Psychological impact of diagnosis and surgery in the treatment of early stage breast cancer

Abstract

PURPOSE: The aim of this study was to investigate the psychological impact of diagnosis and surgery in the treatment of eariy stage breast cancer. It was predicted that diagnosis of breast cancer would be associated with an acute stress reaction. Better psychological adjustment one month after surgery was predicted for women who had undergone breast-conserving surgery in comparison to patients who had received a mastectomy. Suppression of negative emotion in response to breast cancer diagnosis was predicted to be related to poorer short-term psychological adjustment.Method: Twenty-nine women completed baseline psychological measures one week after receiving a breast cancer diagnosis. Follow-up measures completed one month after surgery were obtained in twenty five cases. Evidence of acute stress response was measured using scores for intrusive distress and avoidance on the revised Impact of Events Scale (IES, Horowitz, 1979). Psychological adjustment was assessed based on several key factors described in the literature concerning the psychosocial outcome of breast cancer: levels of psychological distress (anxiety and depression), measured using the Hospital Anxiety and Depression Scale (HAD, Zigmond & Snaith, 1983); coping responses obtained on the Mental Adjustment to Cancer Scale (MAC, Watson, Greer, Young et al, 1988b), and body image satisfaction, assessed using the recently developed Body Image Scale (BIS, Hopwood, Fletcher, Lee & Al Ghazal, 2001). Suppression of negative emotion was indicated by scores for control of negative emotion on an adapted version of the Basic Emotion Scale (Power, 2001).DATA ANALYSIS: Patient scores on psychological measures obtained one week after diagnosis and at follow up one month post-surgery were compared using a within and 1 between subjects repeated measures ANOVA. Patient age at diagnosis, and whether or not they were referred through screening, were then re-entered as covariates within the repeated measures design in post-hoc analyses. Backward multiple linear regression was carried out to examine emotional suppression as a predictor of adjustment assessed using the psychological measures completed at follow up post surgery.RESULTS: Evidence of acute stress response, indicated by clinical 'caseness' for intrusion and avoidance on the IES, was found in 28% of the sample assessed soon after diagnosis, with a proportion of patients (almost 20%) continuing to report high levels of intrusive distress and avoidance at follow up one month after surgery. As predicted, IES scores for intrusion and avoidance were significantly lower between assessment soon after diagnosis and at follow up after surgery (F 1,23 = 13.37, p<0.05). Consistent with previous reports in the literature, no effect was found for type of surgery on any of the measures used. Women who were younger at the time of diagnosis were, however, likely to be more anxious (F 1,23 = 4.48 p<0.05) and to experience greater levels of intrusive distress ( F 1,23 = 4.86, p<0.05). Suppression of negative in response to diagnosis predicted higher levels of intrusive distress and avoidance at one month (F2,22 =6.24, POD.05, R2 =.36), and greater levels of dissatisfaction with body image (F 1,22 = 7.74, p<0.05, R2 = 32). Results are discussed in relation to the previous literature, and in terms of implications for aspects of psychosocial care for breast cancer patients.