Psychological morbidity in Chinese women with breast cancer: a prospective study

Abstract

Objective: To examine predictors of short- and medium-term psychological morbidity (Distress) among Chinese women following breast cancer surgery. Method: Three hundred and three Chinese women were interviewed at 1 week (baseline), 1, 4 and 8 months following surgery. Participants were assessed for baseline Distress (Chinese Health Questionnaire-12) and completed a retrospective assessment of treatment decision making (TDM) difficulties, treatment outcome expectations and satisfaction with TDM involvement. Perceived treatment outcome, Distress, optimism, perceived self-efficacy (SE), and physical symptom distress (PSD) were assessed at each follow-up. Stepwise multivariate regression examined impact of TDM-related and other factors on Distress over time after adjustment for clinical and treatment differences. Results: At baseline, 38% of women had mild, and 40% moderate/severe Distress. Outcome expectation, TDM difficulties and SE predicted baseline CHQ12 scores (adjusted R2=.312). Distress declined significantly over follow-up assessments (p<.001). At one-month post-surgery (adjusted R2= 0.59) Distress was predicted by PSD (p<.001), baseline Distress (p<.001), Expectancy-Outcome incongruence (p<.001), and over-involvement in TDM (p=.003). Three-months post-surgery Distress (adjusted R2 = 0.52) was predicted by one-month post-surgery Distress (p<.001), PSD (p<.001), Expectancy-Outcome Incongruence (p=.001), and low SE (p<.001). Distress at eight-months post-surgery (adjusted R2 = 0.52) was predicted by one-month post-surgery Distress (p<.001), PSD (p<.001), and low optimism (p<.001). Conclusion: Distress declines throughout the first year after breast cancer surgery. One-month post-surgery Distress is a significant predictor of subsequent Distress. This in turn is predicted by consultation involvement and expectations. The early post-surgical period should be considered as a critical time to assess delay Distress.