Neo-adjuvant chemotherapy and distress in breast cancer patients: The moderating role of generalized self-efficacy.

Abstract

e21570 Background: Neo-Adjuvant Chemotherapy (NAC) is commonly recommended as a preoperative treatment for patients with locally advanced breast cancers (BC). However, several studies have shown that NAC can increase patients’ distress. A first aim of this study was to evaluate if BC patients treated with NAC show higher levels of distress as compared to patients undergoing primary surgery (PS). A secondary aim was to evaluate if distress could be significantly correlated with patients’ depression and anxiety, and if generalized self-efficacy (GSE) may moderate these relationships. Methods: one hundred and twenty-four BC patients (61 waiting for PS and 63 undergoing NAC), with a mean age of 51.64 (SD = 9.67), were instructed to complete a series of questionnaires evaluating socio-demographic data, anxiety, depression, distress and GSE. Results: An analysis of covariance was conducted, including treatment condition (NAC vs PS) as an independent variable, patients’ distress as a dependent variable, and age as a covariate. A significant mean difference emerged between groups [F(1, 121) = 5.66, p < .05)]. In particular, NAC patients showed a higher distress (Mean = 6.79) than PS ones (Mean = 5.72). Moreover, patients’ distress appeared moderately correlated with both anxiety (r = .34, p < .05) and depression (r = .36 < .05). Finally, results revealed a significant interaction effect of distress and GSE on depression (β = -.19, p < .05), confirming the moderating role of GSE. In particular, for low levels of GSE (-1 SD), the correlation between distress and depression was large and significant (r = .53, p < .001), while for high level of GSE (+1 SD) this relationship was definitively lower (r = .14, p = .03). No significant moderating effects of GSE were found for stress-anxiety relationship. Conclusions: Results of this study seems to confirm that NAC may induce distress in BC patients. Moreover, distress, significantly related to anxiety and depression, may play a detrimental role for patients’ psychological well-being. Finally, GSE emerged as a moderator of distress-depression relationship, suggesting that negative consequences of stress could be reduced during NAC using GSE-based psychological intervention.

Does Use of Neoadjuvant Chemotherapy Affect the Decision to Pursue Fertility Preservation Options in Young Women with Breast Cancer?

“…Additionally, NAC has been associated with higher levels of psychological distress, which have been linked to anxiety and depression. 32 A study of infertile women demonstrated that patients who screened positive for depression were less likely to initiate fertility treatments, highlighting the complexity of potential factors that enter into the decisional calculus regarding fertility treatment. 33 While the finding that receipt of NAC was associated with less-frequent acceptance of REI referral is novel and significant on its own, it becomes even more important in the context of a recent multicenter study that demonstrated that NAC was an independent negative predictor of completing ovarian stimulation following REI consultation.…”

Neoadjuvant Chemotherapy in Breast Cancer: An Advanced Personalized Multidisciplinary Prehabilitation Model (APMP-M) to Optimize Outcomes

“…Chemotherapy generates a distress that, over time, can severely affect patient quality of life [ 47 , 48 ]. A recent study showed that post-NAC patients have a significantly higher level of distress compared to patients receiving chemotherapy after surgery [ 49 ]. Understanding the needs of patients undergoing NAC enables us to address the communication process more appropriately, provide psychological support, and build clinical and rehabilitation interventions in a more personalized way [ 47 ].…”