title: Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship.
abstract: Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.
authors: a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.|b Department of Medicine and Public Health , Red Cross University College , Stockholm , Sweden.
authors: Fredrik
authors: F
authors: Saboonchi
authors: a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.
authors: Lena-Marie
authors: LM
authors: Petersson
authors: a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.|c Sophiahemmet University, Stockholm , Sweden.
authors: Agneta
authors: A
authors: Wennman-Larsen
authors: a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.
authors: Kristina
authors: K
authors: Alexanderson
authors: a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.|d Centre for Occupational and Environmental Medicine , Stockholm County Council , Stockholm , Sweden.
authors: Marjan
authors: M
authors: Vaez
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D013548:Sweden; D055815:Young Adult
keywords: adjustment; anxiety; breast cancer; transitional survivorship