When Breast Cancer Recurs: A 3-Year Prospective Study of Psychological Morbidity

Abstract: In a prospective study of 269 women diagnosed with early breast cancer, 61 (23%) developed recurrence of their disease within the 3-year study period. Thirty-eight of these women were interviewed following this diagnosis. Women with recurrence of their breast cancer were significantly more likely to experience psychiatric morbidity than women who were disease-free (p < 0.001). There was no statistically significant difference in psychiatric disorder at the interview before recurrence occurred, nor in anxiety personality trait preoperatively between these two groups: mental state prior to the diagnosis of recurrence did not appear to predict which women would develop secondary disease. Fifty percent of the 38 women were found to be clinically anxious, depressed, or both at interview. This psychiatric distress was not associated with the side effects of current cancer treatments, nor with age, but appeared to be a direct response to the cancer having spread. Thirty of the 38 women did not receive any support, directly or by referral, from their hospital, following discovery of recurrent disease. There were some interesting differences in psychiatric morbidity between women, depending on how they interpreted information given to them about their prognosis. These findings have implications for the management of recurrent disease. Many patients in this distressing situation are in need of psychosocial support; doctors also need to receive appropriate training for conveying difficult information about both diagnosis and prognosis.?