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Risk factors for worse anxiety trajectories among patients undergoing cancer chemotherapy

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Abstract

Purpose

Patients undergoing chemotherapy for cancer often experience heightened anxiety. While receipt of chemotherapy occurs over multiple cycles, limited research has examined anxiety longitudinally. The purposes of this study, in a large sample of patients with breast, gynecological, gastrointestinal, or lung cancer, were to evaluate, over the course of two cycles of chemotherapy, for inter-individual differences in the trajectories of anxiety and identify associations between demographic, clinical, symptom, and psychological adjustment characteristics and initial levels and trajectories of anxiety.

Methods

Patients with breast, gynecologic, lung, or gastrointestinal cancer (n = 1323) were assessed with the Spielberger State Anxiety Inventory (STAI-S) six times over two cycles of chemotherapy. At enrollment, patients completed self-report instruments assessing demographic, symptom, stress, and coping characteristics. We used hierarchical linear modeling to identify risk factors associated with initial levels and trajectories of state anxiety.

Results

Inter-individual differences in initial levels of anxiety were associated with functional status, sleep disturbance, morning fatigue, cognitive function, global and cancer-specific stress, resilience, and several coping characteristics (i.e., sense of coherence, acceptance, using emotional support, self-distraction, denial, venting, and self-blame). Demographic and clinical characteristics associated with interindividual differences in anxiety trajectories were age, employment status, and MAX-2 score.

Conclusion

This study provides novel data on the course and predictors of anxiety during two cycles of chemotherapy among a large sample of patients with varied cancer types. Further research focused on risk factors for heightened levels of anxiety during chemotherapy may help point toward more effective interventions for this commonly experienced symptom.

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Funding

This work was funded by a grant from the National Cancer Institute (NCI CA134900).

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Authors and Affiliations

  1. The Warren Alpert Medical School, Brown University, Providence, RI, USA

    Johanna A. Suskin & Ashley R. Stuckey

  2. School of Nursing, University of California, San Francisco, San Francisco, CA, USA

    Steven Paul & Christine Miaskowski

  3. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Yvette P. Conley

  4. Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR, 72205-7199, USA

    Laura B. Dunn

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  1. Johanna A. Suskin
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  5. Christine Miaskowski
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  6. Laura B. Dunn
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Johanna Suskin, Steven Paul, Christine Miaskowski, and Laura Dunn. The first draft of the manuscript was written by Johanna Suskin and Laura Dunn. All authors provided substantial revisions or comments on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laura B. Dunn.

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Ethics approval was granted by the Institutional Review Boards of each of the study sites (see Methods). Written informed consent was obtained from all participants (see Methods).

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The authors declare no competing interests.

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Suskin, J.A., Paul, S., Stuckey, A.R. et al. Risk factors for worse anxiety trajectories among patients undergoing cancer chemotherapy. Support Care Cancer 31, 32 (2023). https://doi.org/10.1007/s00520-022-07481-w

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