Early Cancer Survivorship Distress Trajectories Associated With Socioeconomic Status and Age: Findings From a Multicenter Prospective Study
Anja Mehnert, Ute Goerling, Tanja Zimmermann, Jochen Ernst, Myriel Hermann, Beate Hornemann, Ulrich Keilholz, Florian Lordick, Olaf von dem Knesebeck, David W. Kissane, Anne‐Kathrin Köditz, Franziska Springer
Abstract
ABSTRACT Background Socioeconomic status' (SES) impact on distress during cancer survivorship has been insufficiently studied, although the consequences of low SES can be cumulative and adversely impact a person's ability to access resources required for improved health and quality of life. Patients and Methods We conducted a prospective study involving newly diagnosed patients within 2 months of diagnosis (t1), and at 6‐, 12‐, and 18‐month follow‐up (t2–t4) using the Distress Thermometer (DT). Generalized Linear Mixed Models (GLMM) were used to test for changes in distress over time, with fixed effects of time, SES, and age. Results Out of 1702 eligible patients, 965 completed the baseline DT (53% men, 60.5 years); 779, 681, and 626 participated at follow‐ups. Out of 554 completers, 9% were chronically distressed, while 40.8% were never distressed. Distress decreased in 21.3%, increased in 11.0%, and 17.8% fluctuated over time. Low‐SES patients consistently had the highest rates of distress. Distress scores and the frequency of distress (DT ≥ 5) decreased over time in all SES and age groups: For DT mean scores, GLMM revealed a significant effect of time ( χ 2 (3) = 72.0, p < 0.001), but not of SES ( χ 2 (2) = 5.9, p = 0.052). For frequency of distress, there was a main effect of time ( χ 2 (3) = 41.4, p < 0.001) and SES ( χ 2 (2) = 15.5, p < 0.001). Younger patients (< 65 years) consistently experienced more distress than older patients (≥ 65 years). For DT mean scores, GLMM showed an effect of time ( χ 2 (3) = 72.1, p < 0.001) and age ( χ 2 (1) = 66.2, p < 0.001). Similarly, for frequency of distress we found an effect of time ( χ 2 (3) = 41.7, p < 0.001) and age ( χ 2 (1) = 52.8, p < 0.001). Conclusion Effective psychosocial interventions require a customized approach to decrease distress in vulnerable groups. Trial Registration This study was registered in the International Clinical Trials Registry (NCT04620564, https://clinicaltrials.gov/ )