Psychological distress predicts survival in breast cancer patients
MedWire News: Breast cancer patients with low levels of distress survive longer and have lower levels of disease recurrence than those with high levels of distress, study findings show.
Mogens Groenvold (The Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark) and colleagues report that emotional function and fatigue are significant independent predictors of recurrence free and overall survival, after accounting for biological variables such as menopausal status, estrogen receptor status, tumor biology, lymph node status, and adjuvant therapy use.
The researchers analyzed data from 1588 breast cancer patients who filled out the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 quality of life questionnaire 2 months after their primary operation.
They measured psychological distress using the emotional functioning and fatigue items, with severity rated on a score of 0-100, where 100 shows highest level of functioning.
Information on clinical and pathological variables including time to recurrence and survival time was obtained from the Danish Breast Cancer Cooperative Group register. Patients were followed-up until March 2005, with a median follow-up time of 12.9 years.
An emotional function score of 83-100 was associated with a relative risk of 0.80 for recurrence-free survival and 0.81 for overall survival, compared with an emotional function score of 0-75. Meanwhile, a fatigue score of 33-100 was associated with a relative risk of 1.32 for recurrence-free survival and 1.23 for overall survival, compared with a fatigue score of 0-22.
Groenvold and colleagues comment in the journal
Breast Cancer Research and Treatment: "The finding that both fatigue and psychological distress were associated with the risk of breast cancer recurrence and death is intriguing and raises conceptual and methodological questions."
The researchers propose two possible interpretations. Firstly, patients who do not experience psychological distress maintain a strong immune system that subsequently leads to better cancer resistance, they suggest. This they refer to as the "mind-body model." Alternatively, a lack of psychological distress may reflect mental as well as physical robustness. This they refer to as the "robustness model."
Irrespective of the mechanism underlying the negative effect of distress on breast cancer outcome, the researchers state that effective interventions against psychological distress and/or fatigue should be "available for all breast cancer patients to improve their quality of life as an end in itself."
Breast Cancer Res Treat 2007; 105: 209-219
http://www.springerlink.com/content/t4t37023g4175805/?p=985210d0241046709a17cf420d3161cf&pi=8
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