Breast cancer and depression: issues in clinical care
Many of breast-cancer patients experience distress and most of them experience depression which may lead to amplification of physical symptoms, increased functional impairment, and poor treatment adherence. We did a review on available literature from PubMed about prevalence, distress magnitudes, coping styles, and treatment methods of major depression in women with breast cancer from 1978 to 2010. Diagnosis and treatment of depressive episodes in women with breast cancer is challenging because of overlapping symptoms and co-morbid conditions. Major depression is often under-recognized and undertreated among breast cancer patients. This review highlighted the issues on identifying and managing depression in breast cancer patients in clinical settings. Nowadays, breast cancer is one of the most common malignancies and the leading cause of cancer mortality in women in developed and developing countries.1 The diagnosis of breast cancer should not only include physical condition but also social and psychological condition. This is due to the importance of breast in the womens body image, sexuality and motherhood. The 5-year survival rates of patients with breast cancer have increased to the extent of 89%. The important concern today is to improve the quality of life (QoL) among survivors. Survivors of breast cancer often experience aversive symptoms like fatigue, cognitive problems, and menopausal symptoms. Psychological distress among patients with breast cancer is linked with a worse clinical outcome and at the same time advanced stages of cancer seem to be most stressful and have higher risk for emotional distress. Prevalence of major depression increases with cancer progression, from 11% associated with early-stage, node-negative breast cancer to as great as 50% in women with metastatic breast cancer undergoing palliative therapies.2 Psychological distress due to anxiety and depression are known to predict subsequent quality of life or overall survival in breast cancer patients even years after the disease diagnosis and treatment The psychological response to the diagnosis of breast cancer varies considerably among women.These variations may be due to differences in coping strategies, personality profiles, and available social supports, and to an extent of consultation skills with her medical providers, especially the surgeon who does the breaking of the bad news. Most women undergo concerns and fears about physical appearance and disfigurement, moreover the uncertainty regarding recurrence and fear of death. Among sexually active women, significant body-image-problems are associated with mastectomy, hair loss from chemotherapy, weight gain or loss, and the difficulty of partners in understanding her feelings.5 In 10-30% of women, the diagnosis of breast cancer may lead to increase vulnerability to depressive disorders which include adjustment disorders with depressed mood, major depressive disorder, and mood disorders related to the general medical condition.6 The risk of developing a depressive disorder is highest in the year after receiving diagnosis of breast cancer (Med J Indones. 2012;21:240-6)
Keywords: Breast cancer, coping, depression, distress
Copyright (c) 2012 Thingbaijam B. Singh, Laishram J. Singh, Bhushan B. Mhetre
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