The association between malnutrition and psychological distress in patients with advanced head-and-neck cancer

Objective

Malnutrition and psychological distress are often seen in patients with head-and-neck cancer, but little is known about the interrelationships between those two symptoms. The present study examined the relationship between malnutrition and psychological distress in patients with advanced head-and-neck cancer.

Methods

Using the Patient-Generated Subjective Global Assessment, 99 patients with advanced-stage head-and-neck cancer were screened for nutrition status. The patients were also screened for psychosocial distress (using the Distress Thermometer) and for psychosocial issues (using the Problem Checklist). Any relationship between malnutrition and psychosocial distress was determined by regression and correlation analysis. We also used t-tests to compare distress levels for patients with and without specific nutrition-related symptoms.

Results

The study group included 80 men and 19 women [mean age: 58.4 ± 10.9 years (range: 23–85 years)]. The correlation between poorer nutrition status and level of psychological distress was significant r = 0.37 (p < 0.001). Specifically, reduced food intake and symptoms were both positively associated with distress: r = 0.27 and r = 0.29 respectively, both significant at p < 0.01. After controlling for the effects of psychosocial problems and pain, nutrition status remained a significant predictor of distress, explaining 3.8% of the variance in the distress scores of the patients (p < 0.05).

Conclusions

Malnutrition and symptoms were strongly related to distress in patients with advanced head-and-neck cancer. Our results suggest the need for further research into the complex relationship between nutrition status and distress and into the management of both nutrition and distress in cancer care.     

An examination of distress, sleep, and fatigue in metastatic breast cancer patients

Objective: Few studies have used rapid screening instruments to document the prevalence of distress among metastatic breast cancer patients. This study used the one‐item Distress Thermometer (DT) to assess distress in this population. Anxiety and depressive symptoms, sleep problems, fatigue, and mental health service use were assessed for patients who met the cutoff on the DT for probable distress (score ?4). Methods: A total of 173 metastatic breast cancer patients rated their distress on the DT. Respondents who met study eligibility criteria (n = 90), including a score ?4 on the DT, completed a telephone survey 1 week later that assessed anxiety, depressive symptoms, sleep problems, and fatigue. Associations of study outcomes with demographic and medical characteristics were computed. Results: Sixty percent of the 173 patients met the cutoff for probable distress on the DT. Meeting this cutoff was not associated with age, ethnicity, time since diagnosis, or medical treatments. The majority (61%) of respondents who were classified as distressed on the DT reported clinically significant anxiety or depressive symptoms 1 week later. On average, these patients also showed significant fatigue and sleep disturbance, with 70% reporting decrements in sleep quality. Only 29% of patients with significant anxiety or depressive symptoms accessed mental health services. Conclusions: Results point to a high prevalence of distress, sleep problems, and fatigue across demographic and medical subgroups of metastatic breast cancer patients. A rapid one‐item screening tool may be used to identify patients with a potential need for psychosocial assessment and intervention. Copyright © 2010 John Wiley & Sons, Ltd.     

Correlates of depressive symptomatology in African-American breast cancer patients

Purpose

This study assessed the levels of depressive symptomatology in African-American women with breast cancer compared to those of women without breast cancer and examined demographic, psychosocial, and clinical factors correlated with depression.

Methods

A total of 152 African-American women were recruited from Washington, DC and surrounding suburbs. Breast cancer patients (n?=?76 cases) were recruited from a health care center and women without cancer were recruited from health fairs (n?=?76 comparison). We assessed depression, psychosocial variables (ego strength and social support), and sociodemographic factors from in-person interviews. Stage and clinical factors were abstracted from medical records. Independent sample t test, chi square test, analyses of variance, and multiple regression models were used to identify differences in depression and correlates of depression among the cases and comparison groups.

Results

Women with breast cancer reported significantly greater levels of depression (m?=?11.5, SD?=?5.0) than women without breast cancer (m?=?3.9, SD?=?3.8) (p?<?0.001). Higher cancer stage (beta?=?0.91) and higher age (beta?=?0.11) were associated with depression in the breast patients, explaining 84 % of the variance. In the comparison group, ego strength and tangible support were inversely associated with depressive symptoms, accounting for 32 % of the variance.

Conclusions

Women with more advanced disease may require interdisciplinary approaches to cancer care (i.e., caring for the whole person).

Implications for Cancer Survivors

Depression is often underrecognized and undertreated in African-American breast cancer patients. Understanding the factors related to depression is necessary to integrate psychosocial needs to routine cancer care to improve survivors’ quality of life.     

Disease stage predicts post-diagnosis anxiety and depression only in some types of cancer

Background:

We hypothesised that patients with advanced disease or a cancer type that has a poor prognosis may be more likely to report anxiety and depressive symptoms after diagnosis; younger age and female gender may moderate these effects.

Methods:

Patients (n=3850) were consecutively assessed with PSSCAN, a standardised, validated tool, at two large cancer centres between 2004 and 2009.

Results:

Female patients reported more anxiety and depressive symptoms (P=0.003 to P<0.001) compared with men and a healthy comparison group. Older age was associated with fewer anxiety (P=0.033 to P<0.001) and fewer depressive symptoms (P<0.001), but this was not true for lung cancer. Presence of metastases was associated with more anxiety symptoms in patients with gastrointestinal (P=0.044; R²Δ=0.001), lung (P=0.011; R²Δ=0.016), and prostate (P=0.032; R²Δ=0.008) cancer, but this was not true for breast cancer. Furthermore, early disease stage was associated with fewer depressive symptoms among older prostate cancer patients (P=0.021; R²Δ=0.008). Men with early lung cancer reported fewer anxiety (P=0.020; R²Δ=0.013) and depressive (P=0.017; R²Δ=0.016) symptoms than men with advanced disease or women.

Conclusion:

As hypothesised, disease stage was directly associated with emotional distress, except for patients with breast cancer. Furthermore, age and gender moderated some of these effects.     

Predicting general and cancer-related distress in women with newly diagnosed breast cancer

Background

Psychological distress can impact medical outcomes such as recovery from surgery and experience of side effects during treatment. Identifying the factors that explain variability in distress would guide future interventions aimed at decreasing distress. Two factors that have been implicated in distress are illness perceptions and coping, and are part of the Self-Regulatory Model of Illness Behaviour (SRM). The model suggests that coping mediates the relationship between illness perceptions and distress. Despite this; very little research has assessed this relationship with cancer-related distress, and none have examined women with screen-detected breast cancer. This study is the first to examine the relative contribution of illness perceptions and coping on general and cancer-related distress in women with screen-detected breast cancer.

Methods

Women recently diagnosed with breast cancer (N?=?94) who had yet to receive treatment completed measures of illness perceptions (Revised Illness Perception Questionnaire), cancer-specific coping (Mental Adjustment to Cancer Scale), general anxiety and depression (Hospital Anxiety and Depression scale), and cancer-related distress.

Results

Hierarchical regression analyses revealed that medical variables, illness perceptions and coping predicted 50% of the variance in depression, 42% in general anxiety, and 40% in cancer-related distress. Believing in more emotional causes to breast cancer (β?=?.22, p?=?.021), more illness identity (β?=?.25, p?=?.004), greater anxious preoccupation (β?=?.23, p?=?.030), and less fighting spirit (β?=??.31, p?=?.001) predicted greater depression. Greater illness coherence predicted less cancer-related distress (β?=??.20, p?=?.043). Greater anxious preoccupation also led to greater general anxiety (β?=?.44, p?<?.001) and cancer-related distress (β?=?.37, p?=?.001). Mediation analyses revealed that holding greater beliefs in a chronic timeline, more severe consequences, greater illness identity and less illness coherence increases cancer-specific distress (ps?<?.001) only if women were also more anxiously preoccupied with their diagnosis.

Conclusions

Screening women for anxious preoccupation may help identify women with screen-detected breast cancer at risk of experiencing high levels of cancer-related distress; whilst illness perceptions and coping could be targeted for use in future interventions to reduce distress.

     

Assessment of cardiac exposure in left-tangential breast irradiation

Purpose

To assess the value of treatment-planning related parameters namely, the breast volume; the distance of the inferior field border to diaphragm; and the cardiothoracic ratio for left-tangential breast irradiation.

Patients and methods

Treatment plans of 27 consecutively left-sided breast cancer patients after breast conserving surgery were evaluated for several parameters concerning heart-irradiation. We measured the heart distance respective to the cardiothoracic ratio and the distance of the inferior field border to diaphragm, as well as the breast volume in correlation with the irradiated heart volume.

Results

The mean heart and left breast volumes were 504 cm³ and 672.8 cm³, respectively. The mean heart diameter was 13.4 cm; the mean cardiothoracic ratio 0.51 and the mean distance of the inferior field border to diaphragm was 1.4 cm. Cardiothoracic ratio (p = 0.01), breast volume (p = 0.0002), distance of the inferior field border to diaphragm (p = 0.02) and central lung distance (p = 0.02) were significantly correlated with the measured heart distance. A significant correlation was also found between cardiothoracic ratio, breast volume and distance of the inferior field border to diaphragm with the irradiated heart volume measured by V10, V20 and V40.

Conclusion

The verification of parameters like cardiothoracic ratio, distance of the inferior field border to diaphragm and breast volume in left-sided breast cancer patients may help in determining which patients could benefit from more complex planning techniques such as intensity-modulated radiotherapy to reduced risk of late cardiac injury.     

Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study

Purpose

The purpose of this study was to identify subgroups of breast cancer patients and their partners based on distinct trajectories of depressive symptoms, to examine how relationship quality and medical and sociodemographic factors were associated with these trajectories, and to explore whether patients and partners had similar trajectories.

Methods

A nationwide, population-based cohort of couples dealing with breast cancer was established in Denmark. Participants completed the Center for Epidemiologic Studies-Depression Scale at baseline and 5 and 12 months later. Sociodemographic and medical characteristics were retrieved from registers. A trajectory finite mixture model was used to identify trajectories.

Results

The trajectories of depressive symptoms over time were analyzed in 546 patients and 508 partners. Among patients, 13 % had a high stable trajectory, 38 % an intermediate decreasing trajectory, and 49 % a low trajectory. Similar trajectories were found for partners (11, 22, and 67 %, respectively). Compared to the low trajectory, trajectories with higher depressive symptoms were associated with poorer relationship quality and previous use of antidepressants for patients and partners and with younger age, comorbidity, basic education, and chemotherapy for patients. The trajectories of patients and their partners were weakly correlated.

Conclusions

A considerable minority of patients and partners had a persistently high level of depressive symptoms. Poorer relationship quality and previous antidepressant use most consistently characterized patients and partners with higher depressive symptom trajectories.

Implications for cancer survivors

In clinical practice, attention to differences in depressive symptom trajectories is important to identify and target patients and partners who might need support.

     

Pro-apoptotic effect of Δ2-TGZ in “claudin-1-low” triple-negative breast cancer cells: involvement of claudin-1

Background

Although some studies suggest that breast-conserving therapy (BCT) shows better psychosocial outcomes than mastectomy in patients with primary breast cancer, little is known about the outcomes of these surgical options in recurrent breast cancer. We investigated differences in overall survival and re-recurrence rates as well as psychosocial outcomes among patients who underwent BCT or mastectomy after the diagnosis of recurrent breast cancer in a single-center setting.

Methods

124 of 186 eligible patients who underwent surgical treatment for breast cancer recurrence completed the questionnaires on quality of life (EORTC QLQ-C30 and -BR23), fear of progression (PA-F-KF), anxiety and depression (HADS), and body image (BIS).

Results

Women after breast-conserving surgery (n = 46) showed significantly better outcomes than women after mastectomy (n = 61) with respect to body image (P < 0.001 in BIS and p < 0.001 in BR23), social functioning (p = 0.016), emotional functioning (p = 0.028), and role functioning (p = 0.043). There were no significant group differences regarding anxiety, depression, and fear of progression as well as re-recurrence and survival rates. Predictors of good quality of life were partnership (OR 2.46), higher monthly family income (OR 3.54), and higher professional qualification (OR 4.3) in our group of patients.

Discussion

Our results indicate that patients treated with breast-conserving therapy after recurrent breast cancer perceive lower impairments in body image and several aspects of quality of life than patients treated with mastectomy.

     

Evolution of Symptom Burden of Advanced Lung Cancer Over a Decade

Introduction

Lung cancer is associated with higher levels of symptom distress and unmet needs than other cancer types. We assessed changes in symptoms, function, understanding, and preferences of patients with advanced lung cancer over a 10-year period.

Expression of thioredoxin system and related peroxiredoxin proteins is associated with clinical outcome in radiotherapy treated early stage breast cancer

Background and purpose

Deregulated redox systems provide cancer cells protection from increased oxidative stress, such as that induced by ionizing radiation. Expression of the thioredoxin system proteins (thioredoxin, thioredoxin reductase and thioredoxin interacting protein) and downstream peroxiredoxins (I–VI), was examined in tumor specimens from early stage breast cancer patients, subsequently treated by breast conserving surgery and locoregional radiotherapy, to determine if redox protein expression is associated with clinical outcome.

Material and methods

Nuclear and cytoplasmic expression was assessed using conventional immunohistochemistry on a tissue microarray of 224 tumors.

Results

High expression of cytoplasmic peroxiredoxin-I correlated with a greater risk of local recurrence (p = 0.009). When nuclear and cytoplasmic expression patterns were combined, patients with low nuclear but high cytoplasmic expression of peroxiredoxin-I increased significance (p = 0.005). Both were independent factors (p = 0.006 and 0.003) from multivariate analysis. Associations were obtained between tumor grade and nuclear thioredoxin interacting protein (p = 0.01) and with cytoplasmic expression of peroxiredoxin-V (p = 0.007) but not with peroxiredoxin-I suggesting that the latter may exert influence via regulation of oxidative stress rather than via altering the tumor phenotype.

Conclusions

Results highlight the potential of using redox protein expression, namely peroxiredoxin-I, to predict clinical outcome and support further studies to validate its usefulness as an independent prognostic, and potentially predictive, marker.     

Computergestütztes Screening auf Palliativbedarf bei onkologischen Patienten

Background

Psychosocial screenings are increasingly being used to identify palliative care needs in cancer patients. These instruments are used for the relatively time-consuming assessment of distress as well as information and care needs and serve as a basis for referral of patients for subsequent diagnostic and therapeutic measures. While computer-based screening methods are increasingly being used, they have not yet been applied in Germany.

Aim and method

The current project on counseling and support of cancer patients and their relatives (Beratung und Unterstützung von Krebspatienten und ihren Angehörigen, BUKA) aims at analyzing if the use of a tablet-based screening for palliative and psychosocial care needs is associated with changes in various clinical end of life quality (EoLQ) indicators. Palliative cancer patients with the entities skin cancer, lung cancer, gastrointestinal cancer and primary brain cancer are included in a longitudinal study with two time points, screening and 8-week follow-up. Among the variables assessed are physical symptoms and psychosocial distress as well as information and care needs. In a qualitative pilot study, patients reported high levels of acceptance of the tablet-based screening procedure.

     

Quality of life after immediate breast reconstruction and skin-sparing mastectomy – A comparison with patients undergoing breast conserving surgery

Background

Historically breast cancer surgery was associated with significant psychosocial morbidity and suboptimal cosmetic outcome. Recent emphasis on women’s quality of life following breast cancer treatment has drawn attention to the importance of aesthetic outcome and potential benefits of immediate breast reconstruction (IBR). Our primary aim was to assess patient’s quality of life after IBR, compared to a matched group undergoing breast conservation. We also investigated the oncological safety and morbidity associated with immediate reconstruction.

Methods

A prospectively collected database of all breast cancer patients who underwent IBR at a tertiary referral breast unit was reviewed. Patients were reviewed clinically, and administered two validated quality of life questionnaires, at least one year after completing their treatment.

Results

255 patients underwent IBR following mastectomy over a 55 month period. Reconstruction with ipsilateral latissimus dorsi flap was most commonly performed (88%). After mean follow-up of 36 months, IBR patients’ quality of life was comparable to a group of age-matched women (n = 160) who underwent breast conserving surgery (p = 0.89). No patient experienced local recurrence (0%), distant metastases developed in 4.8% and disease related mortality was 2.2%. Post-operative morbidities included wound infection (11.8%), chronic pain (2.0%), capsular contracture (11%; 36% of whom had radiotherapy) and fat necrosis (14.1%). No patient experienced flap loss.

Conclusions

IBR is a highly acceptable form of treatment for women requiring mastectomy. With high rates of patient satisfaction, low associated morbidity, and proven oncological safety, it is an appropriate recommendation for all women requiring mastectomy.     

Comparison of modulated electron radiotherapy to conventional electron boost irradiation and volumetric modulated photon arc therapy for treatment of tumour bed boost in breast cancer

Background and purpose

To compare few leaf electron collimator (FLEC)-based modulated electron radiotherapy (MERT) to conventional direct electron (DE) and volumetric modulated photon arc therapy (VMAT) for the treatment of tumour bed boost in breast cancer.

Materials and methods

Fourteen patients with breast cancer treated by lumpectomy and requiring post-operative whole breast radiotherapy with tumour bed boost were planned retrospectively using conventional DE, VMAT and FLEC-based MERT. The planning goal was to deliver 10 Gy to at least 95% of the tumour bed volume. Dosimetry parameters for all techniques were compared.

Results

Dose evaluation volume (DEV) coverage and homogeneity were best for MERT (D₉₈ = 9.77 Gy, D₂ = 11.03 Gy) followed by VMAT (D₉₈ = 9.56 Gy, D₂ = 11.07 Gy) and DE (D₉₈ = 9.81 Gy, D₂ = 11.52 Gy). Relative to the DE plans, the MERT plans predicted a reduction of 35% in mean breast dose (p < 0.05), 54% in mean lung dose (p < 0.05) and 46% in mean body dose (p < 0.05). Relative to the VMAT plans, the MERT plans predicted a reduction of 24%, 36% and 39% in mean breast dose, heart dose and body dose, respectively (p < 0.05).

Conclusions

MERT plans were a considerable improvement in dosimetry over DE boost plans. There was a dosimetric advantage in using MERT over VMAT for increased DEV conformity and low-dose sparing of healthy tissue including the integral dose; however, the cost is often an increase in the ipsilateral lung high-dose volume.     

Psychosocial group intervention for patients with primary breast cancer: a randomised trial

Purpose

To test the effectiveness of a psycho-educational group intervention to improve psychological distress measured by POMS TMD, Quality of Life measured by European Organisation for Research and Treatment of Cancer (EORTC), the core and breast cancer module, Mental Adjustment measured by MAC and marital relationship measured by BLRI in women with primary breast cancer conducted 10 weeks after surgery. A secondary outcome was 4-year survival.

Patients and methods

We randomly assigned 210 patients with primary breast cancer to a control or an intervention group. Patients in the intervention group were offered two weekly 6-h sessions of psycho-education and eight weekly 2-h sessions of group psychotherapy. All participants were followed up for Quality of Life, coping ability and social relations 1, 6 and 12 months after the intervention and on survival 4 years after surgical treatment.

Results

No statistically significant effects of the intervention were found on any of the psychosocial questionnaire outcomes. There were not enough cases of death to analyse overall survival. The only statistically significant result was for patients who used anti depressive medication, for whom almost all measures improved over time, in both the control and intervention groups.

Conclusion

Psycho-education and group psychotherapy did not decrease psychological distress or increase Quality of Life, Mental Adjustment or improve marital relationship among patients with primary breast cancer.     

Traitement locorégional du cancer du sein inflammatoire après chimiothérapie néoadjuvante

Purpose

To assess the benefit of breast surgery for inflammatory breast cancer.

Patients and methods

This retrospective series was based on 232 patients treated for inflammatory breast cancer. All patients received primary chemotherapy followed by either exclusive radiotherapy (118 patients, 51%) or surgery with or without radiotherapy (114 patients, 49%). The median follow-up was 11 years.

Results

The two groups were comparable apart from fewer tumors smaller than 70 mm (43% vs 33%, P = 0.003), a higher rate of clinical stage N2 (15% vs 5%, P = 0.04) and fewer histopathological grade 3 tumors (46% vs 61%, P < 0.05) in the no-surgery group. The addition of surgery was associated with a significant improvement in locoregional disease control (P = 0.04) but with no significant difference in overall survival rates or disease-free intervals. Late toxicities were not significantly different between the two treatment groups except for a higher rate of fibrosis in the no-surgery group (P < 0.0001), and more lymphedema in the surgery group (P = 0.002).

Conclusion

Our data suggest an improvement in locoregional control in patients treated by surgery, in conjunction with chemotherapy and radiotherapy, for inflammatory breast cancer.     

Psychosocial interventions to support partners of men with prostate cancer: a systematic and critical review of the literature

Purpose

Prostate cancer poses many challenges for both the man and his partner. Partners have reported a range of issues that impact their own mental health following their partner’s diagnosis of prostate cancer. The aim of this review is to summarise and critically evaluate the current literature reporting psychosocial intervention studies for partners of prostate cancer patients.

Methods

An extensive literature search of electronic databases was conducted (OvidMEDLINE 1946, 26th September 2013, and psychINFO 1967, 26th September 2013) using the keywords prostate cancer AND intervention* OR therapy* OR psychosocial intervention* OR support* AND couple* or Spouse* or Partner* or Intimate partner* matched to the title as well as secondary scanning of reference lists. Studies were included if they described interventions for partners of prostate cancer patients, either solely for the partners or as a couple, intended to alleviate distress and enhance the partner’s or couple’s quality of life, and reported a measurable outcome for partners.

Results

A total of 11 prostate cancer-specific intervention studies that included partners and reported separate results for the partners were found. Only one of these interventions was partner specific, the other eight involved the patient-partner dyad. The studies identified primarily focussed on two areas: emotional distress and sexual intimacy, and mixed findings were reported for efficacy of interventions.

Conclusions

Despite strong evidence that partners of men with prostate cancer experience difficulties associated with the impact of prostate cancer, there is limited research that has investigated the efficacy of psychosocial interventions for partners. Of the reviewed studies, it is evident that interventions targeting the reduction of emotional distress, improved communication and sexual intimacy between the couple and utilisation of strategies that enable partners to express their distress, learn new strategies and implement behavioural change show the most promising results in enhancing partner well-being.

Implications for Cancer Survivors

Significant progress is required in developing and evaluating appropriate and effective psychosocial support interventions for partners of prostate cancer survivors as partners appear to have significant unmet needs in this area.     

The course of anxiety,depression and unmet needs in survivors of diffuse large B cell lymphoma and multiple myeloma in the early survivorship period

Purpose

The purpose of the study is to examine the course of anxiety, depression and unmet needs in diffuse large B cell lymphoma (DLBCL) and multiple myeloma (MM) survivors in the first 2 years post diagnosis.

Methods

DLBCL and MM survivors, recruited through the Victorian Cancer Registry, completed two interviews approximately 7 and 15 months post diagnosis. Hospital Anxiety and Depression Scale (HADS) and Supportive Care Needs Survey (SCNS-SF34) were completed at both interviews. Primary outcomes were prevalence of anxiety, depression and unmet needs (any or moderate–high). Generalized estimating equation examined whether course of anxiety, depression and unmet needs differed between the two cancers.

Results

Overall, 236 DLBCL and 178 MM survivors completed both telephone interviews. Course of anxiety differed (p < 0.01) with rate increasing in DLBCL (14 to 22%) while remaining stable for MM (15 to 12%). Course of depression also differed (p < 0.01), decreasing for MM (22 to 12%) and remaining stable for DLBCL (15 to 16%) survivors. Change in unmet needs was generally similar for the two cancer groups, except for moderate to high psychological needs (p < 0.05).

Conclusions

Patterns of change in anxiety and depression in first 2 years post diagnosis differ for DLBCL and MM survivors.

Implications for cancer survivors

Studying psychological outcomes in mixed haematological cancer samples may be inappropriate, at least in the early survivorship phase. Separate studies of the experiences of people with the different haematological cancer subtypes are needed to ensure psychosocial and supportive care interventions are appropriate to the needs of individuals with different haematological cancers.

     

Consumer credit as a novel marker for economic burden and health after cancer in a diverse population of breast cancer survivors in the USA

Background

Consumer credit may reflect financial hardship that patients face due to cancer treatment, which in turn may impact ability to manage health after cancer; however, credit’s relationship to economic burden and health after cancer has not been evaluated.

Methods

From May to September 2015, 123 women with a history of breast cancer residing in Pennsylvania or New Jersey completed a cross-sectional survey of demographics, socioeconomic position, comorbidities, SF-12 self-rated health, economic burden since cancer diagnosis, psychosocial stress, and self-reported (poor to excellent) credit quality. Ordinal logistic regression evaluated credit’s contribution to economic burden and self-rated health.

Results

Mean respondent age was 64 years. Mean year from diagnosis was 11.5. Forty percent of respondents were Black or Other and 60% were White. Twenty-four percent self-reported poor credit, and 76% reported good to excellent credit quality. In adjusted models, changing income, using savings, borrowing money, and being unable to purchase a health need since cancer were associated with poorer credit. Better credit was associated with 7.72 ([1.22, 14.20], p =?0.02) higher physical health t-score, and a ??2.00 ([??3.92, ??0.09], p =?0.04) point change in psychosocial stress.

Conclusions

This exploratory analysis establishes the premise for consumer credit as a marker of economic burden and health for breast cancer survivors. Future work should validate these findings in larger samples and for other health conditions.

Implications for Cancer Survivors

Stabilizing and monitoring consumer credit may be a potential intervention point for mitigating economic burden after breast cancer.