Introduction

When faced with a diagnosis of cancer, individuals respond psychologically in several different ways. According to some clinicians, the particular coping responses adopted by cancer patients may influence prognosis. That opinion is based upon isolated clinical observations which, though stimulating and valuable, require verification. The few published studies have been succinctly summarised. It is clear that systematic, long-term follow-up studies are needed, and that these studies should focus on patients with early, as opposed to advanced cancer in order to obviate (as far as possible) the effect of the disease process itself on psychological responses. We report here the results of one such study.

Patients and methods

A consecutive series of women admitted to King's College Hospital with breast cancer were studied, the criteria for inclusion being age under 70, no previous history of malignant disease, a breast lump less than 5 cm in diameter with or without palpable ipsilateral axillary glands, no deep attachment of the lump, and no distant metastases. Consequently, all patients fell within the Manchester classifications of stage I or II or T0,1 N0,1 M0. No patients had occult metastases as shown by routine chest X-ray, skeletal survey, full blood count, and serum chemistry (bilirubin, alkaline phosphatase, aspartate transaminase and hydroxybutyrate dehydrogenase, calcium, phosphate, uric acid, sodium, potassium, and urea).

Patients were treated by simple mastectomy; in addition 25 randomly selected patients also received a routine course of prophylactic postoperative radiotherapy to ipsilateral axillary nodes as part of the King's/ Cambridge Breast Trial.

Both clinical and psychological assessments were carried out preoperatively, 3 and 12 months postoperatively, and then annually for a further 4 years.