CASE 50

MG, a 50-year-old mother of two, was recently diagnosed with breast cancer. Despite favorable histology and hormone receptor typing of the tumor, indicating a projected good response to taxol and other chemotherapy, and lack of any nodal involvement, she has had trouble coming to grips with the diagnosis. She has been referred to the psychiatric service for treatment of depression. In addition, recent blood work at the hospital, along with some functional studies, suggests a subtle impairment in immune functioning, which her general practitioner is concerned might impact on longer-term prognosis. What are your concerns? What is the evidence that MG’s mental state might influence her disease? What might be done to address this issue?

QUESTIONS FOR GROUP DISCUSSION

RECOMMENDED APPROACH

DIAGNOSIS

MG was diagnosed with depression.

THERAPY

MG’s physician has referred her to a psychiatrist.

MENTAL HEALTH AND DISEASE

There is a growing realization that mental health can affect disease, both incidence (although data here are more tenuous) and prognosis. There is a wealth of data indicating a link between clinical depression and immune function. A variety of indices used to score depression (e.g., Beck Inventory) have been used to document this relationship. In general, individuals with poor self worth and feelings of hopelessness have been found to show diminished survival compared to controls, all other factors being equal, after diagnosis in a variety of different cancers, with breast cancer being one of these. Accordingly, a major effort has been made to improve psychological factors as adjunctive therapy for cancer.