Symptom burden, Psychosocial Distress, Resilience and Health-Related Quality of Life in Women with Metastatic Breast Cancer Receiving Contemporary Systemic Therapy

Aims: Targeted therapies and immunotherapies have extended survival of women with metastatic breast cancer. However, the role of resilience among women receiving those contemporary treatments remains understudied. We aimed to examine the interrelationships among physical symptom burden, psychosocial distress, resilience and health-related quality of life in women with metastatic breast cancer receiving contemporary systemic cancer treatment. Design: Cross-sectional study. Methods: Women with metastatic breast cancer receiving systemic treatment were recruited across the United States from February to September 2024. Data was collected using validated measures. Psychosocial distress was constructed as a latent variable indicated by anxiety, depression and uncertainty, using confirmatory factor analysis. We conducted structural equation modeling to examine multiple pathways between physical symptom burden, latent psychosocial distress, resilience and health-related quality of life. Results: Of 217 participants, 209 were included in the analysis (mean age = 50.1 years, SD=14.1). Physical symptom burden, psychosocial distress and resilience were significantly associated with health-related quality of life. Significant indirect associations of physical symptom burden and psychosocial distress with health-related quality of life through resilience were identified. Structural equation modeling showed indirect associations between physical symptom burden and health-related quality of life through psychosocial distress and resilience (B=-0.137, 95% CI: -0.217, -0.078, p<0.001). Conclusion: Psychosocial distress appeared to be more proximally associated with resilience than physical symptom burden among this population. Resilience interventions may be strengthened by identifying and addressing anxiety, depression and uncertainty as proximal intervention points for preserving resilience, rather than only including generic stress management components. Impact: This study highlighted the need of resilience interventions that prioritize anxiety and depression screening, mental health referral, and distress focused supportive care alongside symptom management for this population.