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Research Article: Psychosomatic symptom profiles and associated factors of clinically significant anxiety symptoms among breast cancer patients receiving chemotherapy: a multicenter cross-sectional study in China

Date Published: 2026-09-21

Abstract:
Chemotherapy is a cornerstone of breast cancer treatment, but chemotherapy-induced adverse events and psychosocial factors often impair patients’ quality of life and diminish its clinical benefit. To summarize the characteristics of psychosomatic symptoms during chemotherapy for breast cancer and identify associated factors for clinically significant anxiety symptoms. A multicenter cross-sectional study was conducted in four hospitals in China. Basic clinical data and medical history were collected for all participants. The 7-item Generalized Anxiety Disorder Scale (GAD-7) was adopted to evaluate clinically significant anxiety symptoms. The MD Anderson Symptom Inventory (MDASI) and the Symptom Assessment Scale for Breast Cancer Patients Undergoing Chemotherapy were used to collect and assess high-frequency psychosomatic distress. The Social Support Rating Scale (SSRS) measured objective support, subjective support, and utilization of social support, and the Resilience Scale Specific to Cancer (RS-SC) was used to evaluate psychological resilience. Univariate and multivariate binary logistic regression analyses were performed to screen associated factors for clinically significant anxiety symptoms, and Spearman’s rank-order correlation was used to explore correlations between high-frequency psychosomatic symptoms and anxiety. A total of 391 breast cancer patients undergoing chemotherapy were enrolled in this study. The total anxiety incidence was 43.99%, including mild (28.64%), moderate (12.53%), and severe anxiety (2.82%). Binary logistic regression analysis identified clinical stage and cumulative chemotherapy cycles as independent associated factors for anxiety in breast cancer patients during chemotherapy (all P < 0.05). Conversely, age, Karnofsky Performance Status (KPS) score, and mental resilience were confirmed as factors associated with lower anxiety symptoms for anxiety in this population (all P < 0.05). Spearman’s rank correlation analysis revealed that anxiety was positively correlated with difficulty initiating sleep ( ? = 0.358, P < 0.01), fatigue ( ? = 0.322, P < 0.01), and nausea ( ? = 0.366, P < 0.01). Observational findings from this study identify several characteristics associated with clinically significant anxiety among breast cancer patients receiving chemotherapy: younger age, low psychological resilience, poor KPS performance status, advanced clinical stage, and longer cumulative chemotherapy cycles. Difficulty initiating sleep, fatigue, and nausea show correlations with anxiety symptoms in this patient population. These findings highlight that physical symptom assessment and psychological screening should not be separated during clinical care for breast cancer patients undergoing chemotherapy, and provide observational evidence for developing integrated supportive care strategies in real-world oncology practice. https://www.chictr.org.cn/ , identifier ChiCTR2400086704.

Introduction:
Chemotherapy is a cornerstone of breast cancer treatment, but chemotherapy-induced adverse events and psychosocial factors often impair patients’ quality of life and diminish its clinical benefit.

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