Abstract
ObjectivesWe performed an observational prospective cohort study to investigate post-traumatic stress symptoms, emerging after cancer diagnosis, which could influence patients’ short- and long-term adjustment to illness, in order to foster screening measures and management of psychological factors in daily clinical pathways.MethodsPatients’ post-traumatic stress symptoms, psychological well-being and perceived quality of life were assessed through standardised questionnaires. The Profile of Mood States questionnaire was administered at pre-operative assessment (T0), surgical admission (T1) and discharge from hospital (T2). The Impact of Event Scale and the State-Trait Anxiety Inventory were administered at T0, T1, T2 and 2 years after discharge (T3). At 2-year follow-up, women were also asked to rate their perceived quality of life on a 0–10 visual analogue scale.ResultsBetween January 2014 and April 2015, 150 women were enrolled. Results showed that more than 90% of patients experienced post-traumatic stress symptoms after cancer diagnosis (14% with severe symptoms and 76.7% with moderate symptoms) and post-traumatic stress disorder (PTSD) symptoms that persisted up to the 2-year from discharge follow-up, with significant improvement only 2 years after hospital discharge. In particular, mediation models showed that intrusive thoughts impede mood adjustment to the disease during the pre-surgical phase, with anxiety amplifying the negative effect, while symptoms of avoidance are more detrimental in the long term for patients’ quality of life.ConclusionPTSD symptom clusters have different influence on short- and long-term reaction to illness. Based on this evidence, appropriate interventions to manage PTSDs in the context of oncology should be developed.
Highlights
As it is well known that cancer diagnosis is often experienced like a trauma [16], we decided to administer at all-time points the Impact of Events Scale (IES) [14], one of the most widely used self-report measure within the trauma literature and post-traumatic stress disorder (PTSD) symptoms
As the literature has highlighted how posttraumatic stress disorder (PTSD) symptoms and anxiety levels are strongly related after breast cancer diagnosis and during the overall clinical pathway [1], we investigated whether and how anxiety levels mediate the relationship between post-traumatic stress symptoms and mood adjustment to the disease at different time points
To investigate whether anxiety mediates the relationship between post-traumatic stress symptoms and QoL at T3, we conducted mediation models with Impact of Event Scale (IES) subscales scores, anxiety levels and QoL
Summary
Multidisciplinary management of breast cancer patients, including psychosocial evaluation and screening, is mandatory since psychological distress in the form of post-traumatic and anxious symptoms is demonstrated to be very frequent from the earliest moments of the illness trajectory and revealed to have an influence on the entire process of adjustment to disease [1].Breast cancer recently became part of the chronic disease category, and for this reason, the adjustment process does not end with the traditional treatments but encompasses different aspects of medium- and long-term survivorship, such as family planning, coming back to work, social life and the way women plan their future despite the risk of breast cancer recurrence [2].Studying adjustment has been one of the main purposes of psycho-social oncology since it developed in the early 1970s [3] and this is even more true for breast cancer due to its high prevalence and consistent survival rates [4].Starting from the diagnosis communication to surgery, studies show that this time often implies a difficult adjustment process in which women have to work through the situation [5]. Breast cancer recently became part of the chronic disease category, and for this reason, the adjustment process does not end with the traditional treatments but encompasses different aspects of medium- and long-term survivorship, such as family planning, coming back to work, social life and the way women plan their future despite the risk of breast cancer recurrence [2]. Studying adjustment has been one of the main purposes of psycho-social oncology since it developed in the early 1970s [3] and this is even more true for breast cancer due to its high prevalence and consistent survival rates [4]. Starting from the diagnosis communication to surgery, studies show that this time often implies a difficult adjustment process in which women have to work through the situation [5]. Results in the literature are inconsistent regarding type of surgery and its impact on disease adjustment: in some studies, breast conservative surgery seemed to be correlated with better adjustment as compared to mastectomy; but in other studies, it was associated with poorer quality of life [6, 7]
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