title: Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life.
abstract: OBJECTIVE
  Little is known about the prevalence of combined anxiety and depressive symptoms (CADS) in breast cancer patients. Purpose was to evaluate for differences in demographic and clinical characteristics and quality of life (QOL) prior to breast cancer surgery among women classified into one of four distinct anxiety and/or depressive symptom groups.
  
  
  METHODS
  A total of 335 patients completed measures of anxiety and depressive symptoms and QOL prior to and for 6 months following breast cancer surgery. Growth Mixture Modelling (GMM) was used to identify subgroups of women with distinct trajectories of anxiety and depressive symptoms. These results were used to create four distinct anxiety and/or depressive symptom groups. Differences in demographic, clinical, and symptom characteristics, among these groups were evaluated using analyses of variance and Chi square analyses.
  
  
  RESULTS
  A total of 44.5% of patients were categorized with CADS. Women with CADS were younger, non-white, had lower performance status, received neoadjuvant or adjuvant chemotherapy, had greater difficulty dealing with their disease and treatment, and reported less support from others to meet their needs. These women had lower physical, psychological, social well-being, and total QOL scores. Higher levels of anxiety with or without subsyndromal depressive symptoms were associated with increased fears of recurrence, hopelessness, uncertainty, loss of control, and a decrease in life satisfaction.
  
  
  CONCLUSIONS
  Findings suggest that CADS occurs in a high percentage of women following breast cancer surgery and results in a poorer QOL. Assessments of anxiety and depressive symptoms are warranted prior to surgery for breast cancer.
authors.affiliation: Schools of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Marshall
authors.initials: M
authors.lastname: Gold
authors.affiliation: Schools of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dunn
authors.affiliation: Schools of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Phoenix
authors.affiliation: Schools of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: Schools of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hamolsky
authors.affiliation: Schools of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Levine
authors.affiliation: Schools of Nursing, University of California, San Francisco, CA, USA. Electronic address: chris.miaskowski@ucsf.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000209:etiology*; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology*; D017024:Chemotherapy, Adjuvant; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Anxiety; Breast cancer; Depression; Quality of life; Subsyndromal depression; Surgery