After treatment: assessing the long-term psychosocial morbidity and its predictors in breast cancer survivors (#268)
The cancer experience does not end at the completion of the cancer treatment. Side effects of both the disease and its treatment can have a considerable and lasting impact on patients' health-related quality of life (HRQoL) and psychosocial wellbeing. Therefore, a better understanding and greater awareness of this issue will be beneficial to providing optimal breast cancer care. A cross-sectional cohort study was conducted to determine the prevalence and extent of psychosocial distress experienced by long-term breast cancer survivors. 400 English-speaking women treated for DCIS or Stage I-III breast cancer between 1999 and 2009, at least 12 months after surgery and currently disease free, were randomly selected and invited to complete 1) a breast cancer-specific Cancer Worry Scale (CWS), 2) Distress Thermometer (DT) and 3) Body Image Scale (BIS). The response rate was 85.60%. The results revealed a high prevalence of worries regarding the possibility of recurrence (90.4%) and poorer body image perceptions (59.9%) post-treatment. In addition, 65.5% of respondents reported experiencing some level of distress (reported as greater than 4 on the scale). There were strong associations (p<0.05) between younger age and greater psychosocial decrements in all three measures but none between time since surgery and morbidity (p>0.05). Higher TNM staging was associated with greater levels of worry regarding recurrence as well as poorer body image perceptions (p<0.05). Adjuvant chemotherapy was strongly associated with recurrence worries (p=0.007) and poorer body image (p=0.018). In addition, multivariate analysis revealed mastectomy to be a predictor of poorer body image (p<0.0005). Overall, breast cancer survivors may still be experiencing cancer worries, distress and body image problems years after the completion of breast cancer treatment. Identify patients who would be more at risk of experiencing adverse effects following their breast cancer treatment may be able to improve their HRQoL post-treatment.