Predictors of initial levels and trajectories of anxiety in women before and for 6 months after breast cancer surgery

Abstract

Background: The diagnosis of breast cancer, in combination with the anticipation of surgery, evokes fear, uncertainty, and anxiety in most women.

Objective: Study purposes were to examine in patients who underwent breast cancer surgery how ratings of state anxiety changed from the time of the preoperative assessment to 6 months after surgery and to investigate whether specific demographic, clinical, symptom, and psychosocial adjustment characteristics predicted the preoperative levels of state anxiety and/or characteristics of the trajectories of state anxiety.

Interventions/methods: Patients (n = 396) were enrolled preoperatively and completed the Spielberger State Anxiety inventory monthly for 6 months. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of state anxiety.

Results: Patients experienced moderate levels of anxiety before surgery. Higher levels of depressive symptoms and uncertainty about the future, as well as lower levels of life satisfaction, less sense of control, and greater difficulty coping, predicted higher preoperative levels of state anxiety. Higher preoperative state anxiety, poorer physical health, decreased sense of control, and more feelings of isolation predicted higher state anxiety scores over time.

Conclusions: Moderate levels of anxiety persist in women for 6 months after breast cancer surgery.

Implications for practice: Clinicians need to implement systematic assessments of anxiety to identify high-risk women who warrant more targeted interventions. In addition, ongoing follow-up is needed to prevent adverse postoperative outcomes and to support women to return to their preoperative levels of function.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Trajectory of state anxiety as measured with the Spielberger State Anxiety Inventory over the six months of the study (1A). Influence of preoperative state anxiety (1B) and depressive symptoms (1C) scores on inter-individual differences in state anxiety.

Figure 2

Influence of preoperative ratings of life satisfaction (2A), uncertainty (2B), sense of control (2C), and difficulty coping (2D) on inter-individual differences in state anxiety.

Figure 3

Influence of receipt of adjuvant chemotherapy (3A) and preoperative ratings of physical health (3B), importance of spiritual activities (3C), and feelings of isolation (3D) on inter-individual differences in state anxiety.