Japanese Journal of Clinical Oncology Advance Access originally published online on June 16, 2005
Japanese Journal of Clinical Oncology 2005 35(6):302-309; doi:10.1093/jjco/hyi097
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© 2005 Foundation for Promotion of Cancer Research
Psychiatric Disorders Following First Breast Cancer Recurrence: Prevalence, Associated Factors and Relationship to Quality of Life
1 Psychiatry Division, National Cancer Center Hospital East, Kashiwa, Chiba, 2 Psycho-Oncology Division, National Cancer Center Research Institute East, Kashiwa, Chiba, 3 Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima and 4 Department of Psychiatry, Nagoya City University Medical School, Nagoya, Japan
For reprints and all correspondence: Yosuke Uchitomi, Psycho-Oncology Division, National Cancer Center Research Institute East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan. E-mail: yuchitom{at}east.ncc.go.jp
Received March 4, 2005; accepted May 4, 2005
Objective: The purpose of this study was to investigate the prevalence of and factors associated with psychiatric disorders and the impact on quality of life (QOL) in patients with first breast cancer recurrence.
Methods: We analyzed the baseline data on 50 consecutively enrolled recurrent breast cancer patients, participating in a feasibility study of multifaceted psychosocial intervention. Psychiatric disorders, including major depressive disorder (MDD), dysthymic disorder, panic disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder and adjustment disorders (AD), were evaluated according to the Structured Clinical Interview for the DSM-III-R and IV. The patients' demographic data, biomedical factors, social support, mental adjustment to cancer, personality traits and QOL were also evaluated.
Results: Eleven (22%) met the DSM-III-R and IV criteria for MDD, PTSD or AD (MDD, 2%; PTSD, 2%; AD, 20%). Univariate analysis indicated that current doxorubicin/cyclophosphamide, presence of a confidant, past history of MDD, helplessness/hopelessness and neuroticism were significantly associated with psychiatric disorders. On multivariate logistic regression analysis, past history of MDD and helplessness/hopelessness were significant associated factors. Psychiatric disorders were significantly associated with lower functional scales (‘emotional functioning’, ‘body image’ and ‘future perspective’) and higher symptom scales (‘appetite loss’, ‘diarrhea’, ‘fatigue’ and ‘nausea–vomiting’) in QOL.
Conclusions: The result suggests that asking about history of depression and appropriate intervention, including psycho-education, are needed for patients with first breast cancer recurrence in order to detect and manage psychological distress. Although further studies are needed to clarify causal links between psychiatric disorders and QOL, patients' psychiatric disorders were associated with QOL.
Key Words: recurrent breast cancer • psychiatric disorders • associated factors • quality of life
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