Impact of Breast Cancer on Depression
Breast Cancer (BC) is a type of cancer that manifests initially in the breast tissue and is the most common type of cancer amongst women worldwide (Fann et al., 2008). Whilst many patients who are diagnosed with BC experience “normal” levels of stress and distress, it is of concern when women develop signs and symptoms of clinically significant depression or Major Depressive Disorder (MDD) (Sperry, 2010). Hegel et al. (2006) found in their study that though 41% of women with BC showed high levels of distress but only 11% were diagnosed with clinically significant depression. Prevalence estimates of depression in women with BC are highly varied with research pointing to approximately 7-25% (Fann et al., 2008).
The variance in prevalence estimates of Depression in BC patients is attributable to the inconsistency in tools and methods used to screen for the disorder with many clinicians choosing subjective judgement over standardized tools for convenience reasons due to time constraints in oncological settings (Fallowfield, Ratcliffe, Jenkins, & Saul, 2001). A survey of 123 oncologists revealed that only 8% of them used standardised depression screening tools regularly (Mitchell, Kaar, Coggan, & Herdman, 2008). Underestimations of prevalence occur especially in later stages of cancer (Söllner et al., 2001) due to the similarity of depression symptoms with cancer symptoms (e.g. extreme fatigue, loss of interest in usual activities). If time-consuming tools such as the ‘Psychological Distress Inventory’ are not feasible, ‘Ultra-short’ screening tools which have 5 brief items may be beneficial but their screening accuracy has been described as moderate at best in only ‘ruling out depression’ rather than detecting (Mitchell, 2007).
It is recommended these screening tools be used initially to recognise at risk patients and then administer more comprehensive tests and clinical interviews. It has been suggested that certain...