Emotion, Coping Styles And Quality Of Life In Patients With Breast Cancer During The Stage Of Operation And Chemotherapy.

PrefaceBreast cancer is a kind of normal severe malignant tumor to women's health and its incidence tends to increase.At present the most normal and effective treatment measure is still modified radical mastectomy and the chemotherapy after surgery and other measures.But the disease,surgery and chemotherapy give them some psychological stresses.Then the stresses reflect on the emotion and coping styles of the patients.Harmful stresses not only affect the physical function of patients during the operation but affect the quality of life of the patients in the period of chemotherapy, and then they will affect the prognosis.With the development of the biological-psychological-social medical model,clinicians not only limited in the improvement of diagnosis,surgery and adjunctive therapy of breast cancer but gradually pay attention to the psychology,social function and QOL of patients. Nowadays many domestic and overseas studies of stress about breast cancer mainly center on the period of operation,and there hasn't a sustained study that researches the patients with breast cancer from preoperative to the period of chemotherapy.This research will investigate the anxiety,depression,coping styles in the period of operation and chemotherapy and the QOL of the patients with breast cancer.Then we should analyze the relationship between the emotion and coping styles,QOL,the coping styles and QOL.Therefore,we may make a basal exploration for the mental intervention in the future. Subjects and methodsSubjects were 98 women patients in the Shengjing hospital of China Medical University since February to August in 2007,and were diagnose breast cancer before their operation.They all practiced modified radical mastectomy for the fist time and never accept radiation therapy or chemotherapy.Their ages were under seventy. Patients were excluded if they had mental disorder or neurosis before or were the period of onset,had another severe physical disease or a worse physical condition,or were diagnosed breast benign tumor after operation.The subjects were repeatedly investigated HAMA,HAMD and MCMQ on the day before the operation,the 10th day after operation,the initial stage of chemotherapy,the intermediate stage of chemotherapy and the end stage of chemotherapy.And in the stage of chemotherapy the patients were evaluated three times by FACT-B 4.0.The data were calculated by SPSS13.0.The scores of these scales were described by mean±SD,and the compare between every investigation results by randomized blocks analysis of variance:The compare between the mean of scales by LSD;Correlation analysis is Spearman analysis.Results1.Depression,anxiety,coping styles and QOL of patients with breast cancer at every investigation stage(1)The patients had a highest mean of depression after operation,and then tapered.There had no significant deviation between the intermediate and end chemotherapy.There had a significant deviation between others(p＜0.001);There had a highest anxiety mean before operation,and then tapered.Anxiety mean had no significant deviation between after operation and initial chemotherapy,between intermediate and end chemotherapy(p＞0.05).Anxiety mean had a significant deviation between other stage(p＜0,001).(2)Facing coping mean increased gradually.There had a significant deviation between before operation and after operation(p＜0.001),between after operation and initial chemotherapy,between intermediate and end chemotherapy(p＜0.001); Avoidance coping mean decreased gradually and increase at the stage of end chemotherapy,and there had a significant deviation between every stage (p＜0.05).There was no significant deviation between initial and end chemotherapy (p=0.415);Obedience coping mean increased gradually and then decreased since the stage of intermediate chemotherapy,and there had a significant deviation between before operation and after operation(p＜0.01),between initial and end chemotherapy (p＜0.01).There was no significant deviation between after operation and initial chemotherapy,between initial and intermediate chemotherapy.(3)In the stage of chemotherapy,the mean of functional well-being was increased gradually.The mean of QOL and other factors was minimum in intermediate chemotherapy and was maximum in end chemotherapy.The QOL of patients had a significant deviation between every chemotherapy stage(p≤0.001),but the mean of functional well-being was no significant deviation between initial and intermediate chemotherapy(p=0.097).2.The correlativity between anxiety,depression and coping styles of patients with breast cancer of every stageThere was a negative correlation between preoperative anxiety and facing coping (r=-0.209,p＜0.05),and a positive correlation between preoperative anxiety and avoidance coping(r=0.278,p＜0.01);There was a negative correlation between preoperative depression and facing coping(r=-0.313,p＜0.01),and a positive correlation between preoperative depression and avoidance coping(r=0.398,p＜0.001),between preoperative depression and obedience coping(r=0.304,p＜0.01);There was a positive correlation between postoperative depression and avoidance coping(r=0.212,p＜0.05).3.The correlativity between anxiety,depression and QOL of patients with breast cancer of chemotherapy stage In initial chemotherapy stage,there was a negative correlation between the depression of breast cancer patients and social/family well-being,emotional well-being, and there was a negative correlation between the anxiety of the patients and additional concerns;In the end chemotherapy stage,there was a negative correlation between the patients' depression and social/family well-being,emotional well-being,functional well-being,QOL.4.The correlativity between coping styles and QOL in the stage of chemotherapyIn initial chemotherapy stage,there was a positive correlation between facing coping and social/family well-being(r=0.250,p=0.010).In intermediate chemotherapy stage,there was a positive correlation between facing coping and physical well-being (r=0.196,p=0.045),social/family well-being(r=0.215,p=0.031).In end chemotherapy stage,there was a positive correlation between facing coping and social/family well-being(r=0.233,p=0.019),and there was a negative correlation between it and additional concerns(r=-0.192,p=0.049);There was a negative correlation between avoidance coping and the functional well-being of the intermediate (r=-0.225,p=0.021),the emotional well-being of the end(r=-0.229,p=0.018),the social/family well-being of the end(r=-0.205,p=0.035).Conclusion1.The anxiety and depression of breast cancer patients was higher duriong the period of operation than that of the period of chemotherapy.The preoperative medical coping style was avoidance coping.With the therapy going,the patients took facing coping style gradually.Facing coping style is a positive coping style that can improve patients' emotion.The patients using higher avoidance coping style may have higher negative emotion.2.The QOL of breast cancer patients was different in every chemotherapy stage. The QOL was minimum in intermediate chemotherapy stage and maximum in end chemotherapy stage.3.The coping styles,depression and anxiety didn't affect the QOL of patients during the period of chemotherapy,but they affected some aspects of QOL.