Ann Surg Treat Res.  2020 May;98(5):215-223. 10.4174/astr.2020.98.5.215.

Surgical impact on anxiety of patients with breast cancer: 12-month follow-up prospective longitudinal study

• Kim J
• Cho J
• Lee SK
• Choi EK
• Kim IR
• Lee JE
• Kim SW
• Nam SJ

• KMID: 2500822
• DOI: http://doi.org/10.4174/astr.2020.98.5.215

Abstract

Purpose
Breast cancer diagnosis and treatment often produce stress in patients. Anxiety is one of the most prevalent psychological symptoms perceived by breast cancer patients. This study aims to evaluate the temporal patterns of anxiety and find factors associated with persistent anxiety during breast cancer treatment.
Methods
This is prospective cohort study. Between July 2010 and July 2011, we recruited patients with nonmetastatic breast cancer who were expected to receive adjuvant chemotherapy (n = 411) from 2 cancer hospitals in Seoul, Korea. Anxiety was measured using the Hospital Anxiety and Depression Scale.
Results
The mean age of the participants was 46.4 ± 7.9 years. Preoperatively, 44.5% (183 of 411) of the patients showed abnormal anxiety. The proportion of the abnormal anxiety group significantly decreased after surgery (P < 0.01) and this phenomenon continued until the 12-month follow-up point. Patients experienced renewed anxiety at 12 months when the main adjuvant therapies were finished. Socioeconomic factors were not associated with persistent anxiety. Pain, breast, and arm symptoms were significantly higher in the persistently abnormal group, especially at postoperative months 6 and 12.
Conclusion
Surgery was a major relieving factor of anxiety, and patients who finished their main adjuvant treatment experienced renewed anxiety. Surgeons should be the main detectors and care-givers with respect to psychological distress in breast cancer patients. To reduce persistent anxiety, caring for the patient’s physical symptoms is important.

Keyword

Anxiety; Breast neoplasms; Perioperative period; Surgery

Figure

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  Fig. 1 Study population. POD, postoperative day.

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  Fig. 2 Temporal patterns of anxiety symptom severity by mean anxiety dimension in Hospital Anxiety Depression Scale (HADS-A) score from diagnosis to 12 months. POD, postoperative day. *P < 0.001.

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  Fig. 3 Prevalence of anxiety at postoperative day 12 months according to the baseline anxiety (n = 250).

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  Fig. 4 Temporal pattern of anxiety symptom severity by mean anxiety dimension in Hospital Anxiety Depression Scale (HADS-A) score of each group over time (group 1, normal; group 2, newly developed anxiety; group 3, resolved anxiety; and group 4, persistent anxiety). POD, postoperative day.

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  Fig. 5 Comparison of anxiety level with regard to follow-up duration by breast cancer operation type. HADS-A, anxiety dimension in Hospital Anxiety Depression Scale; POD, postoperative day.

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