Breast cancer survivorship:long-term physical and psychological effects of breast cancer and its treatment

Breast cancer is the most common cancer among women in the Netherlands. Fortunately, due to better screening and treatments, survival has improved. The purpose of this study was to assess whether breast cancer survivors, five or more years after diagnosis, experience physical or psychological effects of breast cancer and its treatment. For that, we performed the BLOC (Breast cancer Long-term Outcome of Cardiac function) study, in primary care. We included an unselected population of 350 breast cancer survivors, at least five years after breast cancer diagnosis. These women were matched to 350 women of the same age and general practitioner, who had no history of (breast) cancer.The results show that breast cancer survivors (an average of ten years after diagnosis) are more likely to have mild cardiac dysfunction and cardiovascular disease than women of the same age and general practitioner without a history of cancer. Also, breast cancer survivors more often experience (severe) symptoms of depression, anxiety, and fatigue. It is important to raise awareness of these long-term effects of breast cancer and its treatment, as they may have an impact on the quality of life of these women. We also need to improve information to (future) survivors about these long-term effects. We believe that the results of this study can also be used to improve future guidelines for general practitioners, who, on average, have 21 breast cancer survivors in their practice. Fortunately, most breast cancer survivors will not experience long-term effects; however, we must recognize those who do

Long-term psychological distress in breast cancer survivors and their matched controls:A cross-sectional study

Introduction: Breast cancer survivors often experience psychological distress shortly after diagnosis. Long-term psychological effects, however, have not been clearly demonstrated. Methods: This cross-sectional cohort study included 350 breast cancer survivors and 350 age-matched and general-practitioner-matched women. The median follow-up was 10 years. Using logistic regression we compared breast cancer survivors with controls on having (severe) symptoms of depression and/or anxiety, as measured with the Hospital Anxiety and Depression Scale. In multivariable logistic regression, we adjusted the results for a history of depression or prescription of antidepressants. Results: Larger proportions of breast cancer survivors experienced symptoms of depression (10.6%) compared with controls (4.9%) and symptoms of anxiety (18.6%) compared with controls (16.3%). The odds of symptoms of depression (OR 2.3, 95%CI 1.3-4.2), severe symptoms of depression (OR 3.3, 95%CI 1.1-10.3) and severe symptoms of anxiety (OR 2.1, 95%CI, 1.1-4.0) were significantly higher for breast cancer survivors than for controls, even after adjusting for history of depression or prescription of antidepressants. No significant difference was seen for mild symptoms of anxiety. Conclusions: Breast cancer survivors have an increased risk of symptoms of depression, including severe symptoms, and severe symptoms of anxiety compared with controls, for up to at least 10 years after diagnosis