title: The evolution of psychological distress trajectories in women diagnosed with advanced breast cancer: a longitudinal study.
abstract: BACKGROUND
  Anxiety and depression (distress) over the first year following the initial adjuvant therapy for advanced breast cancer (ABC) remain poorly documented in non-Caucasian populations. This study describes trajectories of distress and their determinants in Chinese women with ABC.
  
  
  METHODS
  Of the 228 Chinese women newly diagnosed with ABC recruited from six oncology units, 192 completed an interview before their first course of chemotherapy (baseline) and follow-up interviews at 1.5, 3, 6, and 12 months thereafter. At baseline, participants were assessed for supportive care needs, psychological distress, physical symptom distress, optimism, and cancer-related rumination. At follow-up, participants completed the measure of psychological distress. Latent growth mixture modeling was used to identify trajectory patterns of distress. Multinominal logistic regression was used to identify predictors of trajectory patterns adjusted for demographic and medical characteristics.
  
  
  RESULTS
  Four distinct trajectories of anxiety and depression were identified. Most women showed low-stable levels of anxiety (68%) and depression (68%), but one in 11 women were chronically anxious (9%) and depressed (9%). Optimism, negative cancer-related rumination, and physical symptom distress predicted both anxiety and depression trajectories. Psychological needs predicted anxiety trajectories. Women in the low-stable distress group reported high optimism, low psychological supportive care needs, low physical symptom distress, and low negative cancer-related rumination.
  
  
  CONCLUSIONS
  Most women with ABC did not experience psychological distress over 12 months following diagnosis of ABC. Preventive interventions should focus on women at risk of high persistent distress and reducing rumination, providing emotional support, and managing physical symptoms.
authors.affiliation: Centre for Psycho-Oncology Research and Training, Division of Behavioural Health, School of Public Health, The University of Hong Kong, Hong Kong.
authors.forename: W W T
authors.initials: WW
authors.lastname: Lam
authors.forename: I
authors.initials: I
authors.lastname: Soong
authors.forename: T K
authors.initials: TK
authors.lastname: Yau
authors.forename: K Y
authors.initials: KY
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Tsang
authors.forename: W
authors.initials: W
authors.lastname: Yeo
authors.forename: J
authors.initials: J
authors.lastname: Suen
authors.forename: W M
authors.initials: WM
authors.lastname: Ho
authors.forename: W K
authors.initials: WK
authors.lastname: Sze
authors.forename: A W Y
authors.initials: AW
authors.lastname: Ng
authors.forename: A
authors.initials: A
authors.lastname: Kwong
authors.forename: D
authors.initials: D
authors.lastname: Suen
authors.forename: R
authors.initials: R
authors.lastname: Fielding
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology*; D044466:Asian People / Q000523:psychology*; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D020380:Needs Assessment; D009367:Neoplasm Staging; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*
keywords: Chinese; advanced breast cancer; anxiety; depression; psychological distress; trajectory patterns