Severe depression more common in patients with ductal carcinoma in situ than early-stage invasive breast cancer patients

Abstract

Purpose Ductal carcinoma in situ (DCIS) is associated with an excellent prognosis; historical studies have shown similar levels of psychological distress in patients with DCIS and with early-stage invasive breast cancer (early-IBC). It is suggested that these results might have led to better patient education about prognosis after DCIS. This study reports the current levels of anxiety, depression, and health-related quality of life (HRQoL) in DCIS and early-IBC patients. Methods DCIS (n = 89) and early-IBC patients, T1-2N0, (n = 361) were selected from the UMBRELLA breast cancer cohort. Patient-reported outcomes were prospectively collected before the start of adjuvant radiotherapy (baseline) and at 3, 6, 12, 18, and 24 months thereafter. Mixed models were used to compare differences in levels of anxiety, depression, and HRQoL between DCIS and early-IBC patients.Results DCIS and early-IBC patients reported similar levels of anxiety, which were highest at baseline. Depression scores were comparable between groups, also after stratification by use of adjuvant chemotherapy. The proportion of patients reporting high-risk depression scores (i.e., Hospital Anxiety and Depression Sale score [8) was significantly higher among patients with DCIS at 6, 12 and 18 months, and this proportion increased over the first 18 months. Health-related quality of life was comparable between both groups. Conclusion Severe depression scores are more common in DCIS patients, despite their excellent prognosis. These results suggest that further improvement of patient education and effective patient doctor communication about the prognostic differences between patients with DCIS and invasive breast cancer is still highly needed.

The impact of the COVID-19 pandemic on quality of life, physical and psychosocial wellbeing in breast cancer patients and survivors – a prospective, multicenter cohort study

“…32 The reduction in this domain is very likely attributable to COVID-19, since we know from pre-COVID-19 work in UMBRELLA that emotional functioning of people treated for breast cancer continues to increase over time (as shown in their supplementary data). 33 Also, the median score for depression worsened significantly during COVID-19. Concerns about the new viral threat might have enhanced overall uncertainty in individuals.…”

“…This may partly be explained by the fact that these scores tend to increase over time since diagnosis and, also in the absence of COVID-19, we would expect an increase in these domains. 33 Another explanation could be found in an effect of a Dutch media campaign that encourages (non-risk) exercise to enhance both public physical and mental wellbeing in these exceptional times. 34 The remarkable, perhaps counter-intuitive, increase in QoL could be explained by the fact that a shared crisis may put patients’ perceived QoL in relation to their disease in a different perspective, and may even accelerate reconceptualization of their QoL.…”

The Importance of Alexithymia in Post-surgery. Differences on Body Image and Psychological Adjustment in Breast Cancer Patients

“…Premature death or the sudden changes that may occur in their lives due to cancer are usually the type of negative thoughts that increase an altered self-assessment of body image and lead to dissatisfaction with themselves (Przezdziecki et al, 2013). In this context, low adaptation is defined by manifested anxiety and depression (Gregorowitsch et al, 2018) as a consequence of stress caused by personal insecurity, which explains why strategies focused on cognitive avoidance, helplessness or persistent worries tend to be the most common to deal with the disease. These coping styles increase the incidence of physical symptoms such as pain, fatigue, insomnia or loss of limb functionality (specifically, in the arm or armpit of the affected breast), which in turn, influence the probability of recurrence (Kvillemo and Bränström, 2014;Ahadzadeh and Sharif, 2018).…”

Readmissions and complications in breast ductal carcinoma in situ: A retrospective study comparing screen- and non-screen-detected patients

“…These results are similar to those reported in the previous studies. 15,16 Interestingly, Gregorowitsch et al 17 have noted that severe depression is more common in DCIS than in early-stage invasive BC.…”