Time-dependent risk of depression, anxiety, and stress-related disorders in patients with invasive and in situ breast cancer.
Despite concerns about the mental health of breast cancer patients, little is known regarding the temporal risk pattern and risk factors of common mental disorders among these patients. We estimated standardized incidence ratios (SIRs) of depression, anxiety and stress-related disorders in a Swedish nationwide cohort of 40,849 women with invasive and 4,402 women with in situ breast cancer (2001-2010, median follow-up = 4.5 years). The impact of patient, tumor and treatment characteristics was analyzed using flexible parametric survival models in a regional cohort of 7,940 invasive breast cancer patients (2001-2013, median follow-up = 7.5 years). Women with invasive breast cancer showed increased rates of depression, anxiety and stress-related disorders [overall SIR (95% CI) = 1.57 (1.46-1.69), 1.55 (1.43-1.68) and 1.77 (1.60-1.95), respectively]. SIRs were highest shortly after diagnosis, but remained increased up to 5 years. Younger age at diagnosis, comorbidity, higher-grade disease, lymph node involvement and chemotherapy were independently associated with the risk of depression and anxiety in invasive cancer patients, with chemotherapy and higher-grade disease conferring short-term risk only, while comorbidities were mainly associated with late-onset events. No clinical risk factors were identified for stress-related disorders except for a greater risk associated with younger age. Patients with in situ cancer only showed an increased incidence of stress-related disorders during the first 6 months after diagnosis [SIR (95% CI) = 2.76 (1.31-5.79)]. The time-dependent risk profile of invasive cancer patients may guide health care professionals for timely and targeted psycho-oncologic interventions.
['Yang|Haomin|H|', 'Brand|Judith S|JS|', 'Fang|Fang|F|', 'Chiesa|Flaminia|F|', 'Johansson|Anna L V|AL|', 'Hall|Per|P|', 'Czene|Kamila|K|']
D000328:Adult D017668:Age of Onset D000368:Aged D000369:Aged, 80 and over D001007:Anxiety D000071960:Breast Carcinoma In Situ D001943:Breast Neoplasms D018270:Carcinoma, Ductal, Breast D018275:Carcinoma, Lobular D015897:Comorbidity D003863:Depression D018450:Disease Progression D004358:Drug Therapy D005260:Female D005500:Follow-Up Studies D006801:Humans D015994:Incidence D008875:Middle Aged D009361:Neoplasm Invasiveness D016016:Proportional Hazards Models D012307:Risk Factors D013315:Stress, Psychological D013548:Sweden D013997:Time Factors D055815:Young Adult
depression anxiety stress-related disorders breast cancer