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.

Does Chemotherapy Really Affect the Quality of Life of Women with Breast Cancer? / 한국유방암학회지

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 (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 (p5 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 / 한국유방암학회지

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 / 한국유방암학회지

PURPOSE: This study was designed to investigate quality of life (QOL) differences between younger ( or =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 > or =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.

Depression and Coping in Breast Cancer Patients / 한국유방암학회지

PURPOSE: The objective of this study was to investigate the predictors of depression and coping and the correlation between depression and use of coping among breast cancer patients in Korea. METHODS: Of 1,250 eligible breast cancer patients attending Yonsei University Severance Hospital, 1,160 completed our surveys. Depression and coping were assessed using the Beck Depression Inventory and Korean Cancer Coping Questionnaire. Socio-demographic characteristics were included in the survey and medical factors were compiled by reviewing each patient's medical chart. RESULTS: Education, economic status, the level of daily activities, menopause and the type of surgery significantly predicted depression. Age, education, economic status, time since surgery, the level of daily activities, and menopause were significant predictors for personal coping; marriage, education, economic status, time since surgery, the surgical method and radiotherapy significantly predicted interpersonal coping. Personal coping and interpersonal coping had significant negative correlations with depression. CONCLUSION: Many factors are significant predictors but education and economic status are the most significant and consistent predictors for both depression and coping in breast cancer patients. Psychosocial intervention should be planned according to different characteristics of breast cancer patients, in order to reduce depression and enhance effective coping.

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 ( 2cm) 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.

An Exploratory Analysis of the Existential Experiences of Women with Cancer / 신경정신의학

OBJECTIVES: Although there have been increasing researches into a variety of aspects associated with women's cancer, most of them are not based on cancer survivor's subjective perspectives but on pathologic and therapists' point of view. This qualitative study explores how women experience living with cancer and aims to construct the dimensions of their existential experiences from their perspectives. METHODS: Focus groups and individual in-depth interviews were conducted to 17 patients who have been surgically treated with breast cancer or gynecologic cancer and attending the outpatient clinic in Yonsei University Severance Hospital in Seoul. The data were analyzed following constant comparison method by Strauss and Corbin. RESULTS: Four major categories were explored by analysis as follows: continuing a fight for life, alienation from the healthy world, women's distinctiveness, and existential transition. Related subjects and concepts by each category were described. CONCLUSION: This study shows that women with cancer experience the meaning of cancer not as a pathological process but as an adaptational process where the concept of health and dysfunction coexisted. It is suggested that oncologic medical team should approach women with cancer based on the bio-psycho-social model considering the whole dimension of patients' experiences.

The Supportive Care Needs of Breast Cancer Patients

PURPOSE: The objective of this study was to assess the supportive needs of breast cancer patients and determine the socio-demographic and clinicopathological predictors of those unmet needs. METHODS: Of 302 eligible breast cancer patients, attending Yonsei University Severance Hospital, 250 completed the surveys. The supportive care needs were assessed by administering a Supportive Care Needs Survey. RESULTS: Of the ten highest perceived needs items, 7 items were related to the health system and information domain and 2 to the psychological domain. The univariate analysis in each domain showed education (P=0.083) and chemotherapy (P=0.042) were significant predictors in the psychological domain; education (0=0.000), time since surgery (P=0.009), node metastasis (0.022), chemotherapy (P=0.001) and radiation therapy (P=0.003) in the physical and daily living domain; age (P=0, 009) and duration of marriage (P= 0.004) for sexuality; node metastasis (P=0.048), TNM stage (P=0.036), and recurrence (P=0.010) in the health system and information domain and religion (P=0.016) in the care and support domain. A multivariate analysis showed age (P=0.0253) and chemotherapy (P=0.0517) as significant independent predictors in the sexuality domain; education (P=0.0010), chemotherapy (P=0.0011), radiation therapy (P= 0.0133) and time since surgery (P=0.036) in the physical and daily living domain; recurrence (P=0.0324) in the health system and information; domain and education (P=0.0134) and chemotherapy (P=0.0207) in psychological domain. CONCLUSION: Breast cancer patients experience high levels of unmet supportive needs across each domain, but especially in the health systems and information domain. Also, the types of needs varied according to the patient subgroups. This study suggests considerable improvements be made in terms of supportive care of breast cancer patients.

A Pychosocial Support Program for Women with Primary Breast Carcinoma

PURPOSE: To our knowledge, there had been no evidence for the efficacy of psychosocial intervention among Korean breast cancer patients. The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population. METHODS: The patient selection criteria were age younger than 70 years, undergoing any postoperative adjuvant therapy, and surgery undergone within the previous 3~6 months as of the start of the study. There were 30 patients that met this criteria. There was no wait-list control group because none of the eligible patients desired to stay in the wait-list control group. Therefore a one group pretest-posttest design was used. We conducted an 8-week, structured, psychosocial group intervention that used psychoeducational strategies combining education and psychological support. Subjects were assessed for psychological distress and coping by administering the Beck Depression Inventory (BDI) and the Ways of Coping Checklist-Revised (WCCL-R) at the baseline and at 8 weeks. RESULTS: Thirty patients participated and the results of 20 of these patients were used for the analysis as appropriate. The posttest results showed significantly lower scores than the pretest results for depression on the BDI (p<0.001), and for avoidance (p<0.001) and wishful thinking (p<0.001) on the WCCL-R. Additionally, the total score for coping on the WCCL-R showed a significant difference after the intervention (p=0.051). CONCLUSION: Despite some limitations, the results of this study suggest that short-term pshchosocial group intervention produces a significant improvement in the quality of life of patients with primary breast carcinoma in terms of managing depression and coping.

A Pychosocial Support Program for Women with Primary Breast Carcinoma / 한국유방암학회지

PURPOSE: To our knowledge, there had been no evidence for the efficacy of psychosocial intervention among Korean breast cancer patients. The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population. METHODS: The patient selection criteria were age younger than 70 years, undergoing any postoperative adjuvant therapy, and surgery undergone within the previous 3~6 months as of the start of the study. There were 30 patients that met this criteria. There was no wait-list control group because none of the eligible patients desired to stay in the wait-list control group. Therefore a one group pretest-posttest design was used. We conducted an 8-week, structured, psychosocial group intervention that used psychoeducational strategies combining education and psychological support. Subjects were assessed for psychological distress and coping by administering the Beck Depression Inventory (BDI) and the Ways of Coping Checklist-Revised (WCCL-R) at the baseline and at 8 weeks. RESULTS: Thirty patients participated and the results of 20 of these patients were used for the analysis as appropriate. The posttest results showed significantly lower scores than the pretest results for depression on the BDI (p<0.001), and for avoidance (p<0.001) and wishful thinking (p<0.001) on the WCCL-R. Additionally, the total score for coping on the WCCL-R showed a significant difference after the intervention (p=0.051). CONCLUSION: Despite some limitations, the results of this study suggest that short-term pshchosocial group intervention produces a significant improvement in the quality of life of patients with primary breast carcinoma in terms of managing depression and coping.

A Pychosocial Support Program for Women with Primary Breast Carcinoma / 한국유방암학회지

PURPOSE: To our knowledge, there had been no evidence for the efficacy of psychosocial intervention among Korean breast cancer patients. The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population. METHODS: The patient selection criteria were age younger than 70 years, undergoing any postoperative adjuvant therapy, and surgery undergone within the previous 3~6 months as of the start of the study. There were 30 patients that met this criteria. There was no wait-list control group because none of the eligible patients desired to stay in the wait-list control group. Therefore a one group pretest-posttest design was used. We conducted an 8-week, structured, psychosocial group intervention that used psychoeducational strategies combining education and psychological support. Subjects were assessed for psychological distress and coping by administering the Beck Depression Inventory (BDI) and the Ways of Coping Checklist-Revised (WCCL-R) at the baseline and at 8 weeks. RESULTS: Thirty patients participated and the results of 20 of these patients were used for the analysis as appropriate. The posttest results showed significantly lower scores than the pretest results for depression on the BDI (p<0.001), and for avoidance (p<0.001) and wishful thinking (p<0.001) on the WCCL-R. Additionally, the total score for coping on the WCCL-R showed a significant difference after the intervention (p=0.051). CONCLUSION: Despite some limitations, the results of this study suggest that short-term pshchosocial group intervention produces a significant improvement in the quality of life of patients with primary breast carcinoma in terms of managing depression and coping.