Oral Papers: Palliative Care & Oncology II
Background and Objectives: Depression and anxiety are experienced by 20-30% of patients with breast cancer during their cancer care trajectory.1 Psychiatric symptom burden may be most severe during chemotherapy, is associated with worse quality of life, and negatively impacts treatment tolerability.2 Research describing depressive and anxiety symptoms longitudinally during active treatment is extremely limited. The objectives of this study were to describe the prevalence of depression and anxiety during chemotherapy in patients with breast cancer and identify pre-chemotherapy demographic and clinical variables associated with depression and anxiety.
Methods: A total of 238 women with stage I-III breast cancer who received adjuvant or neoadjuvant chemotherapy at a large, academic medical center were included. Prior to treatment, participants completed the Geriatric Assessment to assess functional status (Karnofsky Performance Status), mental health (Mental Health Inventory-13), quality of life (FACT-G), and social support (MOS Social Support Survey). Depression and anxiety were assessed longitudinally during chemotherapy using the Patient-Reported Symptom Monitoring (PRSM) instrument. Patients completed at least two PRSM reports during chemotherapy, and reports from the first 12 weeks of treatment were included. Log-binomial logistic regression was used to test associations between baseline variables and depression and anxiety (rated moderate, severe, or very severe) at any timepoint during chemotherapy.
Results: Twenty-three percent of participants had stage I, 50.8% stage II, and 26.5% stage III breast cancer. Anthracycline-based chemotherapy constituted 41.2% of regimens. Clinically significant depression and anxiety were experienced by 24.0% and 39.9% of participants, respectively, at any point during the first 12 weeks of chemotherapy. Depression was associated with pre-chemotherapy poor functional status (p=0.001), worse quality of life (p=0002), MHI depression (p< .0001), MHI anxiety (p< .0001), and less social support (p=0.026). Similarly, anxiety was associated with poor functional status (p=.002), worse quality of life (p=0.001), MHI depression (p< .0001), and MHI anxiety (p< .0001) at baseline.
Discussion and Conclusions: Elevated levels of depression and anxiety were observed in our cohort of patients with breast cancer receiving chemotherapy. The high prevalence of psychiatric symptoms during active treatment is not unexpected given the psychological stress associated with a new cancer diagnosis, profound physical effects of systemic chemotherapy, and neuropsychiatric consequences of supportive medications. Prior to chemotherapy, mental health, functional status, and social support should be evaluated to identify patients at highest risk for adverse psychiatric outcomes during chemotherapy.
1. Linden W, Vodermaier A, MacKenzie R, Greig D. Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age. J Affect Disord. 2012;141(2–3):343–51.
2. Zhang J, Zhou Y, Feng Z, Xu Y, Zeng G. Longitudinal Trends in Anxiety, Depression, and Quality of Life during Different Intermittent Periods of Adjuvant Breast Cancer Chemotherapy. Cancer Nurs. 2018;41(1):62–8.