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The use of a patient-reported outcome questionnaire to assess cancer survivorship concerns and psychosocial outcomes among recent survivors

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Survivor distress is well represented in the literature, but less is known about survivors’ concerns and how these relate to adaptation. Using a newly designed Survivorship Concern Scale, we examined concerns and their relationship to psychosocial adaptation among recent breast cancer (BC) survivors.


One hundred forty-three stage 0–III BC survivors completed an online assessment including the Survivorship Concern Scale (0–3 scale; alpha = 0.91), unmet needs, quality of life (QoL), and anxiety and depressive symptoms within 1 year of end of treatment.


Participants were predominately white (76%), middle-aged (51 years), married (70%), and college educated (79%). Eighty-two percent were stage I or II at diagnosis. Mean degree of survivorship concern was moderate (M = 1.75, SD = 0.70) though variable (range = 0.12–3.00). Survivorship concerns were not significantly related to disease, treatment, or demographic variables except income (p = 0.02). Degree of survivorship concern was significantly associated with all indices of psychosocial adaptation: unmet need (r = 0.50), physical and mental QoL (r = −0.32 and r = −0.32, respectively), depressive symptoms (r = 0.21), and anxiety symptoms (r = 0.51; all p < 0.001). Binary logistic regression suggested that each one-point increase in degree of average concern increased the odds for elevated depressive symptoms by 2.83 (p = 0.03) and increased the odds of elevated anxiety symptoms by 3.69 (p < 0.001).


Survivorship concerns in the year following treatment are moderate but variable. Concerns are associated with QoL, unmet need, and psychosocial adaptation. Adequately addressing concerns may be a way to improve psychosocial outcomes early in the survivorship trajectory.

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  1. In initial analyses, we found income to relate significantly to both levels of survivor concerns and depressive symptoms, unmet need, and physical health component of the QoL measure. We reanalyzed these relationships controlling for income level and found no differences in outcome from the non-adjusted data, with the exception of the physical functioning subscale which was attenuated; therefore, the non-adjusted data is presented for ease of interpretation. No other demographic, disease, or treatment variables were associated with survivorship concerns (all p > 0.10).


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This work was funded by the Abramson Cancer Center Translational Centers of Excellence in Breast Cancer, University of Pennsylvania.

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Correspondence to Steven C. Palmer.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Research was approved by the University of Pennsylvania Institutional Review Board (Protocol #820346). This article does not contain any studies with animals performed by any of the authors.

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Palmer, S.C., Stricker, C.T., DeMichele, A.M. et al. The use of a patient-reported outcome questionnaire to assess cancer survivorship concerns and psychosocial outcomes among recent survivors. Support Care Cancer 25, 2405–2412 (2017).

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