Predictors of distress in female breast cancer survivors: a systematic review

• Published in: Breast cancer research and treatment Vol. 165; no. 2; pp. 229 - 245
• Main Authors: Syrowatka, Ania, Motulsky, Aude, Kurteva, Siyana, Hanley, James A., Dixon, William G., Meguerditchian, Ari N., Tamblyn, Robyn
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2017; Springer; Springer Nature B.V
• Subjects: Age; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - psychology; Cancer research; Cancer Survivors; Chemotherapy; Cigarette smoking; Development and progression; Fatigue; Female; Humans; Medicine; Medicine & Public Health; Mental disorders; Minority & ethnic groups; Oncology; Pain; Physical activity; Quality of Life; Review; Reviews; Risk Factors; Sleep; Sleep disorders; Social interactions; Socioeconomic Factors; Stress, Psychological; Survival; Systematic review; Breast cancer; Distress; Survivorship; Predictor
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-017-4290-9

Purpose
Unmanaged distress has been shown to adversely affect survival and quality of life in breast cancer survivors. Fortunately, distress can be managed and even prevented with appropriate evidence-based interventions. Therefore, the objective of this systematic review was to synthesize the published literature around predictors of distress in female breast cancer survivors to help guide targeted intervention to prevent distress.
Methods
Relevant studies were located by searching MEDLINE, Embase, PsycINFO, and CINAHL databases. Significance and directionality of associations for commonly assessed candidate predictors (
n
 ≥ 5) and predictors shown to be significant (
p
 ≤ 0.05) by at least two studies were summarized descriptively. Predictors were evaluated based on the proportion of studies that showed a significant and positive association with the presence of distress.
Results
Forty-two studies met the target criteria and were included in the review. Breast cancer and treatment-related predictors were more advanced cancer at diagnosis, treatment with chemotherapy, longer primary treatment duration, more recent transition into survivorship, and breast cancer recurrence. Manageable treatment-related symptoms associated with distress included menopausal/vasomotor symptoms, pain, fatigue, and sleep disturbance. Sociodemographic characteristics that increased the risk of distress were younger age, non-Caucasian ethnicity, being unmarried, and lower socioeconomic status. Comorbidities, history of mental health problems, and perceived functioning limitations were also associated. Modifiable predictors of distress were lower physical activity, lower social support, and cigarette smoking.
Conclusions
This review established a set of evidence-based predictors that can be used to help identify women at higher risk of experiencing distress following completion of primary breast cancer treatment.