Psychological Distress and Drawing Tests among Women with Breast Cancer.

BACKGROUND: The aim of this study was to evaluate the use of the Diagnostic Drawing Series (DDS) as a screening tool for the breast cancer patients with psychological distress. METHODS: All of 64 patients with breast cancer participated in this study. Patients' depressive and anxiety symptoms were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) when the DDS was applied to the partipicants. RESULTS: Depressed patients used more enclosure in the Feeling drawings (P = 0.002) and tilt in Free drawings (P = 0.048). Patients with anxiety drew a picture over 67% of the paper (P = 0.015) in Tree drawing and more medium pressure (P = 0.049) in Feeling drawings. Thirty four subjects (77.3%) of unstable emotion group used over 67% of the space (P = 0.002). More Landscapes were observed in the Feeling drawings of unstable patients (P = 0.042). CONCLUSION: These results suggested that DDS could be used as a supplemental screening tool for psychological distress in breast cancer patients.

Fatigue and depression in disease-free breast cancer survivors: prevalence, correlates, and association with quality of life.

We performed this study to examine the prevalence and correlates of fatigue and depression, and their relevance to health-related quality of life in disease-free breast cancer survivors. A total of 1,933 breast cancer survivors recruited from five large hospitals in Korea completed a mailed survey, which included the Brief Fatigue Inventory, Beck Depression Inventory, European Organization for Research and Treatment of Cancer QLQ-C30, and QLQ-BR23. With a framework that included sociodemographic, clinical, and symptom characteristics, multivariate logistic regression models were used to identify factors associated with fatigue and depression. Among breast cancer survivors, 66.1% reported moderate to severe fatigue and 24.9% reported moderate to severe depression. Risk factors common to both fatigue and depression were lower income, dyspnea, insomnia, appetite loss, constipation, and arm symptoms. Risk factors for fatigue only included younger age, employment, presence of gastrointestinal disease, and pain. Having a musculoskeletal disease was identified as a risk factor for depression only. Both fatigue and depression were influenced by sociodemographic factors, comorbidity and symptom characteristics rather than cancer or treatment-related factors. Both fatigue and depression were negatively associated with survivors' health-related quality of life. However, the patterns of differences in health-related quality of life according to severity of fatigue or depression were similar. This concurrent examination of risk factors for fatigue and depression may be helpful in the development of clinical management strategies in disease-free breast cancer survivors.

The perceived care needs of breast cancer patients in Korea.

By analyzing the data of 459 patients who completed the Supportive Care Needs Survey (SCNS), the prevalence, medical and non-medical predictors of unmet needs were investigated. Breast cancer patients in Korea experienced high levels of unmet needs across the needs domains, particularly in the health system and information domain (56.9%). Various medical and non-medical variables were identified as significant predictors of unmet needs in each domain. By multivariate analyses, several predictors were identified across the domains including; less education (< or = 9 years) in the psychologic, chemotherapy, short post-surgical interval, and less education in the physical and daily living, younger age (< 50 years) in the sexuality, larger tumor size (> 2 cm) and younger age in the health system and information, and more education (> or = 13 years) in the care and support domain. The results of this study suggest medical professional should consider the complexity and dynamics of meeting patients' needs in providing supportive care services.

Does chemotherapy really affect the quality of life of women with breast cancer?

PURPOSE: The aims of this cross-sectional study were to explore and evaluate the impact of adjuvant chemotherapy on quality of life in breast cancer patients according to the survival time from surgery. METHODS: Completed questionnaires were collected from 534 women with breast cancer. Clinical and sociodemographic characteristics were reviewed and Functional Assessment of Cancer Therapy-Breast cancer instrument, global quality of life, Beck Depression Inventory, and unmet sexuality needs were administered. Descriptive statistics, t-tests, chi-square tests and multiple analysis of covariance were performed while controlling for confounding variables. RESULTS: Statistically significant differences were found between chemotherapy and no chemotherapy group on depression (p=0.026), unmet sexuality needs (p=0.010), breast cancer specific concerns (p=0.010), physical well-being (p=0.001), and emotional well-being (p=0.028). Chemotherapy effects also varied according to survival time since surgery such as for group 1 (<1 year since surgery), significant differences were found on Beck Depression Inventory (p=0.042), unmet sexuality needs (p=0.016), breast cancer subscale (p=0.004), and physical well-being (p=0.016) and for group 3 (>3 years since surgery) on depression (p=0.019) and physical well-being (p=0.028) respectively; however, there were no significant differences between chemotherapy and no chemotherapy group for group 2 (1-3 years since surgery). CONCLUSION: As expected, breast cancer patients who underwent adjuvant chemotherapy experienced significantly worse quality of life than those who did not receive chemotherapy. Furthermore, the adverse chemotherapy effects on the quality of life appear to vary according to the time since surgery. These results suggest that health care professionals may need to address long-term as well as short-term chemotherapy side-effects and intervene accordingly to enhance quality of life of breast cancer patients.

Unmet needs of breast cancer patients relative to survival duration.

PURPOSE: The present study aims to evaluate the prevalence of unmet needs among breast cancer survivors, to assess the relationships between unmet needs and depression and quality of life, and to explore the extent to which unmet needs of breast cancer patients relate to the time elapsed since surgery. MATERIALS AND METHODS: Among 1,250 eligible patients who participated in the study, 1,084 cases (86.7%) were used for analysis. Clinicopathological and social parameters were reviewed and the Supportive Care Needs Survey, Functional Assessment of Cancer Therapy- Breast cancer instrument, and Beck Depression Inventory were administered. The frequency of unmet needs, the association between unmet needs and depression and/or quality of life (QOL) and the impact of the time elapsed since surgery on the patients' unmet needs were analyzed. RESULTS: The highest levels of unmet needs were found to be in the health system and information domain. Patients with a survival duration of less than 1 year since surgery showed significantly higher unmet needs in all need domains except the sexuality domain (p<0.001) than participants in the other groups. Patients with a survival duration of 1-3 years also experienced significantly higher psychological and information needs than long-term survivors (>5 years). In addition, unmet needs were significantly associated with depression (p<0.001) and QOL (p<0.001). CONCLUSION: The present study demonstrated that long-term breast cancer survivors had a significantly lower level of unmet needs than patients with survival duration of less than 3 years after surgery and patients with survival duration of less than 1 year since surgery suffered the greatest unmet needs. QOL might be enhanced if interventions are made for specific unmet needs of each patient group.

Unmet Needs and Their Relationship with Quality of Life among Women with Recurrent Breast Cancer.

PURPOSE: This study aimed to evaluate the prevalence and the effects of unmet needs on quality of life (QOL) among recurrent breast cancer survivors. METHODS: Completed questionnaires were collected from 52 women with recurrent breast cancer. Clinical and socio-demographic characteristics were reviewed, and the Supportive Care Needs Survey, Functional Assessment of Cancer Therapy-Breast Cancer Instrument, and Beck Depression Inventory (BDI) were administered. The frequency of unmet needs and the mean differences by patient characteristics and BDI scores were analyzed. The predictive value of unmet needs on QOL, controlling for socio-demographic variables and then for clinical variables, was analyzed in hierarchical regression models. RESULTS: The most common unmet needs belonged to the health system and information domain. The depressive group had greater unmet needs in the psychological domain (p<0.001), physical and daily living domain (p=0.001), and health and information domain (p=0.002). Patients with lower education attainment and those with lower performance status had greater unmet needs in the psychological needs (p=0.002) and in the physical and daily living needs domain (p=0.002), respectively. Unmet needs in the psychological domain (p=0.008), physical and daily living domain (p=0.022), and sexuality domain (p=0.040) strongly predicted QOL of women with recurrent breast cancer. CONCLUSION: Unmet needs were strong predictors for QOL among recurrent breast cancer patients. This suggests that QOL of women with recurrent breast cancer is possibly more affected by unmet needs than by patient's socio-demographic or clinical characteristics. Intervention strategies could be developed based on the identified needs of women with recurrent breast cancer in order to improve their QOL. Further longitudinal and prospective studies will be necessary to confirm the independent impact of unmet needs on QOL.

Quality of Life Differences between Younger and Older Breast Cancer Patients.

PURPOSE: This study was designed to investigate quality of life (QOL) differences between younger (<50 years) and older (≥50 years) breast cancer survivors and to determine the unique effect of age on QOL after adjusting age-correlated variables. METHODS: One thousand two hundred fifty patients were enrolled. Clinicopatholgical and social parameters were reviewed and Functional Assessment of Cancer Therapy-Breast cancer instrument (FACT-B) and the Ladder of Life scale were used to measure the QOL. Among 1,250 eligible patients, 1,094 patients completed the questionnaire and were used for analysis. Chi-square test, t-test and a series of multiple regression analyses were conducted to verify age-related differences in QOL between two groups and to evaluate the unique contribution of age variable on QOL of breast cancer patients. RESULTS: Significant socio-demographic and clinical differences existed based on age categories, including education, job, time since surgery, chemotherapy and daily activity. Also, there were significant age-related differences in FACT-B total, physical well-being, social/family well-being, functional well-being and breast cancer subscale and in subjective QOL. Older patients ≥50 years showed significantly lower QOL than younger patients <50 years. However, after controlling for age-correlated variables including job, education, time since surgery, chemotherapy, and daily activity, there was no unique age difference in QOL among breast cancer survivors. CONCLUSION: Our study results suggest that older women with breast carcinoma suffered significantly lower QOL, even though the unique age effect was not found. Therefore, various interventions for enhancing QOL for women with breast carcinoma should be provided to older age group.

Factors affecting health-related quality of life in women with recurrent breast cancer in Korea.

PURPOSE: The purpose was to determine the effects of recurrent breast cancer on health-related quality of life (HRQOL). METHODS: We administered the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23, McGill Quality of Life Questionnaire (MQOL), Beck Depression Inventory (BDI), and Brief Fatigue Inventory (BFI) to 152 women experiencing recurrence 1 year after being diagnosed with stage I to III breast cancer. We classified recurrent women as post-, ongoing-, and non-treatment group and performed multivariate-adjusted analyses in HRQOL comparisons with data available from disease-free survivors and general population. RESULTS: Groups not completing treatment were more symptomatic and had poorer functioning in HRQOL than the post-treatment group. Compared to the general population, the post-treatment group showed worse scores concerning role, cognitive, and social functioning, fatigue, and financial difficulties. The post-treatment group showed identical scores to disease-free survivors in most HRQOL domains; however, they reported less fatigue and depression than the disease-free group. Higher overall QOL was related to absence of comorbidity, completing treatment, being involved in decision making, no problems before surgery, and good overall medical care. CONCLUSION: Treatment completed, most degraded aspects of HRQOL in recurrent breast cancer women can return to levels observed in disease-free survivors.