Associations Among Plasma Stress Markers and Symptoms of Anxiety and Depression in Patients with Breast Cancer Following Surgery

Abstract

Objective The objective of present study is to analyze the prevalence of depression and anxiety following breast cancer surgery and to assess the factors that affect postoperative psychological symptoms. Methods The Hamilton Rating Scale for Depression (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Body Image Scale (BIS), and Rosenberg Self Esteem Scale (RSES) were used to assess the psychological states of patients who had been diagnosed with and had undergone surgery for breast cancer. Blood concentrations of the stress markers adrenocorticotropic hormone, cortisol, arginine-vasopressin, and angiotensin-converting enzyme were measured. Pearson’s correlation analysis and multilinear regression analysis were used to analyse the data. Results At least mild depressive symptoms were noted in 50.5% of patients, while 42.4% of patients exhibited at least mild anxiety symptoms. HAM-D score was positively correlated with HAM-A (r=0.83, p<0.001) and BIS (r=0.29, p<0.001) scores and negatively correlated with RSES score (r=-0.41, p<0.001). HAM-A score was positively correlated with BIS score (r=0.32, p<0.001) and negatively correlated with RSES score (r=-0.27, p<0.001). There were no statistically significant associations between stress markers and depression/anxiety. Conclusion Patients with breast cancer frequently exhibit postoperative depression and anxiety, which are related to low levels of self-esteem and distorted body image.

Correlation of Clinicopathological Characteristics of Breast Carcinoma and Depression

“…Women find the breast to be very important: it is a symbol of femininity and sexuality, so surgical removal due to cancer is associated with a sense of loss of sexuality, attraction, and maternity, as well as a negative impact on the overall physical appearance [19]. One study showed that depression was associated with a higher level of anxiety, lower self-esteem, and a distorted image of one’s body expression in women with BC [2].…”

“…Thanks to advanced early detection procedures and more effective treatment, the prognosis of the disease has improved and today 89% of women survive five years from the diagnosis. Due to the increase in the survival rate of women affected by BC, the focus of researchers and clinicians has shifted to monitoring of the quality of life following the complex therapeutic protocols conducted in most cases [2].…”

Comparison of Oncoplastic Breast-Conserving Therapy and Standard Breast-Conserving Therapy in Early-Stage Breast Cancer Patients

“…Breast cancer surgery has significantly improved breast cancer patient survival, but traditional radical mastectomy does not consider the beauty of the breast and may cause the patient to experience negative emotions [ 1 – 3 ]. Breast cancer patients are at high risk of depression, and it is reported about 20%~45% of breast cancer patients have anxiety or depression [ 4 , 5 ].…”

Body image: Integral aspect of psychosocial evaluation for patients undergoing breast reconstruction

“…As a result, patients may avoid social interaction, neglect self‐care, and develop clinically significant levels of depression or anxiety. The association between psychological distress and body image has been evaluated with age, 8 primary breast surgery (mostly mastectomy), 9 risk‐reducing surgery, 10 and post‐treatment either immediately postsurgery 11 or during survivorship 9 . Around 30% of breast cancer survivors expressed body image dissatisfaction after 4 years postbreast surgery and 25% had depression, while 53% had anxiety 9 …”