Psychological distress in breast cancer patients during oncological inpatient rehabilitation: incidence, triggering factors and correlation with treatment-induced side effects.

As a result of the cancer diagnosis and the mostly multimodal, stressful therapy, psychological distress is a common symptom in breast cancer patients. As part of this prospective study, 1400 patients who were admitted to the hospital for oncological rehabilitation were screened for distress and somatic, therapy-induced secondary disorders. Mean distress in the screened population was 5.6 ± 2.56 (range 0-10). In 942 cases (67.3%) a significant distress score (≥ 5) was detected and in 587 cases (41.9%) very high levels of distress (≥ 7) was observed. Psychological distress significantly correlated with younger age, presence of triple negative breast cancer (TNBC), tumor recurrence and metastasis, and inability to work. Treatment-induced side effects such as lymphedema, CIPN or extensive tumor resection (mastectomy) showed a (not significant) trend for higher distress. The high incidence of distress underscores the importance of psycho-oncological therapy offers and the great importance of occupational measures during oncological rehabilitation such as the importance of a successful return to work for a better quality of life in breast cancer patients.

[Early and Late Toxicities and Socio-Medical Relevant Disorders after Oncological Treatment for Breast Cancer-Implications and Assessment of Rehabilitation Requirement]. / Früh- und Spättoxizitäten sowie sozialmedizinisch-relevante Folgestörungen bei Brustkrebs-Patientinnen als Basis der Abschätzung des Reha-Bedarfes.

INTRODUCTION: Reasonable to the improved prognosis of breast cancer (BC) long-term toxicities and side effects of oncological therapy gain more importance for work ability and social life of BC patients. Aim of this study was the analysis of occurence and differences of treatment-related side effects in relation to type of rehabilitation (so-called AHB vs. later rehabilitation) after therapy for BC. METHODS: Clinical and patient related data as early and late toxicities after oncological treatment of 8.000 patients with BC (55.7±10.4y) were analyzed and compared with current literature. RESULTS: In 23.9% a mastectomy was performed, in 87.3% radiotherapy. In most cases an additional systemic treatment (57,6% CTX, 15,1% anti-Her2, 71% antihormonal treatment) was carried out. In 8.1% women suffered from recurrent or metastatic BC. As most common side effects of multimodal treatment weakness/fatigue (73,6%), insomnia (51,9%), CIPN (33%), lymph edema (13,9%) and drug-induced arthralgia (24,8%) were detected. In addition, 60.4% of women reported high levels of psychological distress. Shortly after therapy typical side effects were drug-induced toxicities (Leucopenia, p<0.0001; anemia, p<0.001; weakness/fatigue p<0.001; CIPN, p<0.0001), whereas in a later course chronic lymphedema (p<0.0001), chronic or recurrent disease (p<0.0001), status after mastectomy (p<0.0001) and psychological distress (p<0.0001) were significantly more often seen. Moreover, in this collective patients were significantly younger (53,7±9,8 vs. 56,3±10,7y). CONCLUSIONS: In BC patients, significantly different impairments and toxicities were documented between patients with early rehabilitation and patients with later onset of rehabilitation. These data may help to establish more individual and focused rehabilitation concepts in specialized centers.