Perceived Distress in Women with Breast Cancer during COVID-19 Outbreak: A Multicenter Italian Study
Main Article Content
Abstract
Abstract
Breast Cancer (BC) patients during the COVID-19 outbreak could have an increased risk of developing anxiety and depression. This study aimed to assess the emotional distress of women with BC during the COVID-19 pandemic. Women with a diagnosis of primary BC, at any stage of diagnosis and treatment (i.e., at the moment of diagnosis or receiving active treatment or in follow-up), were prospectively enrolled between April 1- May 1, 2020. The Perceived Stress Scale (PSS) was used to measure the global perceived stress by BC patients. Data from 154 women with a diagnosis of BC were prospectively collected and retrospectively analyzed. Of them, 57 patients underwent neoadjuvant or adjuvant therapy (Group A), 26 patients awaiting surgery or to start chemo/radiation therapy (Group B), whereas 71 were in follow–up (Group C). Overall, the mean PSS’ score was 19 ± 7.4 (range 3 to 35). This showed a high level of perceived stress among the entire population. In particular, a higher score was registered for patients of group A, with a PSS score of 19.5 ± 7.3. The health restriction secondary to the COVID-19 outbreak leads to an increase in distress in BC patients, as confirmed also by the level of PSS score.
Downloads
Article Details
Copyright (c) 2025 Casamassima F, et al.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing and protecting the author rights is the central aim and core of the publishing business. Peertechz dedicates itself in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. Peertechz licensing terms are formulated to facilitate reuse of the manuscripts published in journals to take maximum advantage of Open Access publication and for the purpose of disseminating knowledge.
We support 'libre' open access, which defines Open Access in true terms as free of charge online access along with usage rights. The usage rights are granted through the use of specific Creative Commons license.
Peertechz accomplice with- [CC BY 4.0]
Explanation
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
With this license, the authors are allowed that after publishing with Peertechz, they can share their research by posting a free draft copy of their article to any repository or website.
'CC BY' license observance:
License Name |
Permission to read and download |
Permission to display in a repository |
Permission to translate |
Commercial uses of manuscript |
CC BY 4.0 |
Yes |
Yes |
Yes |
Yes |
The authors please note that Creative Commons license is focused on making creative works available for discovery and reuse. Creative Commons licenses provide an alternative to standard copyrights, allowing authors to specify ways that their works can be used without having to grant permission for each individual request. Others who want to reserve all of their rights under copyright law should not use CC licenses.
Technical Scientific Committee of the Civil Protection. Recommendations for the management of oncological and onco-haematological patients during the COVID-19 emergency.
Lai AG, Pasea L, Banerjee A, Hall G, Denaxas S, Chang WH, et al. Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths, and a population-based cohort study. BMJ Open. 2020;10:e043828. Available from: https://doi.org/10.1136/bmjopen-2020-043828
Gregucci F, Caliandro M, Surgo A, Carbonara R, Bonaparte I, Fiorentino A. Cancer patients in Covid-19 era: Swimming against the tide. Radiother Oncol. 2020;149:109–10. Available from: https://doi.org/10.1016/j.radonc.2020.04.002
Schubart JR, Emerich M, Farnan M, Smith JS, Kauffman GL, Kass RB. Screening for psychological distress in surgical breast cancer patients. Ann Surg Oncol. 2014;21:3348–53. Available from: https://doi.org/10.1245/s10434-014-3919-8
Fallowfield L, Jenkins V. Psychosocial/survivorship issues in breast cancer: are we doing better? J Natl Cancer Inst. 2015;107:335. Available from: https://doi.org/10.1093/jnci/dju335
Gorman JR, Malcarne VL, Roesch SC, Madlensky L, Pierce JP. Depressive symptoms among young breast cancer survivors: the importance of reproductive concerns. Breast Cancer Res Treat. 2010;123:477–85. Available from: https://doi.org/10.1007/s10549-010-0768-4
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17:1729. Available from: https://doi.org/10.3390/ijerph17051729
Steiner JL, Wagner CD, Bigatti SM, Storniolo AM. Depressive rumination mediates cognitive processes and depressive symptoms in breast cancer patients and their spouses. Fam Syst Health. 2014;32:378–88. Available from: https://doi.org/10.1037/fsh0000066
Voigt V, Neufeld F, Kaste J, Buehner M, Sckopke P, Wuerstlein R, et al. Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study. Psycho Oncol. 2017;26:74–80. Available from: https://doi.org/10.1002/pon.4102
Tsaras K, Papathanasiou IV, Mitsi D, Veneti A, Kelesi M, Zyga S, et al. Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors. Asian Pac J Cancer Prev. 2018;19:1661–9. Available from: https://doi.org/10.22034/apjcp.2018.19.6.1661
Swainston J, Chapman B, Grunfeld EA, Derakshan N. COVID-19 lockdown and its adverse impact on psychological health in breast cancer. Front Psychol. 2020;11:2033. Available from: https://doi.org/10.3389/fpsyg.2020.02033
Adams M. How to cope with COVID-19 stress and anxiety. 2020. Available from: https://www.mdanderson.org/cancerwise/how-to-cope-with-2019-novel-coronavirus-covid-19-stress-and-anxiety.h00-159380367.html
Mapes D. Lessons from cancer patients in the time of coronavirus. 2020. Available from: https://www.fredhutch.org/en/news/center-news/2020/03/lessons-from-cancer-patients-in-the-time-of-coronavirus.html
Herschbach P, Marten‐Mittag B, Henrich G. Revision and psychometric testing of the questionnaire on the burden of cancer patients (FBK‐R23). J Med Psychol. 2003;12:69–76. Available from: http://dx.doi.org/10.3233/ZMP-2003-12_2_05
Lee TY, Chen HH, Yeh ML, Li HL, Chou KR. Measuring reliability and validity of a newly developed stress instrument: Newly Diagnosed Breast Cancer Stress Scale. J Clin Nurs. 2013;22(17–18):2417–25. Available from: https://doi.org/10.1111/jocn.12107
Lee TY, Hsing SC, Li CC. An improved stress-scale specifically designed to measure stress of women with newly diagnosed breast cancer. Int J Environ Res Public Health. 2021;18(5):2346. Available from: https://doi.org/10.3390/ijerph18052346
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:386–96. Available from: https://pubmed.ncbi.nlm.nih.gov/6668417/
Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The social psychology of health. Claremont Symposium on Applied Social Psychology. Newbury Park (CA): Sage; 1988. p. 31–67. Available from: https://www.scirp.org/reference/ReferencesPapers?ReferenceID=1186085
Soria-Reyes LM, Cerezo MV, Alarcón R, Blanca MJ. Psychometric properties of the perceived stress scale (PSS-10) with breast cancer patients. Stress Health. 2023;39(1):115–24. Available from: https://doi.org/10.1002/smi.3170
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatry. 2020;33:e100213. Available from: https://doi.org/10.1136/gpsych-2020-100213
Cui Q, Cai Z, Li J, Liu Z, Sun S, Chen C, Wang G. The psychological pressures of breast cancer patients during the COVID-19 outbreak in China—a comparison with frontline female nurses. Front Psychiatry. 2020;11:559701. Available from: https://doi.org/10.3389/fpsyt.2020.559701