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Diane Blyler, PhD and Karen Weihs, MD. Center for Family Research / Dept. of Psychiatry and Behavioral Sciences, George Washington University, 2300 K Street, NW, Washington, DC 20037, 202-994-4635, dblyler@gwu.edu
Recent estimates suggest that between 25% to 33% of women diagnosed with operable breast cancer will experience a recurrence within five years of diagnosis (Graham et al., 2002). Because women with a similar disease severity have significantly different outcomes, it is important to study the relationship between psychosocial factors and disease recurrence for women with breast cancer. This research explored associations between negative affectivity, severe life events and difficulties, and breast cancer recurrence, including differences in both trait and state anxiety over three time points. Women with an initial diagnosis of breast cancer or second primary diagnosis of breast cancer were recruited from five medical centers in the Washington, D.C. area. Patients were female and had a diagnosis of Stage II or III breast cancer. Data was collected on 91 women at 15 months, 34 months, and 46 months post-diagnosis. Mean age = 50.9 (s.d. = 10.46). Median follow-up years = 7.38. Sample was 51.5% white, 41.8% African American, 2.2% Asian, 5% other. Instruments included the Taylor Manifest Anxiety Scale, the Life Events and Difficulties Schedule (LEDS), and the Profile of Moods State (POMS) at 15, 34, and 46 months after diagnosis (Times 1, 2, & 3, respectively). The Nottingham Prognostic Indicator (NPI) was used to measure disease severity. Statistical models were fit using the Cox Proportional hazards model for the survival analyses. Disease severity was controlled for in each survival analysis. Analyses regarding the association of recurrent breast cancer with negative affectivity and life events used chi-square. Experiencing a severe life event one year or less prior to the initial breast cancer diagnosis predicted time to recurrence (RR = 2.61, CI 1.03 – 6.61). Women who were both high anxious 15 months after diagnosis and who experienced a severe life event in the year prior to diagnosis were the most likely group to experience a recurrence during the follow-up period (chi-square = 3.44, p = 0.06). Trait anxiety scores, measured at least 6 months prior to any recurrence, did not reach statistical significant due to the small sample size but were not only highest for women who experienced a recurrence (effect size = 0.20) but also above the normative cut-point of 8 for the TMAS. For the state anxiety scores, women who experienced a recurrence were significantly higher on the POMS Anger subscale at time 1 (p = 0.05) and the POMS Confusion subscale at time 2 (p = 0.02).
Learning Objectives:
Keywords: Behavioral Research, Breast Cancer
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.