Assesment of distress among breast cancer survivors following primary treatment completion

Anu Neerukonda, Catherine Messina, Michelle Stevens, Lisa Reagan, Barbara Nemesure



To evaluate the presence of distress among breast cancer survivors and to investigate demographic, psychosocial, tumor and treatment related variables that may be associated with distress in this patient population. Although elevated levels of distress have been well documented among cancer patients receiving active treatment, the magnitude of and contributors to distress in cancer survivors have not been well established.



This investigation is based on a retrospective chart review that includes 81 female breast cancer survivors, 21 years of age or older, who received care at the Stony Brook Cancer Center Survivorship Clinic and completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) form between October 2012 and June 2014.



Approximately one-half of the breast cancer survivors reported a clinically significant distress level (4 or higher). Physical and emotional concerns were the most commonly reported problems among the sample of breast cancer survivors. Those who were on an anxiolytic or anti-depressant medication tended to have higher levels of distress (OR: 3.10; 95% CI: 0.90-10.74; P=0.07) and age greater than 60 years at the time of diagnosis was negatively correlated with distress (OR: 0.24; 95% CI: 0.07-0.84; P=0.03).



Findings from this study indicate that more than half of breast cancer survivors experienced distress during the early survivorship phase. This distress was attributable to emotional and physical problems. Although preliminary, these data suggest the need to develop targeted screening strategies for early recognition and interventions to alleviate distress in this population.


Distress Thermometer; Breast Cancer; Survivorship; Distress Screening; National Comprehensive Cancer Network

Full Text:


ACS. 2015. 2014 Cancer Survivorship Statistics – 10 Key Facts 2014 [accessed May 26 2015]. Available from http://www.cancer.org/research/acsresearchupdates/more/2014-cancer-survivorship-statistics-10-key-facts.

Berger, A. M., C. Visovsky, M. Hertzog, S. Holtz, and F. R. Loberiza, Jr. 2012. "Usual and worst symptom severity and interference with function in breast cancer survivors." J Support Oncol no. 10 (3):112-8. doi: 10.1016/j.suponc.2011.11.001.

Boyes, A., C. D'Este, M. Carey, C. Lecathelinais, and A. Girgis. 2013. "How does the Distress Thermometer compare to the Hospital Anxiety and Depression Scale for detecting possible cases of psychological morbidity among cancer survivors?" Support Care Cancer no. 21 (1):119-27. doi: 10.1007/s00520-012-1499-3.

Brant, J. M., S. Beck, W. N. Dudley, P. Cobb, G. Pepper, and C. Miaskowski. 2011. "Symptom trajectories in posttreatment cancer survivors." Cancer Nurs no. 34 (1):67-77. doi: 10.1097/NCC.0b013e3181f04ae9.

Costanzo, E. S., S. K. Lutgendorf, M. L. Mattes, S. Trehan, C. B. Robinson, F. Tewfik, and S. L. Roman. 2007. "Adjusting to life after treatment: distress and quality of life following treatment for breast cancer." Br J Cancer no. 97 (12):1625-31. doi: 10.1038/sj.bjc.6604091.

Dabrowski, M., K. Boucher, J. H. Ward, M. M. Lovell, A. Sandre, J. Bloch, L. Carlquist, M. Porter, L. Norman, and S. S. Buys. 2007. "Clinical experience with the NCCN distress thermometer in breast cancer patients." J Natl Compr Canc Netw no. 5 (1):104-11.

Garofalo, J. P., S. Choppala, H. A. Hamann, and J. Gjerde. 2009. "Uncertainty during the transition from cancer patient to survivor." Cancer Nurs no. 32 (4):E8-E14. doi: 10.1097/NCC.0b013e31819f1aab.

Gil, F., L. Grassi, L. Travado, M. Tomamichel, J. R. Gonzalez, and Group Southern European Psycho-Oncology Study. 2005. "Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients." Support Care Cancer no. 13 (8):600-6. doi: 10.1007/s00520-005-0780-0.

Hewitt, Maria, Sheldon Greenfield, Ellen Stovall, and Editors, Committee on Cancer Survivorship: Improving Care and Quality of Life, Institute of Medicine and National Research Council 2006. From cancer patient to cancer survivor: lost in transition. Washington, D.C. : The National Academies Press

Holland, J. C., and I. Reznik. 2005. "Pathways for psychosocial care of cancer survivors." Cancer no. 104 (11 Suppl):2624-37. doi: 10.1002/cncr.21252.

Howard-Anderson, J., P. A. Ganz, J. E. Bower, and A. L. Stanton. 2012. "Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review." J Natl Cancer Inst no. 104 (5):386-405. doi: 10.1093/jnci/djr541.

Islam, T., M. Dahlui, H. A. Majid, A. M. Nahar, N. A. Mohd Taib, T. T. Su, and B. C. C. study group My. 2014. "Factors associated with return to work of breast cancer survivors: a systematic review." BMC Public Health no. 14 Suppl 3:S8. doi: 10.1186/1471-2458-14-S3-S8.

Li, C., C. Li, L. Forsythe, C. Lerro, and A. Soni. 2015. "Mental health services utilization and expenditures associated with cancer survivorship in the United States." J Cancer Surviv no. 9 (1):50-8. doi: 10.1007/s11764-014-0392-0.

Ma, X., J. Zhang, W. Zhong, C. Shu, F. Wang, J. Wen, M. Zhou, Y. Sang, Y. Jiang, and L. Liu. 2014. "The diagnostic role of a short screening tool--the distress thermometer: a meta-analysis." Support Care Cancer no. 22 (7):1741-55. doi: 10.1007/s00520-014-2143-1.

National Comprehensive Cancer Network, Inc. 2015. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Distress Management, last modified 5/14/2015 [accessed May 26 2015]. Available from http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf.

Ploos van Amstel, F. K., S. W. van den Berg, H. W. van Laarhoven, M. F. Gielissen, J. B. Prins, and P. B. Ottevanger. 2013. "Distress screening remains important during follow-up after primary breast cancer treatment." Support Care Cancer no. 21 (8):2107-15. doi: 10.1007/s00520-013-1764-0.

Roerink, S. H., M. de Ridder, J. Prins, A. Huijbers, H. J. de Wilt, H. Marres, H. Repping-Wuts, N. M. Stikkelbroeck, H. J. Timmers, A. R. Hermus, and R. T. Netea-Maier. 2013. "High level of distress in long-term survivors of thyroid carcinoma: results of rapid screening using the distress thermometer." Acta Oncol no. 52 (1):128-37. doi: 10.3109/0284186X.2012.723822.

Shi, Q., T. G. Smith, J. D. Michonski, K. D. Stein, C. Kaw, and C. S. Cleeland. 2011. "Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society's Studies of Cancer Survivors." Cancer no. 117 (12):2779-90. doi: 10.1002/cncr.26146.

Stanton, A. L. 2012. "What happens now? Psychosocial care for cancer survivors after medical treatment completion." J Clin Oncol no. 30 (11):1215-20. doi: 10.1200/JCO.2011.39.7406.

Wu, H. S., and J. K. Harden. 2015. "Symptom burden and quality of life in survivorship: a review of the literature." Cancer Nurs no. 38 (1):E29-54. doi: 10.1097/NCC.0000000000000135.

DOI: http://dx.doi.org/10.18103/mra.v0i3.217


  • There are currently no refbacks.