Prevalence of Psychiatric Disorders at the Time of Breast Cancer Diagnosis.

Abstract

Introduction: Studies thus far have documented the prevalence of depression and adjustment disorders after treatment of breast cancer. There is dearth of data on the prevalence of psychiatric disorders among newly diagnosed breast cancer patients. This study aimed at determining the prevalence of psychiatric disorders amongst patients at the time of breast cancer diagnosis.Methods: A retrospective study was done at a university based interdisciplinary breast cancer program. Every newly diagnosed breast cancer patient is evaluated by a surgical, medical and radiation oncologist as well as a licensed psychologist. All patients evaluated in 2005 were included. The psychologist performs an abbreviated evaluation that includes past and current psychiatric history, medications, stressors and the ability of the patient to cope with the diagnosis. Recommendations are made when the patient is in need of psychological assistance. Psychiatric diagnoses were made according to DSM-IV criteria. Socio-demographic and clinical data included age, tumor histology, menopausal, marital and occupational status, use of alcohol, tobacco, and recreational drugs, family history of breast cancer and psychiatric disorders, past history of psychiatric disorders and treatment, and race.Results: The study population included 189 females and 1 male. The median (25th-75 percentile) age was 58 (48-68) years. 68.4% had invasive ductal cancer, 68.9% were postmenopausal, 62.1% were married and 16.8% were smokers. 40% of the patients that denied current smoking had a past history of smoking. 58.4% were alcohol consumers and 51.5% were employed at the time of diagnosis. 54.7% of patients had no family history of breast cancer and 91.7% had no family history of psychiatric disorders. 54.7% of the patients were immigrants. 109 (57.3%) of the patients reported a history of psychotherapy and or psychiatric disorders in the past. Past history of psychiatric diagnoses included: major depression, post partum depression, dysthymia, post traumatic stress disorder, anxiety, panic attacks, bipolar disorder, adjustment disorder, anorexia and substance abuse (alcohol and heroin) .One patient had a history of suicidal attempt. At the time of breast cancer diagnosis, 53(27.8%) of the patients were taking psychiatric medications; the majority of these medications were antidepressants and anxiolytics. 15(7.8%) of the patients that denied current use of psychiatric medications had taken medications in the past. Most of the patients were taking a single medication 36(18%), while 4(1.5%) patients were taking up to 4 medications. At the time of evaluation, 31(16.3%) patients were diagnosed with a psychiatric disorder. 18(9.5%) were diagnosed with a depressive disorder; 8(4.2%) with an anxiety disorder, 3(1%) with an adjustment disorder and 2(1%) with bipolar disorder.Conclusion: This study reports a high incidence of psychiatric disorders amongst newly diagnosed breast cancer patients. This may have significant effect on the quality of life during survivorship after breast cancer. Consideration should be given to include a psychologist in the multidisciplinary evaluation of the breast cancer patient. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1068.