Young breast Ca patients at higher risk of distress.(Gynecology)

BOSTON -- The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

"Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with child-bearing years or with years spent in active parenting roles," Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease "and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment," said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress will vary depending on both the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory, clinicians should address "normal" levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

* Clarify and ensure understanding of diagnosis and treatment options and side effects.

* Advise that distress is normal and expected and can increase at transition points.