Abstract PS9-46: Pre-diagnosis major life stressors and breast cancer outcomes
Authors: Pai Tanmayi , Vallow Laura , Seneviratne Danushka , Mussallem Dawn , Cornell Lauren 
Published: February 2021

Abstract
Background: Multiple studies have identified an association between diagnosis of breast cancer and post-diagnosis psychological distress. Some have taken a step further, identifying predictive markers of distress in diagnosed patients and interventions to minimize post-diagnosis distress. Data regarding pre-diagnosis psychological distress and its impact on surgical decision making and clinical outcomes in the breast cancer population are limited. Here, we assessed pre-diagnosis major life stressors and breast cancer outcomes in a single-center population.
Methods: Patients with newly diagnosed stage 0-3 breast cancer seen at Mayo Clinic Florida between June 11, 2018, and October 7, 2019, were included. Prior to their initial visit, patients were administered a voluntary telephone survey regarding the incidence of major life events and stressors during the 18 months preceding their diagnosis. Demographic data including age and ethnicity were also included. Subsequent clinical outcomes were obtained through retrospective chart review. Clinical outcomes were assessed with descriptive statistics. Chi-square tests were used to compare subgroups, with p &lt; 0.05 considered statistically significant.
Results: Of 469 patients seen for a new breast cancer diagnosis, 222 patients completed the intake survey and met inclusion criteria. Median age was 60 (27-84) years. 80.6% of patients were white, 7.7% were black, 5.4% were Asian/Pacific Islander, and 2.3% were Latino. Over 95% endorsed having some form of social support. 51.3% reported experiencing a major life event prior to breast cancer diagnosis. Of these patients (n = 114), 43.9% denoted this stressor as family-related, as compared to 20.2% citing non-breast cancer illness, 14.9% claiming relationship stress, and 14% describing employment-related stress. Only 1.8% endorsed stress caused by financial concerns. Multiple major life events were reported by 10.8% of all included patients. Subgroup analysis of the patients with pre-diagnosis stress revealed a similar demographic distribution to the overall sample. Compared to the subgroup without pre-diagnosis stress (n = 108), there were more patients with carcinoma in situ and stage T3/T4 disease (21.1% versus 13.0%, p = 0.11) and 11.4% versus 10.2%, p = 0.77), respectively) in the subgroup with pre-diagnosis stress, although these differences were not statistically significant. More patients with pre-diagnosis stress elected to undergo mastectomy (34.2% versus 22.2%, p = 0.048) as compared to the group without stress.
Conclusions:
With over half of sample patients reporting pre-diagnosis major life stressors, psychological distress is prevalent prior to breast cancer diagnosis and should be considered as a factor for early intervention, such as psychological and financial counseling, during breast cancer evaluation. The sample population was predominantly white and resource-rich in terms of financial and social support, highlighting a need for characterization of pre-diagnosis psychological distress in more ethnically diverse and/or resource-limited settings. Although additional study is recommended, current data suggest possible associations between pre-diagnosis psychological distress and treatment decision making, particularly the decision to pursue mastectomy.
Citation Format: Tanmayi Pai, Laura Vallow, Danushka Seneviratne, Dawn Mussallem, Lauren Cornell. Pre-diagnosis major life stressors and breast cancer outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-46.