Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer
ABSTRACT To assess the prevalence of depression among low-income, ethnic minority women with breast or gynecologic cancer, receipt of antidepressant medications or counseling services, and correlates of depression.
Study patients were 472 women receiving cancer care in an urban public medical center. Women had a primary diagnosis of breast (stage 0 to III) or gynecologic cancer (International Federation of Gynecology and Obstetrics stage 0 to IIIB). A diagnostic depression screen and baseline questionnaire were administered before or during active treatment or during active follow-up. Self-report data were collected on receipt of depression treatment, use of supportive counseling, pain and receipt of pain medication, functional status and well-being, and perceived barriers to cancer care.
Twenty-four percent of women reported moderate to severe levels of depressive disorder (30% of breast cancer patients and 17% of gynecologic cancer patients). Only 12% of women meeting criteria for major depression reported currently receiving medications for depression, and only 5% of women reported seeing a counselor or participating in a cancer support group. Neither cancer stage nor treatment status was correlated with depression. Primary diagnosis of breast cancer, younger age, greater functional impairment, poorer social and family well-being, anxiety, comorbid arthritis, and fears about treatment side effects were correlated with depression.
Findings indicate that depressive disorder among ethnic minority, low-income women with breast or gynecologic cancer is prevalent and is correlated with pain, anxiety, and health-related quality of life. Because these women are unlikely to receive depression treatment or supportive counseling, there is a need for routine screening, evaluation, and treatment in this population.
Full-textDOI: · Available from: Laila I Muderspach, May 07, 2015
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ABSTRACT: The aim of the research was to examine changes of psychological adaptation of women diagnosed with earlystage breast cancer in the period of 9 months and to sum up the influence of social factors on womens adaptation. Patients and methods. 117 women were involved into the research. They were all diagnosed T1-T2/N0-N1/M0 stages of breast cancer. The patients were questioned 12 days before the operation, a week and 9 months after surgery. The Hospital Anxiety and Depression Scale (HADS) was used. The patients were also distributed according to their education, occupation and marital status. The anxiety and depression subscales were evaluated separately. Results. It was found that clinically significant anxiety and depression (8 and more HADS points in anxiety and depression subscales) were more constantly observed in all groups just before the operation. The condition of anxiety and depression was most obvious among women with college education, unemployed and married. The highest percentage of anxiety (58%) and depression (32%) was found among those who had college education, in the group of unemployed women the percentage being 75% and 37% and in the group of the married ones 57% and 21%. A week after the operation showed a decline of anxiety and depression among all study groups. Following the period of 9 months after the operation, the percentage of women with clinically significant anxiety and depression increased, especially among those who belonged to the group with secondary school education; it included also patients who were unmarried and working. After 9 months, clinically significant anxiety was estimated among 57% of women with secondary school education, 33% of unmarried and 34% working patients. In the group of married women the percentage of depression grew up to 9% in the period of 9 months. Conclusions. The results of the research indicated clinically significant anxiety and depression among the patients at the moment of diagnosis and 9 months after the disease had been diagnosed. This helped to identify the most voulnerable group of patients. Before the operation, the highest level of depres-sion was detected among those who had college education, were unemployed and married. Following the period of 9 months, in women with secondary education, employed, married and unmarried the level of stress rose much higher in comparison with the first week after the operation.
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ABSTRACT: The U.S. population is growing older and becoming more ethnically diverse. Cancer is a disease of the elderly: 61% of cancer diagnoses and 70% of cancer deaths occur in patients above the age of 65. By 2050 there is an expected 99% increase in incidence of cancer in the ethnically diverse population; older ethnically diverse cancer patients will carry 28% of all cancer diagnoses. Among older patients with cancer, 41% experience emotional distress throughout the course of their illness; certain ethnic minority subpopulations may be at greater risk for high levels of distress. Older ethnically diverse cancer patients are significantly underrepresented in the psychosocial oncology literature. In an effort to highlight this gap in the psychosocial oncology literature, we conducted a systematic review of the literature on psychological distress in the geriatric oncology population, ethnic minority oncology populations namely, Blacks and Hispanics. The psychosocial barriers, protective factors and service needs in these populations are reviewed, and the relationship between needs and distress are discussed. It is apparent there is a lack of research aimed at older Black and Hispanic cancer patients; the prevalence and nature of psychological distress and psychosocial needs in this population are unknown. Future research is needed in this understudied area to document the basic information regarding the prevalence and nature of psychological distress in this population.Journal of Geriatric Oncology 04/2012; 3(2):163-173. DOI:10.1016/j.jgo.2011.12.001 · 1.15 Impact Factor
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ABSTRACT: PREFACE BY Professor Raphael Mechoulam Breast cancer is a brutal disease. About 8-9% of all women get breast cancer and it is by far the most prevalent female cancer. According to the World Health Organization breast cancer accounts for 16% of all types of cancer deaths globally. Total deaths of cancer amount to 7,600,000, whereas total breast cancer deaths are 460,000. The incidence rates of breast cancer are increasing and the reasons for this increase are not clear. Although research over the last few decades has discovered many of the mechanisms of breast cancer, we are still far away from fully understanding its devious routes. We have however learned that breast cancer is the result of several different disease pathways, each of which has to be blocked by different pharmacological agents. Numerous drugs are now available and they save millions of lives. But we know now that there is not a single drug that can be compatible for all patients. What do we know of these mechanisms? In brief, there is a subtype (named Luminal A) which is associated with the female hormone estrogen. It develops relatively slowly and the prognosis to treat this breast cancer subtype is generally good. In contrast, a second, related subtype (named Luminal B) is similar to Luminal A tumors. It is also associated with estrogen but it develops faster and the prognosis is by far not as good when compared to the Luminal A type. A third subtype (HER-2) depends on specific genes known as HER2 genes and it has an overall poor prognosis. The forth subtype is not associated with the female hormones or with the HER2 genes; it grows fast and it has a poor prognosis. The treatment of these different types of breast cancer requires different approaches. Hence the first step of modern cancer treatment today needs the establishment of the subtype by investigating the genes of the patient involved and only then should the appropriate treatment be undertaken. In this field of medicine science is indeed opening the door to more personal, individualized therapy. Indeed breast cancer associated with female hormones is treated with tamoxifen which blocks the receptor of the female hormone progesterone and specific anti-HER2 treatments result in improvements in the clinical outcome of patients with HER2- positive breast cancer. For instance Trastuzumab is efficient in early and advanced HER2 breast cancer treatment. This personal, individualized therapy will expand rapidly and maybe, just may be, the grim statistics will improve. However a major problem in cancer therapy is the rapidly formed resistance of the cancer cells to anti-cancer drugs. Cancer cells learn very fast how to get rid of the cancer drug entering the cell. They also learn very fast how to metabolize – and thus neutralize - the drug. The fight against cancer now proceeds on this front too. A very recent observation is that cannabidiol – a constituent of the plant Cannabis sativa – can block the mechanism through which the cancer cell gets rid of the anti-cancer drug. Unexpectedly, recently it was also shown that cannabidiol affects not only proliferation of cancer cells , but also interferes with two other crucial steps of breast cancer cell progression, namely invasion of other tissues and metastasization – transportation to far away organs. May be cannabidiol will lead us to novel anti-cancer drugs acting on several of the cancer mechanisms. At present however neither cannabidiol nor related drugs have been tested in human patients. In the present, excellent book Dr Zornitza Ganeva looks mostly at other aspects of the dreadful disease – the psychological effects of breast cancer on the patient: the initial shock, the slow realization of possible death, the ways to minimize the anxiety and the depression. She thoroughly discusses the existing literature on psycho-oncology and has succeeded in admirably summarizing and presenting it. This book should be seen not only as an academic book, but should also reach – and help – patients. Professor Raphael Mechoulam Head, Division of Science, Israel Academy of Sciences.12/2014; Елестра ЕООД., ISBN: 978-954-90789-7-8