title: Predictors of enduring clinical distress in women with breast cancer.
abstract: To date, little is known about enduring clinical distress as measured with the commonly used distress thermometer. We therefore used the distress thermometer to examine: (a) the prevalence of enduring clinical distress, distress-related problems, and subsequent wish for referral of women with breast cancer, and (b) sociodemographic, clinical, and psychosocial predictors of enduring clinical distress. The study had a multicenter, prospective, observational design. Patients with primary breast cancer completed a questionnaire at 6 and 15 months postdiagnosis. Medical data were retrieved from chart reviews. Enduring clinical distress was defined as heightened distress levels over time. The prevalence of enduring clinical distress, problems, and wish for referral was examined with descriptive analyses. Associations between predictors and enduring clinical distress were examined with multivariate analyses. One hundred sixty-four of 746 patients (22 %) reported having enduring clinical distress at 6 and 15 months postdiagnosis. Of these, 10 % wanted to be referred for care. Fatigue was the most frequently reported problem by patients with and without clinical distress, at both time points. Lack of muscle strength (OR = 1.82, 95 % CI 1.12-2.98), experience of a low level of life satisfaction (OR = 0.77, 95 % CI 0.67-0.89), more frequent cancer worry (OR = 1.40, 95 % CI 1.05-1.89), and neuroticism (OR = 1.09, 95 % CI 1.00-1.18) were predictors of enduring clinical distress. In conclusion, one in five women with breast cancer develops enduring clinical distress. Oncologists, nurse practitioners, and cancer nurses are advised to use single-item questions about distress and distress-related problems to ensure timely detection of high-risk patients. Providers should also routinely assess fatigue and its causes, as fatigue is the most frequently reported distress-related problem over time.
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands. d.n.lo-fo-wong@amc.uva.nl.
authors.forename: Deborah N N
authors.initials: DN
authors.lastname: Lo-Fo-Wong
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands.
authors.forename: Hanneke C J M
authors.initials: HC
authors.lastname: de Haes
authors.affiliation: The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
authors.affiliation: GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
authors.forename: Doris L
authors.initials: DL
authors.lastname: van Abbema
authors.affiliation: Erasmus MC - Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
authors.forename: Mathilda D
authors.initials: MD
authors.lastname: den Boer
authors.affiliation: Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: Marjan
authors.initials: M
authors.lastname: van Hezewijk
authors.affiliation: Reinier de Graaf Hospital, Reinier de Graafweg 3-11, 2625 AD, Delft, The Netherlands.
authors.forename: Marcelle
authors.initials: M
authors.lastname: Immink
authors.affiliation: Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: Ad A
authors.initials: AA
authors.lastname: Kaptein
authors.affiliation: Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands.
authors.forename: Marian B E
authors.initials: MB
authors.lastname: Menke-Pluijmers
authors.affiliation: University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
authors.forename: Anna K L
authors.initials: AK
authors.lastname: Reyners
authors.affiliation: The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
authors.forename: Nicola S
authors.initials: NS
authors.lastname: Russell
authors.affiliation: St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
authors.forename: Manon
authors.initials: M
authors.lastname: Schriek
authors.affiliation: University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Sieta
authors.initials: S
authors.lastname: Sijtsema
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands.
authors.forename: Geertjan
authors.initials: G
authors.lastname: van Tienhoven
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands.
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
mesh_terms: D001943:Breast Neoplasms / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008484:Medicaid; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life; D013315:Stress, Psychological / Q000208:ethnology* / Q000209:etiology; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment; D014481:United States / Q000208:ethnology
keywords: Breast cancer; Distress; Distress thermometer; Referral