A B S T R A C T PurposeNumerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival. MethodsIn a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies-Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival. ResultsMedian survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P ϭ .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association. ConclusionDecreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis. J Clin

Objective-Sleep disturbances are common among women with breast cancer and can have serious consequences. The present study examined depression, pain, life stress, and participation in group therapy in relation to sleep disturbances in a sample of women with metastatic breast cancer.Methods-Ninety-three women with metastatic breast cancer participated in a large intervention trial examining the effect of the group therapy on their symptoms. They completed measures of depression, pain, life stress, and sleep disturbance at baseline, 4, 8 and 12 months. Results-The results showed that higher initial levels of depression at baseline predicted problems associated with getting up in the morning, waking up during the night, and daytime sleepiness. Increases in depression over the course of 12 months were associated with fewer hours of sleep, more problems with waking up during the night and more daytime sleepiness. Higher levels of pain at baseline predicted more problems getting to sleep. Increases in pain predicted more difficulty getting to sleep and more problems waking up during the night. Greater life stress at baseline predicted more problems getting to sleep and more daytime sleepiness.Conclusions-Depression, pain, and life stress scores were each associated with different types of negative change in self-reported sleep disturbances. Depression, especially worsening depression, was associated with the greatest number of types of negative change. The relationships found between sleep disturbance and depression, pain, and life stress suggest specific ways to address the problem of sleep disturbance for women with metastatic breast cancer and show how different types of disturbed sleep may be clinical markers for depression, pain, or life stress in this population.Keywords sleep disturbance; metastatic breast cancer; pain; depression; stressful life events Corresponding Author: Oxana G. Palesh, Ph.D., Department of Radiation Oncology, University of Rochester Medical Center, James P. Wilmot Cancer Center, 601 Elmwood Avenue, Box 704 Rochester, New York 14642. E-mail: Oxana_Palesh@urmc.rochester.edu, phone: (585) 273-3998, fax: (585) 461-5601. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disturbed sleep is common among breast cancer patients (Davidson, MacLean, Brundage, & Schulze, 2002;Koopman, Nouriani et al., 2002;Savard & Morin, 2001) and has been found to be associated not only with poor quality of life (Carpenter & Andrykowski, 1998;Fortner, Stepanski, Wang, Kasprowicz, & Durrence, 2002), depressive symptoms (Koopman, Nouriani et al., 2002), and fatigue (Lic...

Art therapy (with an art therapist) and art making (without an art therapist) show promise as avenues for psychosocial support for women with breast cancer. The purpose of this study was to gain an in-depth understanding of how 17 women with breast cancer in Canada and the USA used art therapy and their own art making to address their psychosocial needs, focusing particularly on meaning making. Narrative analysis of interviews yielded four storylines: Art and Art Therapy as a Haven; Getting a Clearer View; Clearing the Way Emotionally; and Enhancing and Enlivening the Self. The storylines show existence being affirmed, confirmed and proclaimed through visual artistic expression and meaning making being achieved through physical acts of making.