title: Psychological distress and pain significantly increase before death in metastatic breast cancer patients.
abstract: OBJECTIVE
  This study was designed to examine the course of psychological distress and pain from study entry to death in 59 women with metastatic breast cancer participating in a randomized trial of the effects of group psychotherapy on psychosocial outcomes and survival. It was hypothesized that psychological distress would increase significantly before death independent of changes in pain.
  
  
  METHODS
  Data were collected as part of a larger study (N = 125). Analyses were based on data from a subset of women who had died and for whom we had data from at least three assessments. Mean levels of mood, trauma symptoms, depression symptoms, well-being, and pain over three time points were examined: at baseline (T1), the second-to-last assessment before death (T2), and the last assessment before death (T3).
  
  
  RESULTS
  Results indicate that while psychological distress remained relatively constant or declined from T1 to T2, means on all measures significantly changed in the hypothesized direction from T2 to T3. Neither self-reported pain, nor the passage of time, appeared to account for these changes. Additionally, participation in group psychotherapy did not have a significant impact on this change in distress proximal to death.
  
  
  CONCLUSIONS
  Results suggest that specialized end-stage clinical interventions are particularly needed for cancer patients as they approach death. Moreover, intervention studies for patients with deteriorating illnesses may need to take this "spike" in psychological distress and pain proximal to death into account to avoid Type II errors in evaluations of psychological outcomes.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5718, USA. butler@psych.stanford.edu
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Butler
authors.forename: Cheryl
authors.initials: C
authors.lastname: Koopman
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Cordova
authors.forename: Robert W
authors.initials: RW
authors.lastname: Garlan
authors.forename: Sue
authors.initials: S
authors.lastname: DiMiceli
authors.forename: David
authors.initials: D
authors.lastname: Spiegel
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D001293:Attitude to Death; D001943:Breast Neoplasms / Q000503:physiopathology / Q000523:psychology*; D003643:Death; D003863:Depression / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D011615:Psychotherapy, Group; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000209:etiology* / Q000628:therapy; D016019:Survival Analysis; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors; D017211:Treatment Failure