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Emotional distress and unmet supportive care needs in survivors of breast cancer beyond the end of primary treatment

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Abstract

Purpose

Cancer patient survival rates are rapidly growing, and further data are needed on the impact of the disease beyond diagnosis and treatment phases. The aims of this study were to analyze the prevalence and sociodemographic and medical risk factors of clinical distress. Additionally, we also explore the relationship between unmet psychosocial needs and both clinical distress and subgroups of survival periods.

Methods

A cross-sectional study of 450 women who at least 1 month before had completed the primary treatment for breast cancer was conducted. The Brief Symptom Inventory 18 and the Cancer Survivors Unmet Needs measure were used.

Results

One in four women showed clinical distress related to unmet psychosocial needs. None of the sociodemographic and medical predictors was associated with clinical distress. Needs focused on the possibility of recurrence and its cognitive-emotional impact were the most frequent. Needs tended to decrease through periods of survival; however, there was a considerable level of unmet needs even among long-term survivors.

Conclusions

The findings highlight the relevance of extending psychosocial care beyond the breast cancer primary medical treatment. Early and regular screen for distress and unmet supportive needs permits to identify high-risk groups that likely benefit from targeted preventive interventions.

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References

  1. De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D et al (2014) Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. 15:23–24. https://doi.org/10.1016/S1470-2045(13)70546-1

  2. CanCOn (2017) European guide on quality improvement in comprehensive cancer control. https://cancercontrol.eu/archived/uploads/images/Guide/pdf/CanCon_Guide_FINAL_Web.pdf. Accessed 20 May 2017

  3. Aaronson NK, Mattioli V, Minton O, Weis J, Johansen C, Dalton S et al (2014) Beyond treatment- psychosocial and behavioral issues in cancer survivorship research practice. Eur J Cancer 54–64. https://doi.org/10.1016/j.ejcsup.2014.03.005

  4. Valdivieso M, Kujawa AM, Jones T, Baker LH (2012) Cancer survivors in the United States: a review of the literature and a call to action. Int J Med Sci 9:163–173. https://doi.org/10.7150/ijms.3827

    Article  PubMed  PubMed Central  Google Scholar 

  5. NCI (2017) Cancer control continuum. http://cancercontrol.cancer.gov/od/continuum.html. Accessed 20 Dec 2017

  6. Wronski SL (2015) Defining cancer survivor and cancer survivorship: the who, what and when. Psicooncología 12:7–18. https://doi.org/10.5209/rev_PSIC.2015.v12.n1.48900

    Article  Google Scholar 

  7. Burris JL, Armeson K, Sterbal KR (2015) A closer look at unmet needs at the end of primary treatment for breast cancer: a longitudinal pilot study. Behav Med 41:69–76. https://doi.org/10.1080/08964289.2014.889068

    Article  PubMed  Google Scholar 

  8. Guiliani M, McQuestion M, Jones J, Papadakos J, Le LW, Alkazaz N et al (2016) Prevalence and nature of survivorship needs in patients with head and neck cancer. Head Neck 38:1097–1103. https://doi.org/10.1002/hed.24411

    Article  Google Scholar 

  9. Rowlands IJ, Janda M, McKinnon L, Webb PM, Beesly VL (2014) Prevalence, predictors, and correlates of supportive care needs among women 3–5 years after a diagnosis of endometrial cancer. Support Care Cancer 23:1205–1214. https://doi.org/10.1007/s00520-014-2456-0

    Article  PubMed  Google Scholar 

  10. Feuerstein M (2007) Defining cancer survivorship. J Cancer Surviv 1:5–7. https://doi.org/10.1007/s11764-006-0002-x

    Article  PubMed  Google Scholar 

  11. Stanton A, Rowland JH, Ganz PA (2015) Life after diagnosis and treatment of cancer in adulthood. Contributions from psychosocial oncology research. Am Psychol 70:159–174. https://doi.org/10.1037/a0037875

    Article  PubMed  Google Scholar 

  12. Holland JC, Andersen B, Breitbart WS, Buchmann LO, Compas B, Deshields TL, Dudley MM, Fleishman S, Fulcher CD, Greenberg DB, Greiner CB, Handzo GF, Hoofring L, Hoover C, Jacobsen PB, Kvale E, Levy MH, Loscalzo MJ, McAllister-Black R, Mechanic KY, Palesh O, Pazar JP, Riba MB, Roper K, Valentine AD, Wagner LI, Zevon MA, McMillian NR, Freedman-Cass DA (2013) Distress management. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw 11:190–209

    Article  Google Scholar 

  13. NCCN (2017) NCCN clinical practice guidelines in oncology: survivorship. https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. Accessed 20 Dec 2017

  14. Hoffman K, McCarthy E, Recklitis C, Andrea K (2009) Psychological distress in long-term survivors of adult-onset cancer. American Medical Association. Arch Intern Med 169:1274–1281. https://doi.org/10.1001/archinternmed.2009.179

    Article  PubMed  Google Scholar 

  15. Syrjala KL, Yi J (2017) Overview of psychosocial issues in the adult cancer survivor. In: Post TW (ed) UpToDate. UpToDate Inc., Waltham. http://www.uptodate.com. Accessed 15 Jan 2018

  16. Zhao G, Li C, Li J, Balluzet LS (2012) Physical activity, psychological distress, and receipt of mental healthcare services among cancer survivors. J Cancer Surviv 7:131–139. https://doi.org/10.1007/s11764-012-0254-6

    Article  PubMed  Google Scholar 

  17. Avis NE, Levine B, Naughton MJ, Case DL, Naftalis E, Van Zee KJ (2013) Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment. Breast Cancer Res Treat 139:199–206. https://doi.org/10.1007/s10549-013-2513-2

    Article  PubMed  Google Scholar 

  18. Kaiser NC, Hartoonian N, Owen JE (2010) Toward a cancer-specific model of psychological distress: population data from the 2003-2005 National Health Interview Surveys. J Cancer Surviv 4:291–302. https://doi.org/10.1007/s11764-010-0120-3

    Article  PubMed  Google Scholar 

  19. Harrison SE, Watson EK, Ward AM, Khan NF, Turner D, Adams E, Forman D, Roche MF, Rose PW (2011) Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey. J Clin Oncol 29:2091–2098. https://doi.org/10.1200/JCO.2010.32.5167

    Article  PubMed  Google Scholar 

  20. Kornblith AB, Herndon JE, Weiss RB, Zhang C, Zuckerman E et al (2003) Long-term adjustment of survivors of early-stage breast carcinoma 20 years after adjuvant chemotherapy. Cancer 98:679–689. https://doi.org/10.1002/cncr.11531

    Article  PubMed  Google Scholar 

  21. Ploos van Amstel FK, van den Berg SW, van Laarhoven HW, Gielissen MFM, Prins JB, Ottevanger PB (2013) Distress screening remains important during follow-up after primary breast cancer treatment. Support Care Cancer 21:2107–2115. https://doi.org/10.1007/s00520-013-1764-0

    Article  PubMed  Google Scholar 

  22. Wells M, Cunningham M, Lang H, Swartzman S, Philip J, Taylor L, Thomson J (2015) Distress, concerns and unmet needs in survivors of head and neck cancer: a cross-sectional survey. Eur J Cancer Care 24:748–760. https://doi.org/10.1111/ecc.12370

    Article  CAS  Google Scholar 

  23. Boyes A, Girgis A, D’Este C, Zucca AC (2012) Prevalence and correlates of cancer survivors’ supportive care needs 6 months after diagnosis: a population-based cross-sectional study. BMC Cancer 12:150. https://doi.org/10.1186/1471-2407-12-150

    Article  PubMed  PubMed Central  Google Scholar 

  24. Harrison J, Young J, Price M, Butow P, Solomon M (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 17:1117–1128. https://doi.org/10.1007/s00520-009-0615-5

    Article  PubMed  Google Scholar 

  25. Fiszer C, Dolbeault S, Sultan S, Brédart A (2014) Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psycho-Oncology 23:361–374. https://doi.org/10.1002/pon.3432

    Article  PubMed  Google Scholar 

  26. Derogatis LR (2013) Brief Symptom Inventory (BSI-18). National Computer Sistema Pearson, Inc, Minneapolis

    Google Scholar 

  27. Derogatis LR (2001) Brief Symptom Inventory (BSI)-18. Administration, scoring and procedures manual. NCS Pearson, Inc, Minneapolis

    Google Scholar 

  28. Galdón MJ, Durá E, Andreu Y, Ferrando M, Mugui S, Pérez S et al (2008) Psychometric proprieties of the Brief Symptoms Inventory 18 (bsi-18) in a Spanish breast sample. J Psychosom Res 65:533–539. https://doi.org/10.1016/j.jpsychores.2008.05.009

    Article  PubMed  Google Scholar 

  29. Martínez P, Andreu Y, Galdón MJ (under review) Psychometric properties of Brief Symptom Inventory-18 in heterogeneous sample of adult cancer patients

  30. Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hob KM, Lo SK et al (2007) The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: the CaSUN (Cancer Survivors’ Unmet Needs measure). Psycho-Oncology 16:796–804. https://doi.org/10.1002/pon.1137

    Article  CAS  PubMed  Google Scholar 

  31. Phipps AI, Ichikawab L, Bowlesb EJA, Carneyc P, Kerlikowsked K, Migliorett DL (2010) Defining menopausal status in epidemiologic studies: a comparison of multiple approaches and their effects on breast cancer rates. Maturitas 67:60–66. https://doi.org/10.1016/j.maturitas.2010.04.015

    Article  PubMed  PubMed Central  Google Scholar 

  32. Vehling S, Mehnert A, Hartmann M, Oing C, Bokemeyer C, Oechsle K (2016) Anxiety and depression in long-term testicular germ cell tumor survivors. Gen Hosp Psychiatry 38:21–25. https://doi.org/10.1016/j.genhosppsych.2015.09.001

    Article  CAS  PubMed  Google Scholar 

  33. Mehnert A, Koch U (2008) Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res 64:383–391. https://doi.org/10.1016/j.jpsychores.2007

    Article  PubMed  Google Scholar 

  34. Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B (2006) Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncology 15:306–320. https://doi.org/10.1002/pon.955

    Article  PubMed  Google Scholar 

  35. Wenzel LB, Donnelly JP, Fowler JM, Habbal R, Taylor TH, Aziz N, Cella D (2002) Resilience, reflection, and residual stress in ovarian cancer survivorship: a gynecologic oncology group study. Psycho-Oncology 11:142–153

    Article  PubMed  Google Scholar 

  36. Jacobsen PB, Rowland JH, Paskett ED, Van Leeuwen F, Moskowitz C, Katta S, Wollins D, Robison LL (2016) Identification of key gaps in cancer survivorship research: findings from the American Society of Clinical Oncology Survey. J Oncol Pract 12:190–193. https://doi.org/10.1200/JOP.2015.009258

    Article  PubMed  Google Scholar 

  37. Carr W, Wolfe S (1976) Unmet needs as sociomedical indicators. Int J Health Serv 6:417–430. https://doi.org/10.2190/MCG0-UH8D-0AG8-VFNU

    Article  CAS  PubMed  Google Scholar 

  38. Montazeri A, Vahdaninia M, Harirchi I, Ebrahimi M, Khaleghi F, Jarvandi S (2008) Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study. BMC Cancer 8:30. https://doi.org/10.1186/1471-2407-8-330

    Article  Google Scholar 

  39. Holland JC, Reznik I (2005) Pathways for psychosocial care of cancer survivors. Cancer 104:2624–2637

    Article  PubMed  Google Scholar 

  40. Stanton AL (2015) What happens now? Psychosocial care for cancer survivors after medical treatment completion. J Clin Oncol 30:1215–1220. https://doi.org/10.1200/JCO.2011.39.7406

    Article  Google Scholar 

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Acknowledgments

The authors are thankful to the participants and staff of collaborative centers for their cooperation: Fundación Instituto Valenciano de Oncología, Hospital Clínico Universitario de Valencia; Hospital General de Albacete, Hospital Perpetuo Socorro de Albacete; Hospital Rio Ortega de Valladolid, Asociación Española Contra el Cáncer de Valencia y Albacete; Asociación “Vivir como antes” en Valencia; Asociación de Mujeres Afectadas de Cáncer de Mama y Ginecológico de Albacete; Associació pel suport i ajuda en el tractament del càncer of L’Alcoia i El Comtat; and Associació pel suport i ajuda en el tractament del cancer of Castalla.

Funding

This research was funded by the Ministry of Economy and Competitiveness, Government of Spain (PSI2013-45905-R).

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Correspondence to Olga Martínez Arroyo.

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The study was approved by the Ethics Committee of Institutions.

Conflict of interest

The authors declare that they have no competing interests.

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Martínez Arroyo, O., Andreu Vaíllo, Y., Martínez López, P. et al. Emotional distress and unmet supportive care needs in survivors of breast cancer beyond the end of primary treatment. Support Care Cancer 27, 1049–1057 (2019). https://doi.org/10.1007/s00520-018-4394-8

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