Association between life events after diagnosis of breast cancer and metastasis

Dourado, Cláudia de Souza; Souza, Camila Brandão de; Castro, Denise Silveira de; Zandonade, Eliana; Miotto, Maria Helena Monteiro de Barros; Amorim, Maria Helena Costa

doi:10.1590/1413-81232018232.15672015

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Free Themes • Ciênc. saúde colet. 23 (2) • Feb 2018 • https://doi.org/10.1590/1413-81232018232.15672015 copy

Association between life events after diagnosis of breast cancer and metastasis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective was to examine the association between life events post diagnosis of breast câncer and metastasis. Cross-sectional study with 300 women attending a reference hospital in oncology in the Espírito Santo. Was used the instrument Life Events Units-LEU/VAS to evaluate life events reported by women. Data were analyzed by using the nonparametric Wilcoxon and chi-square tests. It was performed odds ratio calculation for the variables associated with metastasis. It was found that 21% of the sample reported at least one life event post diagnosis. Of the 46 women who developed metastases, 20 reported one or more life events (p = 0.001). The odds ratio calculated shows that having life events post diagnosis increases by 2.59 (1,37 – 4,91; p = 0,003) times the chance of developing metastasis. When considering the time between diagnosis and the onset of metastasis there was a median of 18.0 months. The study shows a relationship between life events and metastasis, however emphasize the importance of a more complex analysis to better understand the impacts of these events on the onset and progression of breast cancer.

Key words
Breast neoplasms; Life change events; Stress; Neoplastic metastasis

Variables		n	%
Age group
	Up to 39	27	9.0
	40 to 49	84	28.0
	50 to 59	104	35.0
	60 to 69	65	22.0
	70 and over	20	6.0
Race/color
	White	105	35.0
	Non-white	195	65.0
Years of schooling
	Up to 7	193	64.0
	8 and more	107	36.0
Marital status
	Single	52	17.0
	Married/stable union	162	54.0
	Divorced/separated	46	15.0
	Widowed	40	13.0
	Family income
	Up to 2 x minimum wage	190	63.0
	3 to 4 x minimum wage	81	27.0
	Over 4 x minimum wage	29	10.0
Physical activity
	None	242	81.0
	1 or 2 times per week	16	5.0
	3 or more times per week	42	14.0
Consumption of alcoholic beverages
	Never	154	51.0
	Rarely/socially/weekend	12	4.0
	Former consumer	134	45.0
Smoking
	Non-smoker	204	68.0
	Ex-smoker	84	28.0
	Present smoker	12	4.0
Family breast cancer history
	Yes	95	32.0
	No	205	68.0
Stage of the disease
	Initial (I and II)	140	47.0
	Advanced (III and IV)	160	53.0
Metastasis
	Yes	46	15.3
	No	254	84.7

Life events	Classification of the event	Total		Time in years from diagnosis to event			To whom event happened
Life events	Classification of the event	N	%	Average	Median	SD	You	Others
1. Death in the family	Negative	23	7,7	4,4	4,0	3,0	23	0
2. Prison	Negative	17	5,7	4,5	3,0	3,7	0	17
3. Death of a conjugal partner	Negative	6	2,0	7,3	7,0	5,5	6	0
4. Change in financial condition	Negative	6	2,0	1,7	1,0	1,2	6	0
5. Divorce	Negative	5	1,7	1,8	1,0	1,3	5	0
6. Accident/illness	Negative	5	1,7	3,8	4,0	1,9	2	3
7. Illness in the family	Negative	4	1,3	8,3	8,5	3,3	4	0
8. Family problems	Negative	4	1,3	3,5	3,0	3,0	4	0
9. Death of intimate friend	Negative	3	1,0	3,7	5,0	2,3	3	0
10. Birth of child	Negative	1	0,3	4,0	4,0	-	0	1
	Positive	1	0,3	5,0	5,0	-	1	0
11. Child leaves home	Negative	2	0,7	6,0	6,0	1,4	2	0
12. Loss of job	Negative	1	0,3	6,0	6,0	-	1	0
13. Reconciliation with partner	Positive	1	0,3	1,0	1,0	-	1	0
14. Retirement	Positive	1	0,3	2,0	2,0	-	1	0
15. Separation of couple	Negative	1	0,3	4,0	4,0	-	1	0

Life events	Classification of the event	Score at that time				Score at interview				Wilcoxon p-value
Life events	Classification of the event	N	Average	Median	SD	N	Average	Median	SD	Wilcoxon p-value
1. Death in the family	Negative	23	90.9	100.0	16.5	23	51.3	50.0	38.5	0.001
2. Prison	Negative	17	86.5	100.0	23.4	17	27.1	10.0	30.6	0.001
3. Death of a conjugal partner	Negative	6	83.5	100.0	25.8	6	61.7	65.0	37.6	0.066
4. Change in financial condition	Negative	6	100.0	100.0	0.0	6	56.7	60.0	42.3	0.066
5. Divorce	Negative	5	92.0	100.0	11.0	5	36.0	10.0	39.7	0.066
6. Accident/illness	Negative	5	86.0	100.0	21.9	5	36.0	10.0	39.7	0.068
7. Illness in the family	Negative	4	77.5	80.0	26.3	4	50.0	45.0	37.4	0.180
8. Family problems	Negative	4	100.0	100.0	0.0	4	80.0	85.0	24.5	0.180
9. Death of intimate friend	Negative	3	83.3	100.0	28.9	3	46.7	50.0	35.1	0.109
10. Birth of child	Negative	1	90.0	90.0	-	1	90.0	90.0	-	0.180
	Positive	1	100.0	100.0	-	1	100.0	100.0	-	0.180
11. Child leaves home	Negative	2	100.0	100.0	0.0	2	65.0	65.0	7.1	0.180
12. Loss of job	Negative	1	90.0	900.0	-	1	10.0	10.0	-	0.180
13. Reconciliation with partner	Positive	1	100.0	100.0	-	1	10.0	10.0	-	0.180
14. Retirement	Positive	1	10.0	10.0	-	1	10.0	10.0	-	0.180
15. Separation of couple	Negative	1	100.0	100.0	-	1	50.0	50.0	-	0.180

Variable	Metastasis
	Category	sim		não		χ² p-value	OR (CI 95%)^ OR (CI 95%): Odds ratio (confidence interval 95%)
	Category		%	N	%	χ² p-value
Age group	Up to 39	3	11%	24	89%	0.451
	40 to 49	16	19%	68	81%
	50 to 59	18	17%	86	83%
	60 to 69	8	12%	57	88%
	70 and over	1	5%	19	95%
Family income	Up to 2 x min. wage^* * min. wage = minimum wage.	27	14%	163	86%	0.778
	3 to 4 x min. wage	14	17%	67	83%
	Over 4 x min. wage	5	17%	24	83%
Years’ schooling	Up to 7 years	21	14%	133	86%	0.402
	8 years or more	25	17%	121	83%
Race/color	White	16	15%	89	85%	0.973
	Non-white	30	15%	165	85%
Marital status	Single	8	15%	44	85%	0.277
	Married/stable union	30	19%	132	81%
	Divorced/separated	5	11%	41	89%
	Widowed	3	8%	37	93%
Diagnosis stage	Initial (I and II)	0	0%	140	100%	0.001
	Late (III and IV)	46	29%	114	71%
Life events	None	26	11%	211	89%	0.001	2.59
	1 or more	20	32%	43	68%		(1.37 – 4.91)

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[1] Collaborations

CS Dourado worked on the design, design, analysis and interpretation of the data, as well as on the writing of the article, on the critical revision and approval of the version to be published. C Brandão de Souza worked on the writing of the article, on the critical revision and approval of the version to be published. DS Castro and MHMB Miotto worked on the critical review and approval of the version to be published. E Zandonade worked on the analysis and interpretation of data and approval of the version to be published. MHC Amorim worked on designing, designing, analyzing and interpreting the data, as well as writing the article, critically reviewing and approving the version to be published.