title: Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study.
abstract: OBJECTIVE
  Most women with early-stage breast cancer believe that psychosocial factors are an important influence over whether their cancer will recur. Studies of the issue have produced conflicting results.
  
  
  METHODS
  A population-based sample of 708 Australian women diagnosed before age 60 years with nonmetastatic breast cancer was observed for a median of 8.2 years. Depression and anxiety, coping style, and social support were assessed at a median of 11 months after diagnosis. Hazard ratios for distant disease-free survival (DDFS) and overall survival (OS) associated with psychosocial factors were estimated separately using Cox proportional hazards survival models, with and without adjustment for known prognostic factors.
  
  
  RESULTS
  Distant recurrence occurred in 209 (33%) of 638 assessable patients, and 170 (24%) of 708 patients died during the follow-up period. There were no statistically significant associations between any of the measured psychosocial factors and DDFS or OS from the adjusted analyses. From unadjusted analyses, associations between greater anxious preoccupation and poorer DDFS and OS were observed (P = .02). These associations were no longer evident after adjustment for established prognostic factors; greater anxious preoccupation was associated with younger age at diagnosis (P = .03), higher tumor grade (P = .02), and greater number of involved axillary nodes (P = .008).
  
  
  CONCLUSIONS
  The findings do not support the measured psychosocial factors being an important influence on breast cancer outcomes. Interventions for adverse psychosocial factors are warranted to improve quality of life but should not be expected to improve survival.
authors.affiliation: Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Carlton, Victoria 3053, Australia.
authors.forename: Kelly-Anne
authors.initials: KA
authors.lastname: Phillips
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
authors.forename: Gillian S
authors.initials: GS
authors.lastname: Dite
authors.forename: Carmel
authors.initials: C
authors.lastname: Apicella
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
authors.forename: Roger L
authors.initials: RL
authors.lastname: Milne
mesh_terms: D001315:Australia; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*