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Multicenter Study
. 2025 Aug;14(15):e71076.
doi: 10.1002/cam4.71076.

Early Cancer Survivorship Distress Trajectories Associated With Socioeconomic Status and Age: Findings From a Multicenter Prospective Study

Anja Mehnert-Theuerkauf  1 , Ute Goerling  2 , Tanja Zimmermann  3 , Jochen Ernst  1 , Myriel Hermann  2 , Beate Hornemann  4 , Ulrich Keilholz  2   5 , Florian Lordick  6 , Olaf von dem Knesebeck  7 , David Kissane  8   9   10 , Anne-Kathrin Köditz  1 , Franziska Springer  1
Affiliations
Multicenter Study

Early Cancer Survivorship Distress Trajectories Associated With Socioeconomic Status and Age: Findings From a Multicenter Prospective Study

Anja Mehnert-Theuerkauf et al. Cancer Med. 2025 Aug.

Abstract

Background: Socioeconomic status' (SES) impact on distress during cancer survivorship has been insufficiently studied, although the consequences of low SES can be cumulative and adversely impact a person's ability to access resources required for improved health and quality of life.

Patients and methods: We conducted a prospective study involving newly diagnosed patients within 2 months of diagnosis (t1), and at 6-, 12-, and 18-month follow-up (t2-t4) using the Distress Thermometer (DT). Generalized Linear Mixed Models (GLMM) were used to test for changes in distress over time, with fixed effects of time, SES, and age.

Results: Out of 1702 eligible patients, 965 completed the baseline DT (53% men, 60.5 years); 779, 681, and 626 participated at follow-ups. Out of 554 completers, 9% were chronically distressed, while 40.8% were never distressed. Distress decreased in 21.3%, increased in 11.0%, and 17.8% fluctuated over time. Low-SES patients consistently had the highest rates of distress. Distress scores and the frequency of distress (DT ≥ 5) decreased over time in all SES and age groups: For DT mean scores, GLMM revealed a significant effect of time (χ2(3) = 72.0, p < 0.001), but not of SES (χ2(2) = 5.9, p = 0.052). For frequency of distress, there was a main effect of time (χ2(3) = 41.4, p < 0.001) and SES (χ2(2) = 15.5, p < 0.001). Younger patients (< 65 years) consistently experienced more distress than older patients (≥ 65 years). For DT mean scores, GLMM showed an effect of time (χ2(3) = 72.1, p < 0.001) and age (χ2(1) = 66.2, p < 0.001). Similarly, for frequency of distress we found an effect of time (χ2(3) = 41.7, p < 0.001) and age (χ2(1) = 52.8, p < 0.001).

Conclusion: Effective psychosocial interventions require a customized approach to decrease distress in vulnerable groups.

Trial registration: This study was registered in the International Clinical Trials Registry (NCT04620564, https://clinicaltrials.gov/).

Keywords: age; cancer survivorship; distress; longitudinal study; psycho‐oncology; socioeconomic status.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Course of distress stratified by socioeconomic status (SES) and age (mean values with standard error and frequencies with 95% confidence interval).
FIGURE 2
FIGURE 2
Distress trajectory groups (mean values and standard error).
See this image and copyright information in PMC

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