TY - JOUR
T1 - The effect of treatment on patient-reported distress after breast cancer diagnosis
AU - Fayanju, Oluwadamilola M.
AU - Yenokyan, Karine
AU - Ren, Yi
AU - Goldstein, Benjamin A.
AU - Stashko, Ilona
AU - Power, Steve
AU - Thornton, Madeline J.
AU - Marcom, P. Kelly
AU - Hwang, E. Shelley
N1 - Funding Information:
Supported in part by grant UL1TR001117 from the National Center for Advancing Translational Sciences, the National Institutes of Health (NIH) Roadmap for Medical Research, the Duke Cancer Institute through NIH grant P30CA014236 (Principal Investigator: Michael Kastan), and philanthropic funds through the generosity of Sara and Bruce Brandaleone. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the NIH or any of its components.
Funding Information:
Oluwadamilola M. Fayanju is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award 1KL2TR002554 (Principal Investigator: Laura Svetkey). Karine Yenokyan’s current position at Johns Hopkins is funded by a National Institutes of Health grant for HIV research. Benjamin A. Goldstein is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant K25DK097279. The other authors made no disclosures.
PY - 2019/9
Y1 - 2019/9
N2 - Background: The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) uses a 10-point scale (in which 0 indicates no distress and 10 indicates extreme distress) to measure patient-reported distress. In the current study, the authors sought to examine the relationship between treatment and NCCN DT scores in patients with breast cancer over time. Methods: The authors included women aged ≥18 years who were diagnosed with stage 0 to stage IV breast cancer (according to the seventh edition of the American Joint Commission on Cancer staging system) at a 3-hospital health system from January 2014 to July 2016. Linear mixed effects models adjusted for covariates including stage of disease, race/ethnicity, insurance, and treatment sequence (neoadjuvant vs adjuvant) were used to estimate adjusted mean changes in the DT score (MSCs) per week for patients undergoing lumpectomy, mastectomy only, and mastectomy with reconstruction (MR). Results: The authors analyzed 12,569 encounters for 1029 unique patients (median score, 4; median follow-up, 67 weeks). Patients treated with MR (118 patients) were younger and more likely to be married, white, and privately insured compared with patients undergoing lumpectomy (620 patients) and mastectomy only (291 patients) (all P <.01). After adjusting for covariates, distress scores were found to decline significantly across all 3 surgical cohorts, with patients undergoing MR found to have both the most preoperative distress and the greatest decline in distress prior to surgery (MSC/week: -0.073 for MR vs -0.031 for lumpectomy vs -0.033 for mastectomy only; P =.001). Neoadjuvant therapy was associated with a longitudinal decline in distress for patients treated with lumpectomy (-1.023) and mastectomy only (-0.964). Over time, ductal carcinoma in situ (-0.503) and black race (-1.198) were found to be associated with declining distress among patients treated with lumpectomy and MR, respectively, whereas divorced patients who were treated with mastectomy only (0.948) and single patients treated with lumpectomy (0.476) experienced increased distress (all P <.05). Conclusions: When examined longitudinally in consecutive patients, the NCCN DT can provide patient-reported data to inform expectations and guide targeted support for patients with breast cancer.
AB - Background: The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) uses a 10-point scale (in which 0 indicates no distress and 10 indicates extreme distress) to measure patient-reported distress. In the current study, the authors sought to examine the relationship between treatment and NCCN DT scores in patients with breast cancer over time. Methods: The authors included women aged ≥18 years who were diagnosed with stage 0 to stage IV breast cancer (according to the seventh edition of the American Joint Commission on Cancer staging system) at a 3-hospital health system from January 2014 to July 2016. Linear mixed effects models adjusted for covariates including stage of disease, race/ethnicity, insurance, and treatment sequence (neoadjuvant vs adjuvant) were used to estimate adjusted mean changes in the DT score (MSCs) per week for patients undergoing lumpectomy, mastectomy only, and mastectomy with reconstruction (MR). Results: The authors analyzed 12,569 encounters for 1029 unique patients (median score, 4; median follow-up, 67 weeks). Patients treated with MR (118 patients) were younger and more likely to be married, white, and privately insured compared with patients undergoing lumpectomy (620 patients) and mastectomy only (291 patients) (all P <.01). After adjusting for covariates, distress scores were found to decline significantly across all 3 surgical cohorts, with patients undergoing MR found to have both the most preoperative distress and the greatest decline in distress prior to surgery (MSC/week: -0.073 for MR vs -0.031 for lumpectomy vs -0.033 for mastectomy only; P =.001). Neoadjuvant therapy was associated with a longitudinal decline in distress for patients treated with lumpectomy (-1.023) and mastectomy only (-0.964). Over time, ductal carcinoma in situ (-0.503) and black race (-1.198) were found to be associated with declining distress among patients treated with lumpectomy and MR, respectively, whereas divorced patients who were treated with mastectomy only (0.948) and single patients treated with lumpectomy (0.476) experienced increased distress (all P <.05). Conclusions: When examined longitudinally in consecutive patients, the NCCN DT can provide patient-reported data to inform expectations and guide targeted support for patients with breast cancer.
KW - breast cancer
KW - distress
KW - health disparities
KW - modifiable risk factors
KW - patient-reported outcomes
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U2 - 10.1002/cncr.32174
DO - 10.1002/cncr.32174
M3 - Article
C2 - 31120575
AN - SCOPUS:85066906607
VL - 125
SP - 3040
EP - 3049
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 17
ER -