By: Mridula George, MD
Breast centers need referral processes and programs for those with depressive symptoms
With early breast cancer diagnosis and effective treatments, the proportion of breast cancer survivors has increased over the last decade. A large percentage of survivors, especially younger patients, continue to struggle with depression, fatigue, insomnia, and vasomotor symptoms that impair quality of life.
In a recent study, Bower et al. evaluated the role of mindful awareness practices (MAPs) and survivorship education (SE) in young breast cancer survivors (defined as age <50) with elevated depressive symptoms.
he primary outcome was change in depressive symptoms from pre-intervention to post-intervention using the Center for Epidemiologic Studies-Depression scale (CES-D). A score of 16 or greater is indicative of clinically significant depressive symptoms.
Patients were randomly assigned to MAP (n=85), SE (n=81) or waitlist control (WLC, n=81). MAP and SE interventions were conducted in groups for 2-hour sessions weekly for 6 weeks. Participants in the MAP were advised to practice mindfulness exercises at home on a daily basis and instructed in the informal use of mindfulness in daily life.
Median age of the study participants was 46 years; 62% of the patients enrolled had received chemotherapy, and 66% were receiving endocrine therapy. Mean CES-D scores were greater than 16 in all three groups.
MAPs led to a statistically significant reduction in CES-D from pre-intervention to post-intervention relative to WLC, and were also shown to have effects on fatigue, insomnia, and vasomotor symptoms that persisted over the follow-up.
SE led to reduction in depressive symptoms compared with WLC, but it was not statistically significant at 6 months. SE did not have any effect on fatigue, insomnia, and vasomotor symptoms.
Psychosocial screening should be part of breast cancer survivorship. Breast cancer centers should have referral processes and programs for cancer survivors identified to have depressive and behavioral symptoms. At this time, these resources are not readily available outside of clinical trials.
Mridula George, MD, is Assistant Professor of Medicine/Breast Medical Oncology at Rutgers Cancer Institute of New Jersey in New Brunswick.
Journal of Clinical Oncology
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