Santosh1, Prashant Srivastava2 & Krishan Kumar3

1Ph.D Scholar, Department of Psychology, Kurukshetra University, Kurukshetra and Clinical Psychologist, Department of Psychiatry, Civil Hospital, Karnal, Haryana. 2Psychiatric Social Worker, Department of Psychiatry, Kalpana Chawla Govt. Medical College and Hospital, Karnal. 3Assistant Professor (Clinical Psychology), Department of Psychiatry, PGIMER, Chandigarh.

Correspondence: Prashant Srivastava, e-mail:


Background: Psychiatric disorders such as depression and anxiety are common among cancer patients.  Material and method: A purposive study was conducted among breast cancer patients at university of health sciences Rohtak. A total of 30 patients who were diagnosed with breast cancer and receiving radiotherapy during October 2014- June2015 were interviewed using the Hospital Anxiety and Depression Scale (HADS). The associated factors investigated concerned socio-demographic details and the stage of cancer. In this study the prevalence of anxiety and depression in patients as per the hospital anxiety and depression scale. Result: The moderate level of depression and anxiety were found in majority of patients (46.7%& 36.7% respectively).

Key words: Breast cancer, depression, anxiety.


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. 


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.


(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.



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). 


In the present study the mean age of the subjects at the time of evaluation was 45±8 yrs. This finding was in consistent with the study by Sukanya & Jayan (2013) in which the age range was 35 to 65yrsby Eman et al., (2014); the mean age was 53±13 (range 39-65 yrs), by Burgess et al (2005); mean age was 48±7 yrs & with NCR 2nd Report of the national cancer registry (2004) which shows that the commonest age of breast cancer is between 40 to 49 years with mean age of 50 years.
The finding in this study majority of patients had mild to moderate level of Anxiety (83.3%) as well as depression (70%) is also supported by the study done by Eman et al. (2014),in which 70% of patients were suffering from depression of mild to mod­erate severity and73% of the subjects were having mild to moderate severity level of anxiety. 
· Being a time bound study only a small sample could be taken and hence the generalization of the result remains doubtful.
· The study does not aim at generalization as the sample is not representative.
· Purposive sampling was used. If random sampling would be used then results would be better.
Conclusion and Future Directions
Result suggests mean age was 45 years of respondents. Result finding in this study reveals that majority of patients had mild to moderate level of anxiety (83.3%) as well as depression (70%). It was seen that longer term depression and anxiety, were associated with previous psychological treatment, lack of an intimate confiding relationship, younger age, and severely stressful non-cancer life experiences. Gandubert et al (2009) found that women suffering from breast cancer had significantly higher anxiety, depression, and general symptoms of psychopathology compared to the control group. The health professionals should work on awareness creation on mental illness issues and providing relevant information about mental illness. There is the need to make people more enlightened and increased their awareness on the causes of mental illness and treatment options. 
Burgess, C., Cornelius, V., & Love, S. (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ, 330(702).
Cancer Fact sheet. (2014). N°297. World Health Organization. 
Caroline, B., Victoria, C., Sharon, L., Jill, G., Michael, R., &Amanda, R. (2005).Depression and anxiety in women with early breast cancer: five year observational cohort study. British Medical Journal, 10,1136-44.
Eman, A.E., Elsheshtway, Warda, F., Hala, S., Omar, F.,&Maha, I. (2014).Coping Strategies in Egyptian Ladies with Breast Cancer.Breast Cancer: Basic and Clinical Research, 8, 97–102.
Fafouti, M., Paparrigopoulost,,  Zervas, Y., Rabavils, A.,  Malamos, N., Liappasi, I., &Tzavara, C. (2010).Depression, Anxiety and General Psychopathology in Breast Cancer Patients: A Cross-sectional Control Study. In vivo, 24,803-810.
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Maryam,  St, Zinnatossadat,B.,MohsenHagh, S., Mahtab,Z.,&Shahnaz .(2011). Depression and Health Related Quality of Life in Breast Cancer Patients.Academic Journal of Cancer Research, 4 (2), 43-46.
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Parkin, P. (2005). Global Cancer Statistics. CA: A Cancer Journal for Clinicians, 55, 74-108.
Sarah, K., Megan, B., Pierre, G., Steve, C., Eva, R. S., Sharlene, W., Wendy, B., &Jeffrey, B.(2012). 
Depression and Anxiety Symptoms Relate to Distinct Components of Pain Experience among Patients with Breast Cancer. Pain Research and Treatment, 10, 1155-63.
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Sukanya, B.,&Jayan, C. (2103). Psychosocial Concerns of Breast Cancer Patients: An Explorative Study. Guru Journal of Behavioraland Social Sciences, 1, 4.
World Cancer Report.(2014). World Health Organization. pp. Chapter 1.1. 
Conflict of interest: None
Role of funding source: None 


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