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J Psychosom Res. 2008 Apr;64(4):383-91. doi: 10.1016/j.jpsychores.2007.12.005.

Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors.

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  • 1Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. mehnert@uke.uni-hamburg.de



Psychosocial comorbidity and quality of life (QOL) and its association with knowledge, utilization, and need for psychosocial support have been studied in long-term breast cancer survivors.


One thousand eighty-three patients were recruited through a population-based cancer registry an average of 47 months following diagnosis (66% response rate). Self-report measures (e.g., Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist--Civilian Version, and Short-Form Health Survey) were used.


Thirty-eight percent of patients had moderate to high anxiety, and 22% had moderate to high depression; posttraumatic stress disorder was observed in 12%. The overall psychological comorbidity was 43% and 26% for a possible and probable psychiatric disorder. Disease progress, detrimental interactions, less social support, a lower educational level, and younger age were predictors of psychological comorbidity (P<.004). Lower QOL (P<.01) and higher levels of anxiety (P<.001) were observed in cancer survivors compared to age-adjusted normative comparison groups. Time since diagnosis had no significant impact on psychological comorbidity as well as QOL. Forty-six percent of women felt insufficiently informed about support offers. Insufficient knowledge was associated with older age and lower education (P<.05). Since diagnosis, 57% had participated in cancer rehabilitation and 24% in other psychosocial support programs. Fifteen percent of all patients and 23% of those with a possible psychiatric disorder expressed their need for psychosocial support. Women with distress and perceived support needs who did not participate in past support programs were older, less educated, and less informed (P<.05).


Findings show the long-term impact of breast cancer and indicate need for patient education, screening for psychosocial distress, and implementation of psychological interventions tailored in particular for older women.

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