Palliative & Supportive Care



Psychological morbidity and quality of life in women with advanced breast cancer: A cross-sectional survey


BRENDA  GRABSCH  M.S.W. a1 , DAVID M.  CLARKE  M.S., B.S., M.P.M., F.R.D., FRANZCP a2 , ANTHONY  LOVE  Ph.D. a3 , DEAN P.  McKENZIE  B.A. a4 , RAYMOND D.  SNYDER  M.B., B.S., M.Med., FRACP a5 , SIDNEY  BLOCH  M.B., Ch.B., Ph.D., FRANZCP, Frc.Psych. a1 , GRAEME  SMITH  M.D., B.S., FRANZCP a2 and DAVID W.  KISSANE  M.D., B.S., M.P.H., FRANZCP, FRACRPM a6 c1
a1 University of Melbourne Centre for Palliative Care, Departments of Medicine and Psychiatry, St. Vincent's Hospital and Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
a2 Monash University Department of Psychological Medicine, Monash Medical Centre, Clayton, Victoria, Australia
a3 School of Psychological Sciences, LaTrobe University, Bundoora, Victoria, Australia
a4 Monash University Department of Epidemiology & Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australia
a5 Department of Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
a6 Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York

Article author query
grabsch b   [PubMed][Google Scholar] 
clarke dm   [PubMed][Google Scholar] 
love a   [PubMed][Google Scholar] 
mckenzie dp   [PubMed][Google Scholar] 
snyder rd   [PubMed][Google Scholar] 
bloch s   [PubMed][Google Scholar] 
smith g   [PubMed][Google Scholar] 
kissane dw   [PubMed][Google Scholar] 

Abstract

Objective: Our purpose was to determine the frequency of psychiatric morbidity and to assess the quality of life of women with advanced breast cancer.

Methods: The 227 women in the sample were recruited in Melbourne, Australia, and were interviewed (prior to intervention) for a randomized controlled trial of supportive-expressive group therapy. The main outcome measures were DSM–IV psychiatric diagnoses plus quality of life data based on the EORTC QLQ-C30 (core) and QLQ-BR23 (breast module) instruments.

Results: Forty-two percent of the women (97/227) had a psychiatric disorder; 35.7% (81) of these had depression or anxiety or both. Specific diagnoses were minor depression in 58 women (25.6%), major depression in 16 (7%), anxiety disorder in 14 (6.2%), and phobic disorder in 9 (4%). Seventeen (7.5%) women had more than one disorder. In terms of quality of life, one-third felt less attractive, one-quarter were dissatisfied with their body image, and, in most, sexual interest had waned. Menopausal symptoms such as hot flashes affected less than one-third, whereas symptoms of lymphedema were experienced by 26 (11.5%).

Significance: Women with advanced breast cancer have high rates of psychiatric and psychological disturbance. Quality of life is substantially affected. Clinicians need to be vigilant in monitoring psychological adjustment as part of a comprehensive biopsychosocial approach.

(Received December 23 2005)
(Accepted January 16 2006)


Key Words: Advanced breast cancer; Depression; Anxiety; Psychosocial morbidity; Quality of life.

Correspondence:
c1 Corresponding author: David W. Kissane, M.D., Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. E-mail: kissaned@msckc.org