Evaluation of Depression and Breast Cancer

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ABSTRACT The purpose of this study is to evaluate the effectiveness of an efficacy-enhancing treatment modality and compare it to standard of care in the treatment of depression in breast cancer patient specifically focusing on time of diagnosis, end of treatment and at time of recurrence.

Women with breast cancer will suffer from depression and will often benefit from some extra emotional support. Shock, anxiety, sadness and depression are natural reactions to breast cancer. Even if there is a supportive network of family and friends, a need to discuss these feelings will arise. Counseling can be particularly helpful when breast cancer can disrupt relationships, sex life, or plans for childbearing. If patients are experiencing depression, they may improve more rapidly with the help of brief counseling and or an efficacy-enhancing modality given at the above intervals. This should improve patient recovery both emotionally and with the cancer itself as we will see later.

Depressive symptoms range from mild to severe, from normal states of sadness to clinical syndromes, such as an adjustment disorder with depressed mood or a major depression (Brandt 2002). While the psychological phenomenon is certainly not unique to women with breast cancer, this program will examine depression in the context of breast cancer. This research will help to determine the impact of early interventions at the time of diagnosis, at time of recurrence and at end of treatment care to help decrease the impact of depression and enhance survival and quality of life of women diagnosed with breast cancer Review of Literature Depression is a serious medical condition that affects thought, feelings, and ability to function in everyday life. Depression can occur at any age. National Institute of Mental Health-sponsored studies estimate that 6% of 9 to 17 year olds in the U.S. and almost 10% of American adults, or about 19 million people age 18 and older, experience some form of depression every year (Shaffer,1996). Although available therapies alleviate symptoms in over 80 % of those treated, less than half of people with depression get the help they need (National Advisory, 1993).

Several types of abnormal depressed mood have been documented in individuals with cancer. These diagnoses are based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental disorders (American Psychiatric Association, 1994). The most common psychiatric diagnosis in cancer patients is adjustment disorder with depressed mood. This diagnosis is used to characterize depressive symptoms in response to identifiable stresses such as with cancer. Another psychiatric diagnosis of depression that has been observed in cancer patients is a major depressive episode (American Psychiatric Association, 1994). The essential feature of this disorder is a period of at least two weeks during which there is either depressed mood or loss of interest in nearly all activities. Additional symptoms must also be present to make this diagnosis, these include feelings of worthlessness or guilt, diminished ability to concentrate, recurrent thoughts of death, weight gain or weight loss, insomnia or hypersomnia, psychomotor agitation or retardation or fatigue.

The prevalence of clinically significant depression in women with breast cancer or its relationship to illness related factors is diminutive. In a study of 359 women with early stage breast cancer, depression was observed in 6% of those participants 1 to 3 months after diagnosis (Watson,1991) Another study found that out of 205 women interviewed 18 months after first diagnosed with breast cancer, 44 women had symptoms of major depression in the preceding weeks (21%) (Mausell, 1992). In a sample of 22 women with local recurrence, ten women experienced anxiety and depression (45%). With advanced breast cancer, anxiety and depression are common symptoms as reported in one series of 35 of 139 women (25%) in one series...
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