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Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study

Kelly-Anne Phillips, Richard H. Osborne, Graham G. Giles, Gillian S. Dite, Carmel Apicella, John L. Hopper, Roger L. Milne

From the Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Department of Medicine, St Vincent's Hospital, and Centre for Rheumatic Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne; Cancer Epidemiology Centre, the Cancer Council Victoria, Victoria, Australia; and Spanish National Cancer Centre, Madrid, Spain

Corresponding author: John Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, the University of Melbourne, 723 Swanston St, Carlton, Victoria 3053, Australia; e-mail: j.hopper{at}unimelb.edu.au

Purpose Most women with early-stage breast cancer believe that psychosocial factors are an important influence over whether their cancer will recur. Studies of the issue have produced conflicting results.

Patients and Methods A population-based sample of 708 Australian women diagnosed before age 60 years with nonmetastatic breast cancer was observed for a median of 8.2 years. Depression and anxiety, coping style, and social support were assessed at a median of 11 months after diagnosis. Hazard ratios for distant disease-free survival (DDFS) and overall survival (OS) associated with psychosocial factors were estimated separately using Cox proportional hazards survival models, with and without adjustment for known prognostic factors.

Results Distant recurrence occurred in 209 (33%) of 638 assessable patients, and 170 (24%) of 708 patients died during the follow-up period. There were no statistically significant associations between any of the measured psychosocial factors and DDFS or OS from the adjusted analyses. From unadjusted analyses, associations between greater anxious preoccupation and poorer DDFS and OS were observed (P = .02). These associations were no longer evident after adjustment for established prognostic factors; greater anxious preoccupation was associated with younger age at diagnosis (P = .03), higher tumor grade (P = .02), and greater number of involved axillary nodes (P = .008).

Conclusion The findings do not support the measured psychosocial factors being an important influence on breast cancer outcomes. Interventions for adverse psychosocial factors are warranted to improve quality of life but should not be expected to improve survival.

Supported by the National Health and Medical Research Council (NHMRC) of Australia (Grant No. 145604) and the United States National Institutes of Health (Grant No. RO1 CA102740-01A2). The Australian Breast Cancer Family Study was supported by the NHMRC of Australia, the New South Wales Cancer Council, the Victorian Health Promotion Foundation, and the United States National Cancer Institute, National Institutes of Health (Grant No. RFA CA-95-011), and through cooperative agreements with members of the Breast Cancer Family Registry and principal investigators. K.-A.P. is supported by the Cancer Council Victoria, John Colebatch Clinical Research Fellowship. R.H.O. is supported by an NHMRC Population Health Fellow Fellowship. J.L.H. is an Australia Fellow of the NHMRC and a Victorian Breast Cancer Research Consortium Group Leader.

K.-A.P. and R.H.O. contributed equally to this work.

The content of this article does not necessarily reflect the views or policies of the National Cancer Institute or of any collaborating centers in the Cancer Family Registry (CFR), nor does mention of trade names, commercial products, or organizations imply endorsement by the United States Government or the CFR.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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