Affect, Quality of Life Predict Chronic Distress in Ca Patients


WASHINGTON — Breast cancer patients who are at risk of developing chronic distress may be identified at diagnosis by their low quality of life and high level of negative affectivity, Steven C. Palmer, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.

Psychological distress appears in approximately 25%–35% of women with breast cancer and is generally predicted by younger age, lower optimism, increased pessimism, declining functional status, and greater illness burden.

Most patients lose the feeling of distress over time, but few studies have examined the subset of patients who remain chronically distressed.

Dr. Palmer and his colleagues at the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, are conducting an ongoing study of 154 patients with a mean age of about 53 years who had newly diagnosed ductal carcinoma in situ or breast cancer.

None of the patients had yet received chemotherapy. Most of the patients were white American (75%) and married (68%); 46% were college educated.

At diagnosis, 33% of the patients reported elevated distress on the Hopkins Symptom Checklist, but this decreased to 20% after 3 months and 21% after 6 months.

Most patients (58%) never reported feeling distressed, whereas 21% had a single episode of distress and another 21% had chronic distress (defined as two or more episodes).

Low baseline quality of life and high negative affectivity were independent predictors of chronic distress in a multivariate analysis. Together, they predicted 40% of the variance in chronicity of distress, according to Dr. Palmer.

The level of distress of women who experienced a single episode tended to decline to a nonclinically significant level by 3 months. These women also could not be differentiated from women with chronic distress, based on their baseline level of distress, which would make it difficult to conduct an interventional study on only chronically distressed women.

“You need another stratifier to be able to differentiate how these two” groups will respond to distress over time, Dr. Palmer said.

Women who were never distressed and those who had a single episode slowly improved throughout the 6-month period, whereas women with chronic distress remained at the same level of distress the whole period.

Overall, about 59% of women who were distressed at baseline recovered by 3 months.

“It's both significant and striking that women who have no distress have very high levels of baseline quality of life,” Dr. Palmer said.

Those women had a significantly higher quality of life at baseline than women with one episode of distress. Those with one episode also had significantly higher quality of life than chronically distressed women did.

By the end of 6 months, quality of life had increased slightly among women who were never distressed and had substantially increased in women who had one episode of distress.

Quality of life declined, however, among women with chronic distress even though they started with a low level, he said.

The amount of supportive services that were used by women in each group also seemed to increase with the level of distress.

The study is planned to continue for another 6 months of follow-up.

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