Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care.

PURPOSE: Various long-term symptoms can manifest after breast cancer treatment, but we wanted to clarify whether these are more frequent among long-term breast cancer survivors than matched controls and if they are associated with certain diagnoses. METHODS: This was a cross-sectional, population-based study of 350 breast cancer survivors treated with chemo- and/or radiotherapy ≥5 years (median 10) after diagnosis and 350 women without cancer matched by age and primary care physician. All women completed a questionnaire enquiring about symptoms, underwent echocardiography to assess the left ventricle ejection fraction, and completed the Hospital Anxiety and Depression Scale. Cardiovascular diseases were diagnosed from primary care records. In a multivariable logistic regression analysis, symptoms were adjusted for the long-term effects and compared between cohorts and within the survivor group. RESULTS: Concentration difficulties, forgetfulness, dizziness, and nocturia were more frequent among breast cancer survivors compared with controls, but differences could not be explained by cardiac dysfunction, cardiovascular diseases, depression, or anxiety. Intermittent claudication and appetite loss were more frequent among breast cancer survivors than controls and associated with cardiac dysfunction, depression, and anxiety. Breast cancer survivors treated with chemotherapy with/without radiotherapy were at significantly higher odds of forgetfulness and nocturia, but significantly lower odds of dizziness, compared with breast cancer survivors treated with radiotherapy alone. CONCLUSIONS: Intermittent claudication and appetite loss are common among breast cancer survivors and are associated with cardiac dysfunction and mood disorders. Other symptoms varied by whether the patient underwent chemotherapy with/without radiotherapy (forgetfulness and nocturia) radiotherapy alone (dizziness).

Long-term psychological distress in breast cancer survivors and their matched controls: A cross-sectional study.

INTRODUCTION: Breast cancer survivors often experience psychological distress shortly after diagnosis. Long-term psychological effects, however, have not been clearly demonstrated. METHODS: This cross-sectional cohort study included 350 breast cancer survivors and 350 age-matched and general-practitioner-matched women. The median follow-up was 10 years. Using logistic regression we compared breast cancer survivors with controls on having (severe) symptoms of depression and/or anxiety, as measured with the Hospital Anxiety and Depression Scale. In multivariable logistic regression, we adjusted the results for a history of depression or prescription of antidepressants. RESULTS: Larger proportions of breast cancer survivors experienced symptoms of depression (10.6%) compared with controls (4.9%) and symptoms of anxiety (18.6%) compared with controls (16.3%). The odds of symptoms of depression (OR 2.3, 95%CI 1.3-4.2), severe symptoms of depression (OR 3.3, 95%CI 1.1-10.3) and severe symptoms of anxiety (OR 2.1, 95%CI, 1.1-4.0) were significantly higher for breast cancer survivors than for controls, even after adjusting for history of depression or prescription of antidepressants. No significant difference was seen for mild symptoms of anxiety. CONCLUSIONS: Breast cancer survivors have an increased risk of symptoms of depression, including severe symptoms, and severe symptoms of anxiety compared with controls, for up to at least 10 years after diagnosis.

The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: A systematic review.

OBJECTIVES: It is unclear whether breast cancer survivors have a higher risk of long-term symptoms of depression or anxiety. The aim of this study was to systematically review the evidence about long-term symptoms of depression and anxiety in breast cancer survivors. STUDY DESIGN: Systematic review. MAIN OUTCOME MEASURES: PubMed, Embase, Cochrane and PsycINFO were searched for studies with at least 100 survivors ≥1 year after diagnosis, and which used common questionnaires measuring symptoms of depression or anxiety, by two independent reviewers. The quality was assessed with the NIH 'Quality Assessment Tool' checklist. Prevalence of symptoms of depression and anxiety was compared to time since diagnosis, available control groups and a general female population. RESULTS: Seventeen articles were included in this review with an average quality score of 57% (range 38-86%). The prevalence of symptoms of depression varied from 9.4% to 66.1% and of anxiety from 17.9% to 33.3%. The results on the depression scale suggested an increase in risk of symptoms of depression for breast cancer survivors at one year after diagnosis, which decreases over the ensuing years. Symptoms of anxiety were not more prevalent among the women with early stage breast cancer. CONCLUSIONS: This review suggests a higher prevalence of symptoms of depression among breast cancer survivors than among the general female population, persistent over more than 5 years after diagnosis. Health care providers should be aware of this. There was no indication for an increased prevalence of symptoms of anxiety among breast cancer survivors.