Skip to main content

Advertisement

SpringerLink
Log in

Exploring clinical determinants and anxiety symptom domains among Asian breast cancer patients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Psychological distress, such as anxiety, is commonly experienced by breast cancer patients. This study was designed to evaluate the presentation of anxiety symptom domains among Asian breast cancer patients and to identify clinical factors that were associated with occurrence of anxiety.

Methods

An observational study was conducted between August 2009 and January 2012. Breast cancer patients (stages I to III) with different chemotherapy treatment status completed the Beck Anxiety Inventory (BAI) to evaluate the prevalence and severity of their anxiety symptoms. Demographical and clinical data were collected. Multiple linear regression was conducted to delineate clinical factors associated with anxiety.

Results

A total of 319 patients were recruited (age: 51 ± 9 years; 80.9 % Chinese; 69.6 % stage I/II). The median BAI total score was 8 (IQR, 4–14). Anxiety severities varied greatly across patients with different chemotherapy treatment status: patients who were receiving concurrent chemotherapy at the point of assessment (n = 161) experienced more severe anxiety symptoms, as compared to pre-chemotherapy receiving (n = 78) patients and post-chemotherapy (n = 88) patients (29.8 % vs. 9.0 % vs. 20 %, respectively; p = 0.021). Regression model identified fatigue (p < 0.001) and the concurrent receipt of chemotherapy (p < 0.001) as the strongest factors associated with anxiety. Concomitant neuropsychiatric medicines (antidepressants, anxiolytics, and hypnotics) were moderately associated with anxiety occurrence.

Conclusions

This is the largest series to date to evaluate anxiety symptom domains among Asian breast cancer patients. Results suggest that toxicities of chemotherapy may have contributed to the presentation of anxiety symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Clarke MJ, Collins RE, Davies CE, Godwin JE, Gray RG, Peto RR (1998) Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet 352:930–942

    Article  Google Scholar 

  2. So WKW, Marsh G, Ling WM et al (2010) Anxiety, depression and quality of life among Chinese breast cancer patients during adjuvant therapy. Eur J Oncol Nurs 14:17–22

    Article  PubMed  Google Scholar 

  3. Ann MS, Susan AW (2004) Anxiety and quality of life of women who receive radiation or chemotherapy for breast cancer. Oncol Nurs Forum 31:127–130

    Article  Google Scholar 

  4. Burgess CC, Cornelius V, Love SB, Graham J, Richards MA, Ramirez AJ (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. Br Med J 330:702–705

    Article  Google Scholar 

  5. Del Mastro L, Costantini M, Morasso G et al (2002) Impact of two different dose-intensity chemotherapy regimens on psychological distress in early breast cancer patients. Eur J Cancer 38:359–366

    Article  PubMed  Google Scholar 

  6. Hall A, Fallowfield L (1989) Psychological outcome of treatment for early breast cancer: a review. Stress Med 5:167–175

    Article  Google Scholar 

  7. Payne DK, Hoffman RG, Theodoulou M, Dosik MH, Massie MJ (1999) Screening for anxiety and depression in women with breast cancer: psychiatry and medical oncology gear up for managed care. Psychosomatics 40:64–69

    Article  PubMed  CAS  Google Scholar 

  8. Jones RD (2001) Depression and anxiety in oncology: the oncologist's perspective. J Clin Psychiatry 62:52–57

    Article  PubMed  Google Scholar 

  9. Tel H, Tel H, Doğan S (2011) Fatigue, anxiety and depression in cancer patients. Neurol Psychiatr Brain Res 17:42–45

    Google Scholar 

  10. Brown LF, Kroenke KK (2009) Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics 50:440–447

    PubMed  Google Scholar 

  11. Jansen CE, Cooper BA, Dodd MJ, Miaskowski C (2011) A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients. Support Care Cancer 19:1647–1656

    Article  PubMed  Google Scholar 

  12. Sobel DS (1995) Rethinking medicine: improving health outcomes with cost-effective psychosocial interventions. Psychosom Med 57:234–244

    PubMed  CAS  Google Scholar 

  13. Lueboonthavatchai P (2007) Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. J Med Assoc Thai 90:2164–2174

    PubMed  Google Scholar 

  14. Vahdaninia M, Omidvari S, Montazeri A (2010) What do predict anxiety and depression in breast cancer patients? A follow-up study. Soc Psychiatry Psychiatr Epidemiol 45:355–361

    Article  PubMed  Google Scholar 

  15. Osborne RH, Elsworth GR, Hopper JL (2003) Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry. Eur J Cancer 39:755–762

    Article  PubMed  CAS  Google Scholar 

  16. Hopwood P, Sumo G, Mills J, Haviland JS, Bliss JM (2010) The course of anxiety and depression over 5 years of follow-up and risk factors in women with early breast cancer: results from the UK Standardisation of Radiotherapy Trials (START). Breast 19:84–91

    Article  PubMed  Google Scholar 

  17. Härtl K, Schennach R, Müller MA et al (2010) Quality of life, anxiety, and oncological factors: a follow-up study of breast cancer patients. Psychosomatics 51:112–123

    PubMed  Google Scholar 

  18. Vodermaier A, Linden WL, MacKenzie R, Greig D, Marshall C (2011) Disease stage predicts post-diagnosis anxiety and depression only in some types of cancer. Br J Cancer 105:1814–1817

    Article  PubMed  CAS  Google Scholar 

  19. Lim CC, Devi MK (2011) Anxiety in women with breast cancer undergoing treatment: a systematic review. Int J Evid Based Healthc 9:213–235

    Google Scholar 

  20. Cheung YT, Maung Shwe HG, Tan YP, Fan GKT, Ng RCH, Chan A (2012) Cognitive changes in multiethnic Asian breast cancer patients: a focus group study. Ann Oncol 23:2547–552

    Google Scholar 

  21. Montel SR (2010) Mood and anxiety disorders in breast cancer: an update. Curr Psychiatry Rev 6:56–63

    Article  Google Scholar 

  22. Beck AT, Epstein NB, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56:893–897

    Article  PubMed  CAS  Google Scholar 

  23. Luo N, Fones CS-L, Thumboo J, Li S-C (2004) Factors incluencing health-related quality of life of Asians with anxiety disorders in Singapore. Qual Life Res 13:557–565

    Article  PubMed  Google Scholar 

  24. Beck AT, Steer RA (1990) Beck Anxiety Inventory. Psychological Corporation, San Antonio

  25. Beck AT, Steer RA (1993) Beck Anxiety Inventory Manual. The Psychology Corporation, San Antonio

    Google Scholar 

  26. Beck AT, Steer RA (1991) Relationship between the Beck anxiety inventory and the hamilton anxiety rating scale with anxious outpatients. J Anxiety Disord 5:213–223

    Article  Google Scholar 

  27. Steer RA, Ranieri WF, Beck AT, Clark DA (1993) Further evidence for the validity of the Beck Anxiety Inventory with psychiatric outpatients. J Anxiety Disord 7:195–205

    Article  Google Scholar 

  28. Butt ZA, Wagner LI, Beaumont JL et al (2008) Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice. J Pain Symptom Manage 35:20–30

    Article  PubMed  Google Scholar 

  29. Hopwood P, Haviland JS, Mills J, Sumo G, Bliss JM (2007) The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Breast 16:241–251

    Article  PubMed  Google Scholar 

  30. Asnaani A, Richey JA, Dimaite R, Hinton DE, Hofmann SG (2010) A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. J Nerv Ment Dis 198:551–555

    Article  PubMed  Google Scholar 

  31. Smith SM, Stinson FS, Dawson DA, Goldstein RB, Huang B, Grant BF (2006) Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 36:987–998

    Article  PubMed  Google Scholar 

  32. Lewis-Fernández R, Hinton DE, Laria AJ et al (2010) Culture and the anxiety disorders: recommendations for DSM-V. Depress Anxiety 27:212–229

    Article  PubMed  Google Scholar 

  33. Rao MR, Raghuram NV, Nagendra HR et al (2009) Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial. Complement Ther Med 17:1–8

    Article  PubMed  Google Scholar 

  34. Cavaletti G, Marmiroli P (2010) Chemotherapy-induced peripheral neurotoxicity. Nat Rev Neurol 6:657–666

    Article  PubMed  Google Scholar 

  35. Cella DF, Kallich JD, McDermott A, Xu X (2004) The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol 15:979–986

    Article  PubMed  CAS  Google Scholar 

  36. Nissen MJ, Shapiro AC, Swenson KK (2011) Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer 11:52–60

    Article  PubMed  Google Scholar 

  37. Helms RL, O'Hea EL, Corso M (2008) Body image issues in women with breast cancer. Psychol Health Med 13:313–325

    Article  PubMed  Google Scholar 

  38. Yap KY, Low XH, Chui WK, Chan A (2012) Computational prediction of State anxiety in Asian patients with cancer susceptible to chemotherapy-induced nausea and vomiting. J Clin Psychopharmacol 32: 207–217

    Google Scholar 

  39. Tchekmedyian NS, Kallich JD, McDermott AM, Fayers PM, Erder MH (2003) The relationship between psychologic distress and cancer-related fatigue. Cancer 98:198–203

    Article  PubMed  Google Scholar 

  40. Bender CM, Ergün FS, Rosenzweig MQ, Cohen SM, Sereika SM (2005) Symptom clusters in breast cancer across 3 phases of the disease. Cancer Nurs 28:219–225

    Article  PubMed  Google Scholar 

  41. Fan G, Filipczak L, Chow E (2007) Symptom clusters in cancer patients: a review of the literature. Curr Oncol 14:173–179

    Article  PubMed  CAS  Google Scholar 

  42. Curt GA, Breitbart WSD, Cella DF et al (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist 5:353–360

    Article  PubMed  CAS  Google Scholar 

  43. Möhler H (2012) The GABA system in anxiety and depression and its therapeutic potential. Neuropharmacology 62:42–53

    Article  PubMed  Google Scholar 

  44. Bourin MS, Hascoët M (2001) Drug mechanisms in anxiety. Curr Opin Investig Drugs 2:259–265

    PubMed  CAS  Google Scholar 

  45. Ettinger AB (2006) Psychotropic effects of antiepileptic drugs. Neurol 67:1916–1925

    Article  CAS  Google Scholar 

  46. Kawase E, Karasawa K, Shimotsu S et al (2012) Estimation of anxiety and depression in patients with early stage breast cancer before and after radiation therapy. Breast cancer 19:147–152

    Article  PubMed  Google Scholar 

  47. Takahashi T, Hondo M, Nishimura K et al (2008) Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy. Jpn J Radiol 26:396–401

    Google Scholar 

  48. Garssen B (2004) Psychological factors and cancer development: evidence after 30 years of research. Clin Psychol Rev 24:315–338

    Article  PubMed  Google Scholar 

  49. Schwarz RA, Krauß O, Höckel M, Meyer A, Zenger M, Hinz A (2008) The course of anxiety and depression in patients with breast cancer and gynaecological cancer. Breast Care 3:417–422

    Article  PubMed  Google Scholar 

  50. Hill J, Holcombe C, Clark L et al (2011) Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer. Psychol Med 41:1429–1436

    Article  PubMed  CAS  Google Scholar 

  51. Schou IM, Ekeberg Ö, Kåresen R, Sorensen E (2008) Psychosocial intervention as a component of routine breast cancer care - Who participates and does it help? Psychooncology 17:716–720

    Article  PubMed  Google Scholar 

  52. Björneklett HG, Lindemalm C, Rosenblad A et al (2012) A randomised controlled trial of support group intervention after breast cancer treatment: results on anxiety and depression. Acta Oncol 51:198–207

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study is financed by research grants awarded by the National University of Singapore (R-148-000-166-112) and the National Cancer Centre Singapore (NRFCB12131). Authors would also like to acknowledge Mr. Clement Vee-Lun Lim for his help with data analysis.

Conflict of interest

The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore

    Yin Ting Cheung, Helen Hoi-Lun Lee & Alexandre Chan

  2. Department of Pharmacy, National Cancer Centre Singapore, Level 3 Oncology Pharmacy, 11 Hospital Drive, Singapore, 169610, Singapore

    Yin Ting Cheung & Alexandre Chan

Authors
  1. Yin Ting Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen Hoi-Lun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexandre Chan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cheung, Y.T., Lee, H.HL. & Chan, A. Exploring clinical determinants and anxiety symptom domains among Asian breast cancer patients. Support Care Cancer 21, 2185–2194 (2013). https://doi.org/10.1007/s00520-013-1769-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1769-8

Keywords

Search

Navigation