Mental Health History and Survival among Breast Cancer Patients

Mark S. Walker, Ph.D.

Project Overview:
Cancer patients who have a history of mental health problems are more likely to experience depression and poor quality of life following cancer diagnosis. However, a history of mental health problems may also confer increased risk of mortality. This may occur because of later stage of diagnosis, because of poorer adherence to cancer treatment, or because of poorer health behaviors. It may also occur through a psychoneuroimmunological pathway in which patients who are highly distressed have poorer immune functioning. This study will examine these questions in a sample of breast cancer patients previously treated through the breast cancer multidisciplinary clinic at Siteman Cancer Center.

Objectives: The objective of the study is to determine whether breast cancer patients with a self-reported history of frequent mental health problems have shorter survival than patients with infrequent mental health problems. In addition, the study will examine whether history of mental health problems interacts with current distress, social support or marital status in conferring increased risk of death. The study will also examine whether increased risk, if present, is mediated by current distress at diagnosis, stage of disease at diagnosis, health behaviors, or adherence to recommended treatment.

Methods: The study will augment an existing database of psychosocial measures collected from 350 breast cancer patients at Siteman Cancer Center between 2000 and 2002. This database will be linked with data collected through several other sources. These will include vital records obtained through the Missouri and Illinois Departments of Health; additional psychosocial data abstracted from psychosocial evaluation reports; and disease, treatment and adherence data abstracted from the outpatient medical record. Cox proportional hazard regression will be used to test the effect of history of mental health problems, and to evaluate the role of putative moderators and mediators of that effect.

Significance and Future Plans: Findings from this study will be used to develop a more thorough conceptual model of the role of mental health history, mental health status, and cancer outcomes. Potential directions for this research include longitudinal study to examine mental health status over time as it relates to immunosupression and cancer recurrence; and intervention research to promote screening among patients with major or minor mental illness.

Final Report Abstract:
Research has shown an association between psychological status and survival in some cancers. This study examined current distress, history of mental health problems (MHP), and history of mental health treatment (MHT) as predictors of overall survival among newly diagnosed patients with breast cancer. Read the full Final Report.