Predictors of Initial Levels and Trajectories of Anxiety in Women Before and for 6 Months After Breast Cancer Surgery

Abstract

Background The diagnosis of breast cancer in combination with the anticipation of surgery evokes fear, uncertainty, and anxiety in most women. Objective In patients who underwent breast cancer surgery, study purposes were to examine how ratings of state anxiety changed from the time of the preoperative assessment to 6 months after surgery and to investigate whether specific demographic, clinical, symptom, and psychosocial adjustment characteristics predicted the preoperative levels of state anxiety and/or characteristics of the trajectories of state anxiety. Interventions/Methods Patients (n=396) were enrolled preoperatively and completed the Spielberger State Anxiety inventory monthly for six months. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of state anxiety. Results Patients experienced moderate levels of anxiety prior to surgery. Higher levels of depressive symptoms and uncertainty about the future, as well as lower levels of life satisfaction, less sense of control, and greater difficulty coping predicted higher preoperative levels of state anxiety. Higher preoperative state anxiety, poorer physical health, decreased sense of control, and more feelings of isolation predicted higher state anxiety scores over time. Conclusions Moderate levels of anxiety persist in women for six months following breast cancer surgery. Implications for Practice Clinicians need to implement systematic assessments of anxiety to identify high risk women who warrant more targeted interventions. In addition, ongoing follow-up is needed in order to prevent adverse postoperative outcomes and to support women to return to their preoperative levels of function.

Psychological adjustment after breast cancer: a systematic review of longitudinal studies

“…Perception of greater overall social support predicted greater quality of life and fewer depressive symptoms but did not predict psychological distress . A sense of isolation predicted higher levels of anxiety in 1 study . Support from physician predicted better quality of life .…”

“…Appraisals and illness perceptions of this type are widely viewed as important determinants of reactions to stress . Perceived control predicted less psychological distress and lower anxiety . One study did not find any association between perceived control and psychological distress .…”

“…55 A sense of isolation predicted higher levels of anxiety in 1 study. 49 Support from physician predicted better quality of life. 29 Supportive care from partners predicted less psychological distress.…”

The relationship of cognitive performance to concurrent symptoms, cancer- and cancer-treatment-related variables in women with early-stage breast cancer: a 2-year longitudinal study

“…The trend toward improvement across non-memory-related domains over time is consistent with a recent meta-analysis which found that when assessing studies of cognition in women with breast cancer with a longitudinal design, long-term memory was the only cognitive domain to produce a significant mean effect size ( d = 0.41); this finding indicates that chemotherapy patients typically exhibited improvements in long-term memory when studied prior to chemotherapy and over time (Ono et al 2015). However, an alternate explanation is that cognitive performance at baseline may have been lower than usual as a result of emotional distress (Pérez et al 2014), recovery from surgery (Kyranou et al 2013), and anxiety over the initiation of chemotherapy (Lyon et al 2015). Further, it is also possible that baseline deficits in cognitive performance observed prior to the initiation of chemotherapy reflect the interactive effects of pre-morbid factors including comorbid medical conditions (Mandelblatt et al 2014), systemic inflammation (Cheung et al 2015), residual anesthesia effects (Ramaiah and Lam 2009), and/or individual differences in cognitive and physiological reserve (Opdebeeck et al 2015).…”

Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life

“…In addition, single assessments of anxiety and depressive symptoms were used to diagnosis CADS. However, significant heterogeneity exists in the trajectories of anxiety and depressive symptoms over the course of patients’ cancer treatment (Kyranou et al, 2014a; Kyranou et al, 2014b). …”