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. 2017 Jul;25(7):2321-2333.
doi: 10.1007/s00520-017-3688-6. Epub 2017 Apr 12.

Anxiety after completion of treatment for early-stage breast cancer: a systematic review to identify candidate predictors and evaluate multivariable model development

Jenny Harris  1 , Victoria Cornelius  2 , Emma Ream  3 , Katy Cheevers  4 , Jo Armes  4
Affiliations

Anxiety after completion of treatment for early-stage breast cancer: a systematic review to identify candidate predictors and evaluate multivariable model development

Jenny Harris et al. Support Care Cancer. 2017 Jul.

Abstract

Purpose: The purpose of this review was to identify potential candidate predictors of anxiety in women with early-stage breast cancer (BC) after adjuvant treatments and evaluate methodological development of existing multivariable models to inform the future development of a predictive risk stratification model (PRSM).

Methods: Databases (MEDLINE, Web of Science, CINAHL, CENTRAL and PsycINFO) were searched from inception to November 2015. Eligible studies were prospective, recruited women with stage 0-3 BC, used a validated anxiety outcome ≥3 months post-treatment completion and used multivariable prediction models. Internationally accepted quality standards were used to assess predictive risk of bias and strength of evidence.

Results: Seven studies were identified: five were observational cohorts and two secondary analyses of RCTs. Variability of measurement and selective reporting precluded meta-analysis. Twenty-one candidate predictors were identified in total. Younger age and previous mental health problems were identified as risk factors in ≥3 studies. Clinical variables (e.g. treatment, tumour grade) were not identified as predictors in any studies. No studies adhered to all quality standards.

Conclusions: Pre-existing vulnerability to mental health problems and younger age increased the risk of anxiety after completion of treatment for BC survivors, but there was no evidence that chemotherapy was a predictor. Multiple predictors were identified but many lacked reproducibility or were not measured across studies, and inadequate reporting did not allow full evaluation of the multivariable models. The use of quality standards in the development of PRSM within supportive cancer care would improve model quality and performance, thereby allowing professionals to better target support for patients.

Keywords: Anxiety; Breast cancer; Predictors; Risk; Supportive care; Systematic review.

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Conflict of interest statement

Funding

This research received no specific grant from any funding agency. Open access for this article was funded by King’s College London.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Identification of studies for the systematic review
See this image and copyright information in PMC

References

    1. Santin O, Mills M, Treanor C, Donnelly M. A comparative analysis of the health and well-being of cancer survivors to the general population. Supp Care Cancer. 2012;20(10):2545–2552. doi: 10.1007/s00520-011-1372-9. - DOI - PubMed
    1. National Cancer Survivorship Initiative (2013) Living with and beyond cancer: taking action to improve outcomes. London: NHS Improvement, Department of Health, Macmillan Cancer Support
    1. Richards M, Corner J, Maher J. The National Cancer Survivorship Initiative: new and emerging evidence on the ongoing needs of cancer survivors. Br J Cancer. 2011;105:S1–S4. doi: 10.1038/bjc.2011.416. - DOI - PMC - PubMed
    1. Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, et al. Patients’ supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. J Clin Oncol. 2009;27(36):6172–6179. doi: 10.1200/JCO.2009.22.5151. - DOI - PubMed
    1. Sarkar S, Sautier L, Schilling G, Bokemeyer C, Koch U, Mehnert A. Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients. J Cancer Surviv. 2015;9(4):567–575. doi: 10.1007/s11764-015-0434-2. - DOI - PubMed

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