title: Influence of psychological response on survival in breast cancer: a population-based cohort study.
abstract: BACKGROUND
  The psychological response to breast cancer, such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease, has been suggested as a prognostic factor with an influence on survival. We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer.
  
  
  METHODS
  578 women with early-stage breast cancer were enrolled in a prospective survival study. Psychological response was measured by the mental adjustment to cancer (MAC) scale, the Courtauld emotional control (CEC) scale, and the hospital anxiety and depression (HAD) scale 4-12 weeks and 12 months after diagnosis. The women were followed up for at least 5 years. Cox's proportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response, with adjustment for known clinical factors associated with survival.
  
  
  RESULTS
  At 5 years, 395 women were alive and without relapse, 50 were alive with relapse, and 133 had died. There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD scale category of depression (hazard ratio 3.59 [95% CI 1.39-9.24]). There was a significantly increased risk of relapse or death at 5 years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category (1.55 [1.07-2.25]). There were no significant results found for the category of "fighting spirit".
  
  
  CONCLUSIONS
  For 5-year event-free survival a high helplessness/hopelessness score has a moderate but detrimental effect. A high score for depression is linked to a significantly reduced chance of survival; however, this result is based on a small number of patients and should be interpreted with caution.
authors.affiliation: Royal Marsden Hospital NHS Trust, Sutton, Surrey, UK. maggie.watson@rmh.nthames.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Watson
authors.forename: J S
authors.initials: JS
authors.lastname: Haviland
authors.forename: S
authors.initials: S
authors.lastname: Greer
authors.forename: J
authors.initials: J
authors.lastname: Davidson
authors.forename: J M
authors.initials: JM
authors.lastname: Bliss
mesh_terms: D000368:Aged; D001007:Anxiety; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000209:etiology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012923:Social Class; D011795:Surveys and Questionnaires; D016019:Survival Analysis