Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients.
OBJECTIVE
To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress.


METHODS
Between January 1997 and April 1998, 111 women (33-84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis.


RESULTS
The internal subject-related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: < or =58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful.


CONCLUSIONS
Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff.
Mose
S
S
Department of Radiation Oncology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. S.Mose@vff.uni-frankfurt.de
Budischewski
K M
KM
Rahn
A N
AN
Zander-Heinz
A C
AC
Bormeth
S
S
Böttcher
H D
HD
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011878:Radiotherapy / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology*