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  • We found that younger women


    We found that younger women suffer more anxiety. In contrast, the rate of depression is lower in younger women (<50 years), while the prevalence was very similar in the other age groups among them. Other studies among newly diagnosed women have reported similar prevalence and age-related distributions of anxiety, but somewhat different results for depression, namely the so-called U-effect, with the lowest prevalence of depression among middle-aged women [18]. A systematic review and meta-analysis focused on long-term survivors found similar prevalence data to those obtained in our study [19]. This review is interesting because it highlights the growing problem of some studies that focus on women with newly diagnosed diseases, regardless of the effects on long-term survival, despite the increase in women in this group. This entails a first challenge which is to define what “long-term survival” means. To an oncologist, long-term survivors are women who are still alive 5 years after diagnosis. Both the US Center for Disease Control and the National Coalition for Cancer Survivorship define a cancer survivor as any person living with cancer from the time of diagnosis to the time of death. In any case, the systematic review mentioned above showed that the risk of depression decreases with time from diagnosis, while that of anxiety increases, reaching a prevalence of approximately 17%. These results clearly follow the same pattern as those observed in our work with women in the Dama cohort. Social class is another element with significant influence. We observed a greater proportion of women with probable anxiety and depression in the middle and lower social Epirubicin HCl (IV + V), especially after the follow-up of the disease had been carried out for some time. This is probably because women with fewer economic resources have less access to the different resources that could help meet their health needs. Likewise, the socioeconomic conditions of these groups are linked to a precarization of social connections, reducing the elements of social support for women [20]. In addition, health outcomes are also influenced by the level of deprivation of the neighbourhood, observing worse health outcomes in those who live in more depressed environments. On the other hand, these patients were also less likely to be married and live alone, which has turned out to be a risk factor. Contrary to the hypothesis that social support mediates the relationship between social class and mental health, some studies have shown that this is not the case, and that the socioeconomic level, and specifically the income level, can directly influence the levels of social support, stress of a woman and, consequently, her risk of anxiety and depression [19]. Regarding relapse, there is little previous evidence on the relationship between relapse and anxiety and depression in long-term breast cancer survivors. On the other hand, there is some literature on the effect of fear of relapse, regardless of the stage of the tumour at the time of diagnosis [21]. In many cases, relapse is a difficult issue to address, and affected women often hide the severity of their illness or prognosis from close family and friends. Most experience shock, isolation and a feeling of loss of control, due to significant changes in their daily lives, among which are the inability to work and an increase in medical appointments that cause emotional distress [22]. In fact, long-term survivors can sometimes have a greater need for psychological support, depending on the duration of the treatment period and, above all, the onset of relapse [23]. Emotional support is an important determinant of the mental well-being of cancer survivors. In our study, low emotional support was found to be a clear risk factor for anxiety and depression. A follow-up study carried out in Sweden showed similar results, and fatigue was also found to be relevant [24]. There are several mechanisms that may be mediating the relationship between social support and mental health. Some authors suggest that social support promotes QoL by enhancing of mood and sense of identity, decreasing the burden associated with the activities of daily living, and providing a positive appraisal of coping resources and information [7]. It is also known that the different dimensions of emotional support – tangible, emotional, affective and social interaction – influence self-efficacy in decision-making related to treatment and in the process of self-care and disease management [25]. The concepts of social network and social isolation are closely linked to emotional support, measured by the number of people one relates with and the frequency of such relationships. Some survival studies in women with breast cancer have demonstrated a relationship between social network and mortality, with higher mortality rates in women with a poorer social network [26]. Several studies support the hypothesis that processes (implicit and explicit) that regulate emotions are consequently related to how the CM is confronted. Consequently, the links the CM may have with depression and anxiety and the effects it may have on the disease depend, among other factors, on the loneliness of the women affected. Women who were highly connected and had a rich social network were thus able to cope with cancer by expressing their emotions and had fewer mental health symptoms than women with fewer emotional outlets [27]. However, women who live as a family seem to be more likely to have symptoms of anxiety and depression. In the qualitative interviews that were carried out to better understand the results obtained in the quantitative work, women with children or older parents reported more suffering; especially in those cases with small children. In these, many fears arise since if they die their children will be left alone. A woman tells us: "My husband loves me very much, but he is an adult and over time he can find someone else, but my son, what will he do? A mother does not have a replacement, she is unique."