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A detailed description of the distress trajectory from pre- to post-treatment in breast cancer patients receiving neoadjuvant chemotherapy

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Abstract

Purpose

To characterize the distress trajectory in patients with newly diagnosed, non-metastatic breast cancer from pre-neoadjuvant chemotherapy until 12 months after onset of treatment and to identify demographic and clinical predictors of distress in these patients.

Methods

In a retrospective, longitudinal study, chart review data were abstracted for 252 eligible patients treated at a comprehensive cancer care center. The center screens for distress at least monthly with the distress thermometer; the highest distress score per month was included in the analyses. The growth trajectory was established using mixed modeling and predictors were added to the initial growth model in subsequent models.

Results

Distress showed a cubic growth trajectory with highest distress prior to treatment onset followed by a steep decline in the first three months of treatment. A slight increase in distress was apparent over months 6–10. Being Hispanic was associated with a stronger increase in distress in the second half of the year (p = 0.012). NACT was associated with lower distress and surgery with higher distress (both: p < 0.001).

Conclusion

Distress is at its peak prior to treatment onset and rapidly decreases once treatment has started. Oncologist should be aware that both completion of NACT and undergoing surgery are associated with increases in distress and Hispanic patients may be more at risk for an increase in distress at these times; this suggests that careful monitoring of distress during the treatment trajectory and in Hispanic patients in particular in order to provide timely support.

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Data availability

The data that support the findings of this study are available on reasonable request form the corresponding author.

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Funding

This work was supported by the National Institutes of Health/National Cancer Institute under award number (Grant No. P30CA016672).

Author information

Authors and Affiliations

  1. Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Unit 1454, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA

    Tamara E. Lacourt & Emily A. Tullos

  2. Faculty of Medicine, Institute of Behavioral Sciences, Semmelweis University, 26, Ulloi Ut, Budapest, Hungary

    Zsuzsa Koncz

  3. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1354, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA

    Debu Tripathy

Authors
  1. Tamara E. Lacourt
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  2. Zsuzsa Koncz
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  3. Emily A. Tullos
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Contributions

TL and DT contributed to the study conception and design. Material preparation and data collection were performed by TL and ET. Analyses were performed by TL. The first draft of the manuscript was written by TL and ZK. All authors commented on previous versions of the manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Tamara E. Lacourt.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This observational study and a corresponding waiver for consent was approved by the institution’s Internal Review Board.

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Lacourt, T.E., Koncz, Z., Tullos, E.A. et al. A detailed description of the distress trajectory from pre- to post-treatment in breast cancer patients receiving neoadjuvant chemotherapy. Breast Cancer Res Treat 197, 299–305 (2023). https://doi.org/10.1007/s10549-022-06805-y

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  • DOI: https://doi.org/10.1007/s10549-022-06805-y

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