Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer

Almost half of newly diagnosed breast cancer patients are found to have clinically significant emotional distress or symptoms of psychiatric disorders before treatment is begun, according to a new study published in the December 15, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

The study reveals that while virtually all of the women admitted to experiencing some level of emotional distress, 47 percent met clinically significant screening criteria for emotional distress or a psychiatric disorder, including major depression and post-traumatic stress disorder (PTSD).

Studies have shown that significant emotional distress, including mood disorders and related functional impairments, afflict up to one-third of breast cancer survivors for up to 20 years after treatment. However, little was previously known about the baseline psychological status of newly diagnosed breast cancer patients.

To help characterize pre-treatment psychological status, Mark T. Hegel, Ph.D. of the Department of Psychiatry and the Norris Cotton Cancer Center of Dartmouth Medical School and colleagues conducted psychiatric and functional screening of 236 women newly diagnosed with breast cancer.

Their findings indicate that almost one in two women met clinically significant criteria for emotional distress or a psychiatric disorder. The most common problem was moderate to severe emotional distress (41 percent). The most commonly reported source of distress was related to the cancer diagnosis (100 percent), followed by uncertainty about treatment (96 percent) and concern about physical problems (81 percent). Twenty-one percent of women met criteria for psychiatric disorders, including major depression (11 percent) and PTSD (10 percent). These women also demonstrated significant declines in daily functioning that were due to the emotional disorders. Treatment for their cancer had not yet begun.

Almost two-thirds of the women with depression had moderate to severe levels of depression, for which treatment is strongly recommended. More than half of the women with depression were already taking psychotropic medication but continued to have significant symptoms, suggesting that even when identified as being depressed they may be under-treated.

"This study has at least two important implications," Hegel said. "First, we need to do a better job of getting the word out about how well we can treat breast cancer. These emotional disorders are almost certainly due in part to the fear and helplessness that continues to result from receiving a cancer diagnosis. Second, we need to assess for and provide adequate intervention for the women meeting criteria for these severe but very treatable psychiatric conditions." The investigators recommend that "future research should continue to develop and evaluate methods for detecting significant emotional distress and psychiatric disorders in cancer populations and test innovative interventions for effectively treating and managing these disorders in the oncology setting."