Breast Cancer Research and Treatment

, Volume 120, Issue 3, pp 685–691 | Cite as

Psychological distress and physical health in the year after diagnosis of DCIS or invasive breast cancer

  • Sophie Lauzier
  • Elizabeth Maunsell
  • Pascale Levesque
  • Myrto Mondor
  • Jean Robert
  • André Robidoux
  • Louise Provencher
Epidemiology

Abstract

Ductal carcinoma in situ (DCIS) has an excellent prognosis, but its management can resemble that of early invasive breast cancer. We compared aspects of quality of life of women with DCIS to that of women with invasive disease during the first year after treatment initiation. Participants came from consecutive series of women with newly diagnosed, non-metastatic breast cancer treated in eight Quebec hospitals in 2003. Psychological distress and health-related quality of life were measured using the Psychiatric Symptom Index (PSI) and the SF-12 mental and physical component scales (MCS, PCS). Data were obtained 1, 6, and 12 months after the start of treatment. We used generalized linear models to compare mean scores and explored the possible clinical significance of between-group differences with effect size (ES). Participation and retention among eligible women were high, 86 and 97%, respectively. Among the 800 women who completed all interviews, 13.4% (n = 107) had DCIS and 86.6% (693) invasive disease. No statistically significant between-group differences were found at 1, 6, or 12 months in psychological state (PSI and MCS: P values from 0.065 to 0.904; ES from −0.01 to −0.21). Women with DCIS reported significantly higher levels of physical health, particularly when compared at 1 month to women with invasive disease who had chemotherapy (P value < 0.0001; ES = 0.82). Measured in symptoms of psychological distress, the better prognosis or less aggressive management of DCIS does not offset the general psychological effects of a cancer diagnosis to any great degree.

Keywords

Breast cancer Ductal carcinoma in situ Psychological adaptation Health-related quality of life Psychological distress 

Notes

Acknowledgments

This work was supported by competitive funding from Canadian Breast Cancer Research Alliance [grants #010318, #013324, #017317]; Ministère de la Santé et des Services Sociaux du Québec; Canadian Institutes of Health Research (CIHR: Investigator award for E.M, Ph.D. Fellowship Award for S.L.); Fondation de l’Université Laval (Ph.D. Fellowship Award for S.L.) and CIHR-funded Strategic Training Initiative in Health Research (STIHR) Psychosocial Oncology Research Training program (PORT) (Post-doctoral Fellowship Award for SL). We thank the women and caregivers who participated in the different phases of the Family Costs of Breast Cancer Study, and the study coordinator, interviewers, data manager, statisticians, and the members of the Family Costs of Breast Cancer Clinician Collaborators Group.

References

  1. 1.
    Ernster VL, Ballard-Barbash R, Barlow WE, Zheng Y, Weaver DL, Cutter G et al (2002) Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 94(20):1546–1554PubMedGoogle Scholar
  2. 2.
    Olivotto I, Levine M (2001) Clinical practice guidelines for the care and treatment of breast cancer: the management of ductal carcinoma in situ (summary of the 2001 update). CMAJ 165(7):912–913PubMedGoogle Scholar
  3. 3.
    Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R (2000) Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med 160(7):953–958CrossRefPubMedGoogle Scholar
  4. 4.
    Kennedy F, Hartcourt D, Rumsey N (2009) Perceptions of ductal carcinoma in situ (DCIS) among UK health professionals. Breast 18:89–93CrossRefPubMedGoogle Scholar
  5. 5.
    Partridge A, Winer J, Golshan M, Bellon J, Blood E, Dees E et al (2008) Perceptions and management approaches of physicians who care for women with ductal carcinoma in situ. Clin Breast Cancer 8(3):275–280CrossRefPubMedGoogle Scholar
  6. 6.
    Webb C, Koch T (1997) Women’s experiences of non-invasive breast cancer: literature review and study report. J Adv Nurs 25(3):514–525CrossRefPubMedGoogle Scholar
  7. 7.
    Nekhlyudov L, Kroenke CH, Jung I, Holmes MD, Colditz GA (2006) Prospective changes in quality of life after ductal carcinoma-in situ: results from the nurses’ health study. J Clin Oncol 24(18):2822–2827CrossRefPubMedGoogle Scholar
  8. 8.
    Carrera C, Payne S (1999) Ductal carcinoma in situ (DCIS) of the breast: the need for psychosocial research. Psychooncology 8(6):538–545CrossRefPubMedGoogle Scholar
  9. 9.
    Bluman LG, Borstelmann NA, Rimer BK, Iglehart JD, Winer EP (2001) Knowledge, satisfaction, and perceived cancer risk among women diagnosed with ductal carcinoma in situ. J Womens Health Gend Based Med 10(6):589–598CrossRefPubMedGoogle Scholar
  10. 10.
    Amichetti M, Caffo O, Arcicasa M, Roncadin M, Lora O, Rigon A et al (1999) Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. Breast Cancer Res Treat 54(2):109–115CrossRefPubMedGoogle Scholar
  11. 11.
    Partridge A, Adloff K, Blood E, Dees EC, Kaelin C, Golshan M et al (2008) Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study. J Natl Cancer Inst 100(4):243–251CrossRefPubMedGoogle Scholar
  12. 12.
    van Gestel YR, Voogd AC, Vingerhoets AJ, Mols F, Nieuwenhuijzen GA, van Driel OJ et al (2007) A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ. Eur J Cancer 43(3):549–556CrossRefPubMedGoogle Scholar
  13. 13.
    Rakovitch E, Franssen E, Kim J, Ackerman I, Pignol JP, Paszat L et al (2003) A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat 77(3):285–293CrossRefPubMedGoogle Scholar
  14. 14.
    Lauzier S, Maunsell E, Drolet M, Coyle D, Hebert-Croteau N, Brisson J et al (2008) Wage losses in the year after breast cancer: extent and determinants among Canadian women. J Natl Cancer Inst 100(5):321–332CrossRefPubMedGoogle Scholar
  15. 15.
    Boyer R, Préville M, Légaré G, Vallois P (1993) La détresse psychologique dans la population du Québec non institutionalisée: résultats normatifs de l’enquête Santé Québec. Can J Psychiatry 38:339–343PubMedGoogle Scholar
  16. 16.
    Maunsell E, Brisson J, Deschenes L, Frasure-Smith N (1996) Randomized trial of a psychologic distress screening program after breast cancer: effects on quality of life. J Clin Oncol 14(10):2747–2755PubMedGoogle Scholar
  17. 17.
    Maunsell E, Brisson J, Deschênes L (1989) Psychologic distress after initial treatment for breast cancer: a comparison of partial and total mastectomy. J Clin Epidemiol 42(8):765–771CrossRefPubMedGoogle Scholar
  18. 18.
    Dorval M, Maunsell E, Deschênes L, Brisson J, Mâsse B (1998) Long-term quality of life after breast cancer: comparison of 8-year survivor with population controls. J Clin Oncol 16(2):487–494PubMedGoogle Scholar
  19. 19.
    Ware JE, Kosinski M, Keller SD (1995) SF-12: how to score the SF-12 physical and mental health summary scales, 2nd edn. The Health Institute, New England Medical Center, BostonGoogle Scholar
  20. 20.
    Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C et al (2000) Canadian normative data for the SF-36 health survey. CMAJ 163(3):265–271PubMedGoogle Scholar
  21. 21.
    Institut de la Statistique du Québec (2001) Enquête sociale et de santé 1998, 2nd edn. Les Publications du Québec, Québec, pp 333–352Google Scholar
  22. 22.
    Liu H, Hays RD, Adams JL, Chen WP, Tisnado D, Mangione CM et al (2005) Imputation of SF-12 health scores for respondents with partially missing data. Health Serv Res 40(3):905–921CrossRefPubMedGoogle Scholar
  23. 23.
    Kleinbaum DG, Kupper LL, Muller KE, Nizam A (1998) Applied regression analysis and other multivariable methods, 3rd edn. Duxbury Press, Pacific GroveGoogle Scholar
  24. 24.
    Cortina JM, Nouri H (2000) Effect size for ANOVA designs, 1st edn. Sage, IowaGoogle Scholar
  25. 25.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, HillsdaleGoogle Scholar
  26. 26.
    Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582–592CrossRefPubMedGoogle Scholar
  27. 27.
    Hoffman RS (1997) Psychological impact of non-invasive breast cancer. In: Siverstein MJ (ed) Ductal carcinoma in situ of the breast, 2nd edn. Lippincott Williams & Wilkins, Baltimore, pp 307–313Google Scholar
  28. 28.
    De Morgan S, Redman S, White KJ, Cakir B, Boyages J (2002) “Well, have I got cancer or haven’t I?” The psycho-social issues for women diagnosed with ductal carcinoma in situ. Health Expect 5(4):310–318CrossRefPubMedGoogle Scholar
  29. 29.
    Dorval M, Guay S, Mondor M, Masse B, Falardeau M, Robidoux A et al (2005) Couples who get closer after breast cancer: frequency and predictors in a prospective investigation. J Clin Oncol 23(15):3588–3596CrossRefPubMedGoogle Scholar
  30. 30.
    Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16(2):501–514PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Sophie Lauzier
    • 1
    • 2
    • 3
  • Elizabeth Maunsell
    • 1
    • 2
    • 4
  • Pascale Levesque
    • 1
  • Myrto Mondor
    • 1
  • Jean Robert
    • 1
    • 2
  • André Robidoux
    • 5
  • Louise Provencher
    • 1
    • 2
  1. 1.Unité de recherche en santé des populations, Hôpital du Saint-SacrementCentre de recherche du Centre hospitalier affilé universitaire de QuébecQuébecCanada
  2. 2.Centre des maladies du sein Deschênes-FabiaCentre hospitalier affilé universitaire de QuébecQuébecCanada
  3. 3.School of NursingMcGill UniversityMontréalCanada
  4. 4.Département de médecine sociale et préventive, Faculté de médecineUniversité Laval, QuébecQuébecCanada
  5. 5.Centre intégré du cancer du seinCentre hospitalier de l’Université de Montréal, Hôpital Notre-DameMontréalCanada

Personalised recommendations