Background: Although common, the severity of the psychological symptom cluster (PSC) (ie, co-occurrence of anxiety, depression, fatigue, sleep disturbance) varies among women with breast cancer. In addition, the impact of various types of stress and other risk factors on its severity are understudied, and the influence of the PSC on quality of life (QOL) outcomes remains poorly characterized.

Objective: To identify subgroups of postmenopausal women with breast cancer with distinct PSC severity profiles following surgery and evaluate whether these subgroups differed in terms of demographic and clinical characteristics, symptoms, social and posttraumatic stress, and QOL.

Methods: Following surgery, 159 postmenopausal women with early-stage, hormone receptor-positive breast cancer completed assessments of anxiety, depression, fatigue, sleep disturbance, cognitive function, physical symptoms, stress, and QOL. Latent profile analysis was used to identify subgroups of women based on the severity of the prespecified PSC. Parametric and nonparametric tests were used to evaluate for subgroup differences.

Results: Three distinct PSC severity subgroups were identified (ie, Lower [71.7%], Moderate [23.9%], Higher [4.4%]). Compared with the Lower subgroup, the Moderate subgroup was less likely to have received prior radiation, and the Moderate and Higher subgroups had worse perceived cognitive function, higher symptom burden, higher posttraumatic stress, and lower QOL. Clinically relevant sleep disturbance was common across PSC subgroups.

Conclusions: PSC severity is associated with higher posttraumatic stress and poorer QOL following breast surgery. Sleep disturbance is a common problem and may be undertreated.

Implications for practice: Assessments of posttraumatic stress and sleep disturbance are needed for timely intervention.

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背景：

尽管心理症状群（PSC，即焦虑、抑郁、疲劳和睡眠障碍的共病）在乳腺癌女性患者中很常见，但其严重程度因人而异。此外，不同类型的压力和其他风险因素对PSC严重程度的影响研究不足，PSC对生活质量（QOL）结果的影响也未充分描述。

目的：

确定绝经后早期激素受体阳性乳腺癌手术后的女性患者中具有不同PSC严重程度特征的亚组，并评估这些亚组在人口统计学和临床特征、症状、社会和创伤后应激以及生活质量方面是否存在差异。

方法：

159名接受过手术的绝经后早期激素受体阳性乳腺癌妇女，在术后完成了关于焦虑、抑郁、疲劳、睡眠障碍、认知功能、身体症状、压力和生活质量的评估。使用潜在剖面分析来根据预设PSC的严重程度识别女性亚组，并采用参数和非参数测试来评估各亚组之间的差异。

结果：

确定了三个不同的PSC严重度亚组（即低水平[71.7%]、中等水平[23.9%]、高水平[4.4%]）。与低水平亚组相比，中等水平的亚组更可能没有接受过放射治疗，并且两者的认知功能评分较低、症状负担较高、创伤后应激较高以及生活质量较差。睡眠障碍在各个PSC亚组中普遍存在。

结论：

PSC严重程度与乳腺手术后的更高创伤后应激和更低的生活质量有关。睡眠障碍是一个常见的问题，可能没有得到充分治疗。

实践意义：

需要评估创伤后应激和睡眠障碍以及时进行干预。

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