title: Identifying trajectory clusters in breast cancer survivors' supportive care needs, psychosocial difficulties, and resources from the completion of primary treatment to 8 months later.
abstract: OBJECTIVE
  This study aimed to chart patterns of simultaneous trajectories over 8 months in breast cancer survivors' (BCS) supportive care needs, psychological distress, social support, and posttraumatic growth. Clusters of BCS among these trajectories were identified and characterized.
  
  
  METHODS
  Of 426 BCS study participants, 277 (65%) provided full assessments in the last week of primary cancer treatment and 4 and 8 months later. Latent trajectories were obtained using growth mixture modeling for patients who responded to all scores for at least one time point (n = 348). Then, classification of BCS was performed by hierarchical agglomerative clustering on axes derived from a multiple factor analysis of trajectory assignments. Self-esteem, attachment security, and satisfaction with care were assessed at baseline.
  
  
  RESULTS
  Four trajectory clusters were identified, including two BCS subgroups (63%) with low needs and low psychological distress. Two others (37%) exhibited high or increasing needs and concerning levels of psychological distress. These latter clusters were characterized by higher insecure attachment, lower satisfaction with care, and either lower education or younger age, and having undergone chemotherapy.
  
  
  CONCLUSIONS
  More than a third of BCS present unfavorable patterns in supportive care needs over 8 months after primary cancer treatment. Identified psychosocial and cancer care characteristics point to targets for enhanced BCS supportive care.
authors.affiliation: Psycho-Oncology Unit, Supportive Care Department, Institute Curie, 26 rue d'Ulm, 75005, Paris Cedex 05, France. anne.bredart@curie.fr.|Psychology Institute, LPPS EA 4057, University Paris Descartes, Boulogne Billancourt, France. anne.bredart@curie.fr.
authors.forename: A
authors.initials: A
authors.lastname: Brédart
authors.affiliation: EA 4275, Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.|Institute of High School in Osteopathy, Laboratory of Osteopathy Research, Nantes, France.
authors.forename: O
authors.initials: O
authors.lastname: Merdy
authors.affiliation: Tumor Biology Department, Institut Curie, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Sigal-Zafrani
authors.affiliation: Psycho-Oncology Unit, Supportive Care Department, Institute Curie, 26 rue d'Ulm, 75005, Paris Cedex 05, France.|Psychology Institute, LPPS EA 4057, University Paris Descartes, Boulogne Billancourt, France.
authors.forename: C
authors.initials: C
authors.lastname: Fiszer
authors.affiliation: Psycho-Oncology Unit, Supportive Care Department, Institute Curie, 26 rue d'Ulm, 75005, Paris Cedex 05, France.|Inserm, U 669, Paris, France.|University Paris-Sud and UMR-S0669, University Paris Descartes, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Dolbeault
authors.affiliation: EA 4275, Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.|Unit of Methodology and Biostatistics, University Hospital of Nantes, Nantes, France.
authors.forename: J-B
authors.initials: JB
authors.lastname: Hardouin
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D016000:Cluster Analysis; D004522:Educational Status; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D020380:Needs Assessment; D017060:Patient Satisfaction; D011788:Quality of Life; D012649:Self Concept; D012944:Social Support; D017741:Survivors / Q000523:psychology*; D013997:Time Factors
keywords: Breast neoplasms; Cluster analysis; Longitudinal studies; Patient care management; Supportive care needs; Trajectory