• Shruti GOCHHWAL

The Breast Cancer and Depression Connection

A breast cancer patient can feel a wide range of emotions such as fear, shock, sadness, grief and anger. These feelings are normal.

Low mood normally improves after a few days. But can breast cancer patients experience depressive tendencies as well?

The psychological worry among breast cancer patients is common and is related to worse clinical outcomes.

Anxiety and depression affect about 40% of breast cancer patients. Depression is also linked to a higher relative risk of mortality in breast cancer patients.

Breast cancer patients also appear to be at greater risk for depression than patients with other serious conditions like diabetes, arthritis, chronic lung disease or heart disease.

Increased Vulnerability

In 10% to 30% of women, a breast cancer diagnosis can cause increased vulnerability to depressive conditions.

These include major depressive disorder (MDD), mood disorders related to general medical conditions and adjustment disorders with depressed mood.

The highest risk of getting a depressive condition is in the year after the breast cancer diagnosis.

For instance, breast asymmetry is typical after breast-conserving surgery. Women with breast asymmetry face feelings of self-consciousness and increased fears of cancer recurrence.

More distinct asymmetry can lead to greater depressive disorders. But amidst 90 patients undergoing bilateral prophylactic surgery, the depression rate hadn’t changed over one year after the procedure.

At high doses, chemotherapy can also lead to depressive disorders.

Self-blame for developing breast cancer is dangerous and can affect your mood.

Caption: Self-blame should be avoided.

Credits: Pexels

In 2007, a study showed that higher levels of self-blame is linked to higher levels of depression and decreased quality of life.

Women often blamed themselves for multiple reasons like:

  1. delays in medical consultation

  2. poor coping skills

  3. inability to express emotions

  4. anxiety about their health and treatments

Aggravated Symptoms and Side Effects

Few signs and symptoms of depression in breast cancer patients include:

  1. Dull, hopeless, or sad mood almost daily

  2. Loss of pleasure or interest in activities

  3. Major weight gain or weight loss

  4. Changes in sleep

  5. Less energy or extreme tiredness daily

  6. Feelings of worthlessness, helplessness or guilt

  7. Trouble remembering, focusing, or making decisions

  8. Suicidal thoughts

  9. Wide mood swings to periods of high energy and agitation

Increased side effects from breast cancer treatments, and the experience of these effects such as pain, cognitive impairment, hot flashes, and sexual dysfunctions intensify depression.

Somatic symptoms of depression can be aggravated by breast cancer treatment side effects or mistaken for the effects of the treatment. When the symptoms are mistaken, depression and the need to treat it can get overlooked.

Genetics and Breast Cancer

Few breast cancer patients can have a genetic predisposition to depression.

A study was conducted where researchers analyzed 125 post-menopausal women, 80 of whom underwent surgery for early-stage breast cancer and 45 were healthy.

The patients provided genetic data from saliva or blood samples, which were then assessed for SLC6A4 (gene) polymorphisms.

Caption: The SLC6A4 gene is located in chromosome 17.

Credits: Wikipedia

The physical function domains from the Medical Outcome Study Short Form 36 and the Beck Depression Inventory scores were used to compute outcomes.

Results showed that breast cancer patients were more likely to experience and have aggravated depression symptoms compared with those without breast cancer. Breast cancer patients also had a worse physical function.

After a year, physical function remained a significant factor of depressive symptoms in healthy and breast cancer-laden groups. 

The long allele (LA) genotype was linked to increased depressive symptoms in all study participants and was observed at a higher rate in breast cancer patients.

Depression Screening Tools

Factors that can cause psychiatric disorders in breast cancer patients are:

·       Previous psychiatric illness

·       Family history of psychiatric illness

·       Younger age (less than 45 years)

·       Having young children

·       Limited social support

·       Substance use

·       Pain

·       Physical disability

·       Poor family coherence

·       Financial strain

Several depression screening tools are available. Let’s look at 3 commonly used tools with breast cancer patients.

· National Comprehensive Cancer Center Distress Thermometer

This distress thermometer can be used by breast cancer patients to assess their overall distress level over a week, using a visual analogue on a scale from 0 to 10.

It has been approved for many cancer populations and in different parts of the world. A score of 7 has both good specificity and sensitivity for finding depression in breast cancer patients.

One must consider a complete psychiatric evaluation for scores above 7.

Caption: NCCN Distress thermometer.

Credits: Meteor

Profile of Mood States Questionnaire 

This questionnaire is reliable and contains 65 questions often used in studies of breast cancer and mood dysregulation.

Its subscales include tension-anxiety, depression-dejection, anger-hostility, confusion-bewilderment, fatigue-inertia and vigor-activity.

With the help of a 5-point Likert scale, breast cancer patients can rate their symptoms over the past week. Subscale scores are then added to the total mood disturbance score.

Hospital Anxiety and Depression Scale (HADS)

This is a reliable and sensitive 14-item scale that is often used to study depression and anxiety in breast cancer patients. 

This scale has two 7-item subscales namely, depression and anxiety. Responses are marked on a 5-point Likert scale. The patients need to respond quickly and avoid thinking too long about their answers.

Depression can also lead to poor adherence to breast cancer treatment.

A study determined that compared with non-depressed patients, those with depressive disorders were three times more likely to not adhere to breast cancer treatments.

Depressive symptoms such as poor concentration and a lack of motivation can create difficulty remembering daily treatment goals or understanding treatment recommendations.

Psychotherapy and psychotropic methods are used to treat depression in patients without carcinoma and are also effective for breast cancer patients.

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