Characterizing the psychological distress response before and after a cancer diagnosis.

Psychological distress among cancer survivors is common. It is unknown if symptoms predate diagnosis or differ from patients without cancer because studies are limited to patient follow-up. Linked cohort (Wisconsin Longitudinal Study) and tumor registry records were used to assess the psychological distress response pre- to post-cancer diagnosis. Adjusted predicted probabilities of being in one of five categories of change for three psychological distress measures (depression, anxiety, well-being) were compared for participants diagnosed with cancer between 1993-1994 and 2004-2005 and participants without cancer (N = 5,162). Cancer survivors were more likely to experience clinically significant increases (≥0.8 standard deviation) in depression (15, 95 % CI = 12-18 %) and anxiety (19 %, CI = 16-22 %) compared to their no-cancer counterparts (10 %, CI = 10-11 %; 11 %, CI = 11-12 %). Cancer survivors <5 years from diagnosis were more likely to experience worsening depression. Survivors ≥5 years were more likely to experience worsening anxiety. No significant results were found for well-being. Characterizing the psychological distress response is a prerequisite for identifying at-risk patients and communicating expected symptoms, allowing for proactive resource provision.