Level of psychological distress in patients with metastatic breast cancer is largely defined by predisposition

Abstract

9579 Background: Psychological distress diminishes quality of life in patients with incurable cancer. Although studies state that distress naturally progresses towards the end of life, it could also result from a patient’s individual susceptibility. Therefore, distress was studied in breast cancer patients who participated in the Dutch Bone Metastasis Study. Methods: From March 1996 to September 1998, 1157 patients with painful bone metastases from solid tumors were randomized between single or multiple fraction radiotherapy. During follow-up, patients filled out 13 weekly and thereafter monthly questionnaires to a maximum of 2 years or until death. The Rotterdam Symptom Checklist psychological subscale of 7 items was used. The minimal sum score is 7, a sum score of 28 indicates maximum psychological distress. A sum score above 17 is valued as needing further psychological assessment. At randomization, 3 risk groups for distress were identified: low (score 7–11), intermediate (score 12–16), and high (score 17–28). Distress was analyzed as a function of remaining lifetime in patients who died within the study period. Age, time since primary diagnosis, performance score, pain score and presence of visceral metastases were studied as baseline risk factors for distress. Results: At randomization, 448 women with breast cancer were identified; 37% was low, 30% intermediate and 33% high risk with regard to distress. Median overall survival was similar in all risk groups (17 months, p= 0.8), with 66% of patients dying within the study period. In the high risk group, mean scoring was constant towards the end of life (table). Both low and intermediate risk groups showed a small increase towards death, but stayed below threshold level. No significant risk factors for distress were found. Conclusions: Predisposition rather than the course of metastatic breast cancer seems to define patients at risk for psychological distress. Interventions should be provided to patients identified as high risk early on in the disease. Distress towards death using the Rotterdam Symptom Checklist psychological subscale. Psychological distress per questionnaire returned towards death#, mean score (SD) Risk groups* Q16 Q12 Q9 Q6 Q3 Q1 Low 9 (2) 9 (2) 9 (2) 9 (3) 10 (4) 11 (4) Intermediate 13 (4) 14 (4) 13 (4) 14 (4) 14 (4) 15 (5) High 18 (5) 17 (5) 17 (5) 18 (5) 17 (5) 18 (5) * sum scoring at randomization into 3 risk groups low risk= 7–11, intermediate risk= 12–16, high risk= 17–28. # refers to the time until death, e.g. Q9 is the ninth questionnaire before death, Q1 is the last questionnaire before death. No significant financial relationships to disclose.