Abstract P4-11-01: Effects of high anxiety scores on surgical and overall treatment plan in breast cancer patients treated with neoadjuvant therapy
Authors: Li H , Cheung W , Myers P , McKevitt E , Willemsma K , Deruchie Tan A , Chia S , Simmons C 
Published: February 2018

Abstract
Introduction:
Anxiety is a common symptom in patients with newly diagnosed cancer. Patients with high levels of anxiety have been shown to choose more invasive surgeries in various cancer settings. Rates of contralateral prophylactic mastectomy in the adjuvant setting remain high, despite offering no survival advantage. In the neoadjuvant setting, patients have more time for decisions regarding final surgery. If anxiety is playing a role in their decisions, this could be addressed while on neoadjuvant therapy (NAT). However, the impact of anxiety at initial diagnosis on surgical decision making in this setting has not yet been studied.
Methods:
Data collected from a prospective institutional database of breast cancer patients treated with NAT at the British Columbia Cancer Agency (BCCA) were utilized to identify all patients. Information was extracted from this database with regards to patient and tumour characteristics, initial surgical plan, and final surgery performed. This was cross referenced with patient self-reported anxiety, which was extracted from the Edmonton Symptom Assessment System (ESAS) and the Psychosocial Screen for Cancer (PSSCAN) forms administered at initial consultation. Patients were assigned a score of 0 to 3 based on their answers to the ESAS anxiety scale and the PSSCAN anxiety questions, and whether or not they had any concerns related to their care. Patients were excluded if they had bilateral breast cancer, BRCA mutation or referral to the Hereditary Cancer Program, did not receive NAT or undergo breast surgery, or did not complete the forms. Fisher's exact tests were applied for statistical analysis.
Results:
From 2012-2016, 361 potential patients were identified for this study. A total of 203 patients met eligibility criteria. 93 patients (46%) had low anxiety (score 0 or 1) and 110 patients (54%) had high anxiety (score 2 or 3). Patients with high self-reported anxiety at initial consultation were significantly more likely to undergo bilateral mastectomy for unilateral disease and mastectomy for breast conserving surgery (BCS) eligible disease than those with low self-reported anxiety at initial consultation (37.3% VS 18.3%; p=0.003). No significant differences in treatment times (time interval between biopsy to chemotherapy, chemotherapy to surgery, and surgery to radiation) or investigations were identified when comparing high and low anxiety patients.
Anxiety level and type of surgery performedType of SurgeryAnxiety Level Low (n=93)High (n=110) Bilateral Mastectomy and Mastectomy for BCS eligible disease17 (18.3%)41 (37.3%) BCS and Mastectomy for non-BCS eligible disease76 (81.7%)69 (62.7%) p = 0.0031
Conclusion:
High anxiety scores lead to a 19% increase in bilateral mastectomies in patients without bilateral disease and mastectomies in patients eligible for BCS compared to patients with low anxiety (p = 0.003). These findings suggest that self-reported anxiety levels can inform and assist physicians to identify patients who are more likely to undergo aggressive surgery and may need further counselling and support services. Future work should examine the effects of counselling intervention in patients with high anxiety on surgical decisions.
Citation Format: Li H, Cheung W, Myers P, McKevitt E, Willemsma K, Deruchie Tan A, Chia S, Simmons C. Effects of high anxiety scores on surgical and overall treatment plan in breast cancer patients treated with neoadjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-11-01.