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Predictors of Initial Levels and Trajectories of Anxiety in Women Before and for 6 Months After Breast Cancer Surgery

Kyranou, Marianna PhD, RN; Puntillo, Kathleen PhD, RN; Dunn, Laura B. MD; Aouizerat, Bradley E. PhD, MAS; Paul, Steven M. PhD; Cooper, Bruce A. PhD; Neuhaus, John PhD; West, Claudia RN, MS; Dodd, Marylin PhD, RN; Miaskowski, Christine PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000131

Background: The diagnosis of breast cancer, in combination with the anticipation of surgery, evokes fear, uncertainty, and anxiety in most women.

Objective: Study purposes were to examine in patients who underwent breast cancer surgery how ratings of state anxiety changed from the time of the preoperative assessment to 6 months after surgery and to investigate whether specific demographic, clinical, symptom, and psychosocial adjustment characteristics predicted the preoperative levels of state anxiety and/or characteristics of the trajectories of state anxiety.

Interventions/Methods: Patients (n = 396) were enrolled preoperatively and completed the Spielberger State Anxiety inventory monthly for 6 months. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of state anxiety.

Results: Patients experienced moderate levels of anxiety before surgery. Higher levels of depressive symptoms and uncertainty about the future, as well as lower levels of life satisfaction, less sense of control, and greater difficulty coping, predicted higher preoperative levels of state anxiety. Higher preoperative state anxiety, poorer physical health, decreased sense of control, and more feelings of isolation predicted higher state anxiety scores over time.

Conclusions: Moderate levels of anxiety persist in women for 6 months after breast cancer surgery.

Implications for Practice: Clinicians need to implement systematic assessments of anxiety to identify high-risk women who warrant more targeted interventions. In addition, ongoing follow-up is needed to prevent adverse postoperative outcomes and to support women to return to their preoperative levels of function.

Author Affiliations: School of Nursing (Drs Kyranou, Puntillo, Aouizerat, Paul, Cooper, Dodd, and Miaskowski and Ms West), School of Medicine (Drs Dunn and Neuhaus), and the Institute for Human Genetics (Dr Aouizerat), University of California, San Francisco.

This study was funded by grants from the National Cancer Institute (CA107091 and CA118658). Dr Christine Miaskowski is an American Cancer Society Clinical Research Professor. This project is supported by National Institutes of Health/National Center for Research Resources University of California, San Francisco-Clinical and Translational Science Institute Grant Number UL1 RR024131. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

The authors have no conflicts of interest to disclose.

Correspondence: Christine Miaskowski, PhD, RN, FAAN, Department of Physiological Nursing, University of California, 2 Koret Way–N631Y, San Francisco, CA 94143-0610 (

Accepted for publication January 6, 2014.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins