DEPRESSION AND ANXIETY IN PATIENTS WITH BREAST CANCER: AN OBSERVATIONAL STUDY

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body (Cancer Fact sheet, 2014). In 2012, about 14.1 million new cases of cancer occurred globally (not including skin cancer other than melanoma). It caused about 8.2 million deaths or 14.6% of all human deaths. The most common types of cancer in females are breast cancer, colorectal cancer, lung cancer, and cervical cancer (World Cancer Report, 2014).

Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, or a red scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.Breast cancer is the second most common cancer diagnosed worldwide after lungcancer, with 1.15 million cases in 2002, and the most prevalent cancer in the world with 4.4 million survivors, up to 5 years following diagnosis (Saunders et al., 2009).

However breast cancer is most prevalent type of cancer among women in Malaysia where 1 in 20 women in the country has a lifetime risk (Parkin , 2005).A recent report by the Indian Council of Medical Research predicted a similar trend and stated that the number of breast cancer cases in India is likely to rise to 1, 06,124 in 2015 and to 1, 23,634 in 2020 (Lim &Halimah, 2003).

A study done by Maryam et al., (2011)on 60 women with breast cancer,mean age of 43.8 years in IMKH Hospital in Iran, found that more than half of patients reported depression. 

Caroline et al., (2005) conducted a study on 222 women with early breast cancer. It was seen that nearly 50% of the women with early breast cancer had depression, anxiety, or both in the year after diagnosis, 25% in the second, third, and fourth years, and 15% in the fifth year. The point prevalence was 33% at diagnosis, falling to 15% after one year. 45% of those with recurrence experienced depression, anxiety, or both within three months of the diagnosis.

Sarah et al., (2012) conducted a study on 60 patients to assess the anxiety and depression by The Center for Epidemiological Studies 10-Depression Scale (CESD-10) and The State-Trait Anxiety Inventory-State Scale (STAI-S).The findings indicated that anxiety and depression were common among newly diagnosed patientswith breast cancer; furthermore, patients experienced an appreciable amount of pain even before the oncological treatment started. The state anxiety served as a predictor of the sensory dimension of the pain experience, whereas depression serves as a predictor of the affective dimension of the pain experience.

In another case control study conducted by Fafouti et al., (2010)concluded that the psychiatric treatment was associated with higher scores on somatization, depression, phobic anxiety and general psychopathology. Anxiety, depression, and overall psychopathology are more frequent in breast cancer patients compared to controls. 

Methodology

Aim: To evaluate the level of depression and anxiety in patients with breast cancer.

Study Sample: 

A total Sample of 30 patients with breast cancer receiving treatment atthe Department of Radiotherapy in PGIMS Rohtak during October 2014- June 2015, fulfilling the inclusion and exclusion criteria were included in the study through purposive sampling technique.

Inclusion criteria

· Patient diagnosed with breast cancer and undergoing radiotherapy.

· Patients giving informed consent.

· Aged 18 years and above

· Patient should able comprehend and understand English &Hindi language.

Exclusion criteria 

· Any other co-morbid medical illness

· Patient who had psychoactive substance abuse.

· Non-cooperative patients.

Tools:

(1) Proforma for socio-demographic details:A semi structured proforma for collecting dataregarding socio demographic profile was used. It consists ofitems related to age, sex, education, occupation, religion, marital status, place of domicile & family type. 

(2) Hospital Anxiety and Depression Scale (HADS-Hindi Version):The HADS is a fourteen item scale with seven of the items related to anxiety and seven related to depression. Each item on the questionnaire is scored from 0-3 and thus a person can score between 0 and 21 for either anxiety or depression. It is a Likert scale and therefore the score achievedon HADS is ordinal. The cut off score for both anxiety and depression is 7. For both anxiety and depression, the score range of 8-10 denotes the severity as “Mild”, 11-14 as “Moderate” & 15-21 as “Severe”. For anxiety, this scale gives a specificity of 0.78 and sensitivity of 0.9 and for depression,it gives a specificity of 0.79 and a sensitivity of 0.83. For the purpose of the study, this scale has been translated and validated in Hindi language.

Procedure

After getting the approval from ethical committee of the institute, patients of breast cancer who were undergoing radiotherapyin the Department of Radiotherapy (Regional Cancer centre) at Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, fulfilling the exclusion and inclusion criteria, were enrolled for the study. They were briefly explained that participation is voluntary and non-participant would not affect their treatment in any way.After taking informed consent from the patient, the semi-structured proforma for socio demographic profile was administered on all participants. Further, the subjects were evaluated on HADS (Hindi version). 

 

 Discussion