Trajectories of distress in women with gynaecological cancer treated with curative-intent radiotherapy

Abstract

Objective

The aims of this study were to investigate trajectories of anxiety and depression symptoms among gynaecological cancer (GC) patients having curative-intent radiotherapy (RT) treatment and identify which patient characteristics predict anxiety and depression trajectories.

Methods and measures

Latent profile analysis (LPA) was used to identify unique trajectories of anxiety and depression symptoms, spanning prior to the start of RT until 12-month post-RT, among 151 GC patients in the PeNTAGOn randomized control trial. Demographic and clinical characteristics were assessed at baseline, and anxiety and depression symptoms were assessed five times over 12 months. A bias-adjusted 3-step maximum likelihood approach was used to identify demographic and clinical predictors of trajectory profiles.

Results

Four latent profiles each were identified for anxiety and depression trajectories. Most patients had minimal to mild levels of anxiety or depression that remained steady or declined over 12 months following treatment. A minority of patients were in profiles that exhibited clinically significant distress; either ‘High fluctuating’ anxiety or ‘Mild-moderate fluctuating’ depression. Anxiety and depression profiles were predicted by clinical and demographic factors, such as age, living arrangements, RT type, cancer stage, physical symptom distress and use of support services.

Conclusions

Psychological care of patients in the higher distress trajectories is paramount and, importantly, they could be identified prior to treatment based on the factors identified. Review for at least a month post-RT is warranted.

Keywords:

• Gynaecological cancer
• anxiety
• depression
• distress
• radiotherapy
• trajectory

Acknowledgements

We acknowledge the guidance provided by the late Professor Christine Critchley for the analytical approach used in this manuscript.

Trial registrations

Australian New Zealand Clinical Trial Registry: ACTRN12611000744954; and Australian and New Zealand Gynaecology Oncology Group Trial: [ANZGOG 1102].

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [JS], upon reasonable request.

Additional information

Funding

The PeNTAGOn study (Schofield et al., 2013) was conducted by the Department of Cancer Experiences Research at Peter MacCallum Cancer Centre, in collaboration with ANZGOG. This work was supported by grants from Cancer Australia/Beyond Blue; [Grant number: 566942], and the National Health and Medical Research Council; [Grant Project number: GNT1005708]. The funding bodies have had no role in the design of this study, nor in the collection, analysis and interpretation of data, or writing of this manuscript.