Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort

Abstract

The possibility that psychological response within a few weeks of a breast cancer diagnosis can influence the outcome of the disease is a contentious issue. Psychological response, including helplessness/hopelessness, fighting spirit and depression was assessed in early-stage breast cancer patients between 1 and 3 months post-diagnosis, in order to ascertain effect on cancer prognosis. Patients were followed up for a period of 10 years in order to clarify the effect of psychological response on disease outcome. After 10 years, there is a continuing effect of helplessness/hopelessness on disease-free survival (adjusted hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.11-2.11) but not of depression (adjusted HR for overall survival for ÔcasesÕ 2.43, 95% CI 0.97-6.10). Longer follow-up also indicates that a high fighting spirit confers no survival advantage. The results showed that, in patients who were disease-free at 5 years, their baseline helpless/hopeless response still exerted a significant effect on disease-free survival beyond 5 (and up to 10) years. The effect is therefore maintained for up to 10 years of follow-up. Clinicians may wish to screen for helplessness around the time of diagnosis in order to target psychological care resources. Further large studies, with similarly prolonged follow-up, are needed to replicate this effect and clarify its mechanism of action.

Early discontinuation of tamoxifen

“…15 Depression has also been associated with reduced survival in women with breast cancer, [36][37][38] although the evidence from some studies has been inconclusive. 39 Whereas a number of mechanisms have been proposed to explain this association, results from this study suggest that nonpersistence with tamoxifen may in part provide an explanation.…”

Breast cancer recurrence risk in relation to antidepressant use after diagnosis

“…Even if antidepressant use were not independently associated with the risk of breast cancer recurrence, it could appear to be if antidepressant users had a higher risk of recurrence due to depression and/or inadequate treatment. However, it is unclear whether psychosocial characteristics are independent risk factors for prognosis [59][60][61]. Removing any confounding by indication would likely decrease the hazard ratio; in other words, the lack of an observed is association is unlikely to be due to confounding by indication.…”

Association of Coping Style, Cognitive Errors and Cancer-related Variables with Depression in Women Treated for Breast Cancer

“…Beck et al (34) suggested that patients with depression are hopeless about the future and that as hopelessness increases, so does the severity of depression. In studies done in patients with breast cancer, it has been found that hopelessness is a risk factor for depression and has a negative effect on coping with cancer (35)(36)(37).…”