Covariates
Patient-reported social demographic variables included age, body mass index (BMI), race/ethnicity, education level, and marital status. Clinical factors such as stage, chemotherapy treatment, current aromatase inhibitor use and comorbidities were obtained via chart abstraction. The hospital anxiety and depression scale (HADS) was used to measure depression and anxiety symptoms. The HADS is a 14-item, self-rated instrument for anxiety (7 items) and depression (7 items) in the past week, and was developed for patients with chronic illnesses. Established cutoffs are: 0 to 7, no significant depression/anxiety; 8 to 10, subclinical depression/anxiety; 11 to 21, clinically significant levels of depression/anxiety. The HADS has been extensively used and validated and has demonstrated adequate sensitivity and specificity to detect cases of depression and anxiety in cancer patients [14],[15].