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Anxiety profiles are associated with stress, resilience and symptom severity in outpatients receiving chemotherapy

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Abstract

Purpose

The purposes of this study, in a sample of oncology patients (n = 1326) receiving chemotherapy, were to identify subgroups of patients with distinct anxiety profiles and evaluate for differences in demographic and clinical characteristics, stress and resilience measures, and severity of co-occurring symptoms (i.e., depression, sleep disturbance, attentional function, fatigue, pain).

Methods

Patients completed self-report questionnaires a total of six times over two cycles of chemotherapy. Severity of state anxiety was evaluated using the Spielberger State Anxiety Inventory and resilience was assessed using the Connor-Davidson Resilience Scale. Symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, General Sleep Disturbance Scale, Lee Fatigue Scale, Attentional Function Index and Brief Pain Inventory.

Results

Based on the findings from the latent profile analysis that utilized the six assessments of state anxiety, 47.7% of the patients were classified as “Low,” 28.3% as “Moderate,” 19.5% as “High,” and 4.5.% as “Very High.” Anxiety levels remained relatively stable across the six timepoints. Compared to the Low class, membership in the Moderate, High, and Very High classes was associated with a number of characteristics (e.g., younger age, female gender, lower functional status, more comorbidities). Those patients with higher levels of anxiety reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms.

Conclusion

Our findings suggest that a substantial number of oncology patients may warrant referral to psychological services. Clinicians need to perform systematic assessments of anxiety, stress, and common symptoms and initiate appropriate interventions to enhance resilience and coping.

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Data availability

Data will be provided to the publisher after they obtain a material transfer agreement from the University of California, San Francisco.

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Funding

This study was funded by a grant from the National Cancer Institute (CA134900). Ms. Harris and Oppegaard are supported by a grant from the National Institute of Nursing Research (T32NR016920). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Miaskowski is an American Cancer Society Clinical Research Professor. Ms. Harris is supported by a grant from the American Cancer Society. Ms. Oppegaard and Shin are supported by a grant from the Oncology Nursing Foundation.

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Authors and Affiliations

  1. School of Nursing, University of California, 2 Koret Way – N631Y, San Francisco, CA, 94143-0610, USA

    Kate Oppegaard, Carolyn S. Harris, Joosun Shin, Steven M. Paul, Bruce A. Cooper, Kord M. Kober & Christine Miaskowski

  2. School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA

    Jon D. Levine & Christine Miaskowski

  3. School of Dentistry, University of California, 513 Parnassus Ave, MSB, San Francisco, CA, 94117, USA

    Jon D. Levine

  4. School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA

    Yvette P. Conley

  5. Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA

    Marilyn Hammer

  6. Department of Nursing, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1068, New York, NY, 10029, USA

    Frances Cartwright

  7. Rory Meyers College of Nursing, New York University, 433 1st Avenue, Room 740, New York, NY, 10010, USA

    Fay Wright

  8. School of Medicine, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA

    Laura Dunn

Authors
  1. Kate Oppegaard
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  2. Carolyn S. Harris
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  4. Steven M. Paul
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  10. Fay Wright
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  11. Laura Dunn
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  12. Kord M. Kober
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  13. Christine Miaskowski
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Contributions

All authors contributed to the study conception and design. Data analysis was performed by Steven M. Paul and Bruce A. Cooper. The first draft of the manuscript was written by Kate Oppegaard and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Christine Miaskowski.

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This study was approved by the Committee on Human Research at the University of California.

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 All patients signed written informed consent.

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The authors declare that they have no conflict of interest.

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Oppegaard, K., Harris, C.S., Shin, J. et al. Anxiety profiles are associated with stress, resilience and symptom severity in outpatients receiving chemotherapy. Support Care Cancer 29, 7825–7836 (2021). https://doi.org/10.1007/s00520-021-06372-w

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  • DOI: https://doi.org/10.1007/s00520-021-06372-w

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