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Trajectories of Depressed Mood and Anxiety During Chemotherapy for Breast Cancer

Whisenant, Meagan, PhD, APRN; Wong, Bob, PhD; Mitchell, Sandra A., PhD, CRNP, FAAN; Beck, Susan L., PhD, APRN, FAAN, AOCN; Mooney, Kathi, PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000670
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Background Women are at risk of mood disturbance during treatment for breast cancer.

Objective The aims of this study were to identify classes of women experiencing similar trajectories of depressed mood and anxiety while receiving chemotherapy for breast cancer and to determine associated antecedents and outcomes. The specific aims were to (1) determine the distinct trajectory classes associated with severity of depressed mood and anxiety reported by women undergoing cycles 2 and 3 of chemotherapy for breast cancer, (2) determine if class membership is associated with various antecedent variables, and (3) determine if class membership is associated with days of missed work and hours spent lying down.

Methods In a secondary analysis, classes were identified using Latent Growth Mixture Modeling. Antecedents and outcomes related to class membership were explored.

Results Participants (n = 166; mean age, 53 [SD, 10.8] years) were mostly white (91.46%); half had early-stage disease. Two trajectories of depressed mood and anxiety were identified. Receipt of doxorubicin was associated with the higher severity class for depressed mood (P < .01) and anxiety (P = .04). No college education (P = .03) or spending more hours lying down (P = .03) was associated with the higher severity class for anxiety.

Conclusions Distinct trajectories of mood disturbance are distinguished by baseline severity. Further study is needed to determine if biologic or genomic factors are associated with class membership.

Implications for Practice Identification of women at risk of mood disturbance may allow clinicians to intensify symptom management. Mood disturbance early in the treatment trajectory warrants management to improve outcomes.

Author Affiliations: Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston (Dr Whisenant); College of Nursing (Drs Wong, Beck, and Mooney) and Huntsman Cancer Institute (Drs Beck and Mooney), University of Utah, Salt Lake City; and Outcomes Research Brant, National Cancer Institute, Rockville, Maryland (Dr Mitchell).

Supported in part by a T32 Institutional Training Grant in Cancer, Aging, and End of Life Care (T32NR013456), National Institutes of Health/Department of Health and Human Services (NIH/DHHS) (R01 CA89474 to K.M., principal investigator), and NIH/DHHS (R01 CA120558 to K.M., principal investigator).

The authors have no conflicts of interest to disclose.

Correspondence: Meagan Whisenant, PhD, APRN, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Dr, Unit 1450, Houston, TX 77030 (mswhisenant@mdanderson.org).

Accepted for publication August 28, 2018.

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