Secondary Logo

Journal Logo

Physiological and psychological improvements of Chinese women with breast cancer in perioperative period after brief structured psychotherapy

YU, Hong-luan; LI, Ying; MAO, Xue-qin; MA, Rong; SUN, Jing-zhong; PAN, Fang

Brief report

Department of Psychology (Yu HL and Mao XQ), Department of General Surgery (Ma R and Sun JZ), Qilu Hospital, Shandong University, Jinan 250012, China

Institute of Medical Psychology, School of Medicine, Shandong University, Jinan 250012, China (Li Y and Pan F)

Correspondence to: Dr. PAN Fang, Institute of Medical Psychology, School of Medicine, Shandong University, Jinan 250012, China (Tel: 86–531–88382039. Fax: 86–531–88382515. Email:

This study was supported by the grant from the Department of Science & Technology of Shandong Province (No. 991205714).

(Received April 14, 2006)

Edited by SUN Jing

Several studies have demonstrated that 30%-40% of cancer patients suffer from psychiatric problems such as depression, anxiety and adjustment disorders.1–3 The more positively the breast cancer patients rated their appraisal and tangible dimensions of social support, the lower value their mean cortisol level.4 Malignant melanoma patients who received 6-week structured intervention showed a lessening of emotional discomfort, augmentation of immune function and a decreased recurrence rate and mortality.5,6

Brief structured psychological intervention is a new type of psychotherapy,7 which can help relieve negative emotions of patients who experience stress and give psychological support to reduce posttraumatic syndrome.8 We developed a brief structured psychological intervention covering knowledge of breast cancer treatment, coping strategy and social support.

Back to Top | Article Outline



Patients were excluded if they were reported to use prescription or illicit drugs or had a history of psychiatric disease, diabetes or hypertension. Sixty patients from the Department of General Surgery (Qilu Hospital, Shandong University) during February 2003 to August 2003 were volunteered, aged 30–60 years, married, and diagnosed as breast cancer stage II following fine-needle aspiration and pathological examination. All patients received the standard eradicative operation of breast cancer with the mean hospitalization time 21 days. After signing the written informed concents, they were randomly divided into two equal groups: intervention group (n=30) and control group (n=30) with the balance in gender, age, career, educational level, economic status, religious belief and residential area.

Back to Top | Article Outline

Psychological rating scale

Anxiety mood was assessed with the Chinese language version of self-rating anxiety scale (SAS) written by William W.K. Zung. Depression mood was determined by Chinese language version of self-rating depression scale (SDS) written by William W.K. Zung. Symptom checklist 90 (SCL-90) of Derogatis was used to measure patients' psychological and physiological symptoms. The self-esteem inventory (SET) was measured self-esteem of patients. Coping style was measured with trait coping style questionnaire (TCSQ) designed by Dr. JIANG Qian-jin and the results were presented as positive coping score (PC) and negative coping score (NC). Life event scale (LES) revised by Dr. YANG De-sen was used to investigate the significant events happened during the previous 5 years. Life satisfaction index A (LSIA) was used to investigate how much satisfaction the patient felt with her life.

Back to Top | Article Outline

Serum cortisol test

The fasting blood samples were obtained in the morning 7:00–7:30 on the day after being hospitalized and the tenth day after operation and tested for cortisol by radioimmunoassay (Institute of Beijing North Biological Technique, China).

Back to Top | Article Outline

Electronic skin resistance test

Electronic skin resistance was tested before and after operation using electronic skin resistance recording instrument (DT-830, Peking University, China). Electronic skin resistance tests were done on the same day as the psychological scales.

Back to Top | Article Outline

Brief structured intervention

The brief structured intervention includes three parts: education, stress management and improving social support. Education included knowledge about breast cancer, operations and diet.9 Stress management included an explanation of coping styles and suitable coping skills. Social supporting explained to patients how to use social support and improve social ties. The intervention involved five psychological factors: (1) clarifying the medical condition including diagnosis, prognosis and treatment; (2) methods to release anxiety by relaxation techniques and selfhypnosis; (3) encouraging the patients to express their feeling freely and get social support by establishing social ties; (4) complying with medical regimens; (5) suitable coping with cancer and therapeutic consequences. These managements directly addressed how to increase positive cognition, emotions and behaviours and reduce the harmful effects of stressful life events.10



Back to Top | Article Outline


All tests were done before and after the standard operation. The patients in intervention group underwent 45-minute structured intervention before the operation, the control group had 45 minutes' free talk without intervention (both sessions were finished by Dr. YU Hong-luan).

Back to Top | Article Outline

Statistical analysis

SPSS 10.0 and Sigmaplot 2000 were used in this study. All data were presented as mean±standard deviation (SD) and analyzed using independent t test, paired sample t test and Pearson regression analysis. P value less than 0.05 was considered statistically significant.

Back to Top | Article Outline


Psychological variables

There were no significant differences between the two groups in psychological rating scales before the intervention. Compared with the control group after intervention, the patients in the intervention group had significantly lower scores in SAS, SDS, SCL-90, NC, and higher scores in SET, PC (Table).

Back to Top | Article Outline

Plasma cortisol

There was no significant difference in plasma cortisol between two groups before and after intervention. The intervention group had a lower level of plasma cortisol after intervention and the control group had a higher level than that before intervention (Fig.).



Back to Top | Article Outline

Electronic skin resistance

There was no significant difference in electronic skin resistance between the two groups before intervention (P>0.05); however, electronic skin resistance in the intervention group was significantly higher than that in the control group after intervention ((0.92±0.17) MΩ vs (0.79±0.24) MΩ, P<0.05).

Back to Top | Article Outline

Correlation analysis

The score of SCL-90 significantly positively correlated with LES (r=0.362, P<0.01), and negatively with PC (r=-0.361, P<0.01). The score of PC significantly negatively correlated with SAS (r=-0.265, P<0.05), and LES (r=-0.299, P<0.01). The score of NC significantly negatively correlated with LSIA (r=-0.303, P<0.05). The score of SET significantly negatively correlated with SDS (r=-0.308, P<0.05) and positively with LSIA (r=0.437, P<0.01).

Back to Top | Article Outline


The diagnosis of breast cancer and surgery are major life events that may destroy patients' selfesteem because of changes in body image and sexual function. Psychological intervention could contribute to relief and prevent negative emotion stemming from encounters. Four areas for psychotherapy effecting physiological change are: health maintenance behaviour, healthcare utilization, endocrine environment and immune function.11 Social support is related to higher activity of natural killer cells in patients with stage I and II breast cancer.12 Active confrontation with a fighting spirit may help patients to live longer than surrendering themselves to helplessness and hopelessness.13

Patients in perioperative period stayed in hospital in a very short time and had obvious psychological problems. The aims of brief intervention are to correct coping styles, reduce distress, reclaim personal control ability, increase the solving problem skills and improve morale.14 The results showed that after treatment, compared to the control group, patients in intervention group had significantly lower anxiety, depression, negative coping scores, and significantly higher selfesteem and positive coping scores. This showed that brief intervention could improve significantly psychological states such as anxiety and depression, but had less influence on personality factors such as coping style.

Glucocorticoids play a central role in stress responses, the association between cortisol level and clinical depression is well established. Cortisol recovery in blood after acute stress may be associated with the experience of recent minor life stress leading to enhanced subjective activation during acute challenge.12 This study showed different tendencies in two groups, a increasing tendency in the control group and a decreasing tendency in the intervention group, indicating that patients in the intervention group had lower physiological stress. Even so, we need to observe the different tendencies of two groups for longer times.

Electronic skin resistance reflects the excitability of the sympathetic nervous system facing a stressor, which makes patients secrete more sweat. The patients in the intervention group had higher electronic skin resistance, indicating they had lower level of anxiety.

The results of this study showed that patients' anxiety had significant negative association with the positive coping styles, depression mood had significant negative association with selfesteem, life quality had significant negative association with the negative coping style and positive association with selfesteem. These indicate that brief structured intervention can improve the psychological factors and the life quality of patients with breast cancer. These results should be tested in a larger sample and for a longer time.

Back to Top | Article Outline


1. Hosaka T, Sugiyama Y, Hirai K, Okuyama T, Sugawara Y, Nakamura Y. Effects of a modified group intervention with early-stage breast cancer patients. Gen Hosp Psychiatry 2001; 23: 145-151.
2. Okamura M, Yamawaki S, Akechi T, Taniguchi K, Uchitomi Y. Psychiatric disorders following first breast cancer recurrence: prevalence, associated factors and relationship to quality of life. Jpn J Clin Oncol 2005; 35: 302-309.
3. Wong-Kim EC, Bloom JR. Depression experienced by young women newly diagnosed with breast cancer. Psychooncology 2005;14: 564-573.
4. Turner-Cobb JM, Sephton SE, Koopman C, Blake-Mortimer J, Spiegel D. Social support and salivary cortisol in women with metastatic breast cancer. Psychosom Med 2000; 62: 337-345.
5. Fawzy FI, Cousins N, Fawzy NW, Kemeny ME, Elashoff R, Morton D. A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance. Arch Gen Psychiatry 1990; 47: 720-725.
6. Fawzy FI, Kemeny ME, Fawzy NW, Elashoff R, Morton D, Cousins N, et al. A structured psychiatric intervention for cancer patients. II. Changes over time in immunological measures. Arch Gen Psychiatry 1990; 47: 729-735.
7. Chemtob CM, Tomas S, Law W, Cremniter D. Postdisaster psychosocial intervention: a field study of the impact of debriefing on psychological distress. Am J Psychiatry 1997; 154: 415-417.
8. Rose S, Bisson J. Brief early psychological interventions following trauma: a systematic review of the literature. J Trauma Stress 1998; 11: 697-710.
9. Fawzy NW. A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nurs 1995; 18: 427-438.
10. Cope DG. Functions of a breast cancer support group as perceived by the participants: an ethnographic study. Cancer Nurs 1995; 18: 472-478.
11. Roy MP, Kirschbaum C, Steptoe A. Psychological, cardiovascular, and metabolic correlates of individual differences in cortisol stress recovery in young men. Psychoneuroendocrinology 2001; 26: 375-391.
12. Levy SM, Herberman RB, Whiteside T, Sanzo K, Lee J, Kirkwood J. Perceived social support and tumor-estrogen/progesterone receptor status as predictors of natural killer cell activity in breast cancer patients. Psychosom Med 1990; 52: 73-85.
13. Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioral interventions for cancer treatment-related side effects. Semin Clin Neuropsychiatry 2003; 8: 253-275.
14. Larson MR, Duberstein PR, Talbot NL, Caldwell C, Moyniham JA. A presurgical psychosocial intervention for breast cancer patients: psychological stress and the immune response. J Psychosom Res 2000; 48: 187-194.

breast neoplasms; emotions; adaptation, psychological

© 2007 Chinese Medical Association