An Anxiety, Depressed Mood, and Insomnia in Newly Diagnosed Women Breast Cancer Patients and Thyroid Cancer Patients

처음 진단받은 여성 유방암 환자와 갑상선암 환자에서 나타나는 불안, 우울 및 불면 증상

  • Park, So-Hyun (Department of Psychiatry, College of Medicine, Ewha Womans University) ;
  • Choi, Hee-Yeon (Department of Psychiatry, College of Medicine, Ewha Womans University) ;
  • Lim, Weon-Jeong (Department of Psychiatry, College of Medicine, Ewha Womans University) ;
  • Moon, Byung-In (Department of Surgery, College of Medicine, Ewha Womans University) ;
  • Lim, Woo-Sung (Department of Surgery, College of Medicine, Ewha Womans University)
  • 박소현 (이화여자대학교 의과대학 정신건강의학교실) ;
  • 최희연 (이화여자대학교 의과대학 정신건강의학교실) ;
  • 임원정 (이화여자대학교 의과대학 정신건강의학교실) ;
  • 문병인 (이화여자대학교 의과대학 외과학교실) ;
  • 임우성 (이화여자대학교 의과대학 외과학교실)
  • Received : 2017.08.31
  • Accepted : 2017.10.17
  • Published : 2017.11.30


Objectives In this study, we identified the symptoms of insomnia, anxiety, and depressed mood in newly diagnosed women breast and thyroid cancer patients. Methods The subjects of this study were 1794 women patients who visited the Ewha Womans University Cancer Center for Women. They included 1119 newly diagnosed primary breast cancer patients and 675 newly diagnosed primary thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC-PSI) during their first follow-up visit after surgery, before starting chemotherapy or radiotherapy. The NCC-PSI is composed of the modified distress thermometer (MDT) and the modified impact thermometer (MIT) for insomnia, anxiety, and depressed mood. Results Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. Significant levels of anxiety, depressed mood and insomnia were present in 28, 24.5, and 20.7% in all the subjects, respectively. Moreover, anxiety symptoms, depressed mood and insomnia interfered with the daily lives of 20, 18.4, and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%). Conclusions A significant level of distress was found in about 40% of the total subjects. Nearly 30% of newly diagnosed breast cancer patients reported significant anxiety symptoms and interferences with daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in breast and thyroid cancer treatment are very important to establish integrated cancer care.


  1. Korea Central Cancer Registry, National Cancer Center. Annual Report of Cancer Statistics in Korea in 2014, Ministry of Health and Welfare;2016.
  2. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 2005;330:702.
  3. Hill J, Holcombe C, Clark L, Boothby MR, Hincks A, Fisher J, et al. Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer. Psychol Med 2011;41:1429-1436.
  4. Boyes AW, Girgis A, D'Este CA, Zucca AC, Lecathelinais C, Carey ML. Prevalence and predictors of the short-term trajectory of anxiety and depression in the first year after a cancer diagnosis: a population-based longitudinal study. J Clin Oncol 2013;31:2724-2729.
  5. von Heymann-Horan AB, Dalton SO, Dziekanska A, Christensen J, Andersen I, Mertz BG, et al. Unmet needs of women with breast cancer during and after primary treatment: a prospective study in Denmark. Acta Oncol 2013;52:382-390.
  6. Han SS, Shin IS, Kim YJ. Factors that influence quality of life in cancer patients. Korean J Health Promot Dis Prev 2009;9:33-40.
  7. Greer S. Psychological intervention. The gap between research and practice. Acta Oncol 2002;41:238-243.
  8. Grabsch B, Clarke DM, Love A, McKenzie DP, Snyder RD, Bloch S, et al. Psychological morbidity and quality of life in women with advanced breast cancer: a cross-sectional survey. Palliat Support Care 2006;4:47-56.
  9. Linden W, Vodermaier A, Mackenzie R, Greig D. Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord 2012;141:343-351.
  10. Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P. The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer 2000;88:226-237.<226::AID-CNCR30>3.0.CO;2-P
  11. Maguire P. Improving the detection of psychiatric problems in cancer patients. Soc Sci Med 1985;20:819-823.
  12. Holland JC, Andersen B, Breitbart WS, Compas B, Dudley MM, Fleishman S, et al. Distress management. J Natl Compr Canc Netw 2010;8:448-485.
  13. Korea National Cancer Center. Development of recommendations for distress management toward improvement of quality of life in cancer patients;2009.
  14. Przezdziecki A, Sherman KA, Baillie A, Taylor A, Foley E, Stalgis-Bilinski K. My changed body: breast cancer, body image, distress and self-compassion. Psychooncology 2013;22:1872-1879.
  15. Shim EJ, Hahm BJ, Yu ES, Kim HK, Cho SJ, Chang SM, et al. Development and validation of the National Cancer Center Psychological Symptom Inventory. Psychooncology 2017;26:1036-1043.
  16. Oh ST, Lee S, Lee H, Chang MH, Hong S, Choi WJ. Reflection of pain in cancer patients using a new screening tool for psychological distress. Korean J Psychosom Med 2017;25:56-62.
  17. Ng CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA; MyBCC Study group. Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS One 2017;12:e0172975.
  18. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 2001;24:583-590.
  19. Nikbakhsh N, Moudi S, Abbasian S, Khafri S. Prevalence of depression and anxiety among cancer patients. Caspian J Intern Med 2014;5:167-170.
  20. Craig TJ, Abeloff MD. Psychiatric symptomatology among hospitalized cancer patients. Am J Psychiatry 1974;131:1323-1327.
  21. Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer 1994;74:2570-2578.<2570::AID-CNCR2820740927>3.0.CO;2-3
  22. Hirschfeld RM. The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Prim Care Companion J Clin Psychiatry 2001;3:244-254.
  23. Colleoni M, Mandala M, Peruzzotti G, Robertson C, Bredart A, Goldhirsch A. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet 2000;356:1326-1327.
  24. Liao MN, Chen MF, Chen SC, Chen PL. Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer. Cancer Nurs 2008;31:274-283.
  25. Bender CM, Ergyn FS, Rosenzweig MQ, Cohen SM, Sereika SM. Symptom clusters in breast cancer across 3 phases of the disease. Cancer Nurs 2005;28:219-225.
  26. Knobf MT. Psychosocial responses in breast cancer survivors. Semin Oncol Nurs 2007;23:71-83.
  27. Kadan-Lottick NS, Vanderwerker LC, Block SD, Zhang B, Prigerson HG. Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study. Cancer 2005;104:2872-2881.
  28. Kessler D, Lloyd K, Lewis G, Gray DP. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ 1999;318:436-439.
  29. Ryan H, Schofield P, Cockburn J, Butow P, Tattersall M, Turner J, et al. How to recognize and manage psychological distress in cancer patients. Eur J Cancer Care (Engl) 2005;14:7-15.
  30. Tylee AT, Freeling P, Kerry S. Why do general practitioners recognize major depression in one woman patient yet miss it in another? Br J Gen Pract 1993;43:327-330.
  31. Ayres A, Hoon PW, Franzoni JB, Matheny KB, Cotanch PH, Takayanagi S. Influence of mood and adjustment to cancer on compliance with chemotherapy among breast cancer patients. J Psychosom Res 1994;38:393-402.