Anxiety Level, Symptom Burden Linked in Gynecologic Cancers

Younger age, higher symptom burden, lower income, and childcare responsibilities are associated with a moderate or very high level of anxiety in patients with gynecologic cancers. These findings were presented at the 47th Annual Oncology Nursing Society (ONS) Congress.

Gynecologic cancers, which include ovarian, cervical, uterine, vaginal, and vulvar cancers, are associated with substantial symptom burden. Patients experience an average of 10 to 13 co-occurring symptoms, with severity greater during active treatment.

Anxiety is a common symptom for patients with gynecologic cancer; however, psychological conditions are often underrecognized in this patient population. In this study, Rachel Pozzar, PhD, RN, FNP-BC, of Harvard Medical School and Dana-Farber Cancer Institute in Boston, Massachusetts, and colleagues sought to describe distinct anxiety profiles of subgroups of patients with gynecologic cancers and identify patient characteristics associated with moderate and very high anxiety profiles.

The researchers recruited 230 patients with ovarian cancer (67.1%) or uterine cancer (32.9%) who were 2.1±3.5 years post diagnosis. Patients were aged 59.6±12.7 years, most were non-Hispanic White (77.1%) and many (54.6%) had an annual household income of $70,000 or more.

Patients were recruited during the first or second cycle of chemotherapy from 2 comprehensive cancer centers, a Veterans Affairs hospital, and 4 community-based oncology programs. They were asked to complete questionnaires at home a total of 6 times across 2 cycles of chemotherapy. Assessments were conducted at the second and third cycles or third and fourth cycles, depending on when the patient was recruited.

Dr Pozzar and colleagues used the State Anxiety Inventory (STAI-S) to assess state anxiety levels. A score of 32.2 or higher indicated clinically meaningful state anxiety. Co-occurring symptoms included depression, sleep disturbance, morning and evening fatigue, cognitive impairment, and pain. Distinct state anxiety profiles were identified using latent profile analysis. Chi-square, Kruskal-Wallis, and one-way ANOVA tests were used to assess differences in demographic and clinical characteristics, as well as symptom severity.

Three distinct state anxiety profiles were identified: low (55.2% of patients), moderate (38.3%), and very high (6.5%). Compared with patients whose anxiety level was low, those with a moderate anxiety level were more likely to be younger and have a lower annual household income; those with a very high anxiety level were more likely to have childcare responsibilities.

Clinical characteristics of those with a moderate anxiety level included lower functional status (KPS score), higher comorbidity burden (SCQ score), and more likely to self-report depression. Among those with very high anxiety, additional clinical characteristics included higher number of comorbidities and more likely to self-report lung disease, ulcer/stomach disease, and back pain, as well as having received no prior cancer treatment.

Differences followed the expected pattern for trait and state anxiety, depressive symptoms, sleep disturbance, and cognitive impairment (low < moderate < very high), explained Dr Pozzar in the abstract. Additional findings included: patients with moderate or very high anxiety reported more morning fatigue compared with those with low anxiety. Further, patients with very high anxiety reported more evening fatigue compared with those with low and moderate anxiety. No differences in evening energy scores were found between the 3 groups. Patients with very high anxiety reported less morning energy and higher rates of both cancer and noncancer pain.

“Clinicians should perform routine assessments of anxiety, depression, sleep disturbance, fatigue, cognitive impairment, and pain,” Dr Pozzar concluded, suggesting that further research should explore the underlying mechanisms of these co-occurring symptoms.

Anxiety levels before treatment initiation were not assessed, and patients were predominantly White and affluent so the researchers report that their results may not be generalizable to all patients with gynecologic cancers.

Reference

Pozzar R, Hammer M, Paul S, et al. A higher symptom burden is associated with distinct state anxiety profiles in patients with gynecologic cancer receiving chemotherapy. Oral presentation at: 47th Annual ONS Congress; April 27-May 1, 2022; Anaheim, California.