Determinants of Psychosocial Distress in Breast Cancer Patients at a Safety Net Hospital

Exploring the impact of the COVID-19 pandemic on cancer-related distress among thoracic oncology patients at a rural cancer center

PURPOSE

Cancer-related distress (CRD) is frequently observed in rural settings and may have been exacerbated during the COVID-19 pandemic. We examined pre and post COVID-19 changes in CRD among individuals treated for thoracic cancers at a rural cancer center.

METHODS

Patient demographics, clinical information, and CRD measures derived from the National Comprehensive Cancer Network psychosocial distress problem list were abstracted from electronic medical records for thoracic oncology patients treated at a rural Michigan cancer center before (January 1, 2019-January 1, 2020; n=139) and during (January 20, 2020-January 31, 2021; n=84) the COVID-19 pandemic. CRD scores were calculated by summing the items on the problem lists, and the prevalence of CRD was examined both overall and by specific sources of distress (practical, emotional, social, and physical concerns). We assessed changes in CRD overall and by type using chi-square tests, Fisher's exact tests, and multivariable logistic regression models.

RESULTS

CRD prevalence increased by 9.1% during vs. before the pandemic (97.6% vs. 88.5%; p=0.02), with the largest increases evident for emotional (82.1% vs. 64.0%; p=0.004) and physical (82.1% vs. 67.6%; p=0.02) concerns. CRD scores were slightly higher during vs. before the pandemic, but the differences were not significant (all p-values≥0.05). Compared to those treated in the year prior, patients treated during the pandemic had higher odds of elevated CRD (OR (95% CI) =1.86 (1.1, 3.2)), and practical concerns (OR (95% CI) =2.19 (1.3, 3.8)).

CONCLUSIONS

Findings from this preliminary study suggest an increased prevalence of CRD among rural thoracic oncology patients treated during compared to before the COVID-19 pandemic.

Prevalence and associated factors of psychological distress among patients with breast cancer: a systematic review and meta-analysis

OBJECTIVE

This paper aims to evaluate the literature on the prevalence of psychological distress and its associated factors in patients with breast cancer.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure and Wanfang were searched from inception to 11 June 2024.

ELIGIBILITY CRITERIA

Studies reported data on the prevalence and correlates of psychological distress were included. Review, letter, conference abstracts and articles not available in English and Chinese were excluded.

DATA EXTRACTION AND SYNTHESIS

Two researchers independently conducted literature screening, data extraction and bias risk assessment. Meta-analysis was employed to estimate the prevalence and correlates of psychological distress in patients with breast cancer. The Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale were used for quality assessment. Meta-analysis was performed by using the R V.4.1.1 software.

RESULTS

In total, 34 studies representing 13 828 patients with breast cancer were included in the study. Most of the studies were cross-sectional study (n=25, 73.53%%). The pooled prevalence of psychological distress was 50% (95% CI 42% to 58%, I2=98%). Results showed that psychological distress was positively correlated with younger age (z=0.13, 95% CI 0.07 to 0.20), having children (z=0.39, 95% CI 0.11 to 0.61), poor financial situation (z=0.12, 95% CI -0.03 to 0.26), short time since diagnosis (z=0.19, 95% CI 0.01 to 0.36), previous treatment (z=0.15, 95% CI 0.03 to 0.27), distant metastasis (z=0.31, 95% CI 0.07 to 0.52), chemotherapy (z=0.22, 95% CI 0.05 to 0.38), prior emotional status (z=0.40, 95% CI 0.29 to 0.50), body image damaged (z=0.10, 95% CI -0.01 to 0.21), negative coping (z=0.12, 95% CI -0.11 to 0.34), communication avoidance (z=0.32, 95% CI 0.24 to 0.39) and negatively correlated with married (z=-0.25, 95% CI 0.45 to -0.02), high education level (z=-0.19, 95% CI -0.40 to 0.05), having insured (z=-0.04, 95% CI -0.15 to 0.08), full employment (z=-0.40, 95% CI -0.61 to -0.14), time of completion of treatment (z=-0.12, 95% CI -0.30 to -0.06), surgery (z=-0.05, 95% CI -0.53 to 0.45), social support (z=-0.18, 95% CI -0.29 to -0.06), post-traumatic growth (z=-0.19, 95% CI -0.34 to -0.03), good physical conditions (z=-0.17, 95% CI -0.29 to -0.04), positive coping (z=-0.22, 95% CI -0.53 to 0.15).

CONCLUSION

Our findings indicated that the prevalence of psychological distress in patients with breast cancers was 50% and 21 correlates of psychological distress. Screening and evidence-based interventions are urgent and essential to address this public concern and promote the health of patients with breast cancer.

PROSPERO REGISTRATION NUMBER

CRD42023397109.

Incidence and risk factors for psychological distress in adult female patients with breast cancer: a systematic review and meta-analysis

INTRODUCTION

Cancer-related distress can be described as a complex and unpleasant combination of psychological (such as cognitive, behavioral, and emotional), social, and spiritual challenges that may impact an individual's ability to effectively cope with the physical symptoms of cancer and its treatment. Existing literature has confirmed psychological distress (PD) as an important sequela of breast cancer diagnosis and treatment. However, the incidence and risk factors for PD in adult female patients with breast cancer remain unclear; therefore, focusing on the PD of female breast cancer patients is meaningful, as they are at highest risk of contracting breast cancer, and might differ in their coping styles from men.

OBJECTIVE

This review aimed to identify the incidence and risk factors for PD in adult woman patients with breast cancer, and to help guide targeted intervention to prevent distress.

METHOD

PubMed, Embase, Cochrane Library, CINAL, PsycINFO, China Knowledge Resource Integrated Database, Wanfang Database, the Chinese Biomedical Database, and Weipu Database were searched for data regarding the incidence and risk factors of PD in adult women with breast cancer.

RESULTS

The prevalence of PD, assessed using the distress thermometer, ranged between 11.2%-86.7%, and a meta-analysis of 47 studies with 15,157 adult female breast cancer patients showed that the pooled prevalence was 52.0%. Further, this study identified 40 risk factors. However, owing to the inclusion of at least two studies for a certain risk factor, 10 risk factors were merged for the meta-analysis. Independent risk factors included higher education level, late-stage tumor, emotional concerns, no medical insurance, modified radical mastectomy, and history of depression; age and neuroticism were not associated with PD; and higher monthly income was revealed as a protective factor against it.

CONCLUSION

The incidence of PD in female patients with breast cancer is high and it involves 10 risk factors, though some are controversial owing to insufficient evidence. Further research is needed to explore the underlying mechanisms of PD and develop risk factor-based holistic intervention programs to reduce its incidence.

SYSTEMATIC REVIEW REGISTRATION

The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023433578).

Emotional Distress in Portuguese Cancer Patients: The Use of the Emotion Thermometers (ET) Screening Tool

Cancer patients may experience significant distress. The "Emotion Thermometers" (ETs) are a short visual analogue scale used to screen patients for psychosocial risk. This study aimed to assess emotional distress in a large sample of cancer patients attending psychological services at an non-governmental organization (NGO), and to explore factors that may contribute to it. The ETs were answered by 899 cancer patients. They were, on average, 59.9 years old, the majority were female, had breast cancer, were under treatment or were disease-free survivors, and reported high levels of emotional distress, above the cut-off (≥5). A Generalized Linear Model was used to measure the association between the level of distress, age, gender, disease phase and 33 items of the problem list. Four items-sadness, depression, sleep and breathing-were found to be significantly related to a higher level of distress. Additionally, women and patients who were in the palliative phase also had significantly higher levels of distress. The results confirm the need for early emotional screening in cancer patients, as well as attending to the characteristics of each patient. Additionally, they highlight the utility of the ETs for the clinical practice, allowing to optimize the referral to specialized psychosocial services.