Association of postoperative psychological interventions on compliance and survival in breast cancer patients: A single-center retrospective study

This study aimed to whether different patterns of postoperative psychological intervention were associated with subsequent adherence to adjuvant endocrine therapy and survival in women with hormone receptor-positive (HR+) breast cancer. We conducted a single-center retrospective cohort study including 318 women with stage I-III, HR+ breast cancer who underwent curative-intent surgery between June 2022 and June 2024 at a tertiary hospital in China. Psycho-oncology care delivered within 6 months of surgery was grouped into 3 patterns: no/minimal care (0-1 session), early structured care (≥3 sessions starting within 3 months) and delayed/low-intensity care (≥3 sessions starting > 3-6 months, or 2 sessions spread over >3 months). Overall survival and disease-free survival were evaluated using a 6-month landmark approach. Associations between intervention patterns and outcomes were assessed with logistic regression and Cox models incorporating inverse probability of treatment weighting based on multinomial propensity scores. In total, 215 of 318 patients (67.6%) met the definition of good 1-year adherence. The proportion with good adherence was higher in the early structured (77.0%) and delayed/low-intensity groups (71.6%) than in the no/minimal group (55.7%). Relative to no/minimal care, early structured intervention was associated with a significantly greater odds of good adherence (adjusted odds ratio [OR] 2.15, 95% confidence interval [CI] 1.27-3.64; P = .004), and delayed/low-intensity intervention showed a more modest but still favorable association (adjusted OR 1.81, 95% CI 1.01-3.24; P = .045). In inverse probability of treatment weighting analyses, the ORs for good adherence were 2.05 (95% CI 1.23-3.42; P = .006) for early structured and 1.67 (95% CI 0.95-2.94; P = .075) for delayed/low-intensity care compared with no/minimal care. After a median follow-up of 24.1 months, early structured intervention was associated with lower,. In this postoperative cohort of women with stage I-III, HR+ breast cancer, early structured psychological intervention was independently linked with better 1-year adherence to adjuvant endocrine therapy. Apparent advantages for overall survival and disease-free survival were consistent in direction but imprecise. The findings support embedding structured psycho-oncology care into routine postoperative follow-up to address distress and help patients maintain long-term endocrine therapy.