Trimmel et al: Adequacy of anticipatory anxiety in women receiving chemotherapy for breast cancer In contrast to this, patients who reported moderate anxiety prior to a medical intervention managed to adapt to the new situation more easily. By showing a medium level of anxiety, “work of worry� is initiated, which encourages the person to attend to information that is required for successful coping (Andersen, 1990). Adequate preparation of the patients prior to chemotherapy seems crucial to enable patients to correctly anticipate the consequences of the treatment and thereby optimize their coping skills and adjustment process (Burishet al, 1991; Tierney et al, 1991). Although several authors argue that full information can include certain risks for the cancer patients (Simes et al, 1986; Olver et al, 1995), the majority of studies suggest that extensive knowledge benefits individuals undergoing chemotherapy through correcting misbelieves or reducing anxiety of unexpected events. The present longitudinal study had two main objects. Firstly, to investigate the influence of pretreatment anxiety, expectations and information levels of breast cancer patients on the occurrence and evaluation of chemotherapy related side effects. Secondly, to identify aspects which influence a patients perception of adequacy of pretreatment anxiety levels. With reference to previous research it was expected that the source of information on chemotherapy affected whether pre-treatment anxiety was overestimated or underestimated, or adequately rated. In
addition, it was expected that demographic variables, trait anxiety and expectations of side effects (and their occurrence) will affect prospective and retrospective anxiety ratings.
II. Materials and methods A. Patients Participants were women who were scheduled to receive neoadjuvant or adjuvant chemotherapy at the general hospital in Vienna. Eligibility criteria were: diagnosis of breast cancer, no previous administration of chemotherapy and fluency in German. Of the 50 patients asked to participate, 42 (84%) consented. Of these, 31 women (74%) could again be contacted after completion of their treatment. Two patients had dropped out of chemotherapy at their own request, one woman had developed metastases, and eight participants could not be attained for administrative reasons. The 31 patients who concluded the whole course of the study did not differ from the remaining 11 in terms of demographic and medical variables and state anxiety (T = -.771, df = 40, p = .445) or trait anxiety (T = -2.41, df = 40, p = .811). Demographic characteristics of the sample are presented in Table 1.
B. Procedure Patients were recruited during the waiting period right before their first infusion. After having signed a consent, the women announced demographic information and completed the
Table 1. Demographic and medical characteristics of participants who entered the study (total) and of those who completed the whole course (sub-sample).
Age group
Marital status
Highest education
Chemotherapy Regimen
Menopausal status
Total (N = 42) N % 1 2.4% 7 16.7% 8 19.0% 14 33.3% 8 19.0% 4 9.5% 3 7.1% 3 7.1% 23 54.8% 6 14.3% 7 16.7% 25 59.5% 4 9.5% 9 21.4% 4 9.5% 6 14.3% 36 85.7% 16 38.1% 2 4.8% 8 19.0% 14 33.3% 2 4.8% 16 38.1% 26 61.9%
< 30 30-39 40-49 50-59 60-69 > 70 single community of life married separated / divorced Widowed 9-year elementary school vocational / business school secondary school university / college neoadjuvant Adjuvant CMF ACMF ATCMF AC FAC non-menopausal menopausal
Abbreviations: C = cyclophosphamide; M = methotrexate; F = 5-fluorouracil; A = doxorubicin; T = taxotere.
462
Sub-sample (N = 31) N % 1 3.2% 4 12.9% 6 19.4% 11 35.5% 6 19.4% 3 9.7% 2 6.5% 1 3.2% 17 54.8% 6 19.4% 5 16.1% 19 61.3% 4 12.9% 4 12.9% 4 12.9% 3 9.7% 28 90.3% 11 35.5% 2 6.4% 8 25.8% 10 32.3% 0 0% 11 35.5% 20 64.5%