Trajectories of anxiety among breast cancer patients treated with chemotherapy pre- and post-chemotherapy compared to healthy controls: A nationwide multicenter study.

Abstract

e21711 Background: A diagnosis of breast cancer (BC) elicits a myriad of concerns for women. Treatments are complex, often with multiple components, including chemotherapy. This study describes the trajectory of anxiety among BC patients treated with chemotherapy compared to healthy controls. Methods: This prospective observational study of breast cancer and lymphoma patients is being conducted through the National Cancer Institute Community Oncology Research Program (NCORP). For this analysis, women diagnosed with stage I-III BC and age-matched healthy controls were assessed using the State Trait Anxiety Inventory (STAI) at baseline prior to chemotherapy, 1-month and 6-months post-treatment. Baseline characteristics were compared using Welch’s t-test and chi-squared tests, and proportions of participants reporting anxiety between groups were examined at each time point. Linear mixed models (LMM) were used to compare anxiety trajectories over time, accounting for relevant baseline clinical, medical and demographic factors. Results: Among 945 participants, including 581 BC patients and 364 controls, the average age was 53 years, 91% were White, and 98% were non-Hispanic. Compared to controls, more BC patients reported anxiety scores > 40 at baseline (35% vs. 13%), 1-month (31% vs. 16%), and 6-months (30% vs. 19%), indicating potentially clinically significant anxiety. While BC patients’ anxiety decreased after an apex at baseline, it remained significantly higher than controls’ anxiety at each time point (all p < 0.001), and LMM analysis identified group and group by time interactions for each follow-up (all p < 0.001). Among all participants, predictors of increased anxiety included younger age, post-menopausal status, lower baseline cognitive function and higher baseline depressive symptoms. Conclusions: BC patients reported higher anxiety than controls at all time points, providing further insight into the trajectory of anxiety pre- and post-chemotherapy. Research into optimal timing of assessment and appropriate interventions to minimize anxiety burden in this population is warranted. Clinical trial information: NCT01382082.