The Quality of Life and Degree of Depression of Patients Suffering from Breast Cancer

ORIGINAL PAPER The Quality of Life and Degree of

Depression of Patients Suffering from
doi: 10.5455/medarh.2018.72.202-205
MED ARCH. 2018 JUN; 72(3): 202-205

Breast Cancer
RECEIVED: MAR 22, 2018 | ACCEPTED: MAY 18, 2018

Mirhan Salibasic1, Samir Delibegovic2

1
Clinic for Abdominal Surgery, University Clinical
Center Sarajevo, Bosnia and Herzegovina
2
Clinic for Surgery, University Clinical Center ABSTRACT
Tuzla, Bosnia and Herzegovina Introduction: Breast cancer and its treatment change the perception of mastectomized wom-
en of their physical appearance, which leads to depression and has a negative effect on the
Corresponding author: Mirhan Salihbasic, MD. overall quality of life of those woman. Aim: We wanted to assess the quality of life and the
Clinic for Abdominal Surgery, University Clinical degree of depression of patients suffering from breast cancer, on the basis of a standardised
Center Sarajevo, Bosnia and Herzegovina. questionnaire to assess the patients’ quality of life (QLQ-C-30 BR-23), and the degree of de-
ORCID ID: http://www.orcid.org: 0000-0000- pression using Beck’s Depression Inventory (BDI, II). Materials and Methods: The research
0000-0000. E-mail: mirhan.salibasic@mf.unsa.
was conducted on a sample of 160 patients, who were surveyed before and after the surgical
ba
procedure. The inclusion criteria for the research were: patients suffering from breast cancer
aged between 18 and 70 years, cancer diagnosed by FNB or CORE biopsy. The patients were
divided into two groups: patients having breast-conserving surgery and patients having radi-
cal surgical treatment. Results: There were 47 or 39.37% patients who underwent breast-con-
serving surgery and 113 or 70.62% patients who underwent radical surgery. The results of the
survey conducted show that there was no difference in the quality of life of patients before and
after surgery, regardless of the type of surgical procedure undertaken. However, there was a
significant different in the degree of depression between patients subjected to different sur-
gical procedures, where the patients surveyed post-surgery after radical mastectomy showed
a higher degree of depression than the patients surveyed after breast-conserving surgery.
Conclusion: There is no difference in the quality of life before and after surgery, regardless of
the type of operation. However, there is a significant difference in the degree of depression
in patients after radical mastectomy, who showed a higher degree of depression than the
surveyed patients who underwent breast-conserving surgery.
Keywords: breast cancer, depression, quality of life.

1. INTRODUCTION ance of masectomized women, and

The quality of life comprises one’s may have a negative effect on the
comprehensive and overall satisfac- overall quality of life of those woman.
tion/dissatisfaction with one’s own The alteration in the appearance of a
life. This is the subjective experience woman’s body due to treatment for
of each person, which undoubtedly breast cancer (mastectomy, chemo-
depends on the objective circum- therapy) is a source of psycho-social
stances of that person’s life, as well as difficulties (depression) (1, 2, 4).
their value system, expectations and The American Cancer Society
aspirations. Quality of life relates to states that most patients, their fam-
personal well-being and life satisfac- ilies, and relatives are faced with
tion, including mental and physical some degree of depression, anxiety
health (1, 2). or fear, when cancer becomes part of
We may describe depression as a their lives. That feeling is the normal
feeling of strong sorrow, hopeless- response to the life changes experi-
ness and sadness, which may appear enced (4, 5).
as a reaction to a sad event (the death
of someone close) or it may be with- 2. AIM
© 2018 Mirhan Salibasic, Samir Delibegovic out any particular cause, as unknown Quality of life and the degrees
and inexplicable to us, frequently ac- of depression have not been re-
This is an Open Access article distributed under the
terms of the Creative Commons Attribution Non-
companied by other difficulties of a searched in this group of patients
Commercial License (http://creativecommons.org/ psychological nature (3). in Bosnia and Herzegovina. There-
licenses/by-nc/4.0/) which permits unrestricted Breast cancer and its treatment fore we wanted to assess the quality
non-commercial use, distribution, and reproduction (mastectomy, chemotherapy, and of life and the degree of depression
in any medium, provided the original work is properly radiotherapy) change the experience in surgical patients, pre-operatively
cited.
(perception) of the physical appear- and post-operatively, depending on

202 ORIGINAL PAPER | Med Arch. 2018 JUN; 72(3): 202-205

 The Quality of Life and Degree of Depression of Patients Suffering from Breast Cancer

whether they underwent breast-conserving or radical years, with a variance of σ2 138.0, and standard deviation
procedures, in order to improve the treatment of these of 11.75. The average age of the patients who were treat-
seriously ill patients. ed with radical surgery was 55.21 years, with a variance
of σ2 239.3, and standard deviation of 17.13.
3. PATIENTS AND METHODS Quality of life
The study was conducted as a prospective study. The The EORTC-QLQC30 questionnaire showed the fol-
research encompassed 160 patients treated at the Clinic lowing to be the most important responses: 76.5% men-
for Oncological Surgery of the University Clinical Centre tioned problems in undertaking tiring activities (carry-
in Sarajevo. ing bags), 74.4% mentioned the presence of pain, 80.8%
Informed consent: “Informed consent was obtained patients mentioned the need for rest, 65.9% patients had
from all individual participant included in the study.” difficulty sleeping, 68% patients felt weak, 78.7% were
The patients were divided into two groups: anxious, 65.9% of those surveyed were irritable, 80.8%
Group 1: patients suffering from breast cancer who stated that their illness had caused them financial prob-
were treated with breast-conserving surgery (segmen- lems.
tectomy, quadrantectomy, hemimastectomy). The results of the analysis (correlation analysis and
Group 2: patients suffering from breast cancer who un- T-test) of the patients surveyed pre-operatively and
derwent radical surgery (radical mastectomy). post-operatively showed that there was no difference
The inclusion criteria for the research: patients aged in the quality of life of the surveyed patients before and
between 18 and 70 years, findings of mammography, ul- after surgery. The correlation coefficients of (pre-op-
trasound or magnetic resonance of the breast, confirmed eratively) 0.963662 and (post-operatively) 0.96412 in-
diagnosis of cancer by fine needle or core biopsy, surgical dicate the very high correlation between the groups,
treatment suggested by oncology consultants. that is, there was no significant difference between the
The exclusion criteria for the research: patients young- procedures. The hypothesis was proven with a 5 and
er than 18 and older than 70, and patients who refused to 2.5% risk, because t=1.539365 (pre-operatively) and t
take further part in the research. =0.884821(post-operatively) are lower than the critical
All patients in the research received informed consent values 1.674689 and 2.006647. Therefore, it may be said
from the ethical committee. that there was no significant difference in the quality of
The assessment of quality of life and the degree of de- life of the surveyed patients before and after the opera-
pression in the surveyed patients was conducted pre-op- tion, regardless of the type of surgical procedure planned
eratively and post-operatively on the basis of a stan- (breast-conserving or radical).
dardised questionnaire for assessment of the quality of The degree of depression
life of patients suffering from breast cancer (QLQ-C-30 The degree of depression was greater in patients for
BR-239 and the degree of depression using Beck’s De- whom radical surgery was planned, and this greater de-
pression Inventory (BDI, II). gree of depression continued in the post-operative peri-
od (Tables 1 and 2).
4. RESULTS
During the research, which ran from January 2013 to Minimal Mild de- Moderate Severe
depression pression depression depression
June 2014, a total of 202 patients underwent surgery in
No % No % No % No %
the Clinic for Oncological Surgery of the Clinical Centre
of the University of Sarajevo, and 160 of them, or 79.2%, Breast conserv-
25 53.1 10 21.2 4 8.5 8 17.0
ing surgery
were surveyed. Thirty-six patients (17.8%) did not meet
Radical surgery 66 58.4 9 7.9 24 21.2 14 12.3
the criteria for inclusion in the research (older than 70
years) and four patients (1.98%) refused to take part in Table 1. The degree of depression of the surveyed patients pre-
the research. operatively
The patients (n=160) who were surveyed pre-op- Minimal Mild de- Moderate Severe
eratively were in two groups: a) patients for whom a depression pression depression depression
breast-conserving surgical procedure was planned, of No % No % No % No %
whom there was a total of 47, or 29.3% of those surveyed, Breast-con-
and b) patients for whom a radical surgical procedure 25 53.1% 10 21.2 % 4 8.5% 8 17.0%
serving surgery
was planned, 113 or 70.6% of those surveyed. Radical surgery 66 58.4% 9 7.9% 24 21.2% 14 12.3%
Distribution into groups and sub-groups was under-
taken on the basis of the surgical procedure planned (the Table 2. Degree of depression of the surveyed patients postoperatively
decision on treatment made on the basis of the consul- The results obtained by analysis (correlation analysis
tant’s decision for each patient) and conducted. The av- and T-test) of the patients surveyed pre-operatively and
erage age of those surveyed pre-operatively was 53.91, post-operatively showed a significant difference between
with a variance of σ2227.6, and standard deviation of σ the degrees of depression of the surveyed patients who
15.09. The average age of those surveyed post-operative- underwent different surgical procedures (breast-con-
ly was 53.97, with a variance of σ2225.7, and standard de- serving and radical), and in the case of the radical proce-
viation of σ 15.02. The average age of the patients who dure the degree of depression in the patients was higher.
were treated with breast-conserving surgery was 50.89

ORIGINAL PAPER | Med Arch. 2018 JUN; 72(3): 202-205 203

The Quality of Life and Degree of Depression of Patients Suffering from Breast Cancer

The correlation coefficient pre-operatively was lems these patients encounter are the fear of death, the
0.899488, and post-operatively 0.920687, which indicates destruction of their plans in life, changes to their physical
a high correlation between the groups. The hypothesis of appearance, financial problems and anxiety about their
the equality of the mean of the groups was proven with life. All these may cause the development of depression.
5 and 2.5% risk, because |t| = |-1.4276| is less than the Severe depression is not just sadness or a bad mood;
critical values of 1.7247 and 2.0860. Therefore, it may be severe depression occurs in almost 25% of all patients
said that there was no significant difference in the degree suffering from cancer (9, 10). In patients with breast
of depression before and after the operation. cancer the most significant influence on their physical
For the patients surveyed post-operatively who under- appearance, their self-image and their sex life is mastec-
went radical mastectomy, the hypothesis could not be tomy, and this may be the explanation for the anxiety and
proven with a 5% and 2.5% risk because |t| =|-2.7398| depression in these patients (11).
is greater than the critical values of 1.7247 and 2.0860. In our research it may be said there was a significant
So it may be said that there was a significant difference difference between the degrees of depression of the sur-
between the degrees of depression of the surveyed pa- veyed patients who underwent different surgical proce-
tients who underwent different surgical procedures dures (breast-conserving and radical). The results of this
(breast-conserving and radical). That different is seen in study show that depression is present in all patients with
the difference of the means and equals: 0.6142-0.6813 breast cancer, but it is especially strong in patients who
= -0.0671. The mean value of the responses (the mean have undergone a radical surgical procedure.
number of points) was greater in the case of radical sur- Treatment aimed at preventing the sequalae of medi-
gery than in breast-conserving surgery: 0.6813>0.6142, a cal interventions should be an integral part of the early
difference of 0.0671, so it may be concluded that in the rehabilitation, incorporated into the treatment regime,
case of radical surgery the degree of depression in the and it is also recommended in the pre-operative period
patients was greater. in treating patients suffering from breast cancer to in-
clude psychotherapy.
5. DISCUSSION
The five-year survival rate for breast cancer is close 6. CONCLUSION
to 86%. Results show that women with breast cancer There is no difference in the quality of life before and
achieve their maximum psychological and physical re- after surgery, regardless of the type of operation. The de-
covery one year after establishment of the diagnosis (6, pression is present in all patients with breast cancer, but
7). The highest percentage of cases of breast cancer are it is especially in patients who have undergone a radical
found in middle aged women, Volker et al. (7, 8). The ra- surgical procedure. The education of health care profes-
tio of radical and breast-preserving surgery in our study sional regarding the rehabilitation of oncology patients
is not in accordance with the literature consulted, there is must be multi-discipline in character, in order to pro-
a larger proportion of radical surgical procedures, 113:47 vide adequate assistance to women suffering from breast
(7). Research shows that the type of surgical treatment cancer. Positive legislative changes and decisions on the
does not have a significant effect on the quality of the scope of rights and the framework of the basic package of
patients’ lives (8). Relapse or recurrence of the disease health care services must regulate the issue of the acces-
has a harmful effect on the quality of life in the tested sibility of the vitally necessary resources for this category
population. In our research on a total of 202 patients of patients, especially in relation to the legislation on the
who had undergone surgical treatment, 24 patients, or accessibility of implants and expanders, so important for
11.8%, underwent surgery for a recurrence of the disease. these patients, which in the Bosnia and Herzegovina are
In the course of the research all the patients (n= 160) not on the health insurance list.
who were surveyed pre-operatively completed the same
questionnaire postoperatively (n=160). Completion of • Author's Contribution: Mirhan Salibasic – initial phase (idea,
the questionnaire post-operatively was carried out at the lit-erature review, hypothesis, execution phase, writing). Samir
follow-up examination, on average three months after Delibe-govic – analytical phase (analysis, final writing, revision).
the patient had been discharged. If we take the questions • Conflict of interest: Authors have no conflict of interest.
from the EORTC-QLQ-C30 questionnaire individually, • Informed consent: “Informed consent was obtained from all indi-
the indicators correspond to the data from the literature vidual participant included in the study.”
regarding the most significant symptoms found in the
patients surveyed pre-operatively and post-operatively, REFERENCES
which are pain in the arm on the side of the operated 1. Demetris S, Oren W, Anna P, Neofytos P, Joseph H, Nimrod
breast, financial problems, anxiety, and breathlessness F, Eyal W. Quality of life after breast cancer surgery with or
(5). Special interventions such as education of patients, without reconstruction. Open Access Journal of Plastic Sur-
coping and managing skills, and support groups may gery. 2009; 9: 161-165.
help to improve the quality of life of women after they 2. Martinis T. Perception of quality of life according to age. Uni-
have been diagnosed with breast cancer. versity of Zagreb. Fakulty of humanities and social sciences.
Studies have shown that patients with breast cancer are Department of Psychology. Zagreb 2005: 4-9.
particularly subject to depression, because of the symp- 3. Matti E, Paula O. Beck depression inventory (BDI) in patient
toms, which cause a threat to their life. Some of the prob- with breast disease and breast cancer: a prospective case-con-

204 ORIGINAL PAPER | Med Arch. 2018 JUN; 72(3): 202-205

 The Quality of Life and Degree of Depression of Patients Suffering from Breast Cancer

trol study. 2011; 25: 111-116. 8. Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Per-
4. Nimh.nih.gov (homepage on the Internet). USA.gov. The Na- sistence of restriction in quality of life from the first to the
tional Institute of Mental Health Information Resource Cen- third year after diagnosis in women with breast cancer. J Clin
ter. Updated 2014 Dec 20; cited 2015 Jan 15. Available from: Oncol. 2005; 23: 4945-4953.
http://www.nimh.nih.gov/ 9. Love AW, Grabsch B, Clarke DM, Bloch S, Kissane DW.
5. Cancer.org (homepage on the Internet). Atlanta. The Ameri- Screening for depression in women with metastatic breast
can Cancer Society. Updated 2014 Dec 20; cited 2015 Jan 15. cancer: a comparison of the Beck Depression Inventory Short
Available from: http://www.cancer.org/Cancer/BreastCancer/ Form and the Hospital Anxiety and Depression Scale. Aust N
6. Bottomley A, Aaronson NK; European organisation for re- Z J Psychiatry. 2014; 38: 526-531.
search and treatment of cancer. international perspective on 10. de Souza BF, de Moraes JA, Inocenti A, dos Santos MA, Silva
health-related quality-of-life research in cancer clinical trials: AE, Miasso AI. Women with breast cancer taking chemother-
The European Organization for Research and Treatment of apy: depression symptoms and treatment adherence. Rev.Lat
Cancer Experience. J Clin Oncol. 2007: 25: 5082-5086. Am Enfermagem. 2014; 22: 866-873.
7. Arndt V, Stegmaier C, Ziegler H, Brenner H. A popula- 11. Novin N, Sussan M, Setareh A, Soraya K. Prevalence od de-
tion-based study of the impact of specific symptoms on qual- pression and anxiety among cancer patient. Caspian J Intern
ity of life in women with breast cancer 1 year after diagnosis. Med. 2014; 5: 167-170.
Cancer. 2006; 107: 2496-2503.

ORIGINAL PAPER | Med Arch. 2018 JUN; 72(3): 202-205 205