With Cancer, Stress Is in Not Knowing

Waiting for a diagnosis can be worse than waiting for treatment, study shows.

Nov. 30, 2010— -- CHICAGO -- Waiting for a cancer diagnosis -- and for the procedure that will provide that diagnosis -- can be more nerve-wracking than prepping for treatment, researchers found.

Women awaiting a breast biopsy reported more stress and anxiety than those waiting to be wheeled in for an invasive procedure to treat liver cancer, Dr. Elvira Lang of Harvard and colleagues reported at the Radiological Society of North America meeting here.

"Uncertainty is a greater stressor than awaiting risky treatment," Lang said during a press briefing. "The invasiveness of a procedure has less influence on stress."

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To assess stress levels among patients waiting for radiological tests and treatments, the researchers conducted a retrospective study of 214 women scheduled to have these procedures.

"We wanted to look at who is the most stressed," Lang said. "People coming in for a diagnosis, those being treated for benign disease, or those treated for malignant disease?"

On the State Trait Anxiety Inventory (STAI), breast biopsy patients had significantly higher scores than those undergoing treatment for liver cancer.

They also had greater anxiety than patients awaiting treatment for fibroids.

The women waiting for the biopsy also had higher stress scores on the Perceived Stress Scale than those awaiting treatment.

"Waiting for a breast biopsy was a greater stressor in terms of anxiety and perceived stress than awaiting a much riskier invasive treatment for known cancer," Lang said.

Measures of depression and event impact -- how often the test creeps into everyday thought, for example -- were similar for all patients, and typically well above normal scores. Still, they were generally higher for breast biopsy patients, Lang said.

The findings imply a need for physicians to diffuse that stress, she added. Doctors can teach internal coping skills to get their patients through the scans, and at the same time should avoid negative suggestions, phrases such as 'your results aren't that bad.'

Fear is in Not Knowing

"That actually gives patients more pain and anxiety," she said.

Dr. Bob Kerlan, chief of interventional radiology at the University of California San Francisco, said even though the study is small, the findings are important.

"Anybody who's ever gone even to have just a chest x-ray, you know you worry about the results," Kerlan said. "Getting lessons on how to make those experiences more positive would be a powerful thing."

"It's extremely important for a patient's experience, and their ability to return to that institution" for follow-up tests if need be, he said, adding that this area of research will be increasingly important.