Skip to main content

Advertisement

SpringerLink
Log in

Impact of pre-diagnosis depressive symptoms and health-related quality of life on treatment choice for ductal carcinoma in situ and stage I breast cancer in older women

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To examine whether pre-diagnosis patient-reported health-related quality of life (HRQOL) and depressive symptoms are associated with local treatment for older women with ductal carcinoma in situ (DCIS) and stage I breast cancer (BC).

Methods

Using the SEER-MHOS dataset, we identified women ≥ 65 years old with DCIS or stage I BC diagnosed 1998–2011 who completed surveys ≤ 24 months before diagnosis. Depressive symptoms were measured by major depressive disorder (MDD) risk and HRQOL was measured by Physical and Mental Component Summary scores (PCS and MCS, respectively) of the SF-36/VR-12. Associations with treatment choice (breast-conserving surgery [BCS] and radiation therapy [RT], BCS alone, mastectomy) were assessed with multivariable multinomial logistic regression, controlling for patient characteristics.

Results

We identified 425 women with DCIS and 982 with stage I BC. Overall, 20.4% endorsed depressive symptoms placing them at risk for MDD pre-diagnosis; mean MCS and PCS scores were 52.3 (SD = 10.1) and 40.5 (SD = 11.5), respectively. Among women with DCIS, those at risk for MDD were more likely to receive BCS (adjusted odds ratio [AOR] 2.04, 95% CI 1.04–4.00, p = 0.04) or mastectomy (AOR 1.88, 95% CI 0.91–3.86, p = 0.09) compared to BCS + RT. For DCIS, MCS score was not associated with treatment; higher PCS score was associated with decreased likelihood of receiving mastectomy versus BCS + RT (AOR 0.71 per 10-point increase, 95% CI 0.54–0.95, p = 0.02). For BC, none of the measures were significantly associated with treatment.

Conclusion

Older women at risk for MDD before DCIS diagnosis were less likely to receive RT after BCS, compared to BCS alone or mastectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jemal A, Ward EM, Johnson CJ et al (2017) Annual report to the nation on the status of cancer, 1975–2014, featuring survival. JNCI 109:djx030

    Article  PubMed Central  Google Scholar 

  2. Kerlikowske K (2010) Epidemiology of ductal carcinoma in situ. J the Natl Cancer Inst Monogr 2010:139–141

    Article  Google Scholar 

  3. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67:7–30

    Article  PubMed  Google Scholar 

  4. Smith BD, Smith GL, Hurria A et al (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27:2758–2765

    Article  PubMed  Google Scholar 

  5. Biganzoli L, Wildiers H, Oakman C et al (2012) Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 13:e148–e160

    Article  PubMed  Google Scholar 

  6. Tew WP, Muss HB, Kimmick GG et al (2014) Breast and ovarian cancer in the older woman. J Clin Oncol 32:2553–2561

    Article  PubMed  Google Scholar 

  7. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Correa C, McGale P et al (2010) Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010:162–177

    Article  Google Scholar 

  8. Hughes KS, Schnaper LA, Bellon JR et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 31:2382–2387

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Fyles AW, McCready DR, Manchul LA et al (2004) Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 351:963–970

    Article  PubMed  CAS  Google Scholar 

  10. Potter R, Gnant M, Kwasny W et al (2007) Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. Int J Radiat Oncol Biol Phys 68:334–340

    Article  PubMed  CAS  Google Scholar 

  11. Kunkler IH, Williams LJ, Jack WJ et al (2015) Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 16:266–273

    Article  PubMed  Google Scholar 

  12. Day R, Ganz PA, Costantino JP (2001) Tamoxifen and depression: more evidence from the National Surgical Adjuvant Breast and Bowel Project’s Breast Cancer Prevention (P-1) Randomized Study. J Natl Cancer Inst 93:1615–1623

    Article  PubMed  CAS  Google Scholar 

  13. Somerset W, Stout SC, Miller AH et al (2004) Breast cancer and depression. Oncology (Williston Park) 18:1021–1034 1047–8

    Google Scholar 

  14. Monti DA, Mago R, Kunkel EJ (2005) Practical geriatrics: depression, cognition, and anxiety among postmenopausal women with breast cancer. Psychiatr Serv 56:1353–1355

    Article  PubMed  Google Scholar 

  15. Bardwell WA, Natarajan L, Dimsdale JE et al (2006) Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. J Clin Oncol 24:2420–2427

    Article  PubMed  Google Scholar 

  16. Weitzner MA, Meyers CA, Stuebing KK et al (1997) Relationship between quality of life and mood in long-term survivors of breast cancer treated with mastectomy. Support Care Cancer 5:241–248

    Article  PubMed  CAS  Google Scholar 

  17. Fulton C (1999) Patients with metastatic breast cancer: their physical and psychological rehabilitation needs. Int J Rehabil Res 22:291–301

    Article  PubMed  CAS  Google Scholar 

  18. Badger TA, Braden CJ, Mishel MH et al (2004) Depression burden, psychological adjustment, and quality of life in women with breast cancer: patterns over time. Res Nurs Health 27:19–28

    Article  PubMed  Google Scholar 

  19. Hjerl K, Andersen EW, Keiding N et al (2003) Depression as a prognostic factor for breast cancer mortality. Psychosomatics 44:24–30

    Article  PubMed  Google Scholar 

  20. Watson M, Haviland JS, Greer S et al (1999) Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet 354:1331–1336

    Article  PubMed  CAS  Google Scholar 

  21. Colleoni M, Mandala M, Peruzzotti G et al (2000) Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet 356:1326–1327

    Article  PubMed  CAS  Google Scholar 

  22. Ayres A, Hoon PW, Franzoni JB et al (1994) Influence of mood and adjustment to cancer on compliance with chemotherapy among breast cancer patients. J Psychosom Res 38:393–402

    Article  PubMed  CAS  Google Scholar 

  23. Ambs A, Warren JL, Bellizzi KM et al (2008) Overview of the SEER–Medicare Health Outcomes Survey linked dataset. Health Care Financ Rev 29:5–21

    PubMed  PubMed Central  Google Scholar 

  24. National Cancer Institute: Overview of the SEER program. http://seer.cancer.gov/about/overview.html

  25. Rost K, Burnam MA, Smith GR (1993) Development of screeners for depressive disorders and substance disorder history. Med Care 31:189–200

    Article  PubMed  CAS  Google Scholar 

  26. White AJ, Reeve BB, Chen RC et al (2014) Coexistence of urinary incontinence and major depressive disorder with health-related quality of life in older Americans with and without cancer. J Cancer Surviv 8:497–507

    Article  PubMed  PubMed Central  Google Scholar 

  27. Turner-Bowker DM, Bartley PJ, Ware JE Jr (2002) SF-36® Health Survey & “SF” bibliography: third edition (1988–2000). Lincoln, RI

  28. Selim AJ, Rogers W, Fleishman JA et al (2009) Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res 18:43–52

    Article  PubMed  Google Scholar 

  29. Ware JE Jr, Snow K, Kosinski M (2000) SF-36 health survey manual and interpretation guide. TheHealth Institute, NewEngland Medical Center, Boston

    Google Scholar 

  30. Sepucha KR, Belkora JK, Chang Y et al (2012) Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Inform Decis Mak 12:51

    Article  PubMed  PubMed Central  Google Scholar 

  31. Waljee JF, Rogers MA, Alderman AK (2007) Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol 25:1067–1073

    Article  PubMed  Google Scholar 

  32. Whelan T, Levine M, Willan A et al (2004) Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. JAMA 292:435–441

    Article  PubMed  CAS  Google Scholar 

  33. Street RL Jr, Voigt B, Geyer C Jr et al (1995) Increasing patient involvement in choosing treatment for early breast cancer. Cancer 76:2275–2285

    Article  PubMed  Google Scholar 

  34. Ozanne EM, Schneider KH, Soeteman D et al (2015) onlineDeCISion.org: a web-based decision aid for DCIS treatment. Breast Cancer Res Treat 154:181–190

    Article  PubMed  Google Scholar 

  35. Gumus M, Ustaalioglu BO, Garip M et al (2010) Factors that affect patients’ decision-making about mastectomy or breast conserving surgery, and the psychological effect of this choice on breast cancer patients. Breast Care (Basel) 5:164–168

    Article  Google Scholar 

  36. Chagpar AB, Studts JL, Scoggins CR et al (2006) Factors associated with surgical options for breast carcinoma. Cancer 106:1462–1466

    Article  PubMed  Google Scholar 

  37. Satariano ER, Swanson GM, Moll PP (1992) Nonclinical factors associated with surgery received for treatment of early-stage breast cancer. Am J Public Health 82:195–198

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Guadagnoli E, Weeks JC, Shapiro CL et al (1998) Use of breast-conserving surgery for treatment of stage I and stage II breast cancer. J Clin Oncol 16:101–106

    Article  PubMed  CAS  Google Scholar 

  39. Omer ZB, Hwang ES, Esserman LJ et al (2013) Impact of ductal carcinoma in situ terminology on patient treatment preferences. JAMA Intern Med 173:1830–1831

    Article  PubMed  Google Scholar 

  40. Iglay K, Santorelli ML, Hirshfield KM et al (2017) Impact of preexisting mental illness on all-cause and breast cancer–specific mortality in elderly patients with breast cancer. J Clin Oncol 35(36):4012–4018

    Article  PubMed  Google Scholar 

  41. Goodwin JS, Zhang DD, Ostir GV (2004) Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. J Am Geriatr Soc 52:106–111

    Article  PubMed  PubMed Central  Google Scholar 

  42. Simon GE (2003) Social and economic burden of mood disorders. Biol Psychiatry 54:208–215

    Article  PubMed  Google Scholar 

  43. Kanani R, Davies EA, Hanchett N et al (2016) The association of mood disorders with breast cancer survival: an investigation of linked cancer registration and hospital admission data for South East England. Psychooncology 25:19–27

    Article  PubMed  Google Scholar 

  44. Smit F, Ederveen A, Cuijpers P et al (2006) Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Arch Gen Psychiatry 63:290–296

    Article  PubMed  Google Scholar 

  45. VanItallie TB (2005) Subsyndromal depression in the elderly: underdiagnosed and undertreated. Metabolism 54:39–44

    Article  PubMed  CAS  Google Scholar 

  46. Steffens DC, Fisher GG, Langa KM et al (2009) Prevalence of depression among older Americans: the aging, demographics and memory study. Int Psychogeriatr 21:879–888

    Article  PubMed  PubMed Central  Google Scholar 

  47. Zivin K, Llewellyn DJ, Lang IA et al (2010) Depression among older adults in the United States and England. Am J Geriatr Psychiatry 18:1036–1044

    Article  PubMed  PubMed Central  Google Scholar 

  48. Davidson JR, Meltzer-Brody SE (1999) The underrecognition and undertreatment of depression: what is the breadth and depth of the problem? J Clin Psychiatry 60(Suppl 7):4–9 discussion 10–11

    PubMed  Google Scholar 

  49. McCall NT, Parks P, Smith K et al (2002) The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries. Int J Geriatr Psychiatry 17:557–565

    Article  PubMed  Google Scholar 

  50. Volkers AC, Nuyen J, Verhaak PF et al (2004) The problem of diagnosing major depression in elderly primary care patients. J Affect Disord 82:259–263

    Article  PubMed  Google Scholar 

  51. Koenig HG, George LK, Peterson BL et al (1997) Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes. Am J Psychiatry 154:1376–1383

    Article  PubMed  CAS  Google Scholar 

  52. Zisberg A (2017) Anxiety and depression in older patients: the role of culture and acculturation. Int J Equity Health 16:177

    Article  PubMed  PubMed Central  Google Scholar 

  53. Garside RB, Klimes-Dougan B (2002) Socialization of discrete negative emotions: gender differences and links with psychological distress. Sex Roles 47:115–128

    Article  Google Scholar 

  54. Betancourt JR, Green AR, Carrillo JE et al (2003) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 118:293–302

    Article  PubMed  PubMed Central  Google Scholar 

  55. Fossati P, Coyette F, Ergis AM et al (2002) Influence of age and executive functioning on verbal memory of inpatients with depression. J Affect Disord 68:261–271

    Article  PubMed  Google Scholar 

  56. Porter RJ, Gallagher P, Thompson JM et al (2003) Neurocognitive impairment in drug-free patients with major depressive disorder. Br J Psychiatry 182:214–220

    Article  PubMed  Google Scholar 

  57. Pantel J, Schroder J, Essig M et al (1997) Quantitative magnetic resonance imaging in geriatric depression and primary degenerative dementia. J Affect Disord 42:69–83

    Article  PubMed  CAS  Google Scholar 

  58. Sheline YI, Wang PW, Gado MH et al (1996) Hippocampal atrophy in recurrent major depression. Proc Natl Acad Sci U S A 93:3908–3913

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Hugo M (2001) Mental health professionals’ attitudes towards people who have experienced a mental health disorder. J Psychiatr Ment Health Nurs 8:419–425

    Article  PubMed  CAS  Google Scholar 

  60. Thornicroft G, Rose D, Kassam A (2007) Discrimination in health care against people with mental illness. Int Rev Psychiatry 19:113–122

    Article  PubMed  Google Scholar 

  61. Hughes KS, Schnaper LA, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351:971–977

    Article  PubMed  CAS  Google Scholar 

  62. Carlson RW, McCormick B (2005) Update: NCCN breast cancer clinical practice guidelines. J Natl Compr Cancer Netw 3(Suppl 1):S7–S11

    Google Scholar 

  63. Soulos PR, Yu JB, Roberts KB et al (2012) Assessing the impact of a cooperative group trial on breast cancer care in the medicare population. J Clin Oncol 30:1601–1607

    Article  PubMed  PubMed Central  Google Scholar 

  64. McCormick B, Ottesen RA, Hughes ME et al (2014) Impact of guideline changes on use or omission of radiation in the elderly with early breast cancer: practice patterns at National Comprehensive Cancer Network institutions. J Am Coll Surg 219:796–802

    Article  PubMed  Google Scholar 

  65. Palta M, Palta P, Bhavsar NA et al (2015) The use of adjuvant radiotherapy in elderly patients with early-stage breast cancer: changes in practice patterns after publication of Cancer and Leukemia Group B 9343. Cancer 121:188–193

    Article  PubMed  Google Scholar 

  66. Practice guideline for the (2007) breast conservation therapy in the management of invasive breast carcinoma. J Am Coll Surg 205:362–376

    Article  Google Scholar 

Download references

Funding

No external funding was received for this work. The views expressed in this article are those of the authors.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA

    Daniela L. Buscariollo & Rinaa S. Punglia

  2. Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Angel M. Cronin

  3. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA

    Nancy A. Borstelmann

Authors
  1. Daniela L. Buscariollo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angel M. Cronin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nancy A. Borstelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rinaa S. Punglia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rinaa S. Punglia.

Ethics declarations

Conflict of interest

None of the authors have any conflict of interest related to the subject matter presented.

Ethical approval

This survey study was approved by the Dana-Farber/Harvard Cancer Center (DFCI/HCC) IRB (Protocol #12–420). This article does not contain any studies with animals.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 175 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buscariollo, D.L., Cronin, A.M., Borstelmann, N.A. et al. Impact of pre-diagnosis depressive symptoms and health-related quality of life on treatment choice for ductal carcinoma in situ and stage I breast cancer in older women. Breast Cancer Res Treat 173, 709–717 (2019). https://doi.org/10.1007/s10549-018-5006-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-018-5006-5

Keywords

Search

Navigation