"We thought we'd find that women do worse psychologically after treatment," says Washington University psychologist, Teresa L. Deshields, Ph.D., assistant professor of medicine. "That's the clinical lore. After all, many of the patients referred to us are the ones struggling at the end of treatment. But our study shows that within two weeks most women adjust very well to survivorship."
The research team surveyed 94 women drawn from patients of the radiation oncology practice at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital. The women, averaging 55 years of age, had stage 0, I, II or III breast cancer and at the start of the study were completing the last of a six- to seven-week course of daily radiation treatments.
The women were surveyed five times: on their last day of radiation treatment, two weeks later, several days before their first follow-up appointment (four to six weeks post-treatment) and at three and six months. The survey measured patients' depressive symptoms and quality of life (the quality of life measurement quantifies a set of attributes that include physical, social/family, emotional and functional well-being, and breast-cancer-specific concerns). For the group of breast-cancer survivors, the average score for indications of depression was heightened at the end of treatment compared to a group of healthy men and women. A higher score on the depression index indicates more severe depressive symptoms.
The measure of depressive symptoms dropped significantly after treatment, reaching a low two weeks later and staying fairly stable to the six-month time point. The average score for the breast-cancer survivors was similar to the scores of healthy men and women at the two-week checkpoint.
The average quality of life score for the breast-cancer survivors was low at the end of treatment when tested using a scale that captures important breast-cancer-specific issues such as feelings of femininity or self-consciousness about clothes. In this measurement, lower scores indicate worse quality of life.
The average patient's score rose significantly over the survey period. At the two-week mark the average quality-of-life score for these breast-cancer survivors was near the average score of a control group that consisted of other breast-cancer patients and reached and then exceeded that number at the time of follow-up and later times.
"Previous studies had never looked at breast-cancer survivors so soon after treatment, and we were surprised that most improvement happened so quickly," says Deshields, who directs Psycho-Oncology Services at the Siteman Center. "There's a concept called resiliency, the notion that people can withstand a lot and come through fine. Our largest patient group by far was these resilient patients who never experienced clinically significant depressive symptoms."
The study demonstrated that at each of the survey time points 75 percent of the patients were not clinically depressed. Some patients temporarily experienced symptoms of clinical depression at one or more time points, but only 6 percent stayed depressed throughout the study.
Deshields believes there are some important messages in the study for oncologists. One is that they can reassure patients at the end of treatment that their quality of life will improve quickly and any depressive feelings are likely to dissipate soon.
On the other hand, while most patients do bounce back after treatment, the study also found a small group who stayed depressed. Deshields says if patients don't get better quickly, their doctors should be concerned.
Of those patients who do experience serious emotional difficulties after treatment, their troubles can stem from the sudden loss of medical oversight and the support of family and friends. "When treatment ends, suddenly patients are let go--that's very hard for some people," Deshields says. "Often patients try to reintegrate into their usual lives. Inevitably, they find that life is different--they can't go back to where they were before treatment. They have to find a new normal."
Deshields's next study will use a new pain inventory her group developed to investigate cancer pain. The team will look at clusters of beliefs about cancer pain and determine how they affect cancer patients' tendency to report pain to their doctors.
Deshields T, Tibbs T, Fan M-Y, Bayer L, Taylor M, Fisher E. Ending treatment: the course of emotional adjustment and quality of life among breast cancer survivors immediately following radiation therapy. Supportive Care in Cancer, 2005 Dec;13(12):1018-1026.
Funding from an Alvin J. Siteman Cancer Center Research Development Grant Award supported this research.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Siteman Cancer Center is the only NCI-designated Comprehensive Cancer Center within a 200-mile radius of St. Louis. Siteman Cancer Center is composed of the combined cancer research and treatment programs of Barnes-Jewish Hospital and Washington University School of Medicine.
Supportive Care in Cancer