title: Levels of distress in breast cancer survivors approaching discharge from routine hospital follow-up.
abstract: BACKGROUND
  Hospital-based breast cancer follow-up provides reassurance to patients despite limited evidence for clinical efficacy. Although alternative models of hospital/community-based follow-up have yielded encouraging results, traditional hospital follow-up continues to be offered to all patients. Survival rates continue to rise; consequently, more patients are likely to require support, as many have a limited understanding of the long-term physical and emotional consequences of cancer and its treatment. We examine levels of psychological distress in breast cancer patients in follow-up 2 years or more from diagnosis.
  
  
  METHODS
  This prospective study measured psychological distress levels using standardized measures [Hospital Anxiety and Depression Scale (HADS), Clinical Outcomes for Routine Evaluation (CORE) and Measure Yourself Medical Outcomes Profile (MYMOP)]. Between January and September 2008, 323 consecutive patients were approached in outpatient clinics. Ninety-six patients declined to participate.
  
  
  RESULTS
  Two hundred twenty-seven patients took home patient information sheets; 172 (75%) returned completed questionnaires to assess levels of distress (HADS, CORE). MYMOP provided self-reported data on patient symptoms. Patients reported low levels of distress in hospital-based follow-up, which were comparable or better than general population norms, although there was a significant minority of patients reporting high scores (n = 27, 15.7%) on HADS or CORE. There was good agreement between these two measures. All sub-scales of CORE (except risk) correlated well with HADS for anxiety/depression. No significant changes were detected in the standardized measures. MYMOP results showed that 23.8% of respondents reported both physical and emotional symptoms.
  
  
  CONCLUSIONS
  Breast cancer survivors reported good psychological outcomes 2 years on from diagnosis. Screening for psychological/emotional distress is a vital part of follow-up care, which should be incorporated into UK policy.
authors.affiliation: Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK. j.thompson1@sheffield.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: Thompson
authors.forename: Rob
authors.initials: R
authors.lastname: Coleman
authors.forename: Brigitte
authors.initials: B
authors.lastname: Colwell
authors.forename: Jenny
authors.initials: J
authors.lastname: Freeman
authors.forename: Diana
authors.initials: D
authors.lastname: Greenfield
authors.forename: Karen
authors.initials: K
authors.lastname: Holmes
authors.forename: Nigel
authors.initials: N
authors.lastname: Mathers
authors.forename: Malcolm
authors.initials: M
authors.lastname: Reed
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D001943:Breast Neoplasms / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D006113:United Kingdom / Q000453:epidemiology