The Effect of Temperament on the Association Between Pre-treatment Anxiety and Chemotherapy-Related Symptoms in Patients With Breast Cancer

Abstract

Objective Pre-treatment anxiety (PA) before chemotherapy increases complaints of chemotherapy-related symptoms (CRS). The results on the association have been inconsistent, and the effect of temperament remains unclear. We aimed to determine whether PA is a risk factor for CRS and the effect of differing temperaments on CRS.Methods This prospective study comprised 176 breast cancer patients awaiting adjuvant chemotherapy post-surgery. We assessed CRS, PA, and temperament using the MD Anderson Symptom Inventory (MDASI), the Hospital Anxiety and Depression Scale, and the short form of the Temperament and Character Inventory-Revised, respectively. The MDASI was re-administered three weeks after the first chemo-cycle.Results PA showed weak positive correlation with several CRS after the first cycle; no CRS was significantly associated with PA when pre-treatment depressive symptoms and baseline CRS were adjusted in multiple regression analysis. Moderation model analysis indicated that the PA effect on several CRS, including pain, insomnia, anorexia, dry mouth, and vomiting, was moderated by harm avoidance (HA) but not by other temperament dimensions. In particular, PA was positively associated with CRS in patients with low HA.Conclusion The results in patients with low HA indicate that more attention to PA in patients with confident and optimistic temperaments is necessary.

Using temperament and character dimensions (TCI) to analyze the personality profiles of adults and older adults with cancer managed in outpatient settings

“…Our results are in agreement with research using the Temperament and Character Inventory-Revised (TCI-R) test, which showed that some patients are typified by high Harm Avoidance (HA) and low Self-Directedness (SD) compared to a healthy control group ( Honorato et al, 2017 ; Öztürk et al, 2019 ; Choi et al, 2022 ).…”

“…Therefore, Profile 1 - “Low self-determination and pessimism,” highlighted the presence of a high HA and a low SD, which play an important role as indicators of poor avoidance of adverse stimuli, poor response to stressful conditions, and mood decline. Furthermore, they are indicators of poor adaptation to the disease condition and medical treatment ( Aukst Margetić et al, 2013 ; Choi et al, 2022 ).…”

“…In fact, higher SD scores reflect an organized person with defined personal goals, self-determination, and autonomy ( Cloninger et al, 1993 ). These dimensions of personality are associated with higher quality of life, subjective wellbeing, and a good mood in cancer patients ( Bortolato et al, 2017 ; Choi et al, 2022 ). Profile 2 patients showed medium-high values on this dimension.…”

“…Patients with some psychosomatic diseases, including cancer, present unique personality traits, such as an inability to express emotions (and/or emotional repression, particularly anger), conflict avoidance, need for approval from others, low self-affirmation, and a variety of behaviors (e.g., submissiveness, excessive patience, pathological kindness and agreeableness, cooperation), all described as Type C personalities ( Blatnı and Adam, 2008 ; Lin et al, 2012 ; Batıoğlu-Karaaltın et al, 2017 ; Rochefort et al, 2019 ; Cerezo et al, 2020 ; Knefel et al, 2023 ). One of the most important common findings reported by studies is loss avoidance behavior ( Rademaker et al, 2009 ; Aukst Margetić et al, 2013 ; Honorato et al, 2017 ; Rochefort et al, 2019 ; Margetić et al, 2020 ; Choi et al, 2022 ; Vespa et al, 2022 ). Furthermore, for some authors, personality determines whether or not the patient adapts to the disease condition, treatment (e.g., chemotherapy, cobalt therapy), and outcome ( Naylor et al, 2017 ; Burnos and Bargiel-Matusiewicz, 2018 ; Margetić et al, 2020 ).…”