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Participation in psychosocial oncology and quality-of-life research: a systematic review. Lancet Oncol 2017; 18:e153-e165. [DOI: 10.1016/s1470-2045(17)30100-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022]
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Cho D, Park CL. Moderating effects of perceived growth on the association between fear of cancer recurrence and health-related quality of life among adolescent and young adult cancer survivors. J Psychosoc Oncol 2016; 35:148-165. [PMID: 27749160 DOI: 10.1080/07347332.2016.1247408] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We examined whether (1) fear of cancer recurrence was related to lower health-related quality of life and (2) perceived growth moderated the link between fear of recurrence and health-related quality of life. About 292 adolescent and young adult cancer survivors (diagnosed with cancer at ages 15-34) completed a cross-sectional survey. Fear of recurrence was related to poorer physical and mental health-related quality of life. The negative association between fear of recurrence and mental health-related quality of life was moderated by perceived growth. Fostering perceived growth may mitigate the adverse associations of fear of recurrence and health-related quality of life.
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Affiliation(s)
- Dalnim Cho
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Crystal L Park
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
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An evaluation study of the determinants of future perspective and global Quality of Life in Spanish long-term premenopausal early-stage breast cancer survivors. Contemp Oncol (Pozn) 2016; 20:165-70. [PMID: 27358597 PMCID: PMC4925738 DOI: 10.5114/wo.2016.60073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/23/2016] [Indexed: 01/15/2023] Open
Abstract
Aim of the study Quality of life (QL) is important in premenopausal long-term breast cancer survivors. In this study we assessed QL and factors associated with future perspective and global QL in premenopausal early-stage long-term breast cancer survivors from Spain. Material and methods 243 premenopausal stage I-IIIA relapse-free breast cancer patients who had received surgery 5–20 years previously completed EORTC QLQ-C30 and QLQ-BR23 questionnaires once during follow-up. Univariate and multivariate logistic regression analyses were performed. Results QL mean scores were high in most areas (> 80 in functioning; < 20 in symptoms). The main factors for future perspective were emotional and social functioning, fatigue, breast symptom, and body image. The main factors for global QL were fatigue, pain and physical functioning, and emotional and social functioning. The best logistic model to explain future perspective associated high emotional and social functioning and low breast symptoms with a lower risk of low future perspective (R2 = 0.56). Higher scores in physical and emotional functioning and lower scores in fatigue were associated with a lower risk of low global QL (R2 = 0.50). Conclusions Psychological, social, and physical factors were found to be possible determinants of global QL and future perspective. QL in premenopausal early-stage long-term breast cancer survivors may benefit from multidisciplinary treatment.
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Rayne S, Schnippel K, Firnhaber C, Wright K, Kruger D, Benn CA. Fear of Treatments Surpasses Demographic and Socioeconomic Factors in Affecting Patients With Breast Cancer in Urban South Africa. J Glob Oncol 2016; 3:125-134. [PMID: 28717750 PMCID: PMC5493272 DOI: 10.1200/jgo.2015.002691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Breast cancer is the most common cause of cancer in women in South Africa, and often patients present late. There is little understanding of the psychosocial stresses affecting women with breast cancer in Africa. Methods A questionnaire was distributed to 263 patients with breast cancer at two sites (one government and one private facility) in Johannesburg. Self-reported levels of fear were recorded on summative scales and their relationship to demographic variables assessed through univariable and multivariable modified Poisson regression. Results Fears related to treatments and prognosis, particularly radiation, loss of hair, and loss of breast, were far stronger than those related to socioeconomic barriers. Relative risk (RR) of most fears was higher in women younger than age 40 years, including treatment affordability (RR, 1.80; 95% CI, 1.26 to 2.56), hair loss (RR, 1.48; 95% CI, 1.12 to 2.95), and surgery (RR, 1.31; 95% CI, 1.02 to 1.68). Difficulty taking time off work predicted fear of job loss (RR, 2.59; 95% CI, 1.59 to 4.21) and missing appointments because of transport (RR, 2.46; 95% CI, 1.52 to 3.96) or family commitments (RR, 2.46; 95% CI, 1.52 to 3.96). Women with dependents and black women were more afraid of dying (RR, 1.73; 95% CI, 1.03 to 2.90; and RR, 1.79; 95% CI, 1.33 to 2.24, respectively); however, socioeconomic status in this sample was a strong confounder of race and explained most of the racial differences in levels of fear. Conclusion The most significant fears around breast cancer were related to treatment modalities and adverse effects rather than transport, financial, or work concerns. Young age and job insecurity were predictive of increased fears. Education about treatments has a key role to play in improving access to breast cancer care in South Africa.
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Affiliation(s)
- Sarah Rayne
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Kathryn Schnippel
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Cynthia Firnhaber
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Kathryne Wright
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Deirdre Kruger
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Carol-Ann Benn
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
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Simonelli LE, Siegel SD, Duffy NM. Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psychooncology 2016; 26:1444-1454. [DOI: 10.1002/pon.4168] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Laura E. Simonelli
- Christiana Care Health System; Helen F. Graham Cancer Center & Research Institute; Newark DE USA
| | - Scott D. Siegel
- Christiana Care Health System; Helen F. Graham Cancer Center & Research Institute; Newark DE USA
| | - Nicole M. Duffy
- Christiana Care Health System; Helen F. Graham Cancer Center & Research Institute; Newark DE USA
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Freeman-Gibb LA, Janz NK, Katapodi MC, Zikmund-Fisher BJ, Northouse L. The relationship between illness representations, risk perception and fear of cancer recurrence in breast cancer survivors. Psychooncology 2016; 26:1270-1277. [PMID: 27146965 DOI: 10.1002/pon.4143] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 01/18/2016] [Accepted: 03/20/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fear of cancer recurrence, although distinct from distress continues to be under-evaluated, captured, or treated when standard distress scales are used to assess concerns of cancer survivors. We tested a model assessing the association of demographic and clinical factors, illness representations, and perceived risk with fear of cancer recurrence in breast cancer survivors. METHODS We recruited 117 breast cancer survivors at least one year after completing breast cancer treatment from Internet discussion boards for this cross-sectional, descriptive, correlational study. Participants completed a survey that assessed their level of fear of cancer recurrence as well as their illness representations, perceived risk of recurrence, and demographic and medical characteristics. RESULTS Our model explained 62% of the variance in fear of cancer recurrence. Emotional representations (β = .46, p < .01), symptom attribution (β = .21, p < .01), timeline (β = .23, p < .01), and consequences (β = .16, p < .03) were significantly related to fear of recurrence. By contrast, the majority of clinical and demographic variables were not significant contributors to fear of recurrence. CONCLUSIONS Upon completion of cancer treatment, survivors with more emotional representations of the experience and those who attribute unrelated symptoms to their breast cancer have a higher level of fear of recurrence. Evaluation of these factors during treatment may help mitigate fear of recurrence in the survivorship phase of the breast cancer trajectory. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Nancy K Janz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Maria C Katapodi
- Institute of Nursing Science/Faculty of Medicine, University of Basel, Basel, Switzerland
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Thewes B, Lebel S, Seguin Leclair C, Butow P. A qualitative exploration of fear of cancer recurrence (FCR) amongst Australian and Canadian breast cancer survivors. Support Care Cancer 2015; 24:2269-2276. [PMID: 26581900 PMCID: PMC4805701 DOI: 10.1007/s00520-015-3025-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/08/2015] [Indexed: 11/25/2022]
Abstract
Purpose Few studies have explored coping strategies used by cancer survivors to deal with fear of cancer recurrence (FCR), and little research has been conducted on the specific content of recurrence fears. This study aims to qualitatively explore the strategies used by younger breast cancer survivors to cope with FCR and whether women with low, medium and high levels of FCR employ different coping strategies. An additional aim was to understand the specific content of worst recurrence fears. Method Twenty Australian and 10 Canadian women aged ≤45 years diagnosed with stages 0–II disease at least 1 year prior completed telephone interviews. The transcripts of audio-taped interviews were analysed using the qualitative methodology of transcendental realism. Results Women with higher FCR described using distraction and avoidance and fewer coping skills. The fear of death was a common worst fear at all levels of FCR. However, participants with higher FCR described more elaborate fears of death often involving themes of pain and suffering. Cross-cultural differences were not observed. Conclusions Women with higher FCR report using fewer and more avoidance-based coping techniques. Whilst many participants feared death, those with higher FCR reported more elaborate death fears. Women with high levels of FCR may benefit from learning a greater repertoire of coping skills. Understanding the specific content of FCR can help refine existing psychological treatment protocols for FCR. Implications for FCR treatment are discussed.
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Affiliation(s)
- B Thewes
- Department of Medical Psychology, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen (840), The Netherlands. .,School of Psychology, The University of Sydney, Sydney, Australia.
| | - S Lebel
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Montfort Hospital Research Institute, Ottawa, ON, Canada
| | | | - P Butow
- School of Psychology, The University of Sydney, Sydney, Australia
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Cohee AA, Adams RN, Johns SA, Von Ah D, Zoppi K, Fife B, Monahan PO, Stump T, Cella D, Champion VL. Long-term fear of recurrence in young breast cancer survivors and partners. Psychooncology 2015; 26:22-28. [PMID: 26490953 DOI: 10.1002/pon.4008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/12/2015] [Accepted: 09/25/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fear of a breast cancer recurrence is the most prevalent and disruptive source of distress for long-term survivors and their partners. However, few studies have focused on predictors of fear of recurrence. The aim of this study is to test the efficacy of the Social Cognitive Processing Theory (SCPT) in predicting fear of recurrence in long-term breast cancer survivors diagnosed at age 45 years or younger and their partners. METHODS In a large cross-sectional study, breast cancer survivors (n = 222) 3-8 years from diagnosis and their partners completed a survey assessing demographic characteristics, fear of recurrence, social constraints, and cognitive processing (intrusive thoughts and cognitive avoidance). Mediation analyses were conducted for survivors and partners separately to determine if cognitive processing would mediate the relationship between social constraints and fear of recurrence. RESULTS Cognitive processing mediated the relationship between social constraints and fear of recurrence both for survivors [F(3,213) = 47.541, R2 = 0.401, p < 0.001] and partners [F(3,215) = 27.917, R2 = 0.280, p < 0.001). Demographic variables were not significant predictors of fear of recurrence. CONCLUSIONS As predicted, cognitive processing mediated the relationship between social constraints and fear of recurrence. Results expand the utility of the SCPT in long-term survivors and their partners by supporting its use in intervention design. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andrea A Cohee
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Rebecca N Adams
- Department of Psychology, Purdue University School of Science, West Lafayette, IN, USA
| | - Shelley A Johns
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Diane Von Ah
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Kathleen Zoppi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Betsy Fife
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy Stump
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, USA
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Strickland J, Foley Wells C, Porr C. Safeguarding the Children: The Cancer Journey of Young Mothers. Oncol Nurs Forum 2015; 42:534-41. [DOI: 10.1188/15.onf.534-541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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61
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Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv 2015; 9:481-91. [PMID: 25603948 DOI: 10.1007/s11764-015-0424-4] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/03/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE The prevalence of clinical levels of fear of cancer recurrence (FCR) in cancer survivors is unknown, which may be partly explained by the lack of an assessment method that would make it possible to distinguish between normal and clinical levels of FCR. Moreover, despite the apparent overlap between FCR and manifestations of some psychiatric disorders, no study has yet evaluated the comorbidity of clinical levels of FCR. The goals of this study were to assess the capacity of the Fear of Cancer Recurrence Inventory severity subscale, to consider a shorter form of the FCRI (FCRI-SF), to screen for clinical levels of FCR, and to assess its psychiatric comorbidity. METHODS Sixty French-Canadian cancer survivors (73% of those eligible) who had been treated within the past 4 years for localized breast, prostate, lung, or colorectal cancer were randomly selected. Participants were administered a clinical interview assessing FCR, the Structured Clinical Interview for DSM-IV, and self-report scales. RESULTS A cutoff score of 13 or higher on the FCRI-SF was associated with optimal sensitivity (88%) and specificity (75%) rates for the screening of clinical levels of FCR. Cancer survivors with clinical levels of FCR were significantly more likely to meet the criteria for a current psychiatric disorder (60%) than patients with nonclinical levels (29%). Anxiety disorders tended to be the most common comorbid disorders. CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS The FCRI-SF allows rapid and effective screening of clinical levels of FCR, a condition associated with significant psychiatric comorbidity.
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Affiliation(s)
- Sébastien Simard
- Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725, Chemin Ste-Foy, Québec, G1V 4G5, QC, Canada,
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Dinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C. Comorbidity of fear of progression and anxiety disorders in cancer patients. Gen Hosp Psychiatry 2014; 36:613-9. [PMID: 25213227 DOI: 10.1016/j.genhosppsych.2014.08.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The relation between fear of progression (FoP) and anxiety disorders remains unclear. Therefore, we investigated the comorbidity between clinical FoP and psychiatric anxiety disorders. METHOD In this cross-sectional study, 341 cancer patients undergoing acute inpatient care participated. A structured clinical interview (Structured Clinical Interview for DSM-IV Axis I) was used to identify Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition anxiety disorders and hypochondriasis. Patients completed measures of FoP (Fear of Progression Questionnaire), worries (Penn State Worry Questionnaire, Worry Domains Questionnaire), depression [Patient Health Questionnaire (PHQ): Depression], anxiety (PHQ: General Anxiety Disorder) and somatic symptoms (PHQ: Somatic Symptoms). We cross-tabulated FoP with the presence of anxiety disorders and studied associated variables. RESULTS Of all patients studied, 17.6% suffered from an anxiety disorder. With regard to comorbidity, 68.3% suffered neither from clinical FoP nor from any anxiety disorder, 13.4% had not been diagnosed with an anxiety disorder but experienced clinical FoP, and 11.6% only suffered from an anxiety disorder. The remaining 6.7% suffered from FoP that was comorbid with an anxiety disorder. Patients with a pure FoP did not differ from patients with a pure anxiety disorder on nearly all symptom measures. Only a few associations between the comorbidity pattern and sociodemographic and clinical variables emerged. CONCLUSION Clinical FoP appears to be a distinct phenomenon. It does not differ from anxiety disorders in its psychological and somatic burdens.
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Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Katrin Kremsreiter
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Brennan ME, Butow P, Spillane AJ, Boyle F. Patient-reported quality of life, unmet needs and care coordination outcomes: Moving toward targeted breast cancer survivorship care planning. Asia Pac J Clin Oncol 2014; 12:e323-31. [PMID: 25244662 DOI: 10.1111/ajco.12254] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 11/27/2022]
Abstract
AIM Survivorship care plans (SCPs) have been proposed for universal use with the aim of addressing the many unmet needs of cancer survivors. Trials have failed to find a significant impact of SCPs on quality of life outcomes. This study evaluated quality of life, unmet needs, satisfaction with health care and perception of cancer care coordination at the end of treatment in a cohort of women at the end of treatment for early breast cancer. The aim was to identify specific needs to assist in the design of a tailored SCP. METHODS Women completed patient-reported measures of health-related quality of life (FACT-B [ES]), unmet needs (CaSUN), satisfaction with medical care and cancer care coordination. Total scores and subscale scores for the whole cohort and results of analysis comparing three age groups were reported. RESULTS Sixty-eight women (mean age 56) participated. Mean score for FACT-B = 108 and FACT-B (ES) = 167.4. Younger women (<51 years) reported a significantly lower quality of life (P = 0.001 for FACT-B, TOI and FACT-B [ES]). Using CaSUN, 76.1% of participants reported at least one unmet need; mean number of unmet needs = 6.2. Younger women reported more unmet needs than older women. The most frequently reported unmet need was fear of cancer recurrence. Overall, participants were very satisfied with medical care and cancer care coordination. CONCLUSION Younger women reported poorer quality of life and more unmet needs. SCPs should specifically target younger women and must include strategies to address fear of cancer recurrence if they are to lead to a measureable difference in outcomes.
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Affiliation(s)
- Meagan Elizabeth Brennan
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, North Sydney, New South Wales, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew John Spillane
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Frances Boyle
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, North Sydney, New South Wales, Australia
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Fear of recurrence and its impact on quality of life in patients with hematological cancers in the course of allogeneic hematopoietic SCT. Bone Marrow Transplant 2014; 49:1217-22. [PMID: 25000458 DOI: 10.1038/bmt.2014.139] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 12/22/2022]
Abstract
We examined the course and the prevalence of a high fear of cancer recurrence (FCR) in patients undergoing allogeneic PBSC transplantation (hematopoietic SCT (HSCT)) before HSCT (N=239), 100 days after (n=150, and 12 months after allogeneic HSCT (n=102). The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the EORTC Quality of Life Questionnaire, and the Hospital Anxiety and Depression Scale were used. Pre-HSCT 36% of patients, 100 days after HSCT 24% of patients, and 1 year after HSCT 23% of patients fulfilled the criteria for high FCR (FoP-Q-SF cutoff=34). Being married (b=2.76, P=0.026), female gender (b=4.45, P<0.001) and depression (b=4.44, P<0.001) were significantly associated with FCR at baseline. One hundred days after HSCT, depression significantly predicted FCR (b=6.46, P<0.001). One year following HSCT, female gender (b=6.61, P=0.008) and higher depression were (b=4.88, P=0.004) significant predictors for FCR. Over the three assessment points, patients with high FCR had a significantly lower quality of life compared to patients with low FCR in physical functioning (P=0.019), role functioning (P=0.003), emotional functioning (P<0.001), cognitive functioning (P=0.003), social functioning (P<0.001) and global quality of life (P<0.001). Our data provide evidence that FCR is a prevalent problem in patients with hematological malignancies and has a significant adverse impact on health-related quality of life.
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