Predictors of enduring clinical distress in women with breast cancer

Abstract

To date, little is known about enduring clinical distress as measured with the commonly used distress thermometer. We therefore used the distress thermometer to examine: (a) the prevalence of enduring clinical distress, distress-related problems, and subsequent wish for referral of women with breast cancer, and (b) sociodemographic, clinical, and psychosocial predictors of enduring clinical distress. The study had a multicenter, prospective, observational design. Patients with primary breast cancer completed a questionnaire at 6 and 15 months postdiagnosis. Medical data were retrieved from chart reviews. Enduring clinical distress was defined as heightened distress levels over time. The prevalence of enduring clinical distress, problems, and wish for referral was examined with descriptive analyses. Associations between predictors and enduring clinical distress were examined with multivariate analyses. One hundred sixty-four of 746 patients (22 %) reported having enduring clinical distress at 6 and 15 months postdiagnosis. Of these, 10 % wanted to be referred for care. Fatigue was the most frequently reported problem by patients with and without clinical distress, at both time points. Lack of muscle strength (OR = 1.82, 95 % CI 1.12–2.98), experience of a low level of life satisfaction (OR = 0.77, 95 % CI 0.67–0.89), more frequent cancer worry (OR = 1.40, 95 % CI 1.05–1.89), and neuroticism (OR = 1.09, 95 % CI 1.00–1.18) were predictors of enduring clinical distress. In conclusion, one in five women with breast cancer develops enduring clinical distress. Oncologists, nurse practitioners, and cancer nurses are advised to use single-item questions about distress and distress-related problems to ensure timely detection of high-risk patients. Providers should also routinely assess fatigue and its causes, as fatigue is the most frequently reported distress-related problem over time.

The institution of a Multi‐disciplinary Italian Breast Unit: Reflections of the first psychosocial research study results on distress and quality of life

“…9,10 Prevalence of psychological disorders varies from 20% to 77%. 4,5,[7][8][9][11][12][13][14][15] A decline in quality-of-life is associated, but the need for support tends to remain unrecognized by clinicians and nurses. 5,9,12,16 Distress and quality-of-life in breast cancer patients are relatively understudied in Italy.…”

“…Twenty per cent of patients are commonly affected by emotional distress independent of the disease site and phase . Prevalence of psychological disorders varies from 20% to 77% . A decline in quality‐of‐life is associated, but the need for support tends to remain unrecognized by clinicians and nurses …”

Mechanisms of Neurotoxic Symptoms as a Result of Breast Cancer and Its Treatment: Considerations on the Contribution of Stress, Inflammation, and Cellular Bioenergetics

“…Still, up to 40% of patients experience moderate to severe distress 6 months after diagnosis, and 30% report distress 15 months postdiagnosis [57]. …”

Risk factors of unmet needs among women with breast cancer in the post‐treatment phase

“…Yet, this positive development entails an increasing number of survivors with disease‐ and treatment‐related problems. Many report fatigue, psychological distress, poor physical fitness, motion restriction, lymphedema, sleep problems, cognitive problems, and menopausal symptoms …”

“…Many report fatigue, psychological distress, poor physical fitness, motion restriction, lymphedema, sleep problems, cognitive problems, and menopausal symptoms. [2][3][4][5] Many women with breast cancer receive medical, paramedical, psychosocial, or complementary care to cope with these problems, up to more than 10 years after diagnosis. 6 For most women, the received resources are sufficient.…”