Factors Influencing Elevated Distress Scores at the End of Primary Treatment of Breast Cancer

Jin-Hee Park; Sun Hyoung Bae; Mison Chun; Yong-Sik Jung; Young-Mi Jung

doi:10.5388/aon.2015.15.3.132

Journal List > Asian Oncol Nurs > v.15(3) > 1081835

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Bae, Chun, Jung, and Jung: Factors Influencing Elevated Distress Scores at the End of Primary Treatment of Breast Cancer

Original Article

Asian Oncology Nursing 2015; 15(3): 132-139.

Published online: 30 September 2015

DOI: https://doi.org/10.5388/aon.2015.15.3.132

Factors Influencing Elevated Distress Scores at the End of Primary Treatment of Breast Cancer

Jin-Hee Park¹, Sun Hyoung Bae¹, Mison Chun², Yong-Sik Jung², Young-Mi Jung¹

¹College of Nursing·Nursing Research Institute, Ajou University, Suwon, Korea.

²School of Medicine, Ajou University, Suwon, Korea.

Address reprint requests to: Jung, Young Mi. College of Nursing·Nursing Research Institute, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-7019, Fax: +82-31-219-7020, jdudal@ajou.ac.kr

Received 18 June 2015 Revised 27 August 2015 Accepted 22 September 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to determine the prevalence of distress and to investigate the related problems in breast cancer patients at the end of primary treatment.

Methods

A sample of 118 participants was recruited among outpatients who had successfully completed primary treatment of breast cancer. Data were collected between July, 2013 and October, 2014 using the Distress Thermometer (DT) scale and problem lists. Descriptive statistics and logistic regression analysis were used to analyze data.

Results

Among the 118 patients that participated in this study, 34 patients (28.8%) suffered from elevated distress using the previously validated cut point ≥4 for the DT. Problems most frequently encountered were fatigue (68.8%), worry (59.3%), appearance (51.7%) and memory/concentration (48.3%). Multivariate logistic regression analysis revealed that depression (OR=9.55), worry (OR=8.34), fatigue (OR=8.19) and age (OR=1.14) were independent predictors for elevated distress scores.

Conclusion

Utilizing the DT, onethird of breast cancer patients screened met criteria for distress at the end of the primary treatment. Breast cancer patients with depression, worry, fatigue and older age should be targeted for distress screening and management.

Keywords: Breast Neoplasms, Psychological Distress, Depression, Survivors

Figures and Tables

Table 1

Demographic and Treatment-Related Factors of Patients in Mild Distress Group and Moderate-Severe Distress Group

Characteristics	Categories	Total (N = 118)	Mild distress group (n = 84)	Moderate-severe distress group (n = 34)	χ² or t	p
Characteristics	Categories	n (%) or M ± SD	n (%) or M ± SD	n (%) or M ± SD	χ² or t	p
Age (year)		45.6 ± 7.0	44.5 ± 6.9	48.2 ± 6.9	- 2.64	.009
Educational level^*	≤ Middle school	11 (9.3)	6 (7.1)	5 (14.7)	1.64	.201
Educational level^*	≥ High school	107 (90.7)	78 (92.9)	29 (85.3)	1.64	.201
Presence of spouse	No	20 (16.9)	9 (10.7)	11 (32.4)	8.05	.005
Presence of spouse	Yes	98 (83.1)	75 (89.3)	23 (67.6)	8.05	.005
Religion	No	45 (38.1)	31 (36.9)	14 (41.2)	0.19	.665
Religion	Yes	73 (61.9)	53 (63.1)	20 (58.8)	0.19	.665
Occupation	No	61 (51.7)	44 (52.4)	17 (50.0)	0.06	.815
Occupation	Yes	57 (48.3)	40 (47.6)	17 (50.0)	0.06	.815
Healthcare support^*	No	9 (7.6)	7 (8.3)	2 (5.9)	0.21	1.000
Healthcare support^*	Yes	109 (92.4)	77 (91.7)	32 (94.1)	0.21	1.000
Monthly household income (10,000 won)	≤ 200	13 (11.0)	7 (8.3)	6 (17.7)	2.45	.293
	> 200~ ≤ 400	33 (28.0)	23 (27.4)	10 (29.4)
	> 400	72 (61.0)	54 (64.3)	18 (52.9)
Site of surgery	Right	67 (56.8)	50 (59.5)	17 (50.0)	3.10	.212
	Left	50 (42.4)	34 (40.5)	16 (47.1)
	Bilateral	1 (0.8)	0 (0.0)	1 (2.9)
Type of surgery^*	PM	109 (92.4)	77 (91.7)	32 (94.1)	0.21	1.000
Type of surgery^*	TM	9 (7.6)	7 (8.3)	2 (5.9)	0.21	1.000
Axillary lymph node dissection	No	87 (73.7)	63 (75.0)	24 (70.6)	0.24	.622
Axillary lymph node dissection	Yes	31 (26.3)	21 (25.0)	10 (29.4)	0.24	.622
Stage	Stage I	58 (49.1)	41 (48.8)	17 (50.0)	1.54	.463
	Stage II	54 (45.8)	40 (47.6)	14 (41.2)
	Stage III	6 (5.1)	3 (3.6)	3 (8.8)
Treatment plan	OP + CTx	7 (5.9)	6 (7.1)	1 (2.9)	2.06	.356
	OP + RTx	39 (33.1)	30 (35.7)	9 (26.5)
	OP + CTx + RTx	72 (61.0)	48 (57.2)	24 (70.6)
Adjuvant hormone therapy	No	40 (33.9)	27 (32.1)	13 (38.2)	0.40	.527
Adjuvant hormone therapy	Yes	78 (66.1)	57 (67.9)	21 (61.8)	0.40	.527

CTx=Chemotherapy; M=Mean; Op=Operation; PM=Partial mastectomy; RTx=Radiotherapy; SD=Standard deviation; TM=Total mastectomy.

^*Fisher's exact test.

Table 2

Problem Lists in Mild Distress Group and Moderate-Severe Distress Group

Variables	Total (N = 118)	Mild distress group (n = 84)	Moderate-severe distress group (n = 34)	χ² or t	p
Variables	n (%) or M ± SD	n (%) or M ± SD	n (%) or M ± SD	χ² or t	p
Distress thermometer	2.71 ± 2.43	1.37 ± 1.04	6.03 ± 1.49	- 16.70	< .001
Practical domain
Housing	45 (38.1)	29 (34.5)	16 (47.1)	1.61	.204
Child care	27 (22.9)	17 (20.2)	10 (29.4)	1.15	.283
Transportation	24 (20.3)	13 (15.5)	11 (32.3)	4.26	.039
Insurance/financial	19 (16.1)	12 (14.3)	7 (20.6)	0.71	.399
Work/school^*	18 (15.3)	14 (16.7)	4 (11.8)	0.45	.584
Treatment decision	14 (11.9)	7 (8.3)	7 (20.6)	3.48	.062
Family domain
Family health issues	44 (37.3)	27 (32.1)	17 (50.0)	3.30	.063
Dealing with children	22 (18.6)	15 (17.9)	7 (20.6)	0.12	.730
Dealing with partner	20 (16.9)	13 (15.5)	7 (20.6)	0.45	.503
Ability to have children^*	8 (6.8)	5 (6.0)	3 (8.9)	0.32	.688
Emotional domain
Worry	70 (59.3)	39 (46.4)	31 (91.2)	20.08	< .001
Fear	47 (39.8)	24 (28.6)	23 (67.6)	15.42	< .001
Depression	39 (33.1)	12 (14.3)	27 (79.4)	46.39	< .001
Nervousness	36 (30.5)	19 (22.6)	17 (50.0)	8.56	.003
Sadness	31 (26.3)	12 (14.3)	19 (55.9)	21.62
Loss of interest in usual activities	29 (24.6)	11 (13.1)	18 (52.9)	20.73	< .001
Spiritual/religious domain^*	5 (4.2)	4 (4.8)	1 (2.9)	0.20	1.000
Physical domain
Fatigue	81 (68.6)	51 (60.7)	30 (88.2)	8.52	.004
Appearance	61 (51.7)	38 (45.2)	23 (67.6)	4.87	.027
Memory/concentration	57 (48.3)	32 (38.1)	25 (73.5)	12.17	< .001
Skin dry/itchy	53 (44.9)	36 (42.9)	17 (50.0)	0.50	.480
Tingling in hands/feet	50 (42.4)	34 (40.5)	16 (47.1)	0.43	.512
Bathing/dressing	45 (38.1)	27 (32.1)	18 (52.9)	4.44	.035
Sleep	45 (38.1)	28 (33.3)	17 (50.0)	2.85	.091
Pain	44 (37.3)	30 (35.7)	14 (41.2)	0.31	.578
Feeling Swollen	35 (29.7)	22 (26.2)	13 (38.2)	1.68	.195
Indigestion	22 (18.6)	13 (15.5)	9 (26.5)	1.93	.165
Nose dry/congested	20 (16.9)	14 (16.7)	6 (17.6)	0.02	.898
Eating	19 (16.1)	8 (9.5)	11 (32.4)	9.34	.002
Getting around	19 (16.1)	6 (7.1)	13 (38.2)	17.32	< .001
Sexual	18 (15.3)	14 (16.7)	4 (11.8)	0.45	.502
Fevers	16 (13.6)	9 (10.7)	7 (20.6)	2.01	.156
Nausea	14 (11.9)	8 (9.5)	6 (17.6)	1.53	.217
Constipation^*	12 (10.2)	8 (9.5)	4 (11.8)	0.13	.742
Mouth sores	12 (10.2)	7 (8.3)	5 (14.7)	1.08	.300
Diarrhea^*	6 (5.1)	2 (2.4)	4 (11.8)	4.42	.057
Breathing^*	4 (3.4)	2 (2.4)	2 (5.8)	0.91	.578
Changes in urination^*	2 (1.7)	0 (0.0)	2 (5.8)	5.21	.081
Substance abuse^*	2 (1.7)	1 (1.2)	1 (2.9)	0.45	.495

^*Fisher's exact test.

Table 3

Influencing Factors of Moderate-Severe Distress (N=118)

Variables	β	SE	OR	p	95% CI
Age (year)	0.13	0.06	1.14	.024	1.02, 1.28
Presence of spouse (ref: yes)	- 1.14	0.88	0.32	.195	0.06, 1.79
Transportation (ref: no)	0.07	0.81	0.93	.108	0.22, 5.22
Worry (ref: no)	2.12	1.02	8.34	.037	1.13, 61.44
Fear (ref: no)	0.01	0.75	1.01	.991	0.23, 4.38
Depression (ref: no)	2.26	0.88	9.55	.010	1.70, 53.76
Nervousness (ref: no)	0.49	0.75	1.63	.514	0.38, 7.01
Sadness (ref: no)	0.68	0.80	1.97	.394	0.41, 9.43
Loss of interest in usual activities (ref: no)	0.27	0.88	1.31	.756	0.24, 7.35
Fatigue (ref: no)	2.10	0.93	8.19	.023	1.34, 50.13
Appearance (ref: no)	0.84	0.77	2.31	.275	0.51, 10.33
Memory/concentration (ref: no)	0.93	0.71	2.53	.192	0.63, 10.16
Bathing/dressing (ref: no)	- 1.42	1.05	0.24	.175	0.03, 1.88
Eating (ref: no)	- 0.76	0.88	0.47	.391	0.08, 2.65
Getting around (ref: no)	1.68	1.01	5.35	.098	0.74, 38.84

CI=confidence interval; OR=odds ratio; SE=standard error; ref=reference.

Notes

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (No. 1320290).

References

1. Korean breast cancer society. Accessed May 15, 2014. http://www.kbcs.or.kr.

2. Alfano CM, Rowland JH. Recovery issues in cancer survivorship: a new challenge for supportive care. Cancer J. 2006; 12(5):432–443.

3. National Comprehensive Cancer Network. Distress Thermometer for Patients (v.1.2013). Accessed July 26, 2013. http://www.nccn.org/international/international_adaptations.aspx.

4. Costanzo ES, Lutgendorf SK, Mattes ML, Trehan S, Robinson CB, Tewfik F, et al. Adjusting to life after treatment: distress and quality of life following treatment for breast cancer. Br J Cancer. 2007; 97(12):1625–1631.

5. Jeong K, Heo J, Tae Y. Relationships among distress, family support, and health promotion behavior in breast cancer survivors. Asian Oncol Nurs. 2014; 14(3):146–154.

6. Hansen JA, Feuerstein M, Calvio LC, Olsen CH. Breast cancer survivors at work. J Occup Environ Med. 2008; 50(7):777–784.

7. Shapiro CL, Recht A. Side effects of adjuvant treatment of breast cancer. N Engl J Med. 2001; 344(26):1997–2008.

8. Thewes B, Butow P, Girgis A, Pendlebury S. The psychosocial needs of breast cancer survivors: a qualitative study of the shared and unique needs of younger versus older survivors. Psychooncology. 2004; 13(3):177–189.

9. VanHoose L, Black LL, Doty K, Sabata D, Twumasi-Ankrah P, Taylor S, et al. An analysis of the distress thermometer problem list and distress in patients with cancer. Support Care Cancer. 2015; 23(5):1225–1232.

10. Arndt V, Stegmaier C, Ziegler H, Brenner H. A population-based study of the impact of specific symptoms on quality of life in women with breast cancer 1 year after diagnosis. Cancer. 2006; 107(10):2496–2503.

11. Deimling GT, Bowman KF, Wagner LJ. The effects of cancer-related pain and fatigue on functioning of older adult, long-term cancer survivors. Cancer Nurs. 2007; 30(6):421–433.

12. Lam WW, Shing YT, Bonanno GA, Mancini AD, Fielding R. Distress trajectories at the first year diagnosis of breast cancer in relation to 6 years survivorship. Psychooncology. 2012; 21(1):90–99.

13. Ploos van Amstel FK, Berg SW, Laarhoven HW, Gielissen MF, Prins JB, Ottevanger PB. Distress screening remains important during follow-up after primary breast cancer treatment. Support Care Cancer. 2013; 21(8):2107–2115.

14. Stanton AL. What happens now? Psychosocial care for cancer survivors after medical treatment completion. J Clin Oncol. 2012; 30(11):1215–1220.

15. Head BA, Schapmire TJ, Keeney CE, Deck SM, Studts JL, Hermann CP, et al. Use of the distress thermometer to discern clinically relevant quality of life differences in women with breast cancer. Qual Life Res. 2012; 21(2):215–223.

16. Hegel MT, Moore CP, Collins ED, Kearing S, Gillock KL, Riggs RL, et al. Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer. Cancer. 2006; 107(12):2924–2931.

17. Liu JE, Wang HY, Wang ML, Su YL, Wang PL. Posttraumatic growth and psychological distress in Chinese early-stage breast cancer survivors: a longitudinal study. Psychooncology. 2014; 23(4):437–443.

18. Kwon EJ, Yi M. Distress and quality of life in breast cancer survivors in Korea. Asian Oncol Nurs. 2012; 12(4):289–296.

19. Fann JR, Thomas-Rich AM, Katon WJ, Cowley D, Pepping M, McGregor BA, et al. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008; 30(2):112–126.

20. Lester J, Crosthwaite K, Stout R, Jones RN, Holloman C, Shapiro C, et al. Women with breast cancer: self-reported distress in early survivorship. Oncol Nurs Forum. 2015; 42(1):E17–E23.

21. Fiszer C, Dolbeault S, Sultan S, Brédart A. Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology. 2014; 23(4):361–374.

22. Park JS, Lee HR. Comparison of distress and body Image according to the stages of cancer survivorship in gynecological cancer patients. Asian Oncol Nurs. 2014; 14(1):15–22.

23. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G^*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4):1149–1160.

24. Wang GL, Hsu SH, Feng AC, Chiu CY, Shen JF, Lin YJ, et al. The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan. Psychooncology. 2011; 20(6):639–646.

25. Shim EJ, Shin YW, Jeon HJ, Hahm BJ. Distress and its correlates in Korean cancer patients: pilot use of the distress thermometer and the problem list. Psychooncology. 2008; 17(6):548–555.

26. Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009; 115(22):5349–5361.

27. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011; 12(2):160–174.

28. Koornstra RHT, Peters M, Donofrio S, van den Borne B, de Jong FA. Management of fatigue in patients with cancer – a practical overview. Cancer Treat Rev. 2014; 40(6):791–799.

TOOLS

Similar articles