The effects of emotional distress on the postoperative survival and progression in patients with breast cancer: a prospective observational study

Abstract Background Emotional distress (ED), characterized by symptoms of depression and anxiety, is highly prevalent in patients with breast cancer. Although retrospective studies suggest an association between ED and adverse cancer outcomes, findings from prospective studies remain inconsistent. Objective This prospective observational study aimed to investigate the association between emotional distress and long-term survival outcomes in patients with breast cancer following curative surgery. Methods A total of 159 patients with breast cancer were enrolled. Baseline levels of emotional distress were assessed using standardized scales. Patients were prospectively followed for up to 7 years to monitor overall survival (OS) and progression-free survival (PFS). Inverse probability of treatment weighting (IPTW) was employed to adjust the baseline confounders. Results The unadjusted 7-year OS and PFS rates in patients with ED were numerically lower than those without ED (OS: 78.5% vs. 93.7%; PFS: 76.9% vs. 89.3%). After adjustment using IPTW, emotional distress was independently associated with lower OS (adjusted HR = 6.52, 95% CI: 1.78–23.89, P = 0.005) and PFS (adjusted HR = 3.73, 95% CI: 1.19–11.71, P = 0.024). Conclusion This study provides prospective evidence that emotional distress is associated with reduced survival and an increased risk of disease progression in breast cancer patients following curative surgery. These findings highlight the importance of integrating psychological assessment and supportive care into routine oncologic management.