Psychological Screening and Health Related Quality of Life in Romanian Breast Cancer Survivors

By Achimas-Cadariu, Patriciu; Iancu, Mihaela et al. | Journal of Evidence-Based Psychotherapies, September 2015 | Go to article overview

Psychological Screening and Health Related Quality of Life in Romanian Breast Cancer Survivors


Achimas-Cadariu, Patriciu, Iancu, Mihaela, Pop, Florina, Vlad, Catalin, Irimie, Alexandru, Journal of Evidence-Based Psychotherapies


Introduction

Breast cancer ranks first in terms of frequency and mortality in the female sex in Europe (Ferlay et al., 2015). In Romania, the results are similar (NorthWestern Cancer Registry, 2009). According to World Health Organization data, about one of eight women will develop breast cancer during the course of their life (World Health Organization, 2013).

Despiterecent remarkable progress in the early detection and adjuvant treatment of breast cancer, with an improvement of overall survival, the aspects related to the quality of life of these patients have become extremely important.

Revealing a diagnosis of breast cancer induces a strong emotional and psycho-social reaction in any person who experiences it. Distress experienced in this case extends along a continuum ranging from functional negative emotions of vulnerability such as sadness, worry, to affective problems such as depressive disorder, various anxiety disorders, social isolation or spiritual crisis (The National Comprehensive Cancer Network, 2014; Jorgensen et al., 2015). Initially, distress can be intense, but also persistent, and in the long term, it can generate affective problems such as major depressive episode (Hegel et al., 2006; Jorgensen et al., 2015).

Much more specifically, according to the literature, at least half of the patients with breast cancer will experience emotional distress (Kornlith, &Ligibel, 2003;Tatrow, & Montgomery, 2006;Tojal, & Costa, 2015).

The prevalence of depressive symptoms (which can be conceptualized as emotional distress) tends to be high immediately after diagnosis, during cancer therapy, and after treatment, decreasing in time, but remaining at high levels even 4 years after diagnosis (Fallowield et al., 1990; Burgess et al., 2005; Stafford et al., 2013; Ho et al., 2013;Toja, & Costa, 2015).

The prevalence of anxiety disorders is estimated to range from 4.1 % (Vin-Raviv et al., 2015), 6% to 23% (Stark, & House, 2000). These differences are due to the selected assessment tools, to the type of diagnosis or to the stage of malignancy.

Mixed symptomatology (depression and anxiety) is extremely common in the case of cancer patients; two-thirds of the patients with depression also experience significant clinical levels of anxiety (Brintzenhofe et al., 2009; Smith, 2015). The unpleasant subjective response that occurs in the case of a threat is also expected to be present in the case of a diagnosis of cancer, which is potentially life threatening (Stark et al., 2002; Van Oers et al., 2013).

It seems that clinical anxiety is much more frequent in patients diagnosed with breast cancer than in persons without this malignant pathology (Stark et al., 2000;Fafouti et al., 2010).

Cancer treatment under the conditions of a breast cancer diagnosis (surgery, chemotherapy, radiotherapy and/or hormone therapy), as well as the main emotional reactions and affective problems can significantly affect the quality of life. In addition, survival in the case of a diagnosis of cancer currently tends to be long (Howard et al., 2012; Park et al., 2014; Bantema et al., 2015), and the quality of life of breast cancer survivors has become an extremely important aspect (Salonen et al., 2010;Wani et al., 2015; Chen et al., 2015).

When considering the aspects related to emotional reactions, affective disorders and their impact on the quality of life, the cognitive processes that can determine them also deserve to be examined. The way in which someone processes information can allow them to regulate their emotions/to intensify them and/or to be or not to be overwhelmed by the intensity of these emotions, during or after experiencing a stressful event or a negative life experience. Explicitly addressing the cognitive emotion regulation component can provide an answer in terms of the cognitive coping strategy used.

The most widely used model referring to the way in which people adapt to stressful situations is Lazarus and Folkman'sTransactional Model of Stress and Coping. …

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