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Psychological morbidity in women diagnosed with ductal carcinoma in situ compared with women with early breast cancer receiving radiotherapy

  • William Pidduck
  • Bo Angela Wan
  • Liying Zhang
  • Eileen Rakovitch
  • Selina Chow
  • Stephanie Chan
  • Caitlin Yee
  • Leah Drost
  • Philomena Sousa
  • Donna Lewis
  • Henry Lam
  • Eric Leung
  • Edward ChowEmail author
Original Article
  • 63 Downloads

Abstract

Purpose

Despite having an excellent prognosis, patients with ductal carcinoma in situ (DCIS) report significant anxiety and depression following diagnosis. This study evaluated psychological morbidity using the Edmonton Symptom Assessment Scale (ESAS) in patients with DCIS compared with women with early-stage invasive breast cancer (EIBC) receiving radiotherapy (RT).

Methods

We identified patients diagnosed with DCIS or EIBC (stage I or II breast cancer) from 2011 to 2017 who had at least one ESAS completed pre- and post-RT. Data on systemic treatment, radiation, patient demographics, and disease stage were extracted from existing databases. Psychological morbidity was evaluated through measurement of depression, anxiety, and overall wellbeing within the ESAS. The Wilcoxon rank-sum test or chi-square test was performed for continuous or categorical variables.

Results

This study included 137 women with DCIS and 963 women with EIBC. ESAS was completed on average 28 days before RT (baseline) and 142 days after RT. Baseline ESAS scores showed significantly higher rates of depression among women with EIBC compared with those with DCIS (p = 0.006). Patients with EIBC also reported higher levels of anxiety and lower overall wellbeing than patients with DCIS, but this difference was not statistically significant. Post-RT ESAS scores showed significantly higher anxiety in patients with EIBC compared with DCIS (p = 0.049). Post-RT measures of anxiety and overall wellbeing were higher in patients with EIBC but differences were not statistically significant.

Conclusion

Women with DCIS experience relatively less psychological morbidity than women with EIBC, pre- and post-RT.

Keywords

Radiotherapy DCIS Early breast cancer Anxiety Depression Quality of life ESAS 

Notes

Funding information

This study received financial support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

Compliance with ethical standards

This study was approved by the Sunnybrook Health Sciences Centre research ethics board (REB #151-2017).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2019_5034_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)

References

  1. 1.
    Elshof L, Schaapveld M, Rutgers E, Schmidt M, de Munck L, van Leeuwen F, Wesseling J (2017) The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study. Breast Cancer Res 19(1):26CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Duffy S, Dibden A, Michalopoulos D, Offman J, Parmar D, Jenkins J et al (2016) Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol 17(1):109–114CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Siegel R, J MJ, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fallowfield L, Matthews L, Francis A, Jenkins V, Rea D (2014) Low grade ductal carcinoma in situ (DCIS): how best to describe it? Breast 23(5):693–696CrossRefPubMedGoogle Scholar
  5. 5.
    Giannakeas V, Sopik V, Narod S (2018) Association of radiotherapy with survival in women treated for ductal carcinoma in situ with lumpectomy or mastectomy. JAMA Netw Open 1(4):e181100CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst M (2015) Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173 797 patients. BMJ 351:4901CrossRefGoogle Scholar
  7. 7.
    National Comprehensive Cancer Network (2003) Distress management clinical practice guidelines in oncology. J Natl Compr Cancer Netw 1(3):344CrossRefGoogle Scholar
  8. 8.
    Ozanne E, Schneider K, Soeteman D, Stout N, Schrag D, Fordis M, Punglia R (2015) onlineDeCISion.org: a web-based decision aid for DCIS treatment. Breast Cancer Res Treat 154(1):181–190.  https://doi.org/10.1007/s10549-015-3605-y CrossRefPubMedGoogle Scholar
  9. 9.
    Ruddy K, Meyer M, Giobbie-Hurder A, Emmons K, Weeks J, Winer E, Partridge A (2013) Long-term risk perceptions of women with ductal carcinoma in situ. Oncologist 18(4):362–368.  https://doi.org/10.1634/theoncologist.2012-0376 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    van Gestel YRBM, Voogd AC, Vingerhoets AJJM, Mols F, Nieuwenhuijzen GAP, van Driel OJR, van Berlo CLH, van de Poll-Franse LV (2007) A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ. Eur J Cancer 43(3):549–556CrossRefPubMedGoogle Scholar
  11. 11.
    Lauzier S, Maunsell E, Levesque P, Mondor M, Robert J, Andre´ R et al (2010) Psychological distress and physical health in the year after diagnosis of DCIS or invasive breast cancer. Breast Cancer Res Treat 120(3):685–691CrossRefPubMedGoogle Scholar
  12. 12.
    Liu Y, Pe’rez M, Schootman M, Aft RL, Gillanders WE, Jeffe DB (2011) Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat 130(1):165–173CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Jeffe DB, Perez M, Liu Y, Collins KK, Aft RL, Schootman M (2012) Quality of life over time in women diagnosed with ductal carcinoma in situ, early-stage invasive breast cancer, and agematched controls. Breast Cancer Res Treat 134(1):379–391CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    King MT, Winters ZE, Olivotto IA, Spillane AJ, Chua BH, Saunders C, Westenberg AH, Mann GB, Burnett P, Butow P, Rutherford C (2017) Patient reported outcomes in ductal carcinoma in situ: a systematic review. Eur J Cancer 71:95–108CrossRefPubMedGoogle Scholar
  15. 15.
    Rakovitch E, Franssen E, Kim J, Ackerman I, Pignol JP, Paszat L, Pritchard KI, Ho C, Redelmeier DA (2003) A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat 77(3):285–293CrossRefPubMedGoogle Scholar
  16. 16.
    Gregorowitsch M, van den Bongard H, Young-Afat D, Pignol J, van Gils C, May A, Verkooijen H (2017) Severe depression more common in patients with ductal carcinoma in situ than early-stage invasive breast cancer patients. Breast Cancer Res Treat 167(1):205–213CrossRefPubMedGoogle Scholar
  17. 17.
    Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9CrossRefPubMedGoogle Scholar
  18. 18.
    Kim C, Liang L, Wright F, Hong N, Groot G, Helyer L et al (2017) Interventions are needed to support patient–provider decision-making for DCIS: a scoping review. Breast Cancer Res Treat 168(3):579–592CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Stacey D, Légaré F, Lewis K et al (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 4:1–297Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • William Pidduck
    • 1
  • Bo Angela Wan
    • 1
  • Liying Zhang
    • 1
  • Eileen Rakovitch
    • 1
  • Selina Chow
    • 1
  • Stephanie Chan
    • 1
  • Caitlin Yee
    • 1
  • Leah Drost
    • 1
  • Philomena Sousa
    • 1
  • Donna Lewis
    • 1
  • Henry Lam
    • 1
  • Eric Leung
    • 1
  • Edward Chow
    • 1
    Email author
  1. 1.Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

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