Determinants of Psychosocial Distress in Breast Cancer Patients at a Safety Net Hospital

Published:August 02, 2021DOI:



      Psychosocial distress screening of cancer patients is an American College of Surgeons Commission on Cancer mandate for accredited cancer programs. We evaluated psychosocial distress in breast cancer patients to characterize risk factors for high distress scores at a safety net hospital.

      Materials and Methods

      The psychosocial distress screening form includes a list of potential issues and a distress score scaled from 1 through 10. Psychosocial distress screening results were retrospectively analyzed, along with patient demographics and clinical data. Cochran-Mantel-Haenszel test was applied to identify predictors for high distress scores, which were defined as a score of 5 and greater.


      775 distress screens were completed by 171 breast cancer patients. High distress scores were reported in 21.3%. Patients who had no evidence of disease at time of screening were less likely to report a high distress score compared to those who were newly diagnosed or in active treatment (odds ratio 0.51, 95% CI, 0.38-0.68, P< .0001). Patients with high distress scores were more likely to report concerns with insurance (29.1% vs. 7.6%, P< .0001), transportation (16.4% vs. 4.6%, P< .0001), housing (15.2% vs 2.1%, P< .0001), sadness/depression (63.6% vs. 14.1, P< .0001), and physical issues (89.1% vs. 52.8%, P< .0001).


      Status of cancer at time of screening, particularly newly diagnosed cancer and active treatment of cancer were associated with high distress scores in this patient group. While there should be an emphasis to ensure patients with these risk factors receive psychosocial distress screening, routine periodic screening for all patients should continue to be implemented to ensure quality cancer care.


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        • Hewitt M
        • Herdman R
        • Jimmie H
        Meeting psychosocial needs of women with breast cancer, Washington D.C. The National Academies Press, 2004: 31-54
        • Fafouti M
        • Paparrigopoulos Zervas Y
        • Rabavilas A
        • Malamos N
        • Liappas I
        • Tzavara C
        Depression, anxiety, and general psychopathology in breast cancer patients: a cross sectional control study.
        In vivo. 2010; 24: 803-810
      1. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: distress management. v2.2020. Referenced with permission from the NCCN clinical practice guidelines in oncology (NCCN Guidelines®) for distress management V.2.2020. © National comprehensive cancer network, Inc. 2020. All rights reserved. To view the most recent and complete version of the guideline, go online to 2020 Retrieved from Access date: 5.1.2021

        • Gudenkauf LM
        • Ehlers SL.
        Psychosocial interventions in breast cancer survivorship care.
        Breast. 2018; 38: 1-6
        • Burgess C
        • Cornelius V
        • Love S
        • Graham J
        • Richards M
        • Amanda R
        Depression and anxiety in women with early breast cancer: five year observational cohort study.
        Br Med J. 2005; 330: 702
        • McFarland DC
        • Shaffer KM
        • Tiersten A
        • Holland J.
        Physical symptom burden and its associated with distress, anxiety, and depression in breast cancer.
        Psychosomatics. 2018; 59: 464-471
        • Andreu Y
        • Galdon MH
        • Dura E
        • Martinez P
        • Perez S
        • Murgui S.
        A longitudinal study of psychosocial distress in breast cancer: prevalence and risk factors.
        Psychol Health. 2011; 27: 72-87
        • Acquati C
        • Kayser K.
        Predictors of psychological distress among cancer patients receiving care at a safety-net institution: the role of younger age and psychosocial problems.
        Support Care Cancer. 2017; 25: 2305-2312
        • Cimino T
        • Said K
        • Safier L
        • Harris H
        • Kinderman A.
        Psychosocial distress among oncology patients in the safety net.
        Psychooncology. 2020; 29: 1927-1935
        • Albert M
        • Cimino T
        • Kinderman A
        • Safier L
        • Harris H.
        Psychosocial distress screening in the health care safety net.
        J Clin Oncol. 2016; 34 (91-91)
        • Edge SB
        • Byrd DR
        • Compton CC
        • Fritz AG
        • Greene FL
        • Trotti A
        AJCC cancer staging manual.
        editors7th edition. Springer, France2010
        • Sánchez-Díaz CT
        • Strayhorn S
        • Tejeda S
        • Vijayasiri G
        • Rauscher GH
        • Molina Y.
        What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients?.
        Cancer Causes Control. 2021; 32: 357-367
        • Syrowatka A
        • Motulsky A
        • Kurteva S
        • et al.
        Predictors of distress in female breast cancer survivors: a systematic review.
        Breast Cancer Res Treat. 2017; 165: 229-245
        • Britt GJ
        • Shay RC
        • Rassmusen M
        • Vannice S
        • Lomax JM.
        Psychosocial distress screening at a single urban community oncology center: trends among Hispanic and Caucasian women with newly diagnosed breast cancer.
        J Clin Oncol. 2017; 35 (198-198)
        • Luckett T
        • Goldstein D
        • Butow P
        • et al.
        Pschological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis.
        Lancet North Am Ed. 2011; 12: 1240-1248
        • Schubart JR
        • Emerich M
        • Farnan M
        • Smith JM
        • Kauffman GL
        • Kass RB.
        Screening for psychological distress in surgical breast cancer patients.
        Ann Surg Oncol. 2014; 21: 3348-3353
        • Moadel AB
        • Morgan C
        • Dutcher J.
        Psychosocial needs assessment among an underserved ethnically diverse cancer patient population.
        Cancer. 2006; 109: 446-454
        • Ashing-Giwa K
        • Jun-won Lim
        Examining the impact of socioeconomic status and socioeconomic stress on physical and mental health quality of life among breast cancer survivors.
        Oncol Nurs Forum. 2009; 36: 79-88
        • Almatkyzy G
        • Mojica CM
        • Stroup AM
        • et al.
        Predictors of health-related quality of life among Hispanic and non-Hispanic White breast cancer survivors in New Jersey.
        J Psychosoc Oncol. 2020;
        • Yanez B
        • Thompson EH
        • Stanton AL.
        Quality of life among Latina breast cancer patients: a systematic review of the literature.
        J Cancer Surviv. 2011; 5: 191-207
        • Janz NK
        • Mujahid MS
        • Hawley ST
        • et al.
        Racial/Ethnic differences in quality of life after diagnosis of breast cancer.
        J Cancer Surviv. 2009; 3: 212-222
        • Park B
        • Lee MH
        • Kong SY
        • Lee ES.
        Psychosocial health of disease-free breast cancer survivors compared with matched non-cancer controls.
        Cancer Res Treat. 2017; 51: 178-186
        • Stagl JM
        • Bouchard LC
        • Lechner SC
        • et al.
        Long term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial.
        Cancer. 2015; 121: 1873-1881
        • Hsaio F
        • Kuo W
        • Jow G
        • et al.
        The changes of quality of life and their correlations with psychosocial factors following surgery among women with breast cancer from the post-surgery to post-treatment survivorship.
        Breast. 2019; 44: 59-65
        • Arroyo OM
        • Vaillo YA
        • Lopez PM
        • Garrido JM.
        Emotional distress and unmet supportive care needs in survivors of breast cancer beyond the end of primary treatment.
        Support Care Cancer. 2019; 27: 1049-1057
        • Roth AJ
        • Kornblith AB
        • Batel-Copel L
        • Peabody E
        • Scher HI
        • Holland HC.
        Rapid screening for psychologic distress in men with prostate carcinoma.
        Cancer. 1998; 82: 1904-1908