A longitudinal study of four unique trajectories of psychological distress in cancer survivors after completing potentially curative treatment

Abstract

Background: Many survivors report short-term, transient psychological distress after cancer treatment. Some experience severe, worsening or persistent psychological morbidity which impairs functioning and warrants intervention. Using Bonanno’s trajectories model, this study aimed to distinguish distress trajectories and to identify demographic, medical or psychosocial characteristics that differentiate those at risk of ongoing, clinically significant psychological distress.

Methods: One-hundred and twenty-five cancer survivors of breast, prostate, colorectal or haematological cancers (response rate: 72%) completed measures of psychological distress (BSI-18), unmet needs (CASUN), social support (ESSI), coping styles (Mini-MAC), symptom prevalence (MSAS-SF) and benefit finding (PTGI) immediately after treatment and three and six months later. Distress and its predictors were investigated using linear mixed models. Groups based on Bonnano’s trajectories were also compared on demographic, medical and psychosocial characteristics.

Results: Changes in psychological distress over time were not statistically significant. Using BSI-18 clinical cut-off scores, most survivors (n = 65, 80%) were ‘resilient’, with stable, low distress levels. Almost one-tenth of survivors (n = 7, 9%) reported persistent, ‘clinically significant’ distress. Compared with the ‘resilient’ group, this ‘chronic’ group reported higher unmet needs, benefit finding, physical symptoms and poor coping styles, as well as lower social support immediately after treatment. They were also more likely to have a documented history of psychiatric illness. A ‘recovered’ group (n = 5, 6%) experienced high levels of distress that quickly returned to non-clinical levels and a delayed group (n = 4, 5%) reported initial low distress which worsened after treatment completion.

Conclusions: Most survivors experience low distress (resilience) over time and may not require intense follow-up care. Screening for distress at the end of treatment may help to identify patients with more physical symptoms and unmet needs, less social support and higher use of maladaptive coping styles who are at risk of experiencing non-resilient trajectories of distress for further management of these symptoms.