The effect of treatment on patient‐reported distress after breast cancer diagnosis

Abstract

Background The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) uses a 10‐point scale (in which 0 indicates no distress and 10 indicates extreme distress) to measure patient‐reported distress. In the current study, the authors sought to examine the relationship between treatment and NCCN DT scores in patients with breast cancer over time. Methods The authors included women aged ≥18 years who were diagnosed with stage 0 to stage IV breast cancer (according to the seventh edition of the American Joint Commission on Cancer staging system) at a 3‐hospital health system from January 2014 to July 2016. Linear mixed effects models adjusted for covariates including stage of disease, race/ethnicity, insurance, and treatment sequence (neoadjuvant vs adjuvant) were used to estimate adjusted mean changes in the DT score (MSCs) per week for patients undergoing lumpectomy, mastectomy only, and mastectomy with reconstruction (MR). Results The authors analyzed 12,569 encounters for 1029 unique patients (median score, 4; median follow‐up, 67 weeks). Patients treated with MR (118 patients) were younger and more likely to be married, white, and privately insured compared with patients undergoing lumpectomy (620 patients) and mastectomy only (291 patients) (all P < .01). After adjusting for covariates, distress scores were found to decline significantly across all 3 surgical cohorts, with patients undergoing MR found to have both the most preoperative distress and the greatest decline in distress prior to surgery (MSC/week: ‐0.073 for MR vs ‐0.031 for lumpectomy vs ‐0.033 for mastectomy only; P = .001). Neoadjuvant therapy was associated with a longitudinal decline in distress for patients treated with lumpectomy (‐1.023) and mastectomy only (‐0.964). Over time, ductal carcinoma in situ (‐0.503) and black race (‐1.198) were found to be associated with declining distress among patients treated with lumpectomy and MR, respectively, whereas divorced patients who were treated with mastectomy only (0.948) and single patients treated with lumpectomy (0.476) experienced increased distress (all P < .05). Conclusions When examined longitudinally in consecutive patients, the NCCN DT can provide patient‐reported data to inform expectations and guide targeted support for patients with breast cancer.

Perceived stress, anxiety, and depression in treatment‐naïve women with breast cancer: a case‐control study

“…7 However, psychological problems for this duration have been measured less, with the exception of a few longitudinal studies focusing on anxiety and depression. The results of those studies showed that symptoms of anxiety and depression were at high levels before cancer treatment, then either slightly declined 8,9 or increased. 10 Trajectory research found that 9% of patients were consistently anxious and depressed from pre-chemotherapy to 12 months post-chemotherapy.…”

Surgery and Financial Toxicity are Risk Factors for Distress in Cancer Survivors: A Cross-sectional Study

“…[27] Patients with breast cancer who underwent mastectomy with reconstruction reported higher levels of distress compared with patients undergoing lumpectomy and mastectomy only. [10] Our data showed that statistically signi cant differences were noted between the surgery and chemotherapy group for nervousness, pain, and problems with bathing/dressing. Surgical treatment was a signi cant predictor of psychological distress with 3.09 times risk for psychological distress versus chemotherapy treatment.…”

“…Many studies of distress have focused on the emotional problems (e.g., anxiety, depression) and physical problems (e.g., fatigue) of distress, with little attention to treatment-related and nancial factors. [8][9][10] Financial toxicity has been de ned as objective nancial burden and subjective nancial distress experienced by cancer patients as a result of their treatment. [11] Assessment of nancial toxicity may help to build a framework for nancial counseling interventions on par with symptom management (e.g., for fatigue or pain).…”

Patient‐reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis

“…We recently demonstrated that many patients who were newly diagnosed with breast cancer had clinically significant distress levels at initial consultation after diagnosis, but that over time, distress levels eventually declined to low levels for a majority of women 4 . However, we noted significant racial/ethnic differences in levels of self‐reported distress—measured on a scale of 0 (no distress) to 10 (severe distress)—at patients' first postdiagnosis oncology appointments.…”

“…1, Table 1). 4 The median age at diagnosis was 58 years and ranged from 43 to 60 years, with the youngest group being Hispanic women (n = 23) and the oldest group being non‐Hispanic Black women (n = 258). A majority of patients were non‐Hispanic White (65.6%, n = 675), married/partnered (59.2%, n = 609), and had early‐stage (0‐I) disease (59.8%, n = 615).…”