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17-11-2016 | Breast cancer | Book chapter | Article

30. Psychological Support for the Breast Cancer Patient

Author: Donna B. Greenberg

Publisher: Springer International Publishing

Abstract

Breast cancer treatment challenges a woman’s ability to cope and this chapter discusses psychological assessment of women confronting breast cancer. We review common triggers for anxiety and the effect of antiestrogen treatment on mood. Cancer-focused psychosocial interventions do reduce distress for these patients, but the specific benefit of diagnosis and treatment of major depressive disorder is supported by controlled studies in oncology settings. Both antidepressants and psychotherapeutic treatments are optimal treatment more specifically for major depressive disorder. The diagnosis of major depressive disorder must be evaluated with an understanding of other causes of insomnia, fatigue, and cognitive complaints in breast cancer patients. Patients with psychotic illness require interdisciplinary planning for care.
Literature
1.
Brunault P, Champagne A-L, Huguet G, et al. Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients. Psycho-Oncology. 2015;. doi:10.​1002/​pon.​3947.PubMed
2.
Barton MB, Morley DS, Moore S, Allen JD, Kleinman KP, Emmons KM, Fletcher SW. Decreasing women’s anxieties after abnormal mammograms: a controlled trial. J Natl Cancer Inst. 2004;96:529–38.CrossRefPubMed
3.
Ramirez AJ, Westcombe AM, Burgess CC, Sutton S, Littlejohns P, Richards MA. Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet. 1999;353:1127–31.CrossRefPubMed
4.
Jones SE, Cantrell J, Vukelja S, Pippen J, O’Shaughnessy J, et al. Comparison of menopausal symptoms during the first year of adjuvant therapy with either exemestane or tamoxifen in early breast cancer: report of a tamoxifen exemestane adjuvant multi-center trial substudy. J Clin Oncol. 2007;25:4765–71.CrossRefPubMed
5.
Fallowfield L, Cella D, Cuzick J, et al. Quality of life of postmenopausal women in the Arimidex, Tamoxifen, Alone or in combination (ATAC) adjuvant breast trial. J Clin Oncol. 2004;22:4261–71.CrossRefPubMed
6.
Thomas R, Williams M, Marshall C, Walker L. Switching to letrozole or exemestane improves hot flushes, mood and quality of life in tamoxifen intolerant women. Brit J Cancer. 2008;98:1494–9.CrossRefPubMedPubMedCentral
7.
Waterhouse DM, Calzone KA, Mele C, Brenner DE. Adherence to oral tamoxifen: a comparison of patient selfreport, pill counts, and microelectronic monitoring. J Clin Oncol. 1993;11:1189–97.CrossRefPubMed
8.
Partridge AH, Wang PS, Winer EP, et al. Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol. 2003;21:602–6.CrossRefPubMed
9.
Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA. Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat. 2006;99:215–20.CrossRefPubMed
10.
Kahn KL, Schneider EC, Malin J, Adams JL, Epstein AM. Patient-centered experiences in breast cancer: predicting long-term adherence to tamoxifen use. Med Care. 2007;45:431–9.CrossRefPubMed
11.
Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A. Adherence to initial adjuvant anastrozole therapy among women with early stage breast cancer. J Clin Oncol. 2008;26:556–62.CrossRefPubMed
12.
Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2015;152:239–46.CrossRefPubMedPubMedCentral
13.
Greer JA, Park ER, Prigerson HG, Safren SA. Tailoring cognitive-behavioral therapy to treat anxiety comorbid with advanced cancer. J Cogn Psychother. 2010;24:294–313.CrossRefPubMedPubMedCentral
14.
Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2015;27:20–8. doi:10.​1016/​j.​smrv.​2015.​07.​001.CrossRefPubMed
15.
Grunberg SM. Antiemetic activity of corticosteroids in patients receiving cancer chemotherapy: dosing, efficacy, and tolerability analysis. Ann Oncol. 2007;18:233–40.CrossRefPubMed
16.
Buysse DJ, Reynolds DC III, Hauri PJ, et al. Diagnostic concordance for DSM IV sleep disorders: a report from the APA/NIMH DSV-IV field trial. Am J Psychiatry. 1994;151:1351–60.CrossRefPubMed
17.
Benca RM, Obermeyer WH, Thisted RA, et al. Sleep and psychiatric disorders: a meta-analysis. Arch Gen Psychiatry. 1992;49:651–68.CrossRefPubMed
18.
Weilburg JB, Stakes JW, Roth T. Sleep disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J. Rauch SL, editors. Comprehensive Clinical Psychiatry. Mosby Elsevier; 2008. p. 285–99.
19.
Carpenter JS, Andrykowski MA, Cordova M, Cunningham L, Studts J, McGrath P, Kenady D, Sloan D, Munn R. Hot flashes in postmenopausal women treated for breast carcinoma: prevalence, severity, correlates, management, and relation to quality of life. Cancer. 1998;82:1682–91.CrossRefPubMed
20.
Kronenberg F. Hot flashes: phenomenology, quality of life, and search for treatment options. Exp Gerontol. 1994;29:319–36.CrossRefPubMed
21.
Savard J, Davidson JR, Ivers H, Quesnel C, Rioux D, Dupere V, Lanier M, Smard S, Morin CM. The association between nocturnal hot flashes and sleep in breast cancer survivors. J Pain Sympt Manage. 2004;27:513–22.CrossRef
22.
Stearns V, Beebe KL, Lyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA. 2003;289:2827–34.CrossRefPubMed
23.
Loprinzi CL, Sloan JA, Perez EA, Quella SK, Stella PJ, Mailliard JA, et al. Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol. 2002;20:1578–83.CrossRefPubMed
24.
Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomized controlled trial. Lancet. 2000;356:2059–63.CrossRefPubMed
25.
Pandya KJ, Morrow GR, Roscoe JA, Zhao H, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomized double-blind placebo-controlled trial. Lancet. 2005;366:818–24.CrossRefPubMedPubMedCentral
26.
Bardwell WA, Profant J, Casden DR, Dimsdale JE, Ancoli- Israel S, Natarajan L, Rock CL, Pierce JP. The relative importance of specific risk factors for insomnia in women treated for early stage breast cancer. Psychooncology. 2008;17:9–18.CrossRefPubMedPubMedCentral
27.
Ganz PA, Kwan L, Castellon SA, Oppenheim A, et al. Cognitive complaints after breast cancer treatments: examining the relationship with neuropsyhological test performance. J Nat Cancer Inst. 2013;105:791–801.CrossRefPubMedPubMedCentral
28.
Jenkins V, Shilling V, Deutsch G, et al. A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. Br J Cancer. 2006;94:828–34.CrossRefPubMedPubMedCentral
29.
Joffee H, Hall JE, Gruber S, et al. Estrogen therapy selectively enhances prefrontal cognitive processes: a randomized, double-blind, placebo-controlled study with functional magnetic resonance imaging in premenopausal and recently postmenopausal women. Menopause. 2006;12:411–22.CrossRef
30.
Silverman DH, Dy CJ, Castellon S, Lai J, Pio BS, Abraham L, Waddell K, Petersen L, Phelps ME, Ganz PA. Altered frontocortical cerebellar and basal ganglia activity in adjuvant treated breast cancer survivors 5–10 years after chemotherapy. Breast Cancer Res Treat. 2007;103:303–11.CrossRefPubMed
31.
Ono M, Ogilvie JM, Wilson JS, et al. A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer. Front Oncol. 2015;5:1–19. doi:10.​3389/​fonc.​2015.​00059.CrossRef
32.
Amidi A, Christensen S, Mehlsen M, et al. Long-term subjective cognitive functioning following adjuvant systemic treatment: 7–9 years follow-up of a nationwide cohort of women treated for primary breast cancer. Brit J Cancer. 2015;113:794–801.CrossRefPubMedPubMedCentral
33.
Bower JE. Behavioral symptoms in breasst cancer patients and survivors: fatigue, insomnia, depression, and cognitive disturbance. J Clin Oncol. 2008;26:768–77.CrossRefPubMedPubMedCentral
34.
Kohli S, Fisher SG, Tra Y et al. The effect of modafinil on cognitive function in breast cancer survivors. 2009;115:2605–16.
35.
Mar Fan HG, Clemons M, Xu W, et al. A randomized, placebo-controlled, double-blind trial of the effects of d-methylphenidate on fatigue and cognitive dysfunction in women undergoing adjuvant chemotherapy for breast cancer. Support Care Cancer. 2008;16(577–583):34.
36.
Lawrence JA, Griffin L, Balcueva EP et al. A study of donepezil in female breast cancer survivors with self-reported cognitive dysfunction 1 to 5 years following adjuvant chemotherapy. J Cancer Surviv. 2015 (epub ahead of print).
37.
Schmidt P, Nieman LK, Danaceau MA, Adamas LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338:209–16.CrossRefPubMed
38.
Cohen LS, Soares CN, Otto MW, Vitonis AF, Harlow BL. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry. 2006;63:385–90.CrossRefPubMed
39.
Schmidt PJ, Haq N, Rubinow MD, David R. A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry. 2004;161:2238–44.CrossRefPubMed
40.
Soares CN, Helga A, Joffe H, Bankier B, Cassano P, Petrillo LF, Cohen LS. Escitalopram versus ethyinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep, and quality of life. Menopause. 2006;13:780–6.CrossRefPubMed
41.
Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebocontrolled trial. Arch Gen Psychiatry. 2001;58:529–34.CrossRefPubMed
42.
Andrykowski MA, Schmidt JE, Salsman JM, Beacham AO, Jacobsen P. Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. J Clin Oncol. 2005;23:6613–22.CrossRefPubMedPubMedCentral
43.
Donovan KA, Small BJ, Andrykowski MA, Munster P, Jacobesen PB. From: Utility of a cognitive-behavioral model to predict fatigue following breast cancer treatment. Health Psychol. 2007;26:464–72.CrossRefPubMedPubMedCentral
44.
Servaes P, Verhagen S, Bleijenberg G. Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol. 2002;13:589–98.CrossRefPubMed
45.
Servaes P, Verhagen CA, Bleijenberg G. Relations between fatigue, neuropsychological functioning and physical activity after treatment for breast carcinoma. Cancer. 2002;95:2017–26.CrossRefPubMed
46.
Servaes PM, Gielissen MF, Verhagen S, Bleijenberg G. The course of severe fatigue in disease-free breast cancer patients: a longitudinal study. Psycho Onology. 2007;16:787–95.CrossRef
47.
Bower JE, Ganz PA, Desmond KA, Bernards C, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106:751–8.CrossRefPubMed
48.
Sharpe M, Hawton K, Simpkin S, Surawy C, Hackmann A, Klimes I, Peto T, Warrel D, Seagroatt V. Cognitive behaviour therapy for chronic fatigue syndrome: a randomized controlled trial. Br Med J. 1996;312:22–6.CrossRef
49.
Gielissen MF, Verhagn S, Witjes F, Bleijenberg G. Effects of cognitive behavioral therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavioral therapy: a randomized controlled trial. J Clin Oncol. 2006;42:4882–7.CrossRef
50.
Barsevick AM, Dudley W, Beck S, et al. A randomzied clinical trial of energy conservation for patients with cancerrelated fatigue. Cancer. 2000;100:1302–10.CrossRef
51.
Bower JE. Cancer-related fatigue: mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11:597–609.CrossRefPubMedPubMedCentral
52.
Fann JR, Thomas-Rich AM, Katon WJ, Cowley D, Pepping M, McGregor BA, Gralow J. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008;30:112–26.CrossRefPubMed
53.
Hjerl K, Andersen EW, Keiding N, Mortensen PB, Jorgensen T. Increased incidence of affective disorders, anxiety disorders, and non-natural mortality in women after breast cancer diagnosis: a nation-wide cohort study in Denmark. Acta Psychiatr Scand. 2002;105:258–64.CrossRefPubMed
54.
Yousaf U, Christensen M-LM, Engholm G, Storm HH. Suicides among Danish cancer patients 1971–1999. Br J Cancer. 2005;92:995–1000.CrossRefPubMedPubMedCentral
55.
Schairer C, Brown LM, Chen BE, Howard R, Lynch CF, et al. Suicide after breast cancer: an international population based study of 723810 women. J Natl Cancer Inst. 2006;98:1416–9.CrossRefPubMed
56.
Gonzalez-Perez A, Rodriquez LAG. Breast cancer risk among users of antidepressant medications. Epidemiology. 2005;16:101–5.CrossRefPubMed
57.
Haque R, Enger SM, Chen W, Petitti DB. Breast cancer risk in a large cohort of female antidepressant medication users. Cancer Lett. 2004;221:61–5.CrossRef
58.
Jin Y, Desta Z, Stearns V, Ward B, Ho H, Lee KH, et al. CYP2D6 genotype, antidepressant use, and tamoxifen metabolism during adjuvant breast cancer treatment. J Natl Cancer Inst. 2005;97:30–9.CrossRefPubMed
59.
Lim HS, Lee HJ, Lee KS, Lee ES, Jang IJ, Ro J. Clinical implications of CYP2D6 genotypes predictive of tamoxifen pharmacokinetics in metastatic breast cancer. J Clin Oncol. 2007;25:3837–45.CrossRefPubMed
60.
Goetz MP, Knox SK, Suman VJ, Safgren SL, Ames MM, Visscher DW, et al. The impact of cytochrome P450 2D6 metabolism in women receiving adjuvant tamoxifen. Breast Cancer Res Treat. 2007;101:1213–21.CrossRef
61.
Ratliff B, Dietze EC, Bean GR, Moore C, Wanto S, Seewaldt VL. Correspondence: Re: active tamoxifen metabolite plasma concentrations after coadministration of tamoxifen and the selective serotonin reuptake inhibitor paroxetine. J Natl Cancer Inst. 2004;96:883.CrossRefPubMed
62.
Keller MB, McCullough JP, Klein DN, Arnow B, Dunner DL, Gelenberg AJ, et al. A comparison of nefazadone, the cognitive behavioral—analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000;342:1462–70.CrossRefPubMed
63.
Fawzy FI, Fawzy NW, Arndt LA, et al. Critical review of psychosocial interventions in cancer care. Arch Gen Psychiatry. 1995;52:100–13.CrossRefPubMed
64.
Leubbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytic review. Psycho Oncol. 2001;10:490–502.CrossRef
65.
Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Databases of Systematic Reviews: CD 008729; 2015.
66.
Mustafa M, Carson-Stevens A, Gillespie D, Edwards AGK. Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews CD004253; 2013.
67.
Stagle JM, Bouchard LC, Lechner SC, et al. Long-term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial. Cancer. 2015;121:1873–81.CrossRef
68.
Spiegel D, Butler LD, Giese-Davis J, Koopman C, Miller E, et al. Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer. Cancer. 2007;110:1130–8.CrossRefPubMed
69.
Kissane DW, Li Y. Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized controlled trial. Cancer. 2008;112:443–4.CrossRefPubMed
70.
Kissane D, Grabsch B, Clarke DM, et al. Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial. Psychooncology. 2007;16:277–86.CrossRefPubMed
71.
Classen PJ, Butler LD, Koopman C, et al. Supportive-expressive group therapy and distress in patients with meta-static breast cancer: a randomized clinical intervention trail. Arch Gen Psychiatry. 2001;58:494–501.CrossRefPubMed
72.
Goodwin PJ, Leszcz M, Ennis M et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med. 2001;345:1719–26.
73.
McGregor BA, Dolan ED, Murphy KM, et al. Cognitive behavioral stress management for healthy women at risk for breast cancer: a novel application of a proven intervention. Ann Behav Med. 2015;49:873–84.CrossRefPubMedPubMedCentral
74.
Rauch P, Muriel AC. Raising an emotionally healthy child when a parent is sick. Boston: McGraw Hill; 2005.
75.
Hippisley-Cox J, Vinogradova Y, Coupland C, Parker C. Risk of malignancy in patients with schizophrenia or bipolar disorder: nested case-control study. Arch Gen Psychiatry. 2007;64:1368–76.CrossRefPubMed
76.
Irwin KE, Henderson DC, Knight HP, Pirl WF. Cancer care for individuals with schizophrenia. Cancer. 2014;120:323–34.CrossRefPubMed
77.
Froes Brandao DF, Strasser-Weippi K, Goss PE. Prolactin and breast cancer: the need to avoid undertreatment of serious psychiatric illnesses in breast cancer patients: a review. Cancer Oct 12, 2015. doi:10.​1002/​cncr.​29714.
78.
Greenberg DB. Barriers to the treatment of depression in cancer patients. J Natl Cancer Inst Monogr. 2004;32:127–35.CrossRef
79.
Kessler RC, Berglund P, Bemler O, Jin R, Koretz D, Merkangas KR, et al. The epidemiology of major depressive disorder. JAMA. 2003;289:3095–105.CrossRefPubMed
80.
Fann JR, Ell K, Sharpe M. Integrating psychosocial care into cancer services. J Clin Oncol. 2012;30:1178–86.CrossRefPubMed