Prevalence of Psychological Distress, Anxiety and Depression in Metastatic Breast Cancer Patients

Abstract

Background: Cancer patients experience high levels of cancer-related distress, which may negatively impact on their clinical outcomes, such as survival and quality of life. Distress involves a range of feelings from vulnerability and sadness to depression, anxiety, adjustment disorders, panic and isolation. Importantly, pervasive severe distress has impact on cancer progression. This type of distress dysregulates the hypothalamic pituitary adrenal (HPA) axis and activates the sympathetic nervous system (SNS), impacting the cardiovascular, immune, and endocrine systems. These alterations contribute to biologic activities (e.g., changes in circadian cortisol levels, catecholamine production, activation of proinflammatory cytokines, regulation of leukocyte and tumor cell gene expression, and cellular immune suppression) that can promote cancer growth and metastasis. International standards for quality in cancer care recommend that distress should be recognized, regularly monitored, and treated promptly at all stages of disease, to optimize patients' clinical outcomes. Aim: As part of a larger study, Distressbrain, which aims to examine the associations between psychosocial variables, alterations in specific brain regions, and alterations on HPA axis, SNS activation and proinflammatory cytokines production, the present investigation was conducted to examine specifically the prevalence of distress, anxiety, depression and psychological morbidity in metastatic breast cancer (MBC) patients. Methods: We used the Distress Thermometer (DT), the Hospital and Anxiety Depression Scale (HADS), Brief Symptom Inventory (BSI) for the assessment of these variables. Results: The study is now running with the recruitment of 100 eligible MBC patients under treatment at the Breast Unit, Champalimauld Clinical Center, Lisbon, Portugal. We will present preliminary data about the levels and prevalence of psychological distress, anxiety, depression and psychological morbidity in this population. Conclusion: The results of this study will help to better understand the psychosocial needs of this population for better planning of care and inform cancer policy to allocate human resources to provide it.