Prevalence and Predictors of Distress in Young Women with Newly Diagnosed Early Stage Breast Cancer.
Authors: K. Ruddy, S. Gelber, R. Tamimi, E. Mayer, L. Schapira, S. Come, M. Meyer, E. Winer, A. Partridge
Journal: Cancer Research (2009)

Abstract Background: Previous research suggests that young women are at high risk for psychological distress after a breast cancer diagnosis. We sought to identify factors associated with overall distress, anxiety, and depression in this vulnerable population.Materials and Methods: We have surveyed women age ≤40 with recently diagnosed stage I-III breast cancer in an ongoing prospective multi-center cohort study started in late 2006. The baseline survey includes the Hospital Anxiety and Depression Scale (HADS) as well as sociodemographic and medical history items. Medical record and central pathology review were also performed. Women with HADS scores &amp;gt;14 were considered distressed, and those with scores &amp;gt;10 on the anxiety or depression subscales were considered anxious or depressed, respectively. We conducted multivariate logistic regression modeling to determine predictors of anxiety, depression, and overall distress.Results: The first 258 eligible women who completed the baseline survey are included in this analysis. Median age at diagnosis was 37 years. Seventy-six percent were married, 90% white, 83% college educated, 66% had children, 99% were medically insured, and 60% were employed full time prior to diagnosis. Fifty-two percent of women reported their finances as comfortable. Forty-eight percent reported a household income over $100,000 per year, and only 15% reported an income less than $50,000. Comfortable finances and higher reported income were strongly correlated (Spearman's correlation coefficient = 0.51, p&amp;lt;0.0001). Fifty-four women (21%) reported substantial anxiety, 22 (9%) depression, and 107 (41%) distress by HADS score. Multivariate logistic regression models revealed that women with less than comfortable finances were more likely to be distressed (OR 3.1, 95% CI 1.7-5.6, p=0.0001), anxious (OR 2.4, 95% CI 1.2-4.9, p=0.0139), or depressed (OR 3.3, 95% CI 1.1-10.3, p=0.0375). Women with more advanced stage (stage II or III) breast cancer were also more likely to be anxious (OR 2.3, 95% CI 1.0-5.3, p=.0477). Grade, race, education, mastectomy, chemotherapy, fulltime employment, marital status, whether a woman has children, family history of cancer, and alcohol consumption were not found to be statistically significantly associated with anxiety, depression, or overall distress.Discussion: In this large cohort of young women with early breast cancer, distress is common. Financial status was the only sociodemographic factor that was consistently associated with baseline anxiety, depression, and overall distress. These results suggest that it may be important to target psychosocial interventions including financial counseling early in the course of care, especially given that financial stressors may worsen over time. Future research is needed to develop effective interventions to reduce distress in young women with newly diagnosed breast cancer. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1067.