Abstract
Purpose
The purposes of this study are to examine the course and prevalence of anxiety and depression over 24 months in women with newly diagnosed breast and gynaecologic cancer and, controlling for demographic and clinical confounders, to test the role of neuroticism and psychiatric history in determining outcome 6, 12, 18 and 24 months post-diagnosis.
Methods
Participants completed the Hospital Anxiety and Depression Scale—anxiety subscale and Centre for Epidemiological Studies Depression Scale on an 8-weekly basis from diagnosis until 96 weeks. Changes over time were analyzed with repeated measures ANOVA. Hierarchical linear regression, adjusted a priori for age, chemotherapy and radiation treatment, living alone, education and tumour stream were used to predict anxiety and depression.
Results
Participants were 105 women (66 breast, 39 gynaecologic). Rates of anxiety (18.1 %) and depression (33.3 %) were highest at diagnosis. Average rates of anxiety and depression were 5.9 and 22.4 %, respectively. Average scores of anxiety and depression were highest at diagnosis, with improvement at 8 and 40 weeks, respectively, subsequently maintained. Morbidity at diagnosis was particularly acute among women with a treatment history of anxiety/depression or with high neuroticism. These three variables were the best and only predictors over 24 months.
Conclusions
Women are most vulnerable to anxiety and depression at diagnosis, with improvement over time. Morbidity rates are lower than reported elsewhere. Women with high neuroticism and a psychiatric history are at greatest risk for future morbidity after adjusting for confounders. Early identification of these women plus heightened surveillance or early referral to psychosocial services may protect against longer-term morbidity.
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References
Australian Institute of Health (2012) Cancer in Australia: an overview 2012. AIHW, Canberra
Fallowfield L, Ratcliffe D, Jenkins V, Saul J (2001) Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 84:1011–1015
Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncology 10:19–28
Fowler JM, Carpenter KM, Gupta P, Golden-Kreutz DM, Andersen BL (2004) The gynecologic oncology consult: symptom presentation and concurrent symptoms of depression and anxiety. Obstet Gynecol 103:1211–1217
van Amstel FK P, van den Berg SW, van Laarhoven HW, Gielissen MF, Prins JB, Ottevanger PB (2013) Distress screening remains important during follow-up after primary breast cancer treatment. Support Care Cancer 21:2107–2115
Den Oudsten BL, Van Heck GL, Van der Steeg AF, Roukema JA, De Vries J (2009) Predictors of depressive symptoms 12 months after surgical treatment of early-stage breast cancer. Psycho-Oncology 18:1230–1237
Manne S, Rini C, Rubin S, Rosenblum N, Bergman C, Edelson M et al (2008) Long-term trajectories of psychological adaptation among women diagnosed with gynecological cancers. Psychosom Med 70:677–687
Stafford L, Judd F, Gibson P, Komiti A, Mann G, Quinn M (2013) Screening for depression and anxiety in women with breast and gynaecologic cancer: course and prevalence of morbidity over 12 months. Psycho-Oncology 22:2071–2078
Lindviksmoen G, Hofso K, Paul SM, Miaskowski C, Rustoen T (2013) Predictors of initial levels and trajectories of depressive symptoms in women with breast cancer undergoing radiation therapy. Cancer Nurs 36:E34–E43
Johnson RL, Gold MA, Wyche KF (2010) Distress in women with gynecologic cancer. Psycho-Oncology 19:665–668
Enns A, Waller A, Groff SL, Bultz BD, Fung T, Carlson LE (2013) Risk factors for continuous distress over a 12-month period in newly diagnosed cancer outpatients. J Psychosoc Oncol 31:489–506
Torres MA, Pace TW, Liu T, Felger JC, Mister D, Doho GH et al (2013) Predictors of depression in breast cancer patients treated with radiation: role of prior chemotherapy and nuclear factor kappa B. Cancer 119:1951–1959
Iwatani T, Matsuda A, Kawabata H, Miura D, Matsushima E (2013) Predictive factors for psychological distress related to diagnosis of breast cancer. Psycho-Oncology 22:523–529
Hulbert-Williams L, Neal RD, Morrison V, Hood K, Wilkinson C (2012) Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust? Psycho-Oncology 21:857–867
Wong-Kim E, Bloom J (2005) Depression experienced by young women newly diagnosed with breast cancer. Psycho-Oncology 14:564–573
Kim JM, Jang JE, Stewart R, Kim SY, Kim SW, Kang HJ et al (2013) Determinants of suicidal ideation in patients with breast cancer. Psycho-Oncology 22:2848–2856
Van Esch L, Roukema JA, Ernst MF, Nieuwenhuijzen GA, De Vries J (2012) Combined anxiety and depressive symptoms before diagnosis of breast cancer. J Affect Disord 136:895–901
Osborn R, Demoncada A, Feuerstein M (2006) Psychosocial interventions for depression, anxiety and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36:13–34
Weiss A, Costa PT Jr (2005) Domain and facet personality predictors of all-cause mortality among Medicare patients aged 65 to 100. Psychosom Med 67:724–733
Watson D, Pennebaker J (1989) Health complaints, stress and distress: exploring the central role of negative affectivity. Psychol Rev 96:234–254
Krueger R, Caspi A, Moffitt T, Silva P, McGee R (1996) Personality traits are differentially linked to mental disorders: a multi-trait multi-diagnosis study of an adolescent birth cohort. J Abnorm Psychol 105:299–312
Scott J, Eccleston D, Boys R (1992) Can we predict the persistence of depression? Br J Psychiatry 161:633–637
Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370
Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77
Radloff LS (1977) The CESD scale: a self report scale for research in the general population. Appl Psychol Meas 1:385–401
Mitchell AJ, Meader N, Davies E, Clover K, Carter GL, Loscalzo MJ et al (2012) Meta-analysis of screening and case finding tools for depression in cancer: evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group. J Affect Disord 140:149–160
Luckett T, Butow PN, King MT, Oguchi M, Heading G, Hackl NA et al (2010) A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Support Care Cancer 18:1241–1262
Mulrow C, William J, Gerety M, Ramirez G, Montiel O, Kerber C (1995) Case-finding instruments for depression in primary care settings. Ann Intern Med 122:913–921
Goldberg L (2001) International personality item pool. www.ipip.ori.org
Gow A, Whiteman M, Pattie A, Deary I (2005) Goldberg’s ‘IPIP’ Big-Five factor markers: internal consistency and concurrent validation in Scotland. Personal Individ Differ 39:317–329
Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191
Ferrandina G, Mantegna G, Petrillo M, Fuoco G, Venditti L, Terzano S et al (2012) Quality of life and emotional distress in early stage and locally advanced cervical cancer patients: a prospective, longitudinal study. Gynecol Oncol 124:389–394
Hoey LM, Ieropoli SC, White VM, Jefford M (2008) Systematic review of peer-support programs for people with cancer. Patient Educ Couns 70:315–337
Hartl K, Engel J, Herschbach P, Reinecker H, Sommer H, Friese K (2010) Personality traits and psychosocial stress: quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psycho-Oncology 19:160–169
Linden W, Girgis A (2012) Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction? Psycho-Oncology 21:343–350
Greer J, Pirl W, Park E, Lynch TJ, Temel J (2008) Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer. J Psychosom Res 65:549–552
Carlson LE, Bultz BD Benefits of psychosocial oncology care: improved quality of life and medical cost offset. Health Qual Life Outcomes 1:8
Satin J, Linden W, Phillips M (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 115:5349–5361
Cuijpers P, Smit F, Penninx BW, de Graaf R, ten Have M, Beekman AT (2010) Economic costs of neuroticism: a population-based study. Arch Gen Psychiatry 67:1086–1093
Tamagawa R, Garland S, Vaska M, Carlson LE (2012) Who benefits from psychosocial interventions in oncology? A systematic review of psychological moderators of treatment outcome. J Behav Med 35:658–673
Nakaya N, Hansen PE, Schapiro IR, Eplov LF, Saito-Nakaya K, Uchitomi Y et al (2006) Personality traits and cancer survival: a Danish cohort study. Br J Cancer 95:146–152
Kramer JA, Curran D, Piccart M, de Haes JC, Bruning PF, Klijn JG et al (2000) Randomised trial of paclitaxel versus doxorubicin as first-line chemotherapy for advanced breast cancer: quality of life evaluation using the EORTC QLQ-C30 and the Rotterdam symptom checklist. Eur J Cancer 36:1488–1497
Acknowledgments
This study was supported in part by funding from the Western and Central Melbourne Integrated Cancer Service (WCMICS). The Centre for Women’s Mental Health is supported by the Pratt Foundation. The funding sources had no role in the study design, or collection, analysis and interpretation of data or in the decision to submit the work for publication. The authors wish to thank the breast care nurses Robyn Cordner, Monique Baldacchino, Kerry Shanahan, Bronwyn Flanagan and Claire Noonan for their assistance in recruiting patients to the study. Dr Chad Bousman is acknowledged for his statistical advice. We also thank the participating patients for their support of this research.
Conflict of interest
The authors have no conflict of interest to declare.
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Stafford, L., Judd, F., Gibson, P. et al. Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: prevalence, course and determinants of outcome. Support Care Cancer 23, 2215–2224 (2015). https://doi.org/10.1007/s00520-014-2571-y
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DOI: https://doi.org/10.1007/s00520-014-2571-y