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Effect of Negative Emotions on Breast Cancer Prognosis: History
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Subjects: Oncology
Contributor: Kumar Ganesan

Negative emotions (NEs) are unpleasant moods regularly disruptive, intended to express a negative effect that can be anger, depression, envy, fear, frustration, and sadness. Emotions are multifaceted reactions involving several biochemical and physiological processes within the body. The brain often responds to our feelings by releasing chemicals and hormones, which direct us into a state of whether positive or negative. NEs are a complex process and don't have the capacity to deal with negative feelings, thus often experiencing them. NEs and their impacts have greatly influenced the higher incidence and risk of breast cancer (BC). They were also significantly associated with other high-risk factors including, geographical distribution, emotion types, standard diagnosis of NEs, and follow-up duration. NEs significantly increase the risk for the incidence of BC, which can be supportive of the prognosis of the disease. 

  • breast cancer
  • negative emotions
  • emotion types
  • prognosis

1. Introduction

Breast cancer (BC) is the second foremost cause of cancer demise in women globally. According to the Global Cancer Statistics 2020, the newly affected cases of BC have surpassed lung cancer to become the first leading cancer in the world [1]. BC has become one of the main threats to females due to the high incidence rate [1,2] and mortality rate [3]. Among women, BC accounts for 1 in 4 cancer cases and 1 in 6 cancer deaths, ranking first for incidence in the majority of nations (159 of 185 nations) and for the high death rate in 110 nations [4]. The increased incidence rates of BC could be based on the hormonal, reproductive risk factors (early menarche, advanced maternal age pregnancy, late-onset menopause, less number of children, less breastfeeding, use of oral contraceptives and hormonal therapy), negative emotions (NEs, depression, anxiety, psychosis, and psychological factors) and lifestyle (obesity, alcohol intake, smoking, lacking physical activity) [5,6,7,8]. Recently, researchers found that NEs can affect human endocrine and immune function, which in turn can affect the incidence and development of BC [9]. BC patients receive an extensive period of multimodal treatment, including surgery, radiotherapy, chemotherapy, and invasive treatment, which are frequently accompanied by changes in physical status and function, unpleasant side effects, and declining quality of life [10,11]. Thus, BC patients continuously suffer from NEs under chronic psychological stress. Apart from treatment-related distress, the cancer diagnosis can also aggravate NEs.
Several clinical studies have also suggested that patients with BC suffer a higher incidence of mental disorders compared with the general population [7,12,13]. Anxiety and depression are the most common NEs experienced by most BC patients and the incidence rates are very high during the BC treatment, which was 70% and 60%, respectively [14,15]. These NEs may worsen the treatment, lead to greater pain, a longer stay in the hospital, increase the risk of disease progression, and affect the quality of life, and death [16]. Emotions are multifaceted and widespread human experiences, which occur in two phases namely positive (happiness) or negative (sadness), that can occur rapidly and mechanically. According to the Positive and Negative Affect Schedule (PANAS) scale, the positive affect (PA) represents the enthusiastic, active, and alert, which is a state of high energy, full concentration, and pleasurable engagement. The negative affect (NA) is a general dimension of subjective distress and unpleasable engagement that subsumes a variety of aversive mood states, including anger, contempt, disgust, guilt, fear, and nervousness. Low PA and high NA are the distinguished features of depression and anxiety that generate altered behavioral, physiological, and subjective responses [17]. Patients with BC generally suffer from significant clinical depression even years after diagnosis and treatment [18], which impair physiological and psychological function, and can lead to other serious complications including severe illnesses and even death [19,20].
Earlier studies suggested that several factors connect to depressive symptoms in BC patients, including demographics, disease-related factors, and distinct psychosocial characteristics such as coping styles and personality traits [21,22,23,24]. Emotional suppression is one of the coping style strategies, whereby, the individual can intentionally regulate the expression of NEs including, anxiety, anger, and sadness. Earlier clinical data have also confirmed the association between emotional suppression and psychosocial maladjustment such as depressive symptoms in patients with BC [25,26,27]. For instance, Li et al. [28] found that anger suppression was connected with the advanced level of depression in BC individuals during chemotherapy. Similarly, Kugbey et al. [12] found that emotional suppression was highly connected to the worsening mood in women with advanced BC. All these findings suggest that anger or emotional suppression worsen the mood in women with BC, which promotes a high incidence of BC progression.
Depression or anxiety can influence the physical and psychological function and the quality of patients with BC. The type and severity of life events and the accumulation of the number of life events can increase the psychological burden with NEs that increases the risk of BC [29,30].

2. Effect of Negative Emotions on Breast Cancer Prognosis

Various clinical investigations have proposed that patients with BC suffer a much higher incidence of NEs when compared to the general population [7,12,13]. These NEs may worsen the diagnosis and treatment, lead to an elevated risk of disease progression, and affect the quality of life, and death [16]. Anxiety and depression are the most common NEs experienced by most BC patients. Depression, anxiety, and other psychological factors are greatly connected to the increase in the incidence of BC. Depression was predicted to incur a 30% approximate increase in the incidence rate of BC risk among cancer patients. Psychosis and comorbid depression can also increase the risk of higher incidence rates and cancer-specific mortality [31]. Psychosis and depression are stronger risk factors for BC incidence. Bearing in mind that psychosis and depression co-occur clinically, more care should be given to them during the treatment of BC patients.

Anxiety and other mental illness such as stress and dysthymic also could affect the incidence of BC [7,15,23,32]. Considering that NEs, combining anxiety and depression may appear in the BC patient at the same time, which may greatly increase the risk of BC. Hence, more attention has to be paid during the treatment and screening of the NE individuals. Controversially, in a national representative health survey study from Finland, Knekt et al. found that there is no compulsory connection between depression and the incidence of BC [33]. A prospective cohort study conducted on the elderly population found that long-term depression can elevate the risk of BC [34]. Several factors may affect the incidence of BC including lifestyle, significant events that occurred suddenly in day-to-day life, character, behavioral factors, and biological factors [35]. In recent studies, many life events can contribute to the NEs such as unemployment or material status (single or divorced), which may influence the incidence of BC [36].

NEs comprise of depression, anxiety, and psychological disorders that are highly connected to various biological mechanisms, including the activation of the hypothalamic-pituitary-adrenal axis in patients [37,38]. Alteration in the levels of the female hormone can influence the incidence of BC. According to WHO randomized trial findings, high expression of estrogen plus progesterone is associated with the increased incidence of BC [39]. Recent study findings suggested that patients with depression and severe mental illness, who had received hormonal therapy, have a high incidence of BC with 48.8% and 43%, respectively [40].

It is key to raising awareness amongst healthcare professionals acting at different levels of the healthcare system of the elevated risk of mental health symptoms among BC, specifically psychosis, depression, and other psychological factors. Screening for these mental health disorders in BC patients can merit further investigation. Predictors of distress among BC individuals include having perceived functional limitations, psychiatric history, menopausal stage, fatigue, lower socioeconomic status, and modifiable factors such as vasomotor symptoms, pain, less social support, physical activity, and smoking [32]. Psychosocial care and regular monitoring of patient-reported outcomes during treatment care are possible to reduce the burden of these environments [41].

Since the value of NEs on BC differs nationwide, geographical distribution is also a noteworthy contributing risk factor for the incidence of BC. NEs were considerably more common in Asian women (45.9%), followed by the USA (25.8%) and Europe (28.2%). Our study was inconsistent with earlier reports between 1988–92 regarding the incidence of BC being the highest among women in the USA, followed by Africans, Asians, Europeans, and Hispanics [42,43]. Depression was the highest and strongest gradient effect in most BC patients in the general inpatient population; thus increasing numbers of comorbidities, including mental health-related, negatively impact BC prognosis, and increase BC mortality [44].

3. Conclusions

NEs have adverse effects and prognostic tools for the incidence of BC. The results directly support the requirement for early and periodical detection and timely treatment of mental disorders in patients. Furthermore, physicians, psychiatrists, and oncologists should organize and develop increased options in the coordination of care and treatment for patients with BC. Regular physical exercise, yoga, indoor and outdoor activities, promoting a positive body image, and self-esteem improvement are key points to improve the NEs in BC patients. Early intervention in mental health can be reinforced to reduce the mental health disease as well as the incidence of BC, which may release NEs symptoms in BC patients.

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This entry is adapted from the peer-reviewed paper 10.3390/cancers14030475

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