Nav: Home

Breast cancer: The mental trauma of severe disease

March 02, 2016

According to a study led by Ludwig-Maximilians-Universitaet (LMU) in Munich researchers, a majority of patients diagnosed with breast cancer go on to develop symptoms of post-traumatic stress disorder, and in most of these cases the symptoms persist for at least a year.

The majority of women suffering from breast cancer develop symptoms of post-traumatic stress in the months following receipt of the diagnosis. The latest results of the Cognicares study, led by Dr. Kerstin Hermelink of the Breast Cancer Center in the Department of Gynecology and Obstetrics at the LMU Medical Center, show that such symptoms can still be detected a year after patients have been informed of their condition. The new findings appear in the journal Psycho-Oncology.

In the multicenter Cognicares study, Kerstin Hermelink and her doctoral student Varinka Voigt studied a group of 166 patients who had been newly diagnosed with breast cancer. Over the course of the following year, the participants were assessed at three specific time-points for the presence of clinically significant symptoms of post-traumatic stress disorder (PTSD). The results were then compared with those for a control group of patients without a cancer diagnosis.

During the interval between diagnosis of cancer and the initiation of treatment, 82.5% of all patients were found to exhibit symptoms of PTSD, such as recurrent and intrusive reminders of the experiences associated with cancer, feelings of detachment and emotional numbness, increased arousal, sudden outbursts of anger and an exaggerated startle response. Although a full diagnosis of PTSD was found in only 2% of patients one year after the cancer diagnosis, more than half (57.3%) continued to display one or more symptoms of the disorder at that point. In contrast, the rate of PTSD symptoms due to other traumatic events was very low in the controls and the patients alike. "That the high level of stress should persist for such a long time is particularly striking," says Kerstin Hermelink. Indeed, the severity of the psychological and emotional impact of the cancer diagnosis is underlined by another result reported in the study. When patients who had already had a traumatic experience - such as a serious accident or a violent assault - prior to the development of malignancy, some 40% of them rated having breast cancer as the more severe traumatic event.

"Cognicares is one of the very few longitudinal studies of traumatic stress associated with breast cancer," says Hermelink. Moreover, the data on which the study is based come from diagnostic interviews conducted by psychologists, and not from self-assessments. Only patients who were free of metastatic disease, and could therefore hope to get permanently cured, were recruited into the study, and women who had a history of psychiatric disease were excluded. "Indeed, we assume that the study is likely to somewhat underestimate the true incidence of post-traumatic stress symptoms in breast cancer patients," Hermelink adds.

Influencing factors

The researchers also set out to identify factors that could account for the varying incidence and the varying duration of symptoms of PTSD among their study population. "Neither the type of surgery nor receipt of chemotherapy had any significant effect on either of these variables, but a high level of education did have a favourable impact. A university education is evidently a marker for resources that enable patients to recover more rapidly from the psychological stresses associated with a diagnosis of breast cancer," Hermelink explains.

The results of the study also raise questions regarding the decision of the editors of the latest (2013) edition of the "Diagnostic and Statistical Manual of Mental Disorders" (which serves as the major source of diagnostic guidelines in the field of Psychiatry) to remove the factor 'life-threatening disease' from their list of potential inducers of trauma. "In light of the results of our study, and against the background of my own experience as a psycho-oncologist with breast cancer patients, I regard this decision as highly questionable," says Hermelink. "Doctors should be made aware of the fact that the majority of breast cancer patients develop symptoms of post-traumatic stress subsequent to diagnosis, and need to receive the appropriate support."
-end-


Ludwig-Maximilians-Universität München

Related Breast Cancer Articles:

Does MRI plus mammography improve detection of new breast cancer after breast conservation therapy?
A new article published by JAMA Oncology compares outcomes for combined mammography and MRI or ultrasonography screenings for new breast cancers in women who have previously undergone breast conservation surgery and radiotherapy for breast cancer initially diagnosed at 50 or younger.
Blood test offers improved breast cancer detection tool to reduce use of breast biopsy
A Clinical Breast Cancer study demonstrates Videssa Breast can inform better next steps after abnormal mammogram results and potentially reduce biopsies up to 67 percent.
Surgery to remove unaffected breast in early breast cancer increases
The proportion of women in the United States undergoing surgery for early-stage breast cancer who have preventive mastectomy to remove the unaffected breast increased significantly in recent years, particularly among younger women, and varied substantially across states.
Breast cancer patients with dense breast tissue more likely to develop contralateral disease
Breast cancer patients with dense breast tissue have almost a two-fold increased risk of developing disease in the contralateral breast, according to new research from The University of Texas MD Anderson Cancer.
Some early breast cancer patients benefit more from breast conservation than from mastectomy
Breast conserving therapy (BCT) is better than mastectomy for patients with some types of early breast cancer, according to results from the largest study to date, presented at ECC2017.
One-third of breast cancer patients not getting appropriate breast imaging follow-up exam
An annual mammogram is recommended after treatment for breast cancer, but nearly one-third of women diagnosed with breast cancer aren't receiving this follow-up exam, according to new findings presented at the 2016 Annual Clinical Congress of the American College of Surgeons.
Low breast density worsens prognosis in breast cancer
Even though dense breast tissue is a risk factor for breast cancer, very low mammographic breast density is associated with a worse prognosis in breast cancer patients.
Is breast conserving therapy or mastectomy better for early breast cancer?
Young women with early breast cancer face a difficult choice about whether to opt for a mastectomy or breast conserving therapy (BCT).
Breast density and outcomes of supplemental breast cancer screening
In a study appearing in the April 26 issue of JAMA, Elizabeth A.
Full dose radiotherapy to whole breast may not be needed in early breast cancer
Five years after breast-conserving surgery, radiotherapy focused around the tumor bed is as good at preventing recurrence as irradiating the whole breast, with fewer side effects, researchers from the UK have found in the large IMPORT LOW trial.

Related Breast Cancer Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".