Trajectories and Predictors of Self-Reported Anxiety and Depression in Women with and Without Pain Who Undergo Surgery for Breast Cancer

Depression and anxiety are common emotional symptoms in women with breast cancer and are frequently grouped under the term psychological distress. However, preoperative levels and postoperative trajectories of anxiety and depression might be influenced by distinct factors. This study's purpose was to identify how anxiety and depression in women with breast cancer changed from the time before surgery and for up to six months after, and to investigate whether specific variables predict initial levels and trajectories of anxiety and depression during the same period. Variables were selected following the UCSF Symptom Management Model. This descriptive, longitudinal study enrolled patients from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. A total of 396 women with breast cancer agreed to participate and completed questionnaires prior to surgery, and at 1, 2, 3, 4, 5, and 6 months after surgery. Descriptive statistics and hierarchical linear modeling were used for data analyses. Findings from this study suggest that more than a quarter of the patients (28%) reported pain in their breast prior to surgery. In addition, a significant percentage of women, regardless of pain status, experienced anxiety and depressive symptoms prior to surgery for breast cancer. However, both state anxiety and depression declined over the six month period following surgery. Despite the overall decline in state anxiety and depression, variance components suggested substantial interindividual variability in the patterns of adjustment. Only one demographic (i.e., marital status), and one clinical (i.e., general health status) characteristic predicted baseline levels of depression and trajectories of state anxiety respectively. In contrast, characteristics with independent contributions were symptom characteristics (i.e, trait and state anxiety, attentional fatigue, sleep disturbances, appetite changes, number of hours in pain), and psychosocial adjustment characteristics (i.e., sense of control, life satisfaction, difficulty coping, uncertainty about the future, sense of isolation, fear of metastasis, amount of distress at initial diagnosis and importance of spiritual activities). Nurses may use this information to identify and educate high-risk patients about how anxiety and depression may change following surgery for breast cancer