Breast cancer and depression: issues in clinical care

  • Thingbaijam B. Singh Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, India
  • Laishram J. Singh Department of Radiotherapy, Regional Institute of Medical Sciences, Imphal, India
  • Bhushan B. Mhetre Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, India
Keywords: Breast cancer, coping, depression, distress
Abstract viewed: 1468 times
PDF downloaded: 1134 times


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. (Med J Indones. 2012;21:240-6)


  1. American Cancer Society. Cancer facts and figure 2007. Atlanta: American Cancer Society; 2007.

  2. Musselman DL, Somerset WI, Guo Y, Manatunga AK, Porter M, Penna S, et al. A double-blind, multicenter, parallel-group study of paroxetine, desipramine, or placebo in breast cancer patients (stages I, II, III, and IV) with major depression. J Clin Psychiatry. 2006;67:288-96.

  3. Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;1:27-32.

  4. Mahapatro F, Parkar SR. A comparative study of coping skills and body image: mastectomised vs lumpectomised patients with breast carcinoma. Indian J Psychiatry. 2005;47:198-204.

  5. Fobair P, Stewart SL, Chang S, D'Onofrio C, BanksPJ, Bloom JR. Body image and sexual problems inyoung women with breast cancer. Psychooncology. 2006;15:579-94.

  6. Stanton AL. Psychosocial concerns and interventions forcancer survivors. J Clin Oncol. 2006;24(32):5132-7.

  7. Fann JR, Thomas-Rich AM, Katon WJ, Cowley D, Pepping M, McGregor BA, et al. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008;30:112-26.

  8. Axelrod D, Smith J, Kornreich D, Grinstead E, Singh B, Cangiarella J, et al. Breast cancer in young women. J Am Coll Surg. 2008;206(6):1193-203.

  9. Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26(20):3331-7.

  10. Lee KC, Ray GT, Hunkeler EM, Finley PR. Tamoxifen treatment and new onset depression in breast cancer patients. Psychosomatics. 2007;48:205-10.

  11. Thornton LM, Carson WE, Shapiro CL, Farrar WB, Andersen BL. Delayed emotional recovery after taxanebased chemotherapy. Cancer. 2008;113(3):638-47.

  12. Sarenmalm EK, Ớhlẻn J, Jonsson T, Gaston-Johansson F. Coping with recurrent breast cancer: predictors of distressing symptoms and health-related quality of life. J Pain Symptom Manage. 2007;34:24-39.

  13. Friedman LC, Romero C, Elledge R, Chang J, Kalidas M, Dulay MF, et al. Attribution of blame, self forgiving attitude and psychological adjustment in women with breast cancer. J Behav Med. 2007;30:351-7.

  14. Hegel MT, Moore CP, Collins ED, Kearing S, Gillock KL, Riggs RL, et al. Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer. Cancer. 2006;107:2924-31.

  15. Ali NS, Khalil HZ. Identification of stressors, level of stress, coping strategies, and coping effectiveness among Egyptian mastectomy patients. Cancer Nurs 1991;14:232-9.

  16. Thomas SF, Marks DF. The measurement of coping inbreast cancer patients. Psychooncology 1995;4231-7.

  17. Spiegel D, Riba M. Psychological aspects of cancer. In: DeVita VT, Lawrence TS, Rosenberg SA, editors. Principles and practice of oncology. 8th edition. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. p. 2817-26.

  18. Savard J, Liu L, Natarajan L, Rissling MB, Neikrug AB, HeF, et al. Breast cancer patients have progressively impaired sleep-wake activity rhythms during chemotherapy. Sleep.2009;32(9):1155-60.

  19. Lee KC, Ray GT, Hunkeler EM, Finley PR. Tamoxifen treatment and new-onset depression in breast cancer patients. Psychosomatics. 2007;48:205-10.

  20. Reiche EM, Morimoto HK, Nunes SM. Stress and depression-induced immune dysfunction: implications for the development and progression of cancer. Int RevPsychiatr. 2005;17(6):515-27.

  21. Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298(14):1685-7.

  22. Thaker PM, Han LY, Kamat AA, Arevalo JM, TakahashiR, Lu C, et al. Chronic stress promotes tumor growth and angiogenesis in a mouse model of ovarian carcinoma. NatMed. 2006;12: 939-44.

  23. Weinberger T, Forrester A, Markov D, Chism K, Kunkel EJ. Women at a dangerous intersection: diagnosis and treatment of depression and related disorders in patients with breast cancer. Psychiatr Clin North Am. 2010;33:409-22.

  24. Lorr M, McNair DM, Droppleman LF. POMS profile of mood states [Internet]. [cited 2012 Jan 10]. Available from:

  25. National Comprehensive Cancer Network. Practiceguidelines in oncology - distress management [Internet].[cited 2012 Jan 10].Available from: /professionals/physician_gls/f_guidelines.asp#supportive.

  26. Hegel MT, Collins ED, Kearing S, Gillock KL, Moore CP, Ahles TA. Sensitivity and specificity of the distress thermometer for depression in newly diagnosed breast cancer patients. Psychooncology. 2008;17:556-60.

  27. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-70.


  29. Andersen BL, Shelby RA, Golden-Kreutz DM. RCT of a psychological intervention for patients with cancer: I. mechanisms of change. J Consult Clin Psychol.2007;75(6):927-38.

  30. Dolbreault S, Cayrou S, Bredart A, Viala AL, Desclaux B, Saltel P, et al. The effectiveness of a psycho-educational group after early stage breast cancer treatment: results of a randomized French study. Psychooncology. 2009;18:647-56.

  31. Hunter MS, Coventry S, Hamed H, Fentiman I, Grunfeld EA. Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment. Psychooncology. 2009;18(5):560-3.

  32. Classen CC, Kraemer HC, Blasey C, Giese-Davis J, Koopman C, Palesh OG, et al. Supportive expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial. Psychooncology.2008;17:438-47.

  33. Kissane DW, Grabsch B, Clarke DM, Smith GC, Love AW, Bloch S, Snyder RD, Li Y. Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial. Psychooncology. 2007 Apr;16(4):277-86.

  34. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94:39-49.

  35. Lengacher CA, Johnson-Mallard V, Post-White J, MoscosoMS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18:1261-72.

  36. Altshuler LL, Cohen LS, Moline ML, Kahn DA, Carpenter D, Docherty JP, et al. Treatment of depression in women: a summary of the expert consensus guidelines. J Psychiatr Pract. 2001;7(3):185-208.

  37. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005;365(9472):1687-717.

  38. Borges S, Desta Z, Li L, Skaar TC, Ward BA, Nguyen A, et al. Quantitative effect of CYP2D6 genotype and inhibitors on tamoxifen metabolism: implication for optimization of breast cancer treatment. Clin Pharmacol Ther. 2006;80(1):61-74.

  39. Gelenberg AJ, Freeman MP, Markowitz JP, Rosenbaum JF, Thase ME, Trivedi MH, et al. Practice guidelines for the treatment of patients with major depressive disorder. 3rd ed. Arlington, VA: American Psychiatric Publishing Inc.; 2010.

  40. Vadivelu N, Schreck M, Lopez J, Kodumudi G, Narayan D.Pain after mastectomy and breast reconstruction. Am Surg. 2008;74(4):285-96.

  41. Tasmuth T, Hartel B, KalsoET. Venlafaxine in neuropathicpain following treatment of breast cancer. Eur J Pain. 2002;16:17-24.

  42. Reuben SS, Makari-Judson G, Lurie SD. Evaluation of efficacy of the perioperative administration of venlafaxine XR in the prevention of post-mastectomy pain syndrome. J Pain Symptom Manage: 2004;27(2):133-9.


  44. N, Triaspolitica. "Kanker Payudara: Informasi, Penyebab, Gejala, Stadium Dan Pengobatan." Mau Nanya Dong Dok. N.p, 28 June 2017. Web. 30 June 2017. <>.

How to Cite
Singh TB, Singh LJ, Mhetre BB. Breast cancer and depression: issues in clinical care. Med J Indones [Internet]. 2012Nov.1 [cited 2024Apr.24];21(4):240-6. Available from:
Review Article