Background
Patients and methods
Study design
Data collection and measurement instruments
Sociodemographic and clinical data
Collection instrument
KPS (Karnofsky performance scale)
HADs (Hospital anxiety and depression scale)
SSQ6 (Social support questionnaire)
Sampling and data collection procedure
Statistical analysis
Results
Socio-demographic and clinical characteristics of participants
Variable | All participants N (%) | Description | |||
---|---|---|---|---|---|
Depression | P | Anxiety | P | ||
Health sector: | |||||
Public Private | 180(78.3) 50(21.7) | 12.14 ± 4.06 12.40 ± 4.54 | 0.702 | 14.26 ± 4.07 14.16 ± 4.35 | 0.878 |
Living area | |||||
Rural Urban | 99(43) 131(57) | 12.22 ± 4.01 12.18 ± 4.28 | 0.944 | 14.70 ± 3.85 13.89 ± 4.30 | 0.144 |
Age | |||||
< 50 years ≥ 50 years | 49.2 ± 10.5 126(54.8) 104(45.2) | 12.13 ± 4.05 12.28 ± 4.31 | 0.795 | 14.90 ± 3.73 13.43 ± 4.44 | 0.008* |
Level of education | |||||
unschooled Primary Secondary High school | 150(65.2) 46(20) 17(7.4) 17(7.4) | 12.35 ± 3.93 13.04 ± 4.42 10.06 ± 4.92 10.71 ± 3.92 | 0.031** | 14.27 ± 4.15 15.56 ± 3.84 12.29 ± 4.15 12.35 ± 3.39 | 0.006** |
Medical coverage | |||||
Yes No | 219(95.2) 11(4.8) | 13.18 ± 5.47 12.15 ± 4.09 | 0.424 | 13.73 ± 5.83 14.26 ± 4.04 | 0.769 |
Marital status | |||||
married Widowed Divorced single | 156(67.8) 19(8.3) 22(9.6) 33(14.3) | 11.85 ± 3.95 12.00 ± 4.29 14.18 ± 4.24 12.64 ± 4.77 | 0.089 | 13.95 ± 4.01 13.00 ± 5.27 16.36 ± 3.20 14.88 ± 4.08 | 0.015** |
Living conditions | |||||
Family Other | 216(93.9) 14(6.1) | 12.01 ± 4.12 15.07 ± 3.89 | 0.007* | 14.06 ± 4.11 17.07 ± 3.38 | 0.008* |
Socioeconomic level | |||||
Low average High | 200(87) 18(7. 8) 12(5.2) | 12.06 ± 5.52 10.58 ± 3.63 12.31 ± 4.05 | 0.375 | 14.06 ± 4.38 13.08 ± 3.58 14.32 ± 4.14 | 0.589 |
Occupational status | |||||
Active Inactive Loss of work | 11(4.8) 166(72.2) 53(23) | 12.18 ± 5.02 12.11 ± 4.02 12.47 ± 4.49 | 0.863 | 13.27 ± 3.87 14.17 ± 4.18 14.66 ± 4.03 | 0.549 |
Financial support received | |||||
Yes No | 161(70) 69(30) | 11.83 ± 4.16 13.06 ± 4.06 | 0.040* | 13.88 ± 4.05 15.09 ± 4.20 | 0.041* |
Minor children in charge | |||||
Yes No | 114(49.6) 116(50.4) | 12.62 ± 3.95 11.78 ± 4.34 | 0.127 | 15.06 ± 3.77 13.43 ± 4.30 | 0.003* |
Age of children | |||||
No child < 10years 10–18 years Major | 56(24.4) 44(19.1) 70(30.4) 60(26.1) | 12.50 ± 4.37 12.34 ± 4.21 12.80 ± 3.79 11.12 ± 4.23 | 0.118 | 14.77 ± 3.89 14.77 ± 4.19 15.24 ± 3.51 12.18 ± 4.33 | < 0.001** |
Comorbidity | |||||
Yes No | 78(33.9) 152(66.1) | 12.72 ± 4.40 11.93 ± 4.02 | 0.177 | 14.26 ± 4.30 14.23 ± 4.04 | 0.964 |
Family history of cancer | |||||
Yes No | 89(38.7) 141(61.3) | 12.43 ± 4.32 12.06 ± 4.07 | 0.512 | 14.10 ± 4.17 14.33 ± 4.10 | 0.688 |
Physical activity | |||||
Yes No | 20(8.7) 210(91.3) | 8.90 ± 2.59 12.51 ± 4.15 | < 0.001* | 12.00 ± 3.11 14.45 ± 4.15 | 0.011* |
Variable | All participants N (%) | Description | |||
---|---|---|---|---|---|
Depression | P | Anxiety | P | ||
Time since diagnosis | |||||
≤ 1year > 1year | 10[6-13.75] 171(74.3) 59(25.7) | - 11.97 ± 3.86 12.86 ± 4.91 | 0.090 0.208 | - 13.88 ± 4.01 15.27 ± 4.29 | 0.009*** 0.025* |
Histological type | |||||
Invasive breast carcinoma In situ carcinoma Other | 222(96.5) 6(2.6) 2(0.9) | 12.24 ± 4.18 10.17 ± 2.86 13.50 ± 4.95 | 0.440 | 14.32 ± 4.11 13.00 ± 4.00 9.00 ± 2.83 | 0.146 |
Molecular type | |||||
Luminal A Luminal B HER+ Triple negative Non-class | 92(40) 71(30.9) 30(13) 31(13.5) 6(2.6) | 12.35 ± 4.44 11.14 ± 3.51 13.10 ± 4.33 13.48 ± 4.27 11.33 ± 3.33 | 0.052 | 14.20 ± 4.37 13.37 ± 3.86 15.27 ± 4.02 15.45 ± 3.79 13.83 ± 3.92 | 0.098 |
SBR grade | |||||
Grade I Grade II Grade III | 5(2.2) 125(54.3) 100(43.5) | 10.80 ± 4.66 11.91 ± 3.91 12.63 ± 4.43 | 0.329 | 11.20 ± 5.76 14.06 ± 4.19 14.62 ± 3.91 | 0.149 |
TNM Stage | |||||
Stage I-II Stage III Stage IV | 87(39.3) 94(42.5) 40(18.1) | 10.86 ± 4.22 12.33 ± 3.72 14.55 ± 3.88 | < 0.001** | 12.75 ± 3.89 14.57 ± 3.94 16.45 ± 3.61 | < 0.001** |
Chemotherapy | |||||
Yes No | 228(99.1) 2(0.9) | 12.19 ± 4.16 13.50 ± 4.95 | 0.658 | 14.28 ± 4.11 9.00 ± 2.83 | 0.071 |
Hormonotherapy | |||||
Yes No | 123(53.5) 107(46.5) | 11.85 ± 3.88 12.61 ± 4.44 | 0.171 | 14.05 ± 3.84 14.46 ± 4.43 | 0.459 |
Targeted therapy | |||||
Yes No | 100(43.5) 130(56.5) | 11.63 ± 3.87 12.64 ± 4.33 | 0.068 | 13.76 ± 3.87 14.61 ± 4.29 | 0.122 |
Radiotherapy | |||||
Yes No | 176(76.5) 54(23.5) | 12.22 ± 4.28 12.13 ± 3.79 | 0.887 | 14.20 ± 4.16 14.37 ± 4.04 | 0.790 |
Surgery | |||||
Lumpectomy Mastectomy No | 47(20.4) 157(68.3) 26(11.3) | 10.94 ± 4.77 12.40 ± 3.89 13.27 ± 4.24 | 0.040** | 13.06 ± 4.06 14.37 ± 4.03 15.58 ± 4.41 | 0.034** |
Recurrence | |||||
Yes No | 15(6.5) 215(93.5) | 17.27 ± 3.63 11.85 ± 3.97 | < 0.001* | 17.73 ± 4.03 13.99 ± 4.03 | < 0.001* |
Perceived social support and Karnofsky score
Prevalence of anxiety and depression
Score | Items | Possible interval | Min-Max scores | All patients | Depression | Anxiety | Cronbach’sα | ||
---|---|---|---|---|---|---|---|---|---|
Spearman Correlation | P | Spearman Correlation | P | ||||||
Social support | |||||||||
Satisfaction Availability | 6 6 | 6–36 0–54 | 6–36 0–39 | 8 (6;11) 24 (19;30) | -0.624 -0.495 | < 0.001 < 0.001 | -0.530 -0.414 | < 0.001 < 0.001 | 0.94 0.93 |
Karnofsky score | 0-100 | 40–90 | 70.5 ± 12.2 | -0.489 | < 0.001 | -0.352 | < 0.001 | ||
HADs | |||||||||
Anxiety Presence ≤ 11 Absence > 11 Depression Presence ≤ 11 Absence > 11 | 7 7 | 0–21 0–21 | 4–21 4–21 | 14.2 ± 4.12 178(77.4) 52(22.6) 12.2 ± 4.12 144(62.6) 86(37.4) | - - | - - | - - | - - | 0.74 0.78 |
Predictive factors associated with anxiety and depression in multivariate analysis
Variable | Univariate analysis | |||||
---|---|---|---|---|---|---|
Depression | Anxiety | |||||
β | 95% CI | P | β | 95% CI | P | |
Age < 50 | -0.144 | -1.23, 0.94 | 0.795 | 1.472 | 0.41, 2.53 | 0.007 |
Health sector: Private /Public | 0.256 | -1.06, 1.57 | 0.702 | -0.101 | -1.40, 1.20 | 0.878 |
Living area : Urban /Rural | -0.039 | -1.13, 1.05 | 0.944 | 0.548 | -1.88, 0.27 | 0.144 |
Level of education | ||||||
unschooled Primary Secondary High school | 1.647 2.338 -0.647 Ref | -0.42, 3.72 0.04, 4.63 -3.42, 2.13 | 0.118 0.046 0.646 | 1.914 3.212 -0.059 Ref | -0.12, 3.95 0.95, 5.47 -2.79, -2.67 | 0.065 0.006 0.966 |
Medical coverage | -1.031 | -3.57, 1.50 | 0.424 | 0.538 | -1.98, 3.05 | 0.674 |
Marital status | ||||||
married Widowed Divorced single | Ref 0.147 2.329 0.784 | -1.83, 2.12 0.48, 4.18 -0.77, 2.34 | 0.883 0.014 0.323 | Ref -0.955 2.409 0.924 | -2.90, 0.99 0.58, 4.23 -0.61, 2.46 | 0.335 0.010 0.237 |
Living conditions: Family/Other | -3.058 | -5.29, -0.83 | 0.007 | -3.016 | -5.23, -0.80 | 0.008 |
Socioeconomic level | ||||||
Low average High | Ref -0.254 -1.727 | -2.27, 1.76 -4.16, 0.71 | 0.804 0.164 | Ref -0.269 -1.242 | -2.27, -1.73 -3.66, -1.18 | 0.791 0.313 |
Occupational status | ||||||
Inactive Loss of work Active | 0.357 0.067 Ref | -0.94, 1.66 -2.49, 2.63 | 0.588 0.959 | 0.896 1.388 Ref | -1.64, -3.43 -1.31, -4.08 | 0.487 0.312 |
Financial support received | -1.226 | -2.40, -0.05 | 0.040 | -1.211 | -2.37, -0.05 | 0.041 |
Minor children in charge | 0.838 | -0.24, 1.92 | 0.127 | 1.630 | 0.58, 2.68 | 0.003 |
Age of children | ||||||
No child < 10 years 10–18 years major | 1.383 1.224 1.683 Ref | -0.13, 2.90 -0.39, 2.84 0.25, 3.12 | 0.073 0.137 0.022 | 2.585 2.589 3.060 Ref | 1.13, 4.03 1.04, 4.14 1.69, 4.43 | < 0.001 0.001 < 0.001 |
Comorbidity | 0.784 | -0.36, 1.92 | 0.177 | 0.026 | -1.11, 1.16 | 0.964 |
Family history of cancer | 0.370 | -0.74, 1.48 | 0.512 | -0.225 | -1.33, -0.88 | 0.688 |
Physical activity | -3.614 | -5.48, -1.75 | < 0.001 | -2.452 | -4.33, -0.57 | 0.011 |
Time since diagnosis | 0.047 | 0.003, 0.09 | 0.036 | 0.055 | 0.01, 0.10 | 0.014 |
Histological type | ||||||
Infiltrating carcinoma In situ carcinoma Other | 2.077 3.333 Ref | -1.32, 5.47 -3.37, 10.03 | 0.229 0.328 | 5.320 4.000 Ref | -0.43, 11.07 -2.61, 10.61 | 0.069 0.234 |
Molecular type | ||||||
Luminal A Luminal B HER+ Triple negative Non-class | 1.014 -0.192 1.767 2.150 Ref | -2.40, 4.43 -3.64, 3.25 -1.86, 5.39 -1.46, 5.76 | 0.559 0.912 0.338 0.242 | 0.362 -0.467 1.433 1.618 Ref | -3.03, 3.76 -3.89, 2.96 -2.17, 5.04 -1.97, 5.21 | 0.834 0.788 0.434 0.376 |
SBR grade | ||||||
Grade I Grade II Grade III | Ref 1.112 1.830 | -2.62, 4.85 -1.92, 5.58 | 0.558 0.338 | Ref 2.856 3.420 | -0.83, 6.55 -0.29, 7.13 | 0.129 0.071 |
TNM Stage | ||||||
Stage I-II Stage III Stage IV | Ref 1.468 3.688 | - 0.31, 2.63 2.20, 5.18 | 0.013 < 0.001 | Ref 1.827 3.703 | 0.69, 2.96 2.25, 5.16 | 0.002 < 0.001 |
Chemotherapy | -1.311 | -7.14, 4.52 | 0.658 | 5.285 | -0.46, 11.03 | 0.071 |
Hormonotherapy | -0.762 | -1.84, 0.32 | 0.166 | 0.409 | -0.67, 1.48 | 0.454 |
Targeted therapy | -1.008 | -2.09, 0.08 | 0.068 | -0.848 | -1.92, 0.23 | 0.122 |
Radiotherapy | 0.092 | -1.19, 1.37 | 0.887 | -0.172 | -1.44, 1.09 | 0.790 |
Surgery | ||||||
Lumpectomy Mastectomy No | Ref 1.465 2.333 | 0.11, 2.81 0.35, 4.32 | 0.034 0.021 | Ref 1.306 2.513 | -0.03, 2.64 0.55, 4.48 | 0.056 0.012 |
Recurrence | 5.420 | 3.34, 7.50 | < 0.001 | 3.738 | 1.62, 5.86 | < 0.001 |
Social support | ||||||
Satisfaction Availability | -0.348 -0.258 | -0.40, -0.29 -0.33, -0.18 | < 0.001 < 0.001 | -0.293 -0.221 | -0.35, -0.23 -0.30, -0.15 | < 0.001 < 0.001 |
Karnofsky | -0.179 | -0.22, -0.14 | < 0.001 | -0.127 | -0.17, -0.09 | < 0.001 |
Variable | Multivariate analysis | |||||
---|---|---|---|---|---|---|
Depression | Anxiety | |||||
β | 95% CI | P | β | 95% CI | P | |
Age < 50 | 1.835 | 0.78, 2.89 | < 0.001 | |||
Education Level (Primary) | 2.792 | 1.01, 4.57 | 0.002 | |||
Financial support received | -0.860 | -1.71, -0.01 | 0.048 | -1.115 | -2.04, -0.19 | 0.019 |
Age of children (10–18 years) | 1.433 | 0.22, 2.65 | 0.021 | |||
Physical activity | -1.909 | -3.25, -0.57 | 0.005 | |||
Satisfaction of social support | -0.245 | -0.31, -0.17 | < 0.001 | -0.172 | -0.25, -0.10 | < 0.001 |
Karnofsky | -0.114 | -0.15, -0.08 | < 0.001 | -0.076 | -0.12, -0.03 | < 0.001 |
TNM Stage | ||||||
Stage III Stage IV | 1.216 1.895 | 0.21, 2.22 0.38, 3.40 | 0.018 0.014 | |||
Recurrence | 2.263 | 0.59, 3.93 | 0.008 |