Influence of psychological response on survival in breast cancer: a population-based cohort study

Background The psychological response to breast cancer, such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease, has been suggested as a prognostic factor with an influence on survival. We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer. Methods 578 women with early-stage breast cancer were enrolled in a prospec tive survival study. Psychological response was measured by the mental adju stment to cancer (MAC) scale, the Courtauld emotional control (CEC) scale, and the hospital anxiety and depression (HAD) scale 4-12 weeks and 12 month s after diagnosis. The women were followed up for at least 5 years. Cox's p roportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response, with adjustment for known clinical fac tors associated with survival. Findings At 5 years, 395 women were alive and without relapse, 50 were aliv e with relapse, and 133 had died. There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD s cale category of depression (hazard ratio 3.59 [95% CI 1.39-9.24]). There w as a significantly increased risk of relapse or death at 5 years in women w ith high scores on the helplessness and hopelessness category of the MAC sc ale compared with those with a low score in this category (1.55 [1.07-2.25] ). There were no significant results found for the category of "fighting sp irit". Interpretation For 5-year event-free survival a high helplessness/hopelessn ess score has a moderate but detrimental effect. A high score for depressio n is linked to a significantly reduced chance of survival; however, this re sult is based on a small number of patients and should be interpreted with caution.