title: Anxiety after completion of treatment for early-stage breast cancer: a systematic review to identify candidate predictors and evaluate multivariable model development.
abstract: The purpose of this review was to identify potential candidate predictors of anxiety in women with early-stage breast cancer (BC) after adjuvant treatments and evaluate methodological development of existing multivariable models to inform the future development of a predictive risk stratification model (PRSM).
  
  
  
  Databases (MEDLINE, Web of Science, CINAHL, CENTRAL and PsycINFO) were searched from inception to November 2015. Eligible studies were prospective, recruited women with stage 0-3 BC, used a validated anxiety outcome ≥3 months post-treatment completion and used multivariable prediction models. Internationally accepted quality standards were used to assess predictive risk of bias and strength of evidence.
  
  
  
  Seven studies were identified: five were observational cohorts and two secondary analyses of RCTs. Variability of measurement and selective reporting precluded meta-analysis. Twenty-one candidate predictors were identified in total. Younger age and previous mental health problems were identified as risk factors in ≥3 studies. Clinical variables (e.g. treatment, tumour grade) were not identified as predictors in any studies. No studies adhered to all quality standards.
  
  
  
  Pre-existing vulnerability to mental health problems and younger age increased the risk of anxiety after completion of treatment for BC survivors, but there was no evidence that chemotherapy was a predictor. Multiple predictors were identified but many lacked reproducibility or were not measured across studies, and inadequate reporting did not allow full evaluation of the multivariable models. The use of quality standards in the development of PRSM within supportive cancer care would improve model quality and performance, thereby allowing professionals to better target support for patients.
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK. jenny.harris@kcl.ac.uk.
authors.forename: Jenny
authors.identifier: 0000-0001-8933-117X
authors.initials: J
authors.lastname: Harris
authors.affiliation: Imperial Clinical Trials Unit (ICTU), School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Cornelius
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Ream
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Cheevers
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Armes
mesh_terms: D001007:Anxiety / Q000209:etiology* / Q000628:therapy; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D017741:Survivors / Q000523:psychology*
keywords: Anxiety; Breast cancer; Predictors; Risk; Supportive care; Systematic review