title: Predictors of initial levels and trajectories of anxiety in women before and for 6 months after breast cancer surgery.
abstract: BACKGROUND
  The diagnosis of breast cancer, in combination with the anticipation of surgery, evokes fear, uncertainty, and anxiety in most women.
  
  
  OBJECTIVE
  Study purposes were to examine in patients who underwent breast cancer surgery how ratings of state anxiety changed from the time of the preoperative assessment to 6 months after surgery and to investigate whether specific demographic, clinical, symptom, and psychosocial adjustment characteristics predicted the preoperative levels of state anxiety and/or characteristics of the trajectories of state anxiety.
  
  
  METHODS
  Patients (n = 396) were enrolled preoperatively and completed the Spielberger State Anxiety inventory monthly for 6 months. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of state anxiety.
  
  
  RESULTS
  Patients experienced moderate levels of anxiety before surgery. Higher levels of depressive symptoms and uncertainty about the future, as well as lower levels of life satisfaction, less sense of control, and greater difficulty coping, predicted higher preoperative levels of state anxiety. Higher preoperative state anxiety, poorer physical health, decreased sense of control, and more feelings of isolation predicted higher state anxiety scores over time.
  
  
  CONCLUSIONS
  Moderate levels of anxiety persist in women for 6 months after breast cancer surgery.
  
  
  CONCLUSIONS
  Clinicians need to implement systematic assessments of anxiety to identify high-risk women who warrant more targeted interventions. In addition, ongoing follow-up is needed to prevent adverse postoperative outcomes and to support women to return to their preoperative levels of function.
authors.affiliation: Author Affiliations: School of Nursing (Drs Kyranou, Puntillo, Aouizerat, Paul, Cooper, Dodd, and Miaskowski and Ms West), School of Medicine (Drs Dunn and Neuhaus), and the Institute for Human Genetics (Dr Aouizerat), University of California, San Francisco.
authors.forename: Marianna
authors.initials: M
authors.lastname: Kyranou
authors.forename: Kathleen
authors.initials: K
authors.lastname: Puntillo
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dunn
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Aouizerat
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.forename: John
authors.initials: J
authors.lastname: Neuhaus
authors.forename: Claudia
authors.initials: C
authors.lastname: West
authors.forename: Marylin
authors.initials: M
authors.lastname: Dodd
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology* / Q000601:surgery; D005260:Female; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D011795:Surveys and Questionnaires