Psychiatric disorders following first breast cancer recurrence: prevalence, associated factors and relationship to quality of life.
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.
Okamura
Masako
M
Psychiatry Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Yamawaki
Shigeto
S
Akechi
Tatsuo
T
Taniguchi
Koji
K
Uchitomi
Yosuke
Y
D000223:Adaptation, Psychological; D000275:Adjustment Disorders / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000453:epidemiology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003865:Major Depressive Disorder / Q000453:epidemiology; D004317:Doxorubicin / Q000008:administration & dosage; D019263:Dysthymic Disorder / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000523:psychology; D016584:Panic Disorder / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology
D004317:Doxorubicin; D003520:Cyclophosphamide