Differences in depression, anxiety, and quality of life between women with and without breast pain prior to breast cancer surgery

https://doi.org/10.1016/j.ejon.2012.06.001Get rights and content

Abstract

Purpose of the research

Little is known about the relationships between pain, anxiety, and depression in women prior to breast cancer surgery. The purpose of this study was to evaluate for differences in anxiety, depression, and quality of life (QOL) in women who did and did not report the occurrence of breast pain prior to breast cancer surgery. We hypothesized that women with pain would report higher levels of anxiety and depression as well as poorer QOL than women without pain.

Methods and sample

A total of 390 women completed self-report measures of pain, anxiety depression, and QOL prior to surgery.

Key results

Women with preoperative breast pain (28%) were significantly younger, had a lower functional status score, were more likely to be Non-white and to have gone through menopause. Over 37% of the sample reported clinically meaningful levels of depressive symptoms. Almost 70% of the sample reported clinically meaningful levels of anxiety. Patients with preoperative breast pain reported significantly higher depression scores and significantly lower physical well-being scores. No between group differences were found for patients' ratings of state and trait anxiety or total QOL scores.

Conclusions

Our a priori hypotheses were only partially supported. Findings from this study suggest that, regardless of pain status, anxiety and depression are common problems in women prior to breast cancer surgery.

Introduction

Almost all of the 226,870 women diagnosed with breast cancer in 2012 will undergo surgery (Siegel et al., 2012). While clinical experience suggests that the threat of a cancer diagnosis combined with the uncertainty associated with surgical and adjuvant treatments results in a significant amount of preoperative anxiety and depression, only six studies were identified that used symptom specific scales to evaluate anxiety and depression in women prior to breast cancer surgery (Hanson Frost et al., 2000; Katz et al., 2005; Millar et al., 1995; Ozalp et al., 2003; Parker et al., 2007; Vahdaninia et al., 2010). The most frequently used measures across these studies were the Spielberger State Trait Anxiety Inventory (STAI-S, STAI-T)(Spielberger et al., 1983), the Hospital Anxiety and Depression Scale (Snaith, 2003), the Beck Depression Inventory (Beck and Steer, 1987), and the Center of Epidemiologic Studies Depression scale (CES-D) (Radloff, 1977). Across these studies, approximately 34%–53% of patients were categorized as having clinically meaningful levels of anxiety (Millar et al., 1995; Ozalp et al., 2003; Parker et al., 2007; Ramirez et al., 1995) and 18%–26% had clinically meaningful levels of depressive symptoms (Parker et al., 2007; Vahdaninia et al., 2010). Taken together, findings from this limited number of studies suggest that anxiety and depression are highly prevalent in women prior to breast cancer surgery. The varying prevalence rates may be attributed to differences in the measures used to assess anxiety and depression. In addition, many of these studies had relatively small samples sizes.

Even more limited are the number of studies that evaluated for both psychological distress and the presence of pain in women prior to breast cancer surgery. In one study that used valid methods to assess both psychological distress and the occurrence of pain prior to surgery (Katz et al., 2005), 27.1% of the women reported preoperative breast pain. Compared to pain free patients, women with clinically meaningful levels of acute pain two days after surgery reported higher levels of anxiety and depression. Because recent work from our research team found that 28% of women had pain in their breast prior to breast cancer surgery (McCann et al., 2012) and research on the prevalence of anxiety and depression in the preoperative period are limited, we decided to examine the relationships between preoperative breast pain, anxiety, depression, and QOL in a large sample of breast cancer patients (n = 398) prior to surgery. We hypothesized that women with pain would report higher levels of anxiety and depression as well as poorer QOL than women without pain.

Section snippets

Patients and settings

This descriptive, correlational study is part of a larger study that evaluated for neuropathic pain and lymphedema in women who underwent breast cancer surgery. Patients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices.

Patients were eligible to participate if they were: an adult woman (≥18 years) who would undergo breast cancer surgery on one breast; were able to read, write, and understand English; agreed to

Differences in demographic and clinical characteristics between patients with and without breast pain

Prior to surgery, 28% of the women (n = 110) reported pain in their breast (eight women did not answer the pain question). As shown in Table 1, except for age, KPS scores, ethnicity, income, and menopausal status, no differences were found between the two pain groups in most of the demographic and clinical characteristics. Patients who reported breast pain were significantly younger (p < .0001), more likely to be Non-white (p = .016), premenopausal (p = .01), and had a lower KPS score (p

Discussion

This study is the first to evaluate for differences in depression and anxiety in a large sample of women who did and did not have pain in their breast prior to breast cancer surgery. Regardless of pain status, 37.5% of these women reported a CES-D score above the cutoff for clinically significant levels of depressive symptoms. This prevalence is higher than previous reports of depressive symptoms that ranged between 18% and 26% (Parker et al., 2007). In terms of anxiety, regardless of pain

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgments

This study was funded by grants from the National Cancer Institute (CA107091 and CA118658). Dr. Bradley Aouizerat was funded through the National Institutes of Health (NIH) Roadmap for Medical Research Grant (KL2 RR624130). Dr. Dunn received funding from the Mount Zion Health Fund. Dr. Christine Miaskowski is an American Cancer Society Clinical Research Professor. This project is supported by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131. Its contents are solely the responsibility of the authors

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