Skip to main content

Advertisement

SpringerLink
Log in

Psychological morbidity in women diagnosed with ductal carcinoma in situ compared with women with early breast cancer receiving radiotherapy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Despite having an excellent prognosis, patients with ductal carcinoma in situ (DCIS) report significant anxiety and depression following diagnosis. This study evaluated psychological morbidity using the Edmonton Symptom Assessment Scale (ESAS) in patients with DCIS compared with women with early-stage invasive breast cancer (EIBC) receiving radiotherapy (RT).

Methods

We identified patients diagnosed with DCIS or EIBC (stage I or II breast cancer) from 2011 to 2017 who had at least one ESAS completed pre- and post-RT. Data on systemic treatment, radiation, patient demographics, and disease stage were extracted from existing databases. Psychological morbidity was evaluated through measurement of depression, anxiety, and overall wellbeing within the ESAS. The Wilcoxon rank-sum test or chi-square test was performed for continuous or categorical variables.

Results

This study included 137 women with DCIS and 963 women with EIBC. ESAS was completed on average 28 days before RT (baseline) and 142 days after RT. Baseline ESAS scores showed significantly higher rates of depression among women with EIBC compared with those with DCIS (p = 0.006). Patients with EIBC also reported higher levels of anxiety and lower overall wellbeing than patients with DCIS, but this difference was not statistically significant. Post-RT ESAS scores showed significantly higher anxiety in patients with EIBC compared with DCIS (p = 0.049). Post-RT measures of anxiety and overall wellbeing were higher in patients with EIBC but differences were not statistically significant.

Conclusion

Women with DCIS experience relatively less psychological morbidity than women with EIBC, pre- and post-RT.

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

Similar content being viewed by others

References

  1. Elshof L, Schaapveld M, Rutgers E, Schmidt M, de Munck L, van Leeuwen F, Wesseling J (2017) The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study. Breast Cancer Res 19(1):26

    Article  Google Scholar 

  2. Duffy S, Dibden A, Michalopoulos D, Offman J, Parmar D, Jenkins J et al (2016) Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol 17(1):109–114

    Article  Google Scholar 

  3. Siegel R, J MJ, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29

    Article  Google Scholar 

  4. Fallowfield L, Matthews L, Francis A, Jenkins V, Rea D (2014) Low grade ductal carcinoma in situ (DCIS): how best to describe it? Breast 23(5):693–696

    Article  Google Scholar 

  5. Giannakeas V, Sopik V, Narod S (2018) Association of radiotherapy with survival in women treated for ductal carcinoma in situ with lumpectomy or mastectomy. JAMA Netw Open 1(4):e181100

    Article  Google Scholar 

  6. Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst M (2015) Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173 797 patients. BMJ 351:4901

    Article  Google Scholar 

  7. National Comprehensive Cancer Network (2003) Distress management clinical practice guidelines in oncology. J Natl Compr Cancer Netw 1(3):344

    Article  Google Scholar 

  8. Ozanne E, Schneider K, Soeteman D, Stout N, Schrag D, Fordis M, Punglia R (2015) onlineDeCISion.org: a web-based decision aid for DCIS treatment. Breast Cancer Res Treat 154(1):181–190. https://doi.org/10.1007/s10549-015-3605-y

    Article  PubMed  Google Scholar 

  9. Ruddy K, Meyer M, Giobbie-Hurder A, Emmons K, Weeks J, Winer E, Partridge A (2013) Long-term risk perceptions of women with ductal carcinoma in situ. Oncologist 18(4):362–368. https://doi.org/10.1634/theoncologist.2012-0376

    Article  PubMed  PubMed Central  Google Scholar 

  10. van Gestel YRBM, Voogd AC, Vingerhoets AJJM, Mols F, Nieuwenhuijzen GAP, van Driel OJR, van Berlo CLH, van de Poll-Franse LV (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):549–556

    Article  Google Scholar 

  11. Lauzier S, Maunsell E, Levesque P, Mondor M, Robert J, Andre´ R et al (2010) Psychological distress and physical health in the year after diagnosis of DCIS or invasive breast cancer. Breast Cancer Res Treat 120(3):685–691

    Article  Google Scholar 

  12. Liu Y, Pe’rez M, Schootman M, Aft RL, Gillanders WE, Jeffe DB (2011) Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat 130(1):165–173

    Article  CAS  Google Scholar 

  13. Jeffe DB, Perez M, Liu Y, Collins KK, Aft RL, Schootman M (2012) Quality of life over time in women diagnosed with ductal carcinoma in situ, early-stage invasive breast cancer, and agematched controls. Breast Cancer Res Treat 134(1):379–391

    Article  CAS  Google Scholar 

  14. King MT, Winters ZE, Olivotto IA, Spillane AJ, Chua BH, Saunders C, Westenberg AH, Mann GB, Burnett P, Butow P, Rutherford C (2017) Patient reported outcomes in ductal carcinoma in situ: a systematic review. Eur J Cancer 71:95–108

    Article  Google Scholar 

  15. Rakovitch E, Franssen E, Kim J, Ackerman I, Pignol JP, Paszat L, Pritchard KI, Ho C, Redelmeier DA (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):285–293

    Article  Google Scholar 

  16. Gregorowitsch M, van den Bongard H, Young-Afat D, Pignol J, van Gils C, May A, Verkooijen H (2017) Severe depression more common in patients with ductal carcinoma in situ than early-stage invasive breast cancer patients. Breast Cancer Res Treat 167(1):205–213

    Article  Google Scholar 

  17. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    Article  CAS  Google Scholar 

  18. Kim C, Liang L, Wright F, Hong N, Groot G, Helyer L et al (2017) Interventions are needed to support patient–provider decision-making for DCIS: a scoping review. Breast Cancer Res Treat 168(3):579–592

    Article  Google Scholar 

  19. Stacey D, Légaré F, Lewis K et al (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 4:1–297

    Google Scholar 

Download references

Funding

This study received financial support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada

    William Pidduck, Bo Angela Wan, Liying Zhang, Eileen Rakovitch, Selina Chow, Stephanie Chan, Caitlin Yee, Leah Drost, Philomena Sousa, Donna Lewis, Henry Lam, Eric Leung & Edward Chow

Authors
  1. William Pidduck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bo Angela Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eileen Rakovitch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Selina Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephanie Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Caitlin Yee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Leah Drost
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Philomena Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Donna Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Henry Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Eric Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Edward Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward Chow.

Ethics declarations

This study was approved by the Sunnybrook Health Sciences Centre research ethics board (REB #151-2017).

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pidduck, W., Wan, B.A., Zhang, L. et al. Psychological morbidity in women diagnosed with ductal carcinoma in situ compared with women with early breast cancer receiving radiotherapy. Support Care Cancer 28, 2247–2254 (2020). https://doi.org/10.1007/s00520-019-05034-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-05034-2

Keywords

Search

Navigation