• Wendy W T Lam, Yee Ting Shing, George A Bonanno, Anthony D Mancini, and Richard Fielding.
• Department of Community Medicine and Unit for Behavioural Sciences, Centre for Psycho-Oncology Research and Training, School of Public Health, The University of Hong Kong, Pokulam, Hong Kong. wwtlam@hku.hk
• Psychooncology. 2012 Jan 1;21(1):90-9.

PurposeTo explore how initial trajectories of distress experienced during the first year following diagnosis with early-stage breast cancer (ESBC) relate to subsequent long-term(6 years) psychosocial outcomes.Methods285/303 Chinese women recruited 1-week post-surgery for predominantly ESBC were assessed for distress with the Chinese Health Questionnaire at 1, 4, and 8 months later.Latent growth mixture modeling revealed four distinct distress trajectories during the first 8 months following surgery (Lam et al., 2010). Six years later we reassessed 186 of these 285 women, comparing scores on the Hospital Anxiety and Depression Scale, Impact of Events Scale, and Chinese Social Adjustment Scale by first 8 months’ distress trajectory.ResultsDistress trajectories over the first 8 months post-operatively predicted psychosocial outcomes 6 years later. Women with stable low levels of distress over the first 8 months postoperatively(resilient group) had the best 6-year psychosocial outcomes. Women who experienced chronic distress had significantly greater longer-term psychological distress, cancer-related distress, and poorer social adjustment in comparison to women in the resilient group. Women in the recovered or delayed-recovery groups were comparable to those in the resilient group, except for concerns about appearance and sexuality, and self-image.ConclusionWomen with an illness trajectory characterized by chronic distress over the first 8 months post-operatively had poorest longer-term psychosocial outcomes. Clarification of determinants of chronic distress and means for early identification of at-risk women are needed.This will enable targeted optimization of interventions to prevent and manage chronic distress,improving ESBC rehabilitation efficiency.

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