title: Prevalence and predictors of distress in women taking part in surgical continuity of care for breast cancer: A cohort study.
abstract: OBJECTIVE
  Women with breast cancer often experience distress. This cohort study investigated the prevalence of distress, predictors of distress, and changes in distress during surgical continuity of care for breast cancer (from diagnosis to commencement of adjuvant treatment).
  
  
  METHODS
  The participants were 1079 women with breast cancer who were recruited between April 2013 and May 2014 from 11 breast surgery departments in Denmark. Distress was evaluated using the Distress Thermometer (DT) and predictors of distress were assessed with a self-administered questionnaire at the time of diagnosis (T1), at discharge (T2), and by the start of adjuvant treatment or follow-up (T3). Repeated measures ANOVA, simple and multiple linear regression, and mixed effects regression models were used to identify predictors and estimate changes in distress.
  
  
  RESULTS
  At T1, 249 (24.3%) women reported no or minimal distress, 298 (29.1%) moderate distress, and 407 (39.8%) severe distress. The mean distress was 5.5 points on the DT, which decreased by 0.70 (95% confidence interval (CI) -0.80, -0.54) points from T1 to T3. Predictors of distress were time since diagnosis, age, prior or concurrent intake of antidepressants or sedative medicine, prior emotional status, children living at home, feelings regarding femininity and attractiveness, and hospital.
  
  
  CONCLUSIONS
  More than two-thirds of women with breast cancer experienced moderate or severe distress. Mean distress decreased slightly during surgical continuity of care. However, for some women, distress remained unchanged or even worsened. These findings highlight the need to identify the individual women with distress and offer them adequate support and care.
authors.affiliation: Department of Breast Surgery, Aalborg University Hospital, Sdr Skovvej 3, 9000, Aalborg, Denmark. Electronic address: lojo@rn.dk.
authors.forename: L
authors.initials: L
authors.lastname: Jørgensen
authors.affiliation: Department of Clinical Medicine Aalborg University & Clinical Nursing Research Unit Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark. Electronic address: bisl@rn.dk.
authors.forename: B S
authors.initials: BS
authors.lastname: Laursen
authors.affiliation: Department of Breast Surgery, Aalborg University Hospital, Sdr Skovvej 3, 9000, Aalborg, Denmark. Electronic address: jpg@dadlnet.dk.
authors.forename: J P
authors.initials: JP
authors.lastname: Garne
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, 2109, NSW, Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia. Electronic address: Kerry.Sherman@mq.edu.au.
authors.forename: K A
authors.initials: KA
authors.lastname: Sherman
authors.affiliation: Department of Epidemiology Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark. Electronic address: mso@clin.au.dk.
authors.forename: M
authors.initials: M
authors.lastname: Søgaard
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003718:Denmark; D004644:Emotions; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Breast cancer; Distress; Distress thermometer; Longitudinal; Predictors; Survey