Distress In Breast Cancer Patients Research Articles

Study on the cut-off point and the influencing factors of distress in newly diagnosed breast cancer patients.

Our aim is to investigate the cut-off point of distress and the influencing factors associated with distress in patients with newly diagnosed breast cancer. A cross-sectional survey of distress was conducted in 167 patients with newly diagnosed breast cancer admitted to the Department of General Surgery of a tertiary care hospital from July 2020 to March 2022. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) questionnaire within 3 days of admission. The HADS ≥15 was used as the gold standard, and the cut-off point of the DT measure was analyzed using the Receiver Operating Characteristic (ROC) curve. The cut-off point obtained by ROC curve analysis was used to analyze the influencing factors of distress in breast cancer patients by univariate and multivariate regression analysis. A total of 167 patients completed the survey, with an average HADS score of 8.43 ± 5.84 and a total HADS score of ≥15 in 37 (22.16%) patients, the mean DT score was 2.96 ± 1.85. ROC curve analysis showed an area under the curve of 0.885, with a maximum Jorden index (0.723) at a DT score of 4, the sensitivity was 100.0% and specificity was 72.3%. There were 73 (43.71%) patients with DT score ≥ 4. Regression analysis showed that insurance/financial problems, dealing with partner problems, tension, bathing/dressing problems, pain, and sleep problems were independent risk factors for l distress in newly diagnosed breast cancer patients. A DT score 4 is the cut-off point for distress in patients with newly diagnosed breast cancer. In clinical practice, target intervention should be carried out according to the risk factors of distress of patients.

Breast cancer patient experiences of perioperative distress and anxiety: A qualitative study

Distress, often manifesting as anxiety, is common in breast cancer patients and becomes particularly elevated before surgery. This study investigated perspectives of those undergoing breast cancer surgery concerning what enhances and reduces distress and anxiety across the perioperative period (i.e., from diagnostic evaluation to recovery). The present study conducted qualitative semi-structured individual interviews with 15 adult breast cancer surgery patients within three months post-operation. Quantitative surveys provided background information (e.g., sociodemographics). Individual interviews were analyzed using thematic analysis. Quantitative data were analyzed descriptively. Four main themes emerged from qualitative interviews: 1) "fighting an unknown" (sub-themes: uncertainty, health-related knowledge and experience); 2) "the cancer takes away the control" (sub-themes: "living at the whim of others", trusting care providers); 3) person at the centre of the patient (sub-themes: "managing life:" caregiving and work-related stressors, "everybody jumped in to help:" emotional and instrumental support); and 4) physical and emotional impacts of treatment (sub-themes: pain and impacted mobility, "losing a part of yourself"). Breast cancer patients' experiences of surgery-related distress and anxiety were contextualized by broader experiences of care. Our findings illustrate the illness-specific experience of perioperative anxiety and distress in breast cancer patients and inform patient-centered care and intervention.

Abstract P6-05-34: Depression and Psychological Distress in Breast Cancer Patients

Abstract Introduction: Patients with breast cancer are at increased risk for depression and suicide compared to the general population. Breast cancer is unique among other cancers in that some treatments aim to decrease levels of estrogen, a hormone that is intricately linked to mood regulation. The trauma of diagnosis, invasive treatments, and hormone dysregulation all possibly contribute to poor mental health outcomes. Understanding risk factors associated with depression and distress are important for timely interventions. Methods: We performed a retrospective chart review of breast cancer patients seen at Froedtert & MCW Cancer Center Breast Care Clinic between 2019 and 2020. The present study had two aims. The primary aim was to identify breast cancer patient populations at increased risk of depression and psychological distress. Patient populations were distinguished by tumor pathology, patient demographics, and types of treatment interventions. The secondary aim was to identify demographic and clinical variables associated with changes in self-reported distress and depression. Univariate and multivariate analysis of demographic and clinical variables was performed in relation to Patient Health Questionnaire (PHQ) and The National Comprehensive Cancer Network (NCCN) Distress Thermometer scores. Results: Data from 197 patients was analyzed. Patients with a history of depression scored significantly higher on distress screening (mean= 4.4  3.0, p=0.004) versus patients without psychiatric history (mean 2.8  2.9). Patients under 50 years old reported higher levels of distress than patients over 70 years old (p=0.031, beta= -1.0). Self-reported distress declined significantly with increased time from initial diagnosis (p=0.043; p=0.006 at 2 years). Distress was significantly higher prior to initiation of radiation versus during and immediately following therapy (p=0.028). A history of depression, younger age, passage of time, and temporal relationship to radiation treatment were not associated with significant differences in self-reported depression on multivariate analysis. Distress and depression screening scores were not significantly impacted by surgery or chemotherapy (p=0.5; p=0.11 respectively). Conclusion: Patients with a known history of depression and age less than 50 reported significantly higher levels of distress but not depression associated with diagnosis of breast cancer. Distress exhibited a greater downward trend than depression following initiation of oncologic intervention. The results of this study indicate that breast cancer patients are susceptible to significant fluctuations in psychological distress. In contrast, clinically relevant depression screening scores were less frequent and less subject to deviation. Table 1. Multivariate analysis. Citation Format: Kelly R. Cotchett, Adam H. Kelly, Aniko Szabo, Yee Chung Cheng, Sailaja Kamaraju, Christopher Chitambar, Lyndsey Wallace, Lubna N. Chaudhary, John Burfeind. Depression and Psychological Distress in Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-34.

Are Diagnostic Delays Associated with Distress in Breast Cancer Patients?

Introduction: Receiving a new breast cancer diagnosis can cause anxiety and distress, which can lead to psychologic morbidity, decreased treatment adherence, and worse clinical outcomes. Understanding sources of distress is crucial in providing comprehensive care. This study aims to evaluate the relationship between delays in breast cancer diagnosis and patient-reported distress. Secondary outcomes include assessing patient characteristics associated with delay. Methods: Newly diagnosed breast cancer patients who completed a distress screening tool at their initial evaluation at an academic institution between 2014 and 2019 were retrospectively evaluated. The tool captured distress levels in the emotional, social, health, and practical domains with scores of “high distress” defined by current clinical practice guidelines. Delay from mammogram to biopsy, whether diagnostic or screening mammogram, was defined as >30 days. Result: 745 newly diagnosed breast cancer patients met inclusion criteria. Median time from abnormal mammogram to core biopsy was 12 days, and 11% of patients experienced a delay in diagnosis. The non-delayed group had higher emotional (p = 0.04) and health (p = 0.03) distress than the delayed group. No statistically significant differences in social distress were found between groups. Additionally, patients with higher practical distress had longer time interval between mammogram and surgical intervention compared to those with lower practical distress. Older age, diagnoses of invasive lobular carcinoma or ductal carcinoma in situ, and clinical anatomic stages 0-I were associated with diagnostic delay. Conclusion: Patients with higher emotional or health-related distress were more likely to have timely diagnoses of breast cancer, suggesting that patients with higher distress may seek healthcare interventions more promptly. Improved understanding of sources of distress will permit early intervention regarding the devastating impact of breast cancer diagnosis.

Psychological Distress in Breast Cancer Patients during the Italian COVID-19 Pandemic.

Background. The emergency caused by the SARS-CoV-2 pandemic exacerbated psychological distress. Our aim was to investigate the impact of breast cancer on patients’ lives during the Italian lockdown. Methods. Sixty-five female breast cancer patients were studied, assessing the level of psychological distress with the Hospital Anxiety and Depression Scale (HADS) and the impact of the cancer diagnosis (Impact of Event Scale-Revised—IES—R). In addition, we compared these data with a matched group of breast cancer patients enrolled in 2019. Results. Patients enrolled in 2020 had statistically higher levels of anxious symptomatology and higher levels of traumatic symptomatology due to the cancer diagnosis. A mediation analysis was performed to determine how the experience of distress due to COVID-19 negatively impacted the level of anxiety and amplified the impact of the diagnosis with a significant increase in traumatic symptoms. Conclusions. Considering the vulnerability of these patients and the serious and novel situation that the healthcare system is currently facing, we would like to point out the importance of structured and organised psychological support for these patients.

Psychological distress in breast cancer patients during oncological inpatient rehabilitation: incidence, triggering factors and correlation with treatment-induced side effects.

As a result of the cancer diagnosis and the mostly multimodal, stressful therapy, psychological distress is a common symptom in breast cancer patients. As part of this prospective study, 1400 patients who were admitted to the hospital for oncological rehabilitation were screened for distress and somatic, therapy-induced secondary disorders. Mean distress in the screened population was 5.6 ± 2.56 (range 0-10). In 942 cases (67.3%) a significant distress score (≥ 5) was detected and in 587 cases (41.9%) very high levels of distress (≥ 7) was observed. Psychological distress significantly correlated with younger age, presence of triple negative breast cancer (TNBC), tumor recurrence and metastasis, and inability to work. Treatment-induced side effects such as lymphedema, CIPN or extensive tumor resection (mastectomy) showed a (not significant) trend for higher distress. The high incidence of distress underscores the importance of psycho-oncological therapy offers and the great importance of occupational measures during oncological rehabilitation such as the importance of a successful return to work for a better quality of life in breast cancer patients.

Assessment of anxiety, depression, and distress in breast cancer patients: A comparison among different phases of illness

We aimed to assess the levels of anxious and depressive symptoms and distress in a sample of breast cancer patients in the different phases of the illness. We performed a cross-sectional study. We divided 301 female breast cancer patients into three groups, based on the phase of illness they were in being in post-surgery (N = 100), receiving adjuvant therapies (N = 86), and receiving follow-up care (N = 115). We included the follow-up within the phases of illness. We further divided each group into first diagnosed or with recurrence and we administered Hospital Anxiety and Depression Scale and Distress Thermometer. First-diagnosed patients with clinically relevant anxiety increased from being post-surgery (35.8%), to receiving adjuvant therapies (53.7%), and to being in follow-up (61.5%). In patients with recurrence, distress was stable among the illness phases, but many patients had clinically relevant anxiety (55.65%) and depression (43.48%). First-diagnosed patients’ emotional distress could be more linked to follow-up-related difficulties. During recurrence, high distress could be due to the failure of previous treatments. Distress screening can better orient psycho-social interventions and healthcare resources.

Factors that Influence the Incidence of Depression in Breast Cancer Patients

The prevalence of psychological distress in breast cancer patients is high, and they are at higher risk of experiencing severe anxiety, depression, and potential mood disorders. Depression that occurs in breast cancer patients is influenced by several factors. This study aims to determine the factors that influence the incidence of depression in breast cancer patients. The population of this study were all breast cancer patients in the outpatient clinic for oncology surgery and inpatient building A Zone A 2 nd floor at Dr. Cipto Mangunkusumo General Hospital Jakarta, the sample in this study was 102 respondents. The research design used in this study was cross-sectional. The measuring instrument used to measure the incidence of depression is to use depression screening tools in accordance with those used at Dr. Cipto Mangunkusumo General Hospital Jakarta. Items assessing socio-demography, physical symptom burden, social support, and medical and medication history, with complementary medical record reviews, were used to assess variables potentially associated with depressive symptoms. Logistic regression was used to identify associated factors. The incidence of depression in breast cancer patients was dominated by the group of respondents who did not experience depression as many as 57 people (55.9%), compared to the group of respondents who experienced depression as many as 45 people (44.1%). The results of the logistic regression showed that there was only family support variable which had a p = 0.002 < 0.005, meaning that family support was the most influential variable on the incidence of depression in breast cancer patients. It is recommended to reduce the incidence of depression, namely nurses should facilitate adequate family support for breast cancer patients to reduce the incidence of depression.

The Impact of Socioeconomic Status on the Psychological Distress of Breast Cancer Patients in Kolkata"

Background: Breast cancer patients experience a variety of psychological symptoms such as anxiety, depression that affect their quality of life. The present study probed whether the socioeconomic status had any significance on psychological distress and quality of life of breast cancer patients in India.Method: This was a cross-sectional and observational study, conducted over 111 breast cancer patients in a tertiary cancer hospital, Kolkata. Subjects were eligible to participate and they were of over 23rd years of age and had a histologically confirmed diagnosis of breast cancer had no history of recurrence or metastasis, and had no previous psychological problems. Age, marital status, residence, education, occupation and family income were assesses for patients’ socio economic status. Psychological symptoms and quality of life were assessed by using validated tools. Means and standard deviations of each outcome were compared by socioeconomic status and multivariate linear regression models for evaluating the association between socioeconomic status, psychological distress and quality of lifeResults: The patient group was categorized into three groups based on their income level as follows: ≤500=27.9%), 500-1000=51.4% and high income = ≥1000=20.7%. A total of 111 breast cancer patients participated in the study; the mean age of participants was 49.7 (SE=1.31).After using multivariate logistic regression with fully adjusted models, the patients who were living alone had significantly higher level of depression and poor quality of life compared to those who are employed. Higher education and family income both positively associated with quality of life after adjusting for age, marital status and occupation.Conclusion: The findings revealed that the family income have a significant impact on the psychological distress of the cancer patients. 

Determinants of Psychosocial Distress in Breast Cancer Patients at a Safety Net Hospital

IntroductionPsychosocial distress screening of cancer patients is an American College of Surgeons Commission on Cancer mandate for accredited cancer programs. We evaluated psychosocial distress in breast cancer patients to characterize risk factors for high distress scores at a safety net hospital. Materials and MethodsThe psychosocial distress screening form includes a list of potential issues and a distress score scaled from 1 through 10. Psychosocial distress screening results were retrospectively analyzed, along with patient demographics and clinical data. Cochran-Mantel-Haenszel test was applied to identify predictors for high distress scores, which were defined as a score of 5 and greater. Results775 distress screens were completed by 171 breast cancer patients. High distress scores were reported in 21.3%. Patients who had no evidence of disease at time of screening were less likely to report a high distress score compared to those who were newly diagnosed or in active treatment (odds ratio 0.51, 95% CI, 0.38-0.68, P< .0001). Patients with high distress scores were more likely to report concerns with insurance (29.1% vs. 7.6%, P< .0001), transportation (16.4% vs. 4.6%, P< .0001), housing (15.2% vs 2.1%, P< .0001), sadness/depression (63.6% vs. 14.1, P< .0001), and physical issues (89.1% vs. 52.8%, P< .0001). ConclusionStatus of cancer at time of screening, particularly newly diagnosed cancer and active treatment of cancer were associated with high distress scores in this patient group. While there should be an emphasis to ensure patients with these risk factors receive psychosocial distress screening, routine periodic screening for all patients should continue to be implemented to ensure quality cancer care.

Evaluation of psychological distress in breast cancer patients during the COVID- 19 pandemic

Cancer patients are the vulnerable group of population and have more chances of contracting Corona virus disease 2019 (COVID-19). They are at great risk of passing through very stressful events during this COVID-19 pandemic that may lead to different psychological problems. Different psychological symptoms of breast cancer patients are evaluated in this study during the COVID- 19 pandemic. Consecutive fifty women selected with a non-metastatic breast cancer, scheduled to receive cancer treatment in the upcoming days/weeks not. Received treatment in the past, completed the Impact of Event Scale-Revised(IES-R), the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the Fear of Cancer Recurrence Inventory (FCRI). and the Insomnia Severity Index (ISI) and questionnaires. The study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from the 1st July 2020 to the 30th June 2021.. Patients were investigated about their worries regarding the impact of COVID-19 on their lives as carcinoma breast patients. Since the 1st July 2020 to the 30th June 2021, Consecutive 50 patients were prospectively evaluated. They were diagnosed with non-metastatic breast cancer. The mean age was 42.3 (range 30–70). Most of the patients (90%, n. 45) are married, 8% (n.4) patients are single and 2% (n. 1) patients are widowed. Among the patients 24 (48%) patients have high school or less education level, 19 (38%) have college experience and 7 (14%) have university degrees. Ten patients (20%) lived alone, 8 (16%) with one or two family members, and 32 (64%) with three or more family members. Concerning their working life, 36 (72%) were not working (namely housewives, retired, unemployed, or students) and 14 (28%) was occupied. In consideration of economic status 52% (n. 26) patients have annual family income in BDT 250001- 350000. On the other hand 22% (n. 11) within BDT 350001- 450000, 14% (n. 7) within BDT 150000- 250000, 6% (n. 3) within BDT 450001-550000 and 6% (n. 3) within BDT &gt;550000 respectively. We found that 62% of patients had anxiety (HADS-A), 66% depression (HADS-D), and 68% fulfilled the diagnostic criteria for mild post-traumatic stress disorder (PTSD), 2% patients for moderate and 2% patients for severe PTSD. Results revealed that 50% (n.25) patients were suffering from subthreshold insomnia. On the other hand 46% (n.23) patients had no clinically significant Insomnia but 2% (n.1) patients had moderate and severe insomnia in each category. The Fear of Cancer Recurrence Inventory (FCRI) score was 14.7(SD±6.2) which was more than the cut-off value..Breast cancer patients pass through many stressful events that may develop significant psychological symptoms during this COVID-19 pandemic. The outcome of this study definitely contributes to understand the psychological distress of cancer patients and a to formulate a better plan for their management and psychological support.&#x0D; BSMMU J 2021; 14 (COVID -19 Supplement): 36-41

Wearable technology to track activity and distress in breast cancer patients: case series

: Breast cancer is the most common cancer among women with a 5-year survival rate of up to 99% when detected early. This survival rate presents challenges to healthcare systems and providers in terms of ensuring patients receive adequate and timely support during the lengthy and often difficult journey of treatment and survivorship. The primary aim of this quality improvement project piloted the use of the Fitbit Alta HR fitness trackers in a large academic medical center in the south, where 19 breast cancer patients wore and synchronized a Fitbit Alta HR for 28 days. Participants were patients diagnosed with breast cancer (stages 0, I, II, III) who were actively receiving, or who had recently received, breast cancer treatment and care, and who had not previously used any type of health tracking device. The purpose was to understand how self-reported data could enhance patient-centered breast cancer care. Patients provided information on their physical activity and distress status, that enabled certified exercise physiologists to promote healthy lifestyle choices, identify potential treatment complications, and improve the patient’s overall quality of life. Although the sample size was small, a positive correlation between minutes asleep and number of awakenings (r=0.6852), and a negative correlation between distress levels and minutes fairly active (r=−0.3346), stood out as potential indications of the impact of distress on breast cancer patients. This project illuminated the potential value of understanding the ability to, and effectiveness of, capturing relevant patient reported outcomes as a valuable contribution to patient-centered healthcare delivery for patients undergoing treatment for breast cancer. Important findings suggest that building in the daily distress indicators to wearable devices may provide increased utility and expanded insight when such devices are used for patient reported monitoring and outcomes.

Economic Distress of Breast Cancer Patients Seeking Treatment at a Tertiary Cancer Center in Mumbai during COVID-19 Pandemic: A Cohort Study.

Background:Cancer treatment during nationwide lockdown due to the COVID-19 pandemic has posed several challenges in the delivery of cancer care and carries tremendous potential sequel of impoverishing the households. This study aims to examine the economic distress faced by breast cancer patients receiving treatment at Tata Memorial Center (TMC) Mumbai, India during the nationwide lockdown initiated in March 2020 following the outbreak of COVID-19. Methods:A total of 138 non-metastatic breast cancer patients who were accrued in this study at TMC before imposing of lockdown, and their treatment was impacted because of the COVID-19 outbreak, were interviewed. Telephonic interviews were conducted using a structured schedule which contained information on household and demographic characteristics of the patients, knowledge about COVID-19, their daily expenditure for treatment, difficulties faced during lockdown and how they met expenditures. Descriptive statistics and logistic regression were used in the analyses. Results:The average monthly expenditure of cancer patients had increased by 32% during the COVID-19 period while the mean monthly household income was reduced by a quarter. More than two-thirds of the patients had no income during the lockdown. More than half of the patients met their expenditure by borrowing money, 30% of the patients used their savings, 28% got charity and 25% used household income. About 81% of the patients had reported shortage of money, 32% reported shortage of food and 28% reported shortage of medicine. The distress financing was significantly higher among patients receiving treatment in Mumbai compared to those receiving treatment at their native cities (67% vs. 46%), patients under 40 years of age, illiterate, currently married, Muslim and staying at a rented house. Conclusion:The incremental expenditure coupled with reduced or no income due to the closure of economic activities in the country imposed severe financial stress on breast cancer patients.

A Randomized Controlled Pilot Trial About the Influence of Kyusho Jitsu Exercise on Self-efficacy, Fear, Depression, and Distress of Breast Cancer Patients within Follow-up Care

IntroductionBreast cancer survivors are faced with several psychological issues. We report the influence on self-efficacy by a holistic orientated training schedule based on the “Kyusho Jitsu” martial art and explore the effects on self-efficacy, distress, fear, and depression.MethodsBreast cancer survivors (N = 51) were randomly assigned to an intervention (n = 30) or control group (n = 21). The intervention group participated in a Kyusho Jitsu intervention twice a week over a period of 6 months, the control group received no intervention. Patients from both groups were measured at baseline, 3 and 6 months on level of self-efficacy (German General-Self-Efficacy Scale, SWE), stress (Perceived Stress Questionnaire, PSQ20), and fear and depression (Hospital Anxiety and Depression Scale, HADS).ResultsAnalysis of the original data showed a significant difference between both groups regarding the subscale “joy” (P = .018). Several significant results within the intervention group were seen in self-efficacy (P = .014), fear (P = .009) and the overall score for fear and depression (P = .043). Both groups improved significantly within “worries” (intervention P = .006, control P = .019) and the PSQ20 overall score (both P = .005). The control group also significantly improved in the subscale for “demands” (P = .019).ConclusionTo summarize, our pilot study showed that Kyusho Jitsu training is safe and feasible. Though, the intervention alone cannot be considered as being effective enough to help breast cancer survivors regarding relevant psychological issues, but might be an important supplement offer within follow-up care.

Effectiveness and Determinant Factors of Successfull Scalp Cooling in Preventing Chemotherapy Induced Alopecia in Breast Cancer Patients : Literature Review

Background: Chemotherapy induced Alopecia (CIA) is one of the most complained and cause the highest distress in breast cancer patients with chemotherapy. Cryotherapy or Scalp Cooling is an alternative intervention to reduce metabolism of cytotoxic agents against hair follicle by lowering the temperature of the scalp. Literature that discusses the effectiveness of Cryotherapy in breast cancer patients is still limited.Objective: Summarize and investigate the effect of Cryotherapy on preventing Chemotherapy induced Alopecia in breast cancer patients and its determinant factors of successfull Cryotherapy . Design: Literature ReviewData Sources: A search was performed by using Ebscohost, Scopus, Science Direct, and ProQuest database from 2009 to 2019 for research article.Review methods: A systematic process was used to analyze and extract data include studies using CASP.Result: From 278 articles that have been observed using CASP, only 10 articles match the inclusion criteria. Total respondents in 10 articles were 1201 breast cancer patients undergoing chemotherapy. All articles used in this study showed positive results about the effect of Cryotherapy on decreasing the severity of Chemotherapy Induced Alopecia (CIA) measured by hair preservation, hair loss, hair regrowth, and decreasing use a wig or head covering. The importance of continuously monitoring the patient's condition to manage the side effects caused by Cryotherapy such as headaches, cold, and nausea.Conclusion:Cryotherapy significantly reduce the severity of CIA by inhibit the process of mitosis and vasoconstriction. There are several factors that must be considered when giving Cryotherapy, such as type of chemotherapy, dosages, device, duration of administration, and temperature. For further research, it is important to considered some factors that can affect the successfull of Cryotherapy and the patient response

Emotional state, fatigue, functional status and quality of life in breast cancer: exploring the moderating role of psychological inflexibility

ABSTRACT Previous findings demonstrate that psychological flexibility (PF) might be a protective factor regarding distress in breast cancer patients. Our research aimed to examine the moderating effect of psychological inflexibility (PI) on the relationship between emotional state, fatigue, functional status and quality of life (QOL) in breast cancer. The research was conducted on 64 women (Mage=58.36, SD=11.30) while undergoing radiation therapy. Five moderation analyses were performed with depression, anxiety, stress (Depression Anxiety Stress Scales – 21; DASS-21), fatigue (the Fatigue Assessment Scale Serbian; FAS) and functional status (the Upper Extremity Functional Index; UEFI) as predictors, QOL (Quality of Life Instrument – Breast Cancer Patient Version; QOL-BC) as criterion and PI (Acceptance and Action Questionnaire; AAQ II) as a moderator. The significant moderating effect of PI was obtained in the relationship of QOL with the depression, anxiety, fatigue and functional status. As anxiety, depression, fatigue and functional difficulties decrease, participants who are psychologically flexible report better QOL. On the other hand, psychologically inflexible individuals consistently report impaired QOL, regardless of whether indicators of depression, anxiety, fatigue and diminished functional status are prominent or not. Our findings support the notion that PF may have an important role in the improvement of emotional state and QOL in breast cancer patients. It would be also plausible to assume that interventions aimed at modifying the capacity for PF, might be useful in coping with fatigue and functional complications, which should be explored in future studies.

Managing Cancer and Living Meaningfully (CALM) Intervention on Chemotherapy-Related Cognitive Impairment in Breast Cancer Survivors.

Objective: To evaluate the effectiveness and feasibility of Managing Cancer and Living Meaningfully (CALM), which is used to reduce chemotherapy-related cognitive impairment (CRCI), relieve psychological distress, and improve quality of life (QOL) in Chinese breast cancer survivors (BCs). Methods: Seventy-four BCs were enrolled in this study. All patients were randomly assigned to either the CALM group or the care as usual (CAU) group. All patients were evaluated by the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog), Distress Thermometer (DT), and the Functional Assessment of Cancer Therapy–Breast (FACT-B) before and after CALM or CAU application to BCs with CRCI. We compared the differences in all these scores between the CALM group and the control group and analyzed the correlation between cognitive function and QOL. Results: Compared with the CAU group, the performance of the CALM group on the FACT-Cog, DT, and FACT-B showed significant differences before and after CALM (t = −18.909, −5.180, −32.421, P = .000, .000, .000, respectively). Finally, there was a positive correlation between cognitive function and QOL in breast cancer patients before (r = 0.579, P = .000) and after (r = 0.797, P = .000) treatment. Conclusions: The present results indicated that CALM has salutary effects on the improvement of cognitive impairment and QOL and relieves psychological distress in breast cancer patients, which may be due to a positive correlation between psychological distress and cognitive function or QOL.

Surgical impact on anxiety of patients with breast cancer: 12-month follow-up prospective longitudinal study.

PurposeBreast cancer diagnosis and treatment often produce stress in patients. Anxiety is one of the most prevalent psychological symptoms perceived by breast cancer patients. This study aims to evaluate the temporal patterns of anxiety and find factors associated with persistent anxiety during breast cancer treatment.MethodsThis is prospective cohort study. Between July 2010 and July 2011, we recruited patients with nonmetastatic breast cancer who were expected to receive adjuvant chemotherapy (n = 411) from 2 cancer hospitals in Seoul, Korea. Anxiety was measured using the Hospital Anxiety and Depression Scale.ResultsThe mean age of the participants was 46.4 ± 7.9 years. Preoperatively, 44.5% (183 of 411) of the patients showed abnormal anxiety. The proportion of the abnormal anxiety group significantly decreased after surgery (P < 0.01) and this phenomenon continued until the 12-month follow-up point. Patients experienced renewed anxiety at 12 months when the main adjuvant therapies were finished. Socioeconomic factors were not associated with persistent anxiety. Pain, breast, and arm symptoms were significantly higher in the persistently abnormal group, especially at postoperative months 6 and 12.ConclusionSurgery was a major relieving factor of anxiety, and patients who finished their main adjuvant treatment experienced renewed anxiety. Surgeons should be the main detectors and care-givers with respect to psychological distress in breast cancer patients. To reduce persistent anxiety, caring for the patient's physical symptoms is important.

Cognitive Performance and Psychological Distress in Breast Cancer Patients at Disease Onset.

ObjectiveMany cancer patients complain about cognitive dysfunction. While cognitive deficits have been attributed to the side effects of chemotherapy, there is evidence for impairment at disease onset, prior to cancer-directed therapy. Further debated issues concern the relationship between self-reported complaints and objective test performance and the role of psychological distress.MethodWe assessed performance on neuropsychological tests of attention and memory and obtained estimates of subjective distress and quality of life in 27 breast cancer patients and 20 healthy controls. Testing in patients took place shortly after the initial diagnosis, but prior to subsequent therapy.ResultsWhile patients showed elevated distress, cognitive performance differed on a few subtests only. Patients showed slower processing speed and poorer verbal memory than controls. Objective and self-reported cognitive function were unrelated, and psychological distress correlated more strongly with subjective complaints than with neuropsychological test performance.ConclusionThis study provides further evidence of limited cognitive deficits in cancer patients prior to the onset of adjuvant therapy. Self-reported cognitive deficits seem more closely related to psychological distress than to objective test performance.

We are in this together - Aren't we? Congruence of common dyadic coping and psychological distress of couples facing breast cancer.

Breast cancer (BC) can be understood as a we-disease, which affects a couple as a unit and requires coping as a unit (eg, common dyadic coping, CDC). However, partners can be incongruent in their perceptions of CDC, for example, because of misunderstandings and lack of mutuality or conflict, which may likely be associated with greater distress. Thus, this paper examines the effect of CDC congruence on individual psychological distress in cancer patients and their partners. Seventy mixed-sex couples in which the woman had nonmetastatic BC completed self-report questionnaires at 2 weeks, 3 months, and 1 year after cancer surgery. CDC congruence measured the difference between patients' and partners' CDC perceptions while controlling for CDC itself. Multilevel modeling showed negative associations between couples' CDC and psychological distress. Beyond this effect, female patients' psychological distress was associated with CDC congruence with an interaction showing that psychological distress was greater when couples were congruent with low rather than a high CDC. Less congruence was associated with greater psychological distress in BC patients but not their male partners - especially if the couple reported low CDC. Health professionals should identify and address diverging perceptions, so that additional distress can be minimized for BC patients.