title: Trajectories and predictors of state and trait anxiety in patients receiving chemotherapy for breast and colorectal cancer: Results from a longitudinal study.
abstract: OBJECTIVE
  To examine the trajectories and predictors of state and trait anxiety in patients undergoing chemotherapy for breast or colorectal cancer.
  
  
  METHODS
  Secondary analysis of data collected as part of a large multi-site longitudinal study. Patients with breast or colorectal cancer completed validated scales assessing their state and trait anxiety levels (State-Trait Anxiety Inventory) and symptom burden (Rotterdam Symptom Checklist) at the beginning of each chemotherapy cycle. Longitudinal mixed model analyses were performed to test changes of trait and state anxiety over time and the predictive value of symptom burden and patients' demographic (age, gender) and clinical characteristics (cancer type, stage, comorbidities, ECOG performance status).
  
  
  RESULTS
  Data from 137 patients with breast (60%) or colorectal cancer (40%) were analysed. Linear time effects were found for both state (χ2= 46.3 [df = 3]; p < 0.001) and trait anxiety (χ2= 17.708 [df = 3]; p = 0.001), with anxiety levels being higher at baseline and gradually decreasing over the course of chemotherapy. Symptom burden (β = 0.21; SD = 0.06; p = 0.001) predicted state anxiety throughout treatment, but this effect disappeared when accounting for trait anxiety scores before the start of chemotherapy (β = 0.85; SD = 0.05; p < 0.001). Patients' baseline trait anxiety was the only significant predictor of anxiety throughout treatment.
  
  
  CONCLUSIONS
  Changes in the generally stable characteristic of trait anxiety indicate the profoundly life-altering nature of chemotherapy. The time point before the start of chemotherapy was identified as the most anxiety-provoking, calling for interventions to be delivered as early as possible in the treatment trajectory. Patients with high trait anxiety and symptom burden may benefit from additional support.
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom. Electronic address: a.schneider@surrey.ac.uk.
authors.forename: Annegret
authors.initials: A
authors.lastname: Schneider
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Kotronoulas
authors.affiliation: University of the West of Scotland, Almada St, Hamilton, South Lanarkshire, ML3 0JB, United Kingdom.
authors.forename: Constantina
authors.initials: C
authors.lastname: Papadopoulou
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Lisa
authors.initials: L
authors.lastname: McCann
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Morven
authors.initials: M
authors.lastname: Miller
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Jackie
authors.initials: J
authors.lastname: McBride
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Polly
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Bettles
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Whitehouse
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Nora
authors.initials: N
authors.lastname: Kearney
authors.affiliation: University of Surrey, Guildford, GU2 7XH, United Kingdom.
authors.forename: Roma
authors.initials: R
authors.lastname: Maguire
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001008:Anxiety Disorders / Q000209:etiology*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: Anxiety; Chemotherapy; Oncology; Physical symptoms; Psychological adjustment; Supportive care