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Psychosocial issues don't hurt breast ca outcomes. (Depression, Helplessness).

SAN ANTONIO -- Psychosocial factors aren't related to outcome in women with early-stage breast cancer, Dr. Pamela J. Goodwin reported at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

Contrary to popular belief, breast cancer patients who at diagnosis are depressed, anxious, or score high on helplessness/hopelessness measures don't subsequently have higher rates of distant metastasis or death than those who are free of such psychological baggage. And women with a fighting-spirit coping style don't fare differently than those with a more fatalistic attitude toward their disease, said Dr. Goodwin, director of the Marvelle Koffler Breast Center at Mt. Sinai Hospital, Toronto.

She reported on 378 women with surgically removed early-stage breast cancer who completed an extensive battery of psychological and health-related quality-of-life tests about 10 weeks after their diagnosis.

They were then prospectively followed for a median of 5.8 years, during which there were 57 distant cancer recurrences and 34 deaths.

Dr. Goodwin's hypothesis was that relapse and death would be more likely in women with poor health-related quality of life, a less active coping style, and greater depression, anxiety, and other psychological distress.

At the time the study began there was some evidence to suggest such factors influence prognosis in advanced breast cancer, but very little data on early-stage disease.

Her hypothesis wasn't borne out. The great majority of the dozens of psychosocial and health-related quality of life variables assessed proved unrelated to cancer outcomes in univariate analyses. The few weak associations that were identified became nonsignificant after adjustment for age, body mass index, tumor stage, and the use of adjuvant therapy.

Dr. Goodwin said she sees these findings as liberating for breast cancer patients. The data indicate there is no single best way for them to deal with their disease. This removes pressure to respond in a certain way that may not come naturally to some.

"This is a positive finding. It lets women be themselves," she said at the meeting.

Assessment tools utilized in the study were the Psychosocial Adjustment to Illness Scale, the Courtauld Emotional Control Scale, the Profile of Mood States, the core 30 items of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the Mental Adjustment to Cancer Scale, and the Impact of Events Scale.
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Author:Jancin, Bruce
Publication:Clinical Psychiatry News
Geographic Code:1CANA
Date:Feb 1, 2003
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