Identifying the principal drivers of heightened anxiety during breast cancer diagnosis through the analysis of social media data on Reddit: mixed methods study (Preprint)

Abstract

More than 85% of patients report heightened levels of anxiety following cancer diagnosis. Anxiety can become amplified during the early stages of the breast cancer diagnosis process when ambiguity is high. High levels of anxiety can negatively impact patients by reducing their ability to function physically, make decisions, and adhere to treatment plans, with all these elements combined serving to diminish the quality of life.

Using individual social media posts about breast cancer experiences from reddit.com (r/breastcancer), we aim to understand the dimensions of cancer-related anxiety as individuals move from suspecting to confirming cancer diagnosis.

Our team coded the entire corpus of 2,170 unique posts from r/breastcancer with respect to key variables, including whether the post was related to prediagnosis, diagnosis, or postdiagnosis concerns. We then used Linguistic Inquiry and Word Count (LIWC) to rank-order the codified posts as low-, neutral- or high-anxiety. High-anxiety posts were then retained for deep qualitative analysis to identify key themes relative to diagnostic progression.

After several iterations of data analysis and classification through both qualitative and computational methods, we identified a total of 448 high-anxiety posts across the three diagnosis categories. Our analyses revealed that individuals experience higher anxiety before a confirmed cancer diagnosis. Analysis of the high-anxiety posts revealed that the drivers of anxiety differed depending on an individual’s stage in the diagnostic process. Prediagnosis anxiety was driven by physical symptoms, cancer-related risk factors, and difficulty navigating the healthcare system. During the diagnosis period, high anxiety was associated with physical symptoms, cancer-related risk factors, and unclear communication. Following diagnosis, high anxiety posts generally discussed topics related to treatment options, understanding medical reports, or financial or other logistical issues.

This study has practical, theoretical, and methodological implications for cancer research. Content analysis reveals the key drivers of anxiety at each stage (pre-, during, and postdiagnosis) and provides key insights into how clinicians can help alleviate anxiety at all stages of diagnosis. Findings provide insights into cancer-related anxiety as a process beginning prior to engagement with the healthcare system: when an individual first notices possible cancer symptoms.