OpenLB
Open Library of Bioscience
Advanced Search
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Apr, 2022;30 (4): 3521-3530.

Trajectories of adjustment disorder symptoms in post-treatment breast cancer survivors.

Lonneke M A Wijnhoven, José A E Custers, Linda Kwakkenbos, Judith B Prins
Author Information
  1. Lonneke M A Wijnhoven: Department of Medical Psychology 926, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Lonneke.Wijnhoven@radboudumc.nl. ORCID
  2. José A E Custers: Department of Medical Psychology 926, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. ORCID
  3. Linda Kwakkenbos: Department of Medical Psychology 926, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. ORCID
  4. Judith B Prins: Department of Medical Psychology 926, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. ORCID
PMID: 35020075 DOI: 10.1007/s00520-022-06806-z

Abstract

OBJECTIVE: Breast cancer survivors (BCS) may experience problems to adjust to their situation after cancer treatment completion. In case of severe distress, an adjustment disorder (AD) might develop. This study investigates the course of AD symptoms during 1 year and its predictors in BCS up to 5 years post-treatment.
METHODS: BCS completed the Hospital Anxiety and Depression Scale (HADS) at baseline, 3, 6, and 12 months. HADS total scores were defined as no mental disorder (MD) symptoms (≤ 10), AD symptoms (11-14), and any other MD symptoms (≥ 15). Over the course of four assessments, symptom trajectories were a priori defined as no MD symptoms, AD symptoms, fluctuating AD symptoms below and above cut-offs, or any other MD symptoms. Complementary, latent class growth analysis (LCGA) was used to identify data-driven trajectories.
RESULTS: Among 293 BCS with complete data, the majority was classified as no MD symptoms (54.4%), followed by 37.5% in the fluctuating AD symptoms trajectory. Only 1.4% had AD symptoms, and 6.8% had any other MD symptoms. With LCGA (N = 459), three trajectories were found: stable no MD symptoms (58.6%), stable AD symptoms (32.9%), and high increasing any other MD symptoms (8.5%). Compared to BCS with no MD symptoms, BCS with fluctuating AD symptoms or any other MD symptoms were younger, less able to handle daily activities, and showed more social support discrepancy, neuroticism, and less optimism.
CONCLUSIONS: Results of our study showed that AD symptoms in BCS up to 5 years post-treatment fluctuate over 1 year. It is thus important to appropriately assess AD over the course of 5 years post-treatment as AD symptoms can fluctuate.

Keywords

Adjustment disorder Breast cancer survivors Oncology Psychology Trajectory analysis

References

  1. Akizuki N, Akechi T, Nakanishi T, Yoshikawa E, Okamura M, Nakano T, Murakami Y, Uchitomi Y (2003) Development of a brief screening interview for adjustment disorders and major depression in patients with cancer. Cancer 97:2605–2613. https://doi.org/10.1002/cncr.11358 [DOI: 10.1002/cncr.11358]
  2. American Cancer Society (2020) Cancer facts & figures 2020. In: Editor (ed)^(eds) Book Cancer Facts & Figures 2020. American Cancer Society City
  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). American Psychiatric Association, Washington, DC [DOI: 10.1176/appi.books.9780890425596]
  4. Andrykowski MA, Cordova MJ, Studts JL, Miller TW (1998) Posttraumatic stress disorder after treatment for breast cancer: prevalence of diagnosis and use of the PTSD checklist - Civilian version (PCL-C) as a screening instrument. J Consult Clin Psych 66:586–590. https://doi.org/10.1037/0022-006x.66.3.586 [DOI: 10.1037/0022-006x.66.3.586]
  5. Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, Palmer N, Ream E, Young A, Richardson A (2009) Patients’ supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. J Clin Oncol 27:6172–6179. https://doi.org/10.1200/JCO.2009.22.5151 [DOI: 10.1200/JCO.2009.22.5151]
  6. Bachem R, Casey P (2018) Adjustment disorder: a diagnosis whose time has come. J Affect Disord 227:243–253. https://doi.org/10.1016/j.jad.2017.10.034 [DOI: 10.1016/j.jad.2017.10.034]
  7. Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II. San Antonio 78:490–498
  8. Bell ML, Fairclough DL, Fiero MH, Butow PN (2016) Handling missing items in the Hospital Anxiety and Depression Scale (HADS): a simulation study. BMC Res Notes 9:479. https://doi.org/10.1186/s13104-016-2284-z [DOI: 10.1186/s13104-016-2284-z]
  9. Carta MG, Balestrieri M, Murru A, Hardoy MC (2009) Adjustment disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemiology Ment Health 5:15. https://doi.org/10.1186/1745-0179-5-15 [DOI: 10.1186/1745-0179-5-15]
  10. Casey P (2009) Adjustment disorder: epidemiology, diagnosis and treatment. CNS Drugs 23:927–938. https://doi.org/10.2165/11311000-000000000-00000 [DOI: 10.2165/11311000-000000000-00000]
  11. Casey P, Bailey S (2011) Adjustment disorders: the state of the art. World Psychiatry 10:11–18. https://doi.org/10.1002/j.2051-5545.2011.tb00003.x [DOI: 10.1002/j.2051-5545.2011.tb00003.x]
  12. Cook SA, Salmon P, Hayes G, Byrne A, Fisher PL (2018) Predictors of emotional distress a year or more after diagnosis of cancer: a systematic review of the literature. Psychooncology 27:791–801. https://doi.org/10.1002/pon.4601 [DOI: 10.1002/pon.4601]
  13. Cornelius LR, Brouwer S, de Boer MR, Groothoff JW, van der Klink JJ (2014) Development and validation of the diagnostic interview adjustment disorder (DIAD). Int J Methods Psychiatr Res 23:192–207. https://doi.org/10.1002/mpr.1418 [DOI: 10.1002/mpr.1418]
  14. Costanzo ES, Lutgendorf SK, Mattes ML, Trehan S, Robinson CB, Tewfik F, Roman SL (2007) Adjusting to life after treatment: distress and quality of life following treatment for breast cancer. Br J Cancer 97:1625–1631. https://doi.org/10.1038/sj.bjc.6604091 [DOI: 10.1038/sj.bjc.6604091]
  15. Custers JA, Kwakkenbos L, van der Graaf WT, Prins JB, Gielissen MF, Thewes B (2020) Not as stable as we think: a descriptive study of 12 monthly assessments of fear of cancer recurrence among curatively-treated breast cancer survivors 0–5 years after surgery. Front Psychol 11:580979. https://doi.org/10.3389/fpsyg.2020.580979 [DOI: 10.3389/fpsyg.2020.580979]
  16. Denissen JJ, Geenen R, van Aken MA, Gosling SD, Potter J (2008) Development and validation of a Dutch translation of the Big Five Inventory (BFI). J Pers Assess 90:152–157. https://doi.org/10.1080/00223890701845229 [DOI: 10.1080/00223890701845229]
  17. Helgeson VS, Snyder P, Seltman H (2004) Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change. Health Psychol 23:3–15. https://doi.org/10.1037/0278-6133.23.1.3 [DOI: 10.1037/0278-6133.23.1.3]
  18. Henselmans I, Helgeson VS, Seltman H, de Vries J, Sanderman R, Ranchor AV (2010) Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis. Health Psychol 29:160–168. https://doi.org/10.1037/a0017806 [DOI: 10.1037/a0017806]
  19. Hund B, Reuter K, Harter M, Brahler E, Faller H, Keller M, Schulz H, Wegscheider K, Weis J, Wittchen HU, Koch U, Friedrich M, Mehnert A (2016) Stressors, symptom profile, and predictors of adjustment disorder in cancer patients. Results from an Epidemiological Study with the Composite International Diagnostic Interview, Adaptation for Oncology (Cidi-O). Depress Anxiety 33:153–161. https://doi.org/10.1002/da.22441 [DOI: 10.1002/da.22441]
  20. Ibbotson T, Maguire P, Selby P, Priestman T, Wallace L (1994) Screening for anxiety and depression in cancer-patients - the effects of disease and treatment. Eur J Cancer 30:37–40. https://doi.org/10.1016/S0959-8049(05)80015-2 [DOI: 10.1016/S0959-8049(05)80015-2]
  21. Jung T, Wickrama KAS (2008) An introduction to latent class growth analysis and growth mixture modeling. Soc Personal Psychol Compass 2:302–317. https://doi.org/10.1111/j.1751-9004.2007.00054.x [DOI: 10.1111/j.1751-9004.2007.00054.x]
  22. Kant J, Czisch A, Schott S, Siewerdt-Werner D, Birkenfeld F, Keller M (2018) Identifying and predicting distinct distress trajectories following a breast cancer diagnosis - from treatment into early survival. J Psychosom Res 115:6–13. https://doi.org/10.1016/j.jpsychores.2018.09.012 [DOI: 10.1016/j.jpsychores.2018.09.012]
  23. Kissane DW, Grabsch B, Love A, Clarke DM, Bloch S, Smith GC (2004) Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Aust N Z J Psychiatry 38:320–326. https://doi.org/10.1080/j.1440-1614.2004.01358.x [DOI: 10.1080/j.1440-1614.2004.01358.x]
  24. Kostev K, Jacob L, Kalder M (2017) Risk of depression, anxiety, and adjustment disorders in women with a suspected but unconfirmed diagnosis of breast or genital organ cancer in Germany. Cancer Causes Control 28:1021–1026. https://doi.org/10.1007/s10552-017-0948-1 [DOI: 10.1007/s10552-017-0948-1]
  25. Kugaya A, Akechi T, Okuyama T, Okamura H, Uchitomi Y (1998) Screening for psychological distress in Japanese cancer patients. Jpn J Clin Oncol 28:333–338. https://doi.org/10.1093/jjco/28.5.333 [DOI: 10.1093/jjco/28.5.333]
  26. Lam WW, Bonanno GA, Mancini AD, Ho S, Chan M, Hung WK, Or A, Fielding R (2010) Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psychooncology 19:1044–1051. https://doi.org/10.1002/pon.1658 [DOI: 10.1002/pon.1658]
  27. Lotfi-Jam K, Gough K, Schofield P, Aranda S, Jefford M (2019) A longitudinal study of four unique trajectories of psychological distress in cancer survivors after completing potentially curative treatment. Acta Oncol 58:782–789. https://doi.org/10.1080/0284186X.2018.1562209 [DOI: 10.1080/0284186X.2018.1562209]
  28. Maercker A, Einsle F, Kollner V (2007) Adjustment disorders as stress response syndromes: a new diagnostic concept and its exploration in a medical sample. Psychopathology 40:135–146 [DOI: 10.1159/000099290]
  29. Mehnert A, Brähler E, Faller H, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Boehncke A, Hund B (2014) Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol 32:3540–3546. https://doi.org/10.1200/JCO.2014.56.0086 [DOI: 10.1200/JCO.2014.56.0086]
  30. Mehnert A, Koch U (2007) Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study. Psycho-Oncol 16:181–188. https://doi.org/10.1002/pon.1057 [DOI: 10.1002/pon.1057]
  31. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12:160–174. https://doi.org/10.2165/11311000-000000000-00000 [DOI: 10.2165/11311000-000000000-00000]
  32. Nederlandse Kankerregistratie (NKR) I (2020). In: Editor (ed)^(eds) Book, City
  33. Ozalp E, Soygur H, Cankurtaran E, Turhan L, Akbiyik D, Geyik P (2008) Psychiatric morbidity and its screening in Turkish women with breast cancer: a comparison between the HADS and SCID tests. Psychooncology 17:668–675. https://doi.org/10.1002/pon.1286 [DOI: 10.1002/pon.1286]
  34. Riba MB, Donovan KA, Andersen B, Braun I, Breitbart WS, Brewer BW, Buchmann LO, Clark MM, Collins M, Corbett C (2019) Distress management, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 17:1229–1249. https://doi.org/10.6004/jnccn.2019.0048 [DOI: 10.6004/jnccn.2019.0048]
  35. Scheier MF, Carver CS (1985) Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol 4:219–247. https://doi.org/10.1037//0278-6133.4.3.219 [DOI: 10.1037//0278-6133.4.3.219]
  36. Shevlin M, Hyland P, Ben-Ezra M, Karatzias T, Cloitre M, Vallieres F, Bachem R, Maercker A (2020) Measuring ICD-11 adjustment disorder: the development and initial validation of the International Adjustment Disorder Questionnaire. Acta Psychiatr Scand 141:265–274. https://doi.org/10.1111/acps.13126 [DOI: 10.1111/acps.13126]
  37. Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM (1997) A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 27:363–370. https://doi.org/10.1017/s0033291796004382 [DOI: 10.1017/s0033291796004382]
  38. Stanton AL (2012) What happens now? Psychosocial care for cancer survivors after medical treatment completion. J Clin Oncol 30:1215–1220. https://doi.org/10.1200/JCO.2011.39.7406 [DOI: 10.1200/JCO.2011.39.7406]
  39. Stevens L, Rodin I (2011) Reactions to stress. In: Stevens L, Rodin I (eds) Psychiatry (Second Edition). Churchill Livingstone, pp. 62–63. https://doi.org/10.1016/B978-0-7020-3396-4.00035-4
  40. Syrowatka A, Motulsky A, Kurteva S, Hanley JA, Dixon WG, Meguerditchian AN, Tamblyn R (2017) Predictors of distress in female breast cancer survivors: a systematic review. Breast Cancer Res Treat 165:229–245. https://doi.org/10.1007/s10549-017-4290-9 [DOI: 10.1007/s10549-017-4290-9]
  41. Tang HY, Xiong HH, Deng LC, Fang YX, Zhang J, Meng H (2020) Adjustment disorder in female breast cancer patients: prevalence and its accessory symptoms Curr. Med Sci 40:510–517. https://doi.org/10.1007/s11596-020-2205-1 [DOI: 10.1007/s11596-020-2205-1]
  42. van Sonderen FLP (2012) Het meten van de sociale steun met de sociale steunlijst-interacties (SSL-I) en sociale steunlijst-discrepanties (SSL-D): een handleiding. UMCG / Rijksuniversiteit Groningen, Research Institute SHARE Groningen
  43. Vodermaier A, Millman RD (2011) Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis. Support Care Cancer 19:1899–1908. https://doi.org/10.1007/s00520-011-1251-4 [DOI: 10.1007/s00520-011-1251-4]

Grants

  1. 2011.WO11.C106/Pink Ribbon Foundation

MeSH Term

Adjustment Disorders
Breast Neoplasms
Cancer Survivors
Depression
Female
Humans
Quality of Life
Survivors
Journal Article

Word Cloud

Created with Highcharts 10.0.0symptomsADMDBCScancerdisorderpost-treatmentsurvivorscourse5 yearstrajectoriesfluctuatingBreastadjustmentstudy1 yearHADS6definedanalysisLCGA4%5%stablelessshowedfluctuateOBJECTIVE:mayexperienceproblemsadjustsituationtreatmentcompletioncaseseveredistressmightdevelopinvestigatespredictorsMETHODS:completedHospitalAnxietyDepressionScalebaseline312 monthstotalscoresmental≤ 1011-14≥ 15fourassessmentssymptomprioricut-offsComplementarylatentclassgrowthusedidentifydata-drivenRESULTS:Among293completedatamajorityclassified54followed37trajectory18%N = 459threefound:586%329%highincreasing8ComparedyoungerablehandledailyactivitiessocialsupportdiscrepancyneuroticismoptimismCONCLUSIONS:ResultsthusimportantappropriatelyassesscanTrajectoriesbreastAdjustmentOncologyPsychologyTrajectory

Similar Articles

Cited By