Psychiatric symptoms mediate the effect of resilience on health‐related quality of life in patients with breast cancer: Longitudinal examination

Abstract

Objective Patients with breast cancer receiving neoadjuvant chemotherapy are at increased risk of poor health‐related quality of life (HRQOL). This study examined clinical caseness on depression and anxiety mediate the relationship between resilience and HRQOL in patients with breast cancer. Methods A total of 193 patients with breast cancer undergoing neoadjuvant chemotherapy completed questionnaires including the Connor–Davidson Resilience Scale, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy‐Breast before the first session (T0), before the start of the last session (T1), and 6 months after the end (T2) of chemotherapy. Mediation analyses using a bootstrapping method was performed. Results The indirect effect (IE) through T1 depression was significant (IE through depression = 0.043, 95% confidence interval [CI] [0.002–0.090]), while IE through T1 anxiety was not significant (IE through anxiety = 0.037, 95% CI [−0.010–0.097]) in the association between T0 resilience and T2 HRQOL. Conclusions Clinical caseness on HADS depression subscale during chemotherapy was a mediating factor of the relationship between resilience before chemotherapy and HRQOL after chemotherapy in patients with breast cancer receiving neoadjuvant chemotherapy. Depression during chemotherapy in patients with breast cancer may be a target symptom of screening and intervention to maintain the HRQOL after chemotherapy. Also, patients with low resilience are more likely to develop depression during chemotherapy, and clinicians should carefully monitor whether depression occurs in these patients with low resilience.

Quality of life in patients with breast cancer with neoadjuvant chemotherapy: a systematic review

“…Patients with BC with late chronotype have an increased risk of CINV during NAC. In another study, Lee et al 31 indicated that depression during NAC was a mediator in the relationship between resilience and health-related QOL in patients with BC, and QOL after NAC can be improved by screening and intervening for depression during NAC in patients with BC. Meanwhile, Takada et al 29 reported that high QOL before chemotherapy was an independent factor in overall survival ( table 3 ).…”

“…Seven studies were designed as prospective cohort studies,20–25 three were RCTs,26–28 one was a retrospective cohort study29 and one was a cross-sectional study 30. Two studies were each from Brazil25 27 and Korea,21 31 and one each from China,20 Japan,29 India,22 UK,26 Germany,23 Indonesia,30 Iran24 and the USA 28. One study compared QOL in BC patients with NAC and adjuvant therapy,25 and three studies compared QOL in patients with different regimens of NAC 22 24 26.…”

“…One study compared QOL in BC patients with NAC and adjuvant therapy,25 and three studies compared QOL in patients with different regimens of NAC 22 24 26. Two studies were in the same clinical trial registration with different included subjects 21 31. The QOL-related instruments used were: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, the Quality of Life Questionnaire-Breast Cancer Module, the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Multinational Association of Supportive Care in Cancer Antiemesis Tool, Quality of Life Questionnaire for Cancer Patients Treated with Anti-Cancer Drugs-Breast, Functional Assessment of Cancer Therapy of Breast, Functional Assessment of Cancer Therapy-Taxane, 36-Item Short Form Health Survey Questionnaire, Body Image Scale, Rotterdam Symptom Checklist, Mood Rating Scale, Global Distress Scale, Treatment Side-Effects Questionnaire, Fragebogen erlebter Defizite der Aufmerksamkeit, Rosenberg Self Esteem Scale, Brief Fatigue Inventory and Centre for Epidemiologic Studies–Depression Scale (table 1).…”

“…Eight studies evaluated psychological effects during NAC and 52% of patients get negative effects on psychological aspects (table 2; figure 2). Four studies evaluated emotional function,22 24 25 28 three studies evaluated anxiety/depression21 26 31 and two evaluated role function 24 27. Lee et al 31 reported that the depression in BC patients was most severe during NAC compared with before and after NAC.…”

Tilapia Skin Peptides Ameliorate Cyclophosphamide-Induced Anxiety- and Depression-Like Behavior via Improving Oxidative Stress, Neuroinflammation, Neuron Apoptosis, and Neurogenesis in Mice

“…A significant number of cancer patients have psychological problems (depression, anxiety, cognitive impairment, etc.) following chemotherapy treatment that further reduces the quality of lifestyle ( 3 , 4 ).…”