, schizophrenia, and other psychotic disorder). Multivariable binomial regression was used to assess the association between mental illness and delays of ≥60 and ≥90 days after adjustment for confounders.

RESULTS

Patients with comorbid anxiety and depression had an increased risk for diagnosis delay of ≥90 days from symptom recognition (RR 1.11; 95% CI 1.00, 1.23), and those with severe mental illness had an increased risk for initial treatment delay of ≥60 days from diagnosis (RR 1.36; 95% CI 1.06, 1.74). Patients with any mental illness experienced an increased risk for adjuvant chemotherapy delay of ≥90 days from last operation (RR 1.13; 95% CI 1.01, 1.26) and each category of mental illness, except depression, showed a non-significant trend for this association.

CONCLUSION

Breast cancer patients with mental illness should be closely managed by a cross-functional care team, including a psychiatrist, a primary care physician, and an oncologist, to ensure adequate care is received within an appropriate timeframe.

Does the Presence of a Major Psychiatric Disorder Affect Tolerance and Outcomes in Men With Prostate Cancer Receiving Radiation Therapy?

Prior studies have suggested that men with prostate cancer and psychiatric disorders (+Psy) have worse outcomes compared with those without (-Psy), particularly due to delayed diagnosis or reduced access to definitive treatment. In the current study, the toxicity and outcomes of men who were primarily diagnosed through prostate-specific antigen screening and who underwent definitive treatment with external beam radiation was investigated. The charts of 469 men diagnosed with prostate cancer from 2003 to 2010 were reviewed. The presence of +Psy was based on a Diagnostic and Statistical Manual of Mental Disorders-Fourth edition diagnosis of posttraumatic stress disorder, depression, schizophrenia, bipolar disorder, and/or generalized anxiety disorder. Kaplan-Meier analysis was used to analyze biochemical control, distant control, prostate cancer-specific survival, and overall survival. One hundred patients (21.3%) were identified as +Psy. At a median follow-up of 73 months, there were no differences regarding 6-year biochemical control (79.8% -Psy vs. 80.4% +Psy, p = .50) or 6-year distant metastatic-free survival (96.4% -Psy vs. 98.0% +Psy, p = .36). There were also no differences regarding the 6-year prostate cancer-specific survival (98.4% -Psy vs. 99.0% +Psy, p = .45) or 6-year overall survival (80.2% -Psy vs. 82.2% +Psy, p = .35). Short- and long-term genitourinary and gastrointestinal toxicities were similar between the groups. On multivariate analyses with propensity score adjustment, +Psy was not a significant predictor for toxicity, biochemical recurrence, or survival. The presence of +Psy was not associated with higher toxicity or worse clinical outcomes, suggesting that effective removal of screening and treatment barriers may reduce the survival disparities of these patients.

The association of mood disorders with breast cancer survival: an investigation of linked cancer registration and hospital admission data for South East England

Background

Data linkage studies find that depression before or after a breast cancer diagnosis predicts reduced survival. This study aimed to determine whether depression or bipolar recorded in routine hospital admission data independently predicts survival in English breast cancer patients and whether onset in relation to cancer diagnosis is significant.

Methods

Data on 77 173 women diagnosed with breast cancer (ICD‐10 C50) in South East England, 2000–2009, were included. Of these, 131 women had a diagnosis of bipolar affective disorder (ICD‐10 F31) and 955 of depression (either depressive episodes (ICD‐10 F32) or depressive disorder (ICD‐10 F33)) recorded in Hospital Episode Statistics between 3 years before and a year following cancer diagnosis. Kaplan–Meier plots were used to examine overall survival. Cox regression analyses were carried out overall and separately for mood disorder diagnoses before and after the cancer diagnosis and adjusted for confounding variables.

Results

A record of depression was a predictor of worse overall survival in breast cancer patients (adjusted HR = 1.33, 95% CI: 1.20–1.48, p < 0.001), while the effect of bipolar was not statistically significant (adjusted HR = 1.33, 95% CI: 0.97–1.82, p = 0.079). New recordings of depression and bipolar diagnoses following a cancer diagnosis appeared better predictors of overall survival than a prior history of either.

Conclusions

There is evidence that English breast cancer patients with depression and bipolar recorded in routine hospital data have worse overall survival than those without these mood disorders. Further work exploring the concordance of records within administrative health data with clinical diagnosis and cause‐specific death within these patient groups is needed. © 2015 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

Cancer and serious mental illness--patient, caregiver and professional perspectives: study protocol

AIM

To explore the experience of serious mental illness and cancer from the perspective of patients, significant others and healthcare professionals involved in their care.

BACKGROUND

Serious mental illness is associated with poorer cancer outcomes. Those suffering from this comorbidity receive fewer specialist interventions and die earlier than the general population. Prior qualitative research in this area has comprised of a single study focussing on healthcare professionals and there is little evidence regarding the experiences of patients and caregivers.

DESIGN

A qualitative exploration using approximately 36 semi-structured interviews.

METHODS

Semi-structured digitally recorded interviews conducted with: adults living with serious mental illness and diagnosed with cancer; those providing them with informal support and care; and healthcare professionals. Questions will focus on the experience of having cancer and serious mental illness or caring for someone with this comorbidity, experiences of healthcare and priorities for patients and carers. Framework analysis will be used. Research Ethics Committee and Trust Research & Development approval was obtained. A steering group comprising six people with experience of either cancer or mental illness provided feedback and ratified the patient information sheets and interview schedules.

DISCUSSION

There is a paucity of research addressing stakeholder perspectives on the experience of cancer and of cancer services for people with serious mental illness. Dissemination of findings will inform practice relating to the care of an often neglected population, informing better support for their significant others and the professionals involved in their care.

The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care.

Impact of depression on the intensity of patient navigation for women with abnormal cancer screenings

Patient navigation is increasingly being used to support vulnerable patients to receive timely and quality medical care. We sought to understand whether patients with depression utilize additional patient navigation services after abnormal cancer screening. We compared depressed and non-depressed women using three different measures of intensity of patient navigation: number of patient-navigator encounters, encounter time, and number of unique barriers to care. The study population consisted of 1,455 women who received navigation after abnormal screening for breast or cervical cancer at one of six community health centers in Boston. Navigators spent a median of 60-75 minutes over one or two encounters per participant, with 49% of participants having one or more documented barrier to care. Depressed women did not differ in total numbers of encounters, encounter time, or unique barriers compared with non-depressed women. Our findings suggest that pre-existing depression does not predict which women will utilize additional navigation services.

The interface of physical and mental health

PURPOSE

The interaction between physical and mental health is complex. In this paper we aim to provide an overview of the main components of this relationship and to identify how care could be improved for people with co-morbidities.

METHODS

We performed a literature search of MedLine, Ovid and Psycinfo and identified studies that examined the association between mental illness and physical illness. We also examined the key policy documents and guidelines in this area.

RESULTS

People with mental health conditions are at higher risk of developing physical illness, have those conditions diagnosed later and have much higher mortality rates. Conversely, people with a diagnosis of physical illness, especially cardiovascular disease, diabetes and cancer have a greater chance of developing a mental health problem. When both mental and physical illnesses conditions are present together, there are higher overall rates of morbidity, healthcare utilisation, and poorer quality of life.

CONCLUSIONS

Physicians and psychiatrists need to be aware of the co-occurrence of mental and physical health problems and the challenges posed for both general and mental health services. There is a need to screen appropriately in both settings to ensure timely diagnosis and treatment. Liaison psychiatry provides psychological assessment and treatment for people with physical illness, but there is a gap in the provision of physical healthcare for people with severe mental illness. There is a need for public policy to drive this forward to overcome the institutional barriers to equitable access to healthcare and for educators to reverse the tendency to teach mind and body as separate systems.

A cohort study on mental disorders, stage of cancer at diagnosis and subsequent survival

OBJECTIVES

To assess the stage at cancer diagnosis and survival after cancer diagnosis among people served by secondary mental health services, compared with other local people.

SETTING

Using the anonymised linkage between a regional monopoly secondary mental health service provider in southeast London of four London boroughs, Croydon, Lambeth, Lewisham and Southwark, and a population-based cancer register, a historical cohort study was constructed.

PARTICIPANTS

A total of 28 477 cancer cases aged 15+ years with stage of cancer recorded at diagnosis were identified. Among these, 2206 participants had been previously assessed or treated in secondary mental healthcare before their cancer diagnosis and 125 for severe mental illness (schizophrenia, schizoaffective or bipolar disorders).

PRIMARY AND SECONDARY OUTCOME MEASURES

Stage when cancer was diagnosed and all-cause mortality after cancer diagnosis among cancer cases registered in the geographical area of southeast London.

RESULTS

Comparisons between people with and without specific psychiatric diagnosis in the same residence area for risks of advanced stage of cancer at diagnosis and general survival after cancer diagnosed were analysed using logistic and Cox models. No associations were found between specific mental disorder diagnoses and beyond local spread of cancer at presentation. However, people with severe mental disorders, depression, dementia and substance use disorders had significantly worse survival after cancer diagnosis, independent of cancer stage at diagnosis and other potential confounders.

CONCLUSIONS

Previous findings of associations between mental disorders and cancer mortality are more likely to be accounted for by differences in survival after cancer diagnosis rather than by delayed diagnosis.

The impact of comorbidity on cancer survival: a review

Background

A number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence.

Methods

All English-language articles published during 2002–2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted.

Results

Our search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity.

Conclusion

Despite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.

Gender differences in the association between depressive mood and mortality: a 12-year follow-up population-based study

BACKGROUND

Depressive mood has been associated with all-cause mortality in both men and women. This study aimed at exploring gender differences in the association between depressive mood and specific causes of mortality as well as factors that may account for it, including education, marital status, social support, health behaviors, and chronic diseases.

METHODS

A population-based survey including 6043 subjects (2892 men and 3151 women) was conducted in 1996 in the north-east of France with a questionnaire covering education, marital status, social support, health behaviors (smoking status, alcohol consumption, body mass index), and chronic diseases. Depressive mood was measured using the Duke Health Profile questionnaire. Cox regression models were used to examine its association with subsequent natural all-cause mortality, and cardiovascular and cancer mortality.

RESULTS

During a follow-up of 12.5 years, 406 men and 303 women died from a natural cause. Adjusting for all covariates, depressive mood predicted natural mortality in both men [Hazard Ratio (HR)=1.30; 95% confidence interval (CI): 1.00-1.69] and women (HR=1.37; 95% CI: 1.06-1.77). However, this association was significant for cardiovascular mortality in men (HR=1.63; 95% CI: 1.00-2.65) whereas it was significant for cancer mortality in women (HR=1.71; 95% CI: 1.11-2.64).

LIMITATIONS

Baseline data were self-reported and the response rate was low.

DISCUSSION

Preventive strategies aiming at reducing the increased mortality associated with depressive mood should take gender into account. Depressed men may warrant a better screening for cardiovascular risk factors and diseases, whereas depressed women may benefit from better cancer prevention measures.

Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies

BACKGROUND

Substantial uncertainty exists about prevalence of mood disorders in patients with cancer, including those in oncological, haematological, and palliative-care settings. We aimed to quantitatively summarise the prevalence of depression, anxiety, and adjustments disorders in these settings.

METHODS

We searched Medline, PsycINFO, Embase, and Web of Knowledge for studies that examined well-defined depression, anxiety, and adjustment disorder in adults with cancer in oncological, haematological, and palliative-care settings. We restricted studies to those using psychiatric interviews. Studies were reviewed in accordance with PRISMA guidelines and a proportion meta-analysis was done.

FINDINGS

We identified 24 studies with 4007 individuals across seven countries in palliative-care settings. Meta-analytical pooled prevalence of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria was 16·5% (95% CI 13·1-20·3), 14·3% (11·1-17·9) for DSM-defined major depression, and 9·6% (3·6-18·1) for DSM-defined minor depression. Prevalence of adjustment disorder alone was 15·4% (10·1-21·6) and of anxiety disorders 9·8% (6·8-13·2). Prevalence of all types of depression combined was of 24·6% (17·5-32·4), depression or adjustment disorder 24·7% (20·8-28·8), and all types of mood disorder 29·0% (10·1-52·9). We identified 70 studies with 10,071 individuals across 14 countries in oncological and haematological settings. Prevalence of depression by DSM or ICD criteria was 16·3% (13·4-19·5); for DSM-defined major depression it was 14·9% (12·2-17·7) and for DSM-defined minor depression 19·2% (9·1-31·9). Prevalence of adjustment disorder was 19·4% (14·5-24·8), anxiety 10·3% (5·1-17·0), and dysthymia 2·7% (1·7-4·0). Combination diagnoses were common; all types of depression occurred in 20·7% (12·9-29·8) of patients, depression or adjustment disorder in 31·6% (25·0-38·7), and any mood disorder in 38·2% (28·4-48·6). There were few consistent correlates of depression: there was no effect of age, sex, or clinical setting and inadequate data to examine cancer type and illness duration.

INTERPRETATION

Interview-defined depression and anxiety is less common in patients with cancer than previously thought, although some combination of mood disorders occurs in 30-40% of patients in hospital settings without a significant difference between palliative-care and non-palliative-care settings. Clinicians should remain vigilant for mood complications, not just depression.

FUNDING

None.

Specific phobias in older adults: characteristics and differential diagnosis

BACKGROUND

Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging.

METHODS

A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used.

RESULTS

Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia.

CONCLUSIONS

First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.

Primary care physicians' assessments of older patients' health and psychological status and recommendation of mammography

BACKGROUND

Recommendation of mammography may be particularly important for older women; nevertheless, physicians are less likely to recommend mammography to older women. Our objective was to examine the characteristics of older patients for whom primary care physicians recommend mammography.

METHODS

Two hundred sixteen women aged 65 to 80 years were screened for depressive symptoms in primary care offices and invited to participate. They then completed a baseline in-home assessment between 2001 and 2003. At the time of the baseline in-home assessment, mammogram use and psychological status were assessed with commonly used and validated standard questionnaires. At the time of the index visit, physicians were asked to provide assessments of the patients.

RESULTS

Patient-reported physician recommendation of mammography was more likely among patients the physicians rated as anxious than among patients the physicians rated as not being anxious (unadjusted odds ratio, 2.08; 95% confidence interval, 1.10-3.94). In multivariate models that controlled for physician ratings of knowledge of the patient, the association between physician rating of anxiety with patient-reported physician recommendation of mammography remained significant. Patient-reported physician recommendation of mammography was not significantly more likely among patients the physicians rated as depressed than among patients the physicians rated as not being depressed (unadjusted odds ratio, 1.57; 95% confidence interval, 0.86-2.85).

CONCLUSIONS

Identification of anxiety may influence the recommendation of mammography among primary care physicians. An understanding of factors that influence the recommendation of mammography by primary care physicians may have important implications for interventions to improve rates of mammography use among older women.

Psychiatric illness delays diagnosis of esophageal cancer

Evidence suggests that patients with psychiatric illnesses may be more likely to experience a delay in diagnosis of coexisting cancer. The association between psychiatric illness and timely diagnosis and survival in patients with esophageal cancer has not been studied. The specific aim of this retrospective cohort study was to determine the impact of coexisting psychiatric illness on time to diagnosis, disease stage and survival in patients with esophageal cancer. All patients with a diagnosis of esophageal cancer between 1989 and 2003 at the Portland Veteran's Administration hospital were identified by ICD-9 code. One hundred and sixty patients were identified: 52 patients had one or more DSM-IV diagnoses, and 108 patients had no DSM-IV diagnosis. Electronic charts were reviewed beginning from the first recorded encounter for all patients and clinical and demographic data were collected. The association between psychiatric illness and time to diagnosis of esophageal cancer and survival was studied using Cox proportional hazard models. Groups were similar in age, ethnicity, body mass index, and history of tobacco and alcohol use. Psychiatric illness was associated with delayed diagnosis (median time from alarm symptoms to diagnosis 90 days vs. 35 days in patients with and without psychiatric illness, respectively, P < 0.001) and the presence of advanced disease at the time of diagnosis (37% vs. 18% of patients with and without psychiatric illness, respectively, P= 0.009). In multivariate analysis, psychiatric illness and depression were independent predictors for delayed diagnosis (hazard ratios 0.605 and 0.622, respectively, hazard ratio < 1 indicating longer time to diagnosis). Dementia was an independent risk factor for worse survival (hazard ratio 2.984). Finally, psychiatric illness was associated with a decreased likelihood of receiving surgical therapy. Psychiatric illness is a risk factor for delayed diagnosis, a diagnosis of advanced cancer, and a lower likelihood of receiving surgical therapy in patients with esophageal cancer. Dementia is associated with worse survival in these patients. These findings emphasize the importance of prompt evaluation of foregut symptoms in patients with psychiatric illness.

Breast and cervical cancer screening for women with mental illness: patient and provider perspectives on improving linkages between primary care and mental health

OBJECTIVE

Previous research suggests that women with mental illness may be at increased risk for breast and cervical cancer. This qualitative study of patients and primary care and mental health providers explored challenges to accessing and providing breast and cervical cancer screening for women with mental illness.

METHOD

Key informant patient and provider participants were recruited from a community health setting and teaching hospital. Narrative data from 1) interviews with women in a community primary care setting (n = 16); 2) telephone interviews with women with mental illness (n = 16); and 3) focus groups with primary care providers (n = 9) and mental health providers (n = 26) were collected.

RESULTS

Patient, provider, and system factors that may contribute to suboptimal cancer screening among women with mental illness were identified. Communication between primary care and mental health providers was noted as a key area for intervention to enhance screening. Barriers to and possibilities for a more proactive role for mental health providers were also considered.

CONCLUSIONS

Both patient and provider study participants emphasized the need to address communication gaps between primary care and mental health providers and to promote the active collaboration of mental health providers in preventive cancer screening for women with mental illness.

Depression, quality of life and breast cancer: a review of the literature

Depression is misdiagnosed and undertreated among breast cancer population. Risk factors for depression in the 5 years after diagnosis are related more to the patient rather than to the disease or its treatment. The breast cancer stage (early and advanced) is not statistically significant in terms of rates of psychosocial distress except for recurrence. Risk factors of depression might impair quality of life such as fatigue, past history or recent episode of depression after the onset of cancer, cognitive attitudes of helplessness/hopelessness, resignation. Body image impairment from mastectomy and sexuality aftermath generates higher rates of mood disorders. The link between increased risk of breast cancer and depression is controversial among the literature. Some studies suggest a protective factor, others find a relation between stress, immunity and cancer occurrence or even mortality. Breast cancer survivors report a higher prevalence of mild to moderate depression with a lower quality of life in all areas except for family functioning. Treatment of depression in breast cancer women improves their quality of life and may increase longevity. Antidepressant medications remain the cornerstone of depression treatment. The hypothetical link between their prescription and increased breast cancer risk is not supported by literature's data.

The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial

BACKGROUND

Few studies have tested the effects of a depression intervention on the risk for death associated with depression.

OBJECTIVE

To test whether an intervention to improve depression care can modify the risk for death.

DESIGN

Practice-based, randomized, controlled trial.

SETTING

20 primary care practices in New York, New York, and Philadelphia and Pittsburgh, Pennsylvania.

PATIENTS

1226 randomly sampled patients identified through a 2-stage, age-stratified (60 to 74 years and > or =75 years) depression screening.

INTERVENTION

Depression care manager working with primary care physicians to provide algorithm-based care.

MEASUREMENTS

Depression status based on clinical interview and vital status at 5 years by using the National Death Index.

RESULTS

At baseline, 396 patients met criteria for major depression and 203 patients met criteria for clinically significant minor depression. After a median follow-up of 52.8 months, 223 patients died. Patients with depression in intervention practices were less likely to have died than those in usual care practices (adjusted hazard ratio, 0.67 [95% CI, 0.44 to 1.00]). Risk for death was reduced in patients with major depression (adjusted hazard ratio, 0.55 [CI, 0.36 to 0.84]) but not in patients with clinically significant minor depression (adjusted hazard ratio, 0.97 [CI, 0.49 to 1.92]). The benefit seemed to be almost entirely attributable to a reduction in deaths due to cancer.

LIMITATIONS

The mechanism for an effect on deaths due to cancer is unclear. Depression status, cause of death, and vital status might have been misclassified.

CONCLUSIONS

Older primary care patients with major depression in practices that implemented depression care management were less likely to die over a 5-year period than were patients with major depression in usual care practices. The effect seemed to be limited to deaths due to cancer. The mechanism for such an effect is unclear and warrants further investigation. ClinicalTrials.gov registration number: NCT00000367.

Suicide After Breast Cancer: an International Population-Based Study of 723 810 Women

Few studies have examined long-term suicide risk among breast cancer survivors, and there are no data for women in the United States. We quantified suicide risk through 2002 among 723,810 1-year breast cancer survivors diagnosed between January 1, 1953, and December 31, 2001, and reported to 16 population-based cancer registries in the United States and Scandinavia. Among breast cancer survivors, we calculated standardized mortality ratios (SMRs) and excess absolute risks (EARs) compared with the general population, and the probability of suicide. We used Poisson regression likelihood ratio tests to assess heterogeneity in SMRs; all statistical tests were two-sided, with a .05 cutoff for statistical significance. In total 836 breast cancer patients committed suicide (SMR = 1.37, 95% confidence interval [CI] = 1.28 to 1.47; EAR = 4.1 per 100,000 person-years). Although SMRs ranged from 1.25 to 1.53 among registries, with 245 deaths among the sample of US women (SMR = 1.49, 95% CI = 1.32 to 1.70), differences among registries were not statistically significant (P for heterogeneity = .19). Risk was elevated throughout follow-up, including for 25 or more years after diagnosis (SMR = 1.35, 95% CI = 0.82 to 2.12), and was highest among black women (SMR = 2.88, 95% CI = 1.44 to 5.17) (P for heterogeneity = .06). Risk increased with increasing stage of breast cancer (P for heterogeneity = .08) and remained elevated among women diagnosed between 1990 and 2001 (SMR = 1.36, 95% CI = 1.18 to 1.57). The cumulative probability of suicide was 0.20% 30 years after breast cancer diagnosis.

Comorbidity as a predictor of stage of illness for patients with breast cancer

OBJECTIVE

The purpose of this research was to determine whether comorbidity affects the stage at which breast cancer is diagnosed.

METHODS

Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI) was merged with Medicare claims for 17,468 women diagnosed with breast cancer from 1993 to 1995.

RESULTS

Women with cardiovascular disease, musculoskeletal disorders, mild-to-moderate gastrointestinal disease, and nonmalignant benign breast disease had a 13%, 7%, 14%, and 24% lower odds, respectively, of being diagnosed with advanced breast cancer. Women with diabetes, other endocrine disorders, psychiatric disorders, or hematologic disorders increased the odds of a late-stage diagnosis by 19%, 11%, 20%, and 19% respectively. Mammography screening and contact with the medical care system decreased the odds of late-stage diagnosis.

DISCUSSION

Four hypotheses are suggested to explain this link between comorbid illness and stage at diagnosis: (1) the "surveillance" hypothesis, (2) the "physiological" hypothesis, (3) the "competing demand" hypothesis, and (4) the "death from other causes" hypothesis.

CONCLUSIONS

Comorbidity may complicate the diagnostic decision-making process for breast cancer. The results suggest that contact with the medical care system improves the odds of early-stage diagnosis. Thus, barriers to access for people with chronic conditions may exacerbate those chronic conditions and increase the odds of late-stage breast cancer.

Post-treatment symptoms among ethnic minority breast cancer survivors

PURPOSE/OBJECTIVES

To determine racial and ethnic differences in the range and number of post-treatment symptoms among women who have undergone surgical and postsurgical treatment for breast cancer.

DESIGN

Retrospective study.

SETTING

Community-based social services agency and public health clinic.

METHODS

Face-to-face interview of 116 women who had undergone breast cancer surgery.

SAMPLE

Primarily low-income women in an urban area in northern California. Participants were recruited via posted flyers regarding the study.

MAIN RESEARCH VARIABLES

Outcomes (depression, fatigue, pain, and swelling from lymphedema) and demographics (ethnicity, age, income, insurance, education, and marital status).

FINDINGS

The typical participant was 47 years old, had 12 years of education, and was a parent (74%), unmarried (67%), heterosexual (88%), uninsured (68%), and employed (66%). Thirty percent were Caucasian, 30% African American, 25% Latina, and 15% women of other ethnic backgrounds. African American women and Latinas reported increased rates of pain and an increased number of symptoms. Latinas also reported higher rates of fatigue and depression. In multivariate analyses, an increased number of symptoms were associated with decreased income, with receiving chemotherapy, with having a mastectomy, and with Latina ethnicity.

CONCLUSIONS

These data suggest an increased rate of post-treatment symptoms experienced by low-income and ethnic minority women.

IMPLICATIONS FOR NURSING

A need exists for affordable, culturally appropriate symptom management interventions. Nursing will have a vital role in designing, testing, and offering such interventions.

Specific phobia of illness: search for a new subtype

Specific phobia of illness makes its appearance in DSM-IV as a new diagnostic subtype, separate from hypochondriasis. A review of the literature indicates that, while there is some support for this new category, studies have not as yet been done that could provide validation. Illness phobia appears to be a significant problem; it is prevalent in the general population and is associated with distress and impairment, including interference with medical care. It appears to be associated with older age, physical illness, and female gender. Group comparisons are needed showing that persons with this phobia can be distinguished from hypochondriasis on the basis of these and other demographic and illness features. We outline a research agenda for demonstrating this separation.

Psychological factors and cancer development: Evidence after 30 years of research

The question whether psychological factors affect cancer development has intrigued both researchers and patients. This review critically summarizes the findings of studies that have tried to answer this question in the past 30 years. Earlier reviews, including meta-analyses, covered only a limited number of studies, and included studies with a questionable design (group-comparison, cross-sectional or semiprospective design). This review comprises only longitudinal, truly prospective studies (N=70). It was concluded that there is not any psychological factor for which an influence on cancer development has been convincingly demonstrated in a series of studies. Only in terms of 'an influence that cannot be totally dismissed,' some factors emerged as 'most promising': helplessness and repression seemed to contribute to an unfavorable prognosis, while denial/minimizing seemed to be associated with a favorable prognosis. Some, but even less convincing evidence, was found that having experienced loss events, a low level of social support, and chronic depression predict an unfavorable prognosis. The influences of life events (other than loss events), negative emotional states, fighting spirit, stoic acceptance/fatalism, active coping, personality factors, and locus of control are minor or absent. A methodological shortcoming is not to have investigated the interactive effect of psychological factors, demographic, and biomedical risk factors.

Fear, Anxiety, Worry, and Breast Cancer Screening Behavior: A Critical Review

Anxiety, fear, and worry are variously described as facilitators and barriers of breast cancer screening. However, several contradictions are evident in this research. A review article described the literature regarding the relations among fear, anxiety, and worry, along with emotion regulatory styles, and breast cancer screening behaviors before critiquing it in an attempt to uncover preliminary explanations for these discrepancies. Three main conclusions are drawn. First, it is suggested that researchers need to clearly define the components of cancer and the screening process that women are afraid of as each may bear a different relation to screening behavior. Second, greater care needs to be taken to employ psychometrically valid and reliable measures of fear and anxiety. Third, studies need to more systematically test findings across the minority and ethnic groups at greatest risk. A framework is presented and suggestions regarding the continued development of this promising area of research are made.

Changes in Psychological Distress of Women With Breast Cancer in Long-Term Remission and Their Husbands

The purpose of this randomized, prospective study was to identify factors influencing the psychological distress of breast cancer patients and their husbands during remission. Background variables and distress levels of 172 couples in two locations (Graz, Austria, and Jerusalem, Israel) were assessed by using three standardized instruments in two interviews conducted 6-8 months apart. In both geographic-cultural groups, women whose partners refused to participate in the interview reported significantly less perceived family support. The global severity index (measuring total psychological distress) reflected minor changes in psychological distress of both patients and their husbands over time.

Clinical and demographic profile of cancer patients in a consultation-liaison psychiatric service

CONTEXT

An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders.

OBJECTIVE

To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity.

TYPE OF STUDY

Descriptive study.

SETTING

Tertiary-care teaching hospital.

PARTICIPANTS

319 patients referred 412 times to the consultation-liaison psychiatry service.

PROCEDURES

From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do C ncer, and also all referrals registered at the consultation-liaison psychiatry service.

MAIN MEASUREMENTS

The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service.

RESULTS

Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders.

CONCLUSION

A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated patients, who deserved special attention throughout the psychiatric interventions.

Do women who screen positive for mental disorders in primary care have lower mammography rates?

Disparities in mammography rates have been documented for underserved populations, yet no data are available for women with mental illness in primary care settings. We analyzed data on mammography rates for 526 women age 40-70 who were new patients and completed the Primary Care Evaluation of Mental Disorders (PRIME-MD). There were no significant differences in mammography rates among women who screened negative and positive for any mental illness (56% and 53%, respectively). Screening for mental disorders in primary care does not appear to identify women at risk for nonreceipt of mammography.