Skip to main content

Advertisement

SpringerLink
Log in

Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns

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

Abstract

Breast cancer diagnosis and treatment can negatively impact fertility in premenopausal women and influence reproductive planning. This study investigates whether concerns about reproduction after breast cancer treatment were associated with long-term depressive symptoms. Participants include 131 women diagnosed with early-stage breast cancer at age 40 or younger participating in the Women’s Healthy Eating and Living (WHEL) Survivorship Study. Participants were enrolled an average of 1.5 years postdiagnosis and depressive symptoms were monitored 6 times throughout the average additional 10 year follow-up period. Detailed recall of reproductive concerns after treatment was collected an average of 12 years postdiagnosis. Multilevel regression was used to evaluate whether mean long-term depressive symptoms differed as a function of reproductive concerns and significant covariates. Multilevel regression identified greater recalled reproductive concerns as an independent predictor of consistent depressive symptoms after controlling for both social support and physical health (B = 0.02, SE = 0.01, P = 0.04). In bivariate analyses, being nulliparous at diagnosis and reporting treatment-related ovarian damage were both strongly associated with higher reproductive concerns and with depressive symptoms. Reported reproductive concerns after breast cancer treatment were a significant contributor to consistent depressive symptoms. Younger survivors would benefit from additional information and support related to reproductive issues.

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. Theriault RL, Sellin RV (1994) Estrogen-replacement therapy in younger women with breast cancer. J Natl Cancer Inst Monogr (16):149–152

  2. American Cancer Society (2005) Breast cancer facts and figures 2005–2006. American Cancer Society Inc., Atlanta

    Google Scholar 

  3. Goodwin PJ, Ennis M, Pritchard KI, Trudeau M, Hood N (1999) Risk of menopause during the first year after breast cancer diagnosis. J Clin Oncol 17(8):2365–2370

    CAS  PubMed  Google Scholar 

  4. Knobf MT (2006) The influence of endocrine effects of adjuvant therapy on quality of life outcomes in younger breast cancer survivors. Oncologist 11(2):96–110

    Article  PubMed  Google Scholar 

  5. Reichman BS, Green KB (1994) Breast cancer in young women: effect of chemotherapy on ovarian function, fertility, and birth defects. J Natl Cancer Inst Monogr (16):125–129

  6. Bines J, Oleske DM, Cobleigh MA (1996) Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 14(5):1718–1729

    CAS  PubMed  Google Scholar 

  7. Dunn J, Steginga SK (2000) Young women’s experience of breast cancer: defining young and identifying concerns. Psychooncology 9(2):137–146

    Article  CAS  PubMed  Google Scholar 

  8. Partridge A, Gelber S, Peppercorn J, Sampson E, Knudsen K, Laufer M, Rosenberg R, Przypyszny M, Rein A, Winer EP (2004) Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22(20):4174–4183

    Article  PubMed  Google Scholar 

  9. Schover LR (1999) Psychosocial aspects of infertility and decisions about reproduction in young cancer survivors: a review. Med Pediatr Oncol 33(1):53–59

    Article  CAS  PubMed  Google Scholar 

  10. Schover LR (2005) Motivation for parenthood after cancer: a review. J Natl Cancer Inst Monogr (34):2–5

  11. Thewes B, Butow P, Girgis A, Pendlebury S (2004) The psychosocial needs of breast cancer survivors; a qualitative study of the shared and unique needs of younger versus older survivors. Psychooncology 13(3):177–189

    Article  CAS  PubMed  Google Scholar 

  12. Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE (2003) Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 21(22):4184–4193

    Article  PubMed  Google Scholar 

  13. Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L (1996) Breast cancer survivors: psychological concerns and quality of life. Breast Cancer Res Treat 38:183–199

    Article  CAS  PubMed  Google Scholar 

  14. Avis NE, Crawford S, Manuel J (2004) Psychosocial problems among younger women with breast cancer. Psychooncology 13(5):295–308

    Article  PubMed  Google Scholar 

  15. 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):501–514

    CAS  PubMed  Google Scholar 

  16. Leventhal B, Shearer P (1989) Recognising and managing the late effects of treatment. Oncology 3:73–84

    Google Scholar 

  17. Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P (1996) An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res Treat 39(3):261–273

    Article  CAS  PubMed  Google Scholar 

  18. Schover LR (1994) Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr (16):177–182

  19. Wong-Kim EC, Bloom JR (2005) Depression experienced by young women newly diagnosed with breast cancer. Psychooncology 14(7):564–573

    Article  PubMed  Google Scholar 

  20. Bloom JR, Stewart SL, Johnston M, Banks P, Fobair P (2001) Sources of support and the physical and mental well-being of young women with breast cancer. Soc Sci Med 53(11):1513–1524

    Article  CAS  PubMed  Google Scholar 

  21. Bloom JR, Kessler L (1994) Risk and timing of counseling and support interventions for younger women with breast cancer. J Natl Cancer Inst Monogr (16):199–206

  22. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 330(7493):702

    Article  PubMed  Google Scholar 

  23. Compas BE, Stoll MF, Thomsen AH, Oppedisano G, Epping-Jordan JE, Krag DN (1999) Adjustment to breast cancer: age-related differences in coping and emotional distress. Breast Cancer Res Treat 54(3):195–203

    Article  CAS  PubMed  Google Scholar 

  24. Vinokur AD, Threatt BA, Vinokur-Kaplan D, Satariano WA (1990) The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer 65(5):1242–1254

    Article  CAS  PubMed  Google Scholar 

  25. Bardwell WA, Natarajan L, Dimsdale JE, Rock CL, Mortimer JE, Hollenbach K, Pierce JP (2006) Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. J Clin Oncol 24(16):2420–2427

    Article  PubMed  Google Scholar 

  26. Fallowfield LJ, Baum M, Maguire GP (1986) Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. Br Med J (Clin Res Ed) 293(6558):1331–1334

    Article  CAS  Google Scholar 

  27. Hjerl K, Andersen EW, Keiding N, Mouridsen HT, Mortensen PB, Jorgensen T (2003) Depression as a prognostic factor for breast cancer mortality. Psychosomatics 44(1):24–30

    Article  PubMed  Google Scholar 

  28. Lehto US, Ojanen M, Dyba T, Aromaa A, Kellokumpu-Lehtinen P (2006) Baseline psychosocial predictors of survival in localised breast cancer. Br J Cancer 94(9):1245–1252

    Article  PubMed  Google Scholar 

  29. Spiegel D, Giese-Davis J (2003) Depression and cancer: mechanisms and disease progression. Biol Psychiatry 54(3):269–282

    Article  PubMed  Google Scholar 

  30. Grunfeld E, Coyle D, Whelan T, Clinch J, Reyno L, Earle CC, Willan A, Viola R, Coristine M, Janz T et al (2004) Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. CMAJ 170(12):1795–1801

    PubMed  Google Scholar 

  31. Osborn T (2007) The psychosocial impact of parental cancer on children and adolescents: a systematic review. Psychooncology 16(2):101–126

    Article  PubMed  Google Scholar 

  32. Pitceathly C, Maguire P (2003) The psychological impact of cancer on patients’ partners and other key relatives: a review. Eur J Cancer 39(11):1517–1524

    Article  CAS  PubMed  Google Scholar 

  33. Reich M, Lesur A, Perdrizet-Chevallier C (2008) Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat 110(1):9–17

    Article  CAS  PubMed  Google Scholar 

  34. Schag CA, Ganz PA, Polinsky ML, Fred C, Hirji K, Petersen L (1993) Characteristics of women at risk for psychosocial distress in the year after breast cancer. J Clin Oncol 11(4):783–793

    CAS  PubMed  Google Scholar 

  35. Borrell-Carrio F, Suchman AL, Epstein RM (2004) The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med 2(6):576–582

    Article  PubMed  Google Scholar 

  36. Kendler KS, Gardner CO, Prescott CA (2002) Toward a comprehensive developmental model for major depression in women. Am J Psychiatry 159(7):1133–1145

    Article  PubMed  Google Scholar 

  37. Aapro M, Cull A (1999) Depression in breast cancer patients: the need for treatment. Ann Oncol 10(6):627–636

    Article  CAS  PubMed  Google Scholar 

  38. Duffy LS, Greenberg DB, Younger J, Ferraro MG (1999) Iatrogenic acute estrogen deficiency and psychiatric syndromes in breast cancer patients. Psychosomatics 40(4):304–308

    CAS  PubMed  Google Scholar 

  39. Jacobsen PB, Bovbjerg DH, Redd WH (1993) Anticipatory anxiety in women receiving chemotherapy for breast cancer. Health Psychol 12(6):469–475

    Article  CAS  PubMed  Google Scholar 

  40. Leedham B, Ganz PA (1999) Psychosocial concerns and quality of life in breast cancer survivors. Cancer Invest 17(5):342–348

    Article  CAS  PubMed  Google Scholar 

  41. Yeter K, Rock CL, Pakiz B, Bardwell WA, Nichols JF, Wilfley DE (2006) Depressive symptoms, eating psychopathology, and physical activity in obese breast cancer survivors. Psychooncology 15(6):453–462

    Article  PubMed  Google Scholar 

  42. Spiegel D (1996) Cancer and depression. Br J Psychiatry Suppl (30):109–116

  43. Spiegel D, Sands S, Koopman C (1994) Pain and depression in patients with cancer. Cancer 74(9):2570–2578

    Article  CAS  PubMed  Google Scholar 

  44. Bloom JR (1990) The relationship of social support and health. Soc Sci Med 30(5):635–637

    Article  CAS  PubMed  Google Scholar 

  45. Simpson JS, Carlson LE, Beck CA, Patten S (2002) Effects of a brief intervention on social support and psychiatric morbidity in breast cancer patients. Psychooncology 11(4):282–294

    Article  PubMed  Google Scholar 

  46. Rodrigue JR, Park TL (1996) General and illness-specific adjustment to cancer: relationship to marital status and marital quality. J Psychosom Res 40(1):29–36

    Article  CAS  PubMed  Google Scholar 

  47. Green FL (2002) AJCC cancer staging manual. Springer, New York

    Book  Google Scholar 

  48. Pierce JP, Faerber S, Wright FA, Rock CL, Newman V, Flatt SW, Kealey S, Jones VE, Caan BJ, Gold EB et al (2002) A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) Study. Control Clin Trials 23(6):728–756

    Article  PubMed  Google Scholar 

  49. Burnam MA, Wells KB, Leake B, Landsverk J (1988) Development of a brief screening instrument for detecting depressive disorders. Med Care 26(8):775–789

    Article  CAS  PubMed  Google Scholar 

  50. Wenzel L, Dogan-Ates A, Habbal R, Berkowitz R, Goldstein DP, Bernstein M, Kluhsman BC, Osann K, Newlands E, Seckl MJ et al (2005) Defining and measuring reproductive concerns of female cancer survivors. J Natl Cancer Inst Monogr (34):94–98

  51. Ware JE Jr, Kosinski M (2001) SF-36 physical and mental health summary scales for users of version 1, 2nd edn. Quality Metric Incorporated, Lincoln, RI

    Google Scholar 

  52. Ware JE, Snow KK, Kosinski M, Gandek B (2000) SF-36 health survey: manual and interpretation guide. Quality Metric Incorporated, Lincoln, RI

    Google Scholar 

  53. Gorman JR, Roesch SR, Parker BA, Madlensky L, Saquib N, Newman VA, Pierce JP (2009) Physical and mental health correlates of pregnancy following breast cancer. Psycho-Oncology. doi:10.1002/pon.1614

    Google Scholar 

  54. Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714

    Article  CAS  PubMed  Google Scholar 

  55. Berkman LF, Syme SL (1979) Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 109(2):186–204

    CAS  PubMed  Google Scholar 

  56. Raudenbush SW, Byrk AS (2002) Heirarchical linear models: applications and data analysis methods, 2nd edn. Sage, Thousand Oaks, CA

    Google Scholar 

  57. Ganz PA, Hirji K, Sim MS, Schag CA, Fred C, Polinsky ML (1993) Predicting psychosocial risk in patients with breast cancer. Med Care 31(5):419–431

    Article  CAS  PubMed  Google Scholar 

  58. Thewes B, Meiser B, Taylor A, Phillips KA, Pendlebury S, Capp A, Dalley D, Goldstein D, Baber R, Friedlander ML (2005) Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol 23(22):5155–5165

    Article  CAS  PubMed  Google Scholar 

  59. Braun M, Hasson-Ohayon I, Perry S, Kaufman B, Uziely B (2005) Motivation for giving birth after breast cancer. Psychooncology 14(4):282–296

    Article  PubMed  Google Scholar 

  60. Schover LR, Rybicki LA, Martin BA, Bringelsen KA (1999) Having children after cancer. A pilot survey of survivors’ attitudes and experiences. Cancer 86(4):697–709

    Article  CAS  PubMed  Google Scholar 

  61. Dow KH, Harris JR, Roy C (1994) Pregnancy after breast-conserving surgery and radiation therapy for breast cancer. J Natl Cancer Inst Monogr (16):131–137

  62. Joormann J, Teachman BA, Gotlib IH (2009) Sadder and less accurate? False memory for negative material in depression. J Abnorm Psychol 118(2):412–417

    Article  PubMed  Google Scholar 

  63. Connell S, Patterson C, Newman B (2006) A qualitative analysis of reproductive issues raised by young Australian women with breast cancer. Health Care Women Int 27(1):94–110

    Article  PubMed  Google Scholar 

  64. Thewes B, Meiser B, Rickard J, Friedlander M (2003) The fertility- and menopause-related information needs of younger women with a diagnosis of breast cancer: a qualitative study. Psychooncology 12(5):500–511

    Article  PubMed  Google Scholar 

  65. Cimprich B, Ronis DL, Martinez-Ramos G (2002) Age at diagnosis and quality of life in breast cancer survivors. Cancer Pract 10(2):85–93

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was initiated with the support of the California Breast Cancer Research Program (Grant 14GB-0140) and the Walton Family Foundation, and continued funding from National Cancer Institute Grants CA 69375 and CA 72092. Some of the data were collected from the General Clinical Research Centers, National Institutes of Health Grants M01-RR00070, M01-RR00079, and M01-RR00827.

Author information

Authors and Affiliations

  1. Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA, 92093-0901, USA

    Jessica R. Gorman, Vanessa L. Malcarne, Lisa Madlensky & John P. Pierce

  2. Department of Psychology, San Diego State University, San Diego, CA, 92120-4913, USA

    Vanessa L. Malcarne

  3. Department of Psychology, San Diego State University, San Diego, CA, 92182-4611, USA

    Scott C. Roesch

Authors
  1. Jessica R. Gorman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vanessa L. Malcarne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott C. Roesch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Madlensky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John P. Pierce
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John P. Pierce.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gorman, J.R., Malcarne, V.L., Roesch, S.C. et al. Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns. Breast Cancer Res Treat 123, 477–485 (2010). https://doi.org/10.1007/s10549-010-0768-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-010-0768-4

Keywords

Search

Navigation