Abstract
The possibility that psychological response within a few weeks of a breast cancer
diagnosis can influence the outcome of the disease is a contentious issue. Psychological
response, including helplessness/hopelessness, fighting spirit and depression was
assessed in early-stage breast cancer patients between 1 and 3 months post-diagnosis,
in order to ascertain effect on cancer prognosis. Patients were followed up for a
period of 10 years in order to clarify the effect of psychological response on disease
outcome. After 10 years, there is a continuing effect of helplessness/hopelessness
on disease-free survival (adjusted hazard ratio (HR) 1.53, 95% confidence interval
(CI) 1.11–2.11) but not of depression (adjusted HR for overall survival for ‘cases’
2.43, 95% CI 0.97–6.10). Longer follow-up also indicates that a high fighting spirit
confers no survival advantage. The results showed that, in patients who were disease-free
at 5 years, their baseline helpless/hopeless response still exerted a significant
effect on disease-free survival beyond 5 (and up to 10) years. The effect is therefore
maintained for up to 10 years of follow-up. Clinicians may wish to screen for helplessness
around the time of diagnosis in order to target psychological care resources. Further
large studies, with similarly prolonged follow-up, are needed to replicate this effect
and clarify its mechanism of action.
Keywords
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Article info
Publication history
Accepted:
January 31,
2005
Received in revised form:
January 5,
2005
Received:
August 11,
2004
Identification
Copyright
© 2005 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
