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Rhee TG, Pawloski PA, Parsons HM. Health-related quality of life among US adults with cancer: Potential roles of complementary and alternative medicine for health promotion and well-being. Psychooncology 2019; 28:896-902. [PMID: 30803097 DOI: 10.1002/pon.5039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We estimated prevalence of complementary and alternative medicine (CAM) use by reason for use (treatment, wellness, or both) among non-institutionalized adults with cancer in the United States. We also examined health-related quality of life (HRQOL) outcomes among adults with cancer who used CAM. METHODS We used data from the 2012 National Health Interview Survey (NHIS), which represents non-institutionalized adults with cancer (n = 2967 unweighted). Using a cross-sectional design with survey sampling techniques, we estimated past year prevalence of CAM use. We ran multivariable logistic regression analyses to investigate the odds of perceived benefits of CAM. RESULTS In the past 12 months, 35.1% of adults with cancer reported using some form of CAM. Among CAM users, 56.0% used CAM for both treatment and wellness, and 32.4% used CAM for wellness only. Only 11.6% used CAM for treatment only. Regardless of reason for use, the most commonly used CAM types in the past year were herbal therapies (56.8%), chiropractic (27.1%), and massage (24.9%). Among CAM users, those using CAM for wellness only and for a combination of treatment and wellness reported significantly higher odds of "a better sense of controlling health" and "improved overall health and feeling better" compared with treatment only users. Similar patterns were found in other HRQOL outcomes, but they were not statistically different. CONCLUSIONS CAM is widely used among adults with cancer for wellness only or a combination of treatment and wellness. Given improved HRQOL outcomes, CAM may be a promising approach for enhancing health promotion and well-being among adults with cancer.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut Health Center, Farmington, Connecticut.,Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Pamala A Pawloski
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota.,HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota
| | - Helen M Parsons
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Muzzatti B, Gipponi K, Flaiban C, Cormio C, Carnaghi C, Tralongo P, Caruso M, Cavina R, Tirelli U, Annunziata MA. The impact of cancer: An Italian descriptive study involving 500 long-term cancer survivors. Eur J Cancer Care (Engl) 2019; 28:e13007. [PMID: 30740807 DOI: 10.1111/ecc.13007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/13/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The well-being and quality of life (QoL) of long-term cancer survivors may be affected, both positively and negatively, by psychosocial factors related to the experience of being a cancer patient. We investigated whether, in long-term cancer survivors, the psychosocial impacts of cancer associate with socio-demographic-clinical variables; whether, within the positive and negative dimensions taken separately, some impacts are more intense than others; and whether these impacts explain QoL. METHODS Italian long-term cancer survivors (n = 500) completed the Impact of Cancer (IOC-V2) and Short Form 36 Health Survey (SF-36) questionnaires. RESULTS The IOC-V2 negative impact score associated with gender, education, occupational status and health issues, whereas no association was found between the positive impact score and socio-demographic-clinical variables. Of the positive impacts, Altruism/Empathy was the highest (p < 0.001); Positive self-evaluation was higher than Health awareness (p = 0.001); and Meaning of cancer was the lowest (p < 0.001). Among the negative impacts, Worry was the highest (p < 0.001), whereas Body changes concerns was higher than both Appearance concerns (p < 0.001) and Life Interferences (p < 0.001). The assessed impacts explained more than 25% of the variance of both physical and mental functioning scores. CONCLUSIONS The provided data document psychosocial factors affecting QoL in Italian long-term cancer survivors.
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Affiliation(s)
- Barbara Muzzatti
- Unit of Oncological Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Katiuscia Gipponi
- Unit of Oncological Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Cristiana Flaiban
- Unit of Oncological Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Claudia Cormio
- Experimental Unit of Psycho-Oncology, National Cancer Centre Giovanni Paolo II, Bari, Italy
| | - Carlo Carnaghi
- Medical Oncology, Humanitas Mater Domini, Castellanza, Italy
| | - Paolo Tralongo
- Medical Oncology, Rete Assistenza Oncologica, Siracusa, Italy
| | - Michele Caruso
- Medical Oncology, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | | | - Umberto Tirelli
- Medical Oncology A, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Butow P, Williams D, Thewes B, Tesson S, Sharpe L, Smith AB, Fardell JE, Turner J, Gilchrist J, Girgis A, Beith J. A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability. Psychooncology 2019; 28:533-539. [PMID: 30597658 DOI: 10.1002/pon.4971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/16/2018] [Accepted: 12/23/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE ConquerFear is a metacognitive intervention for fear of cancer recurrence (FCR) with proven efficacy immmediately and 6 months post-treatment. This qualitative study documented barriers and facilitators to the sustainability of ConquerFear from the perspective of study therapists. METHODS Fourteen therapists who had delivered ConquerFear in a randomised controlled trial completed a semi-structured phone interview, reaching theoretical saturation. Themes from thematic analysis were mapped to the Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework. RESULTS Participants were 13 males and one female with, on average, 14 years psycho-oncology experience. Nine over-arching themes were identified, falling into three domains, which when present, were facilitators, and if absent, were barriers: evidence (intervention credibility, experienced efficacy, perceived need for intervention); context (positive attitude to and capacity for survivorship/FCR care, favourable therapist orientation and flexibility, strong referral pathways); and facilitation of implementation (intervention/service fit, intervention/patient fit, and training, support, and provided resources). CONCLUSIONS ConquerFear is a sustainable intervention in routine clinical practise. Facilitators included a sound evidence base; a receptive context; good fit between the intervention, therapist orientation, and patient need; and flexibility of delivery. Where absent, these factors served as barriers. These results have implications for enhancing uptake of psycho-oncology interventions in routine care.
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Affiliation(s)
- Phyllis Butow
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,School of Psychology, The University of Sydney, Sydney, Australia
| | - Douglas Williams
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Belinda Thewes
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia
| | - Stephanie Tesson
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,School of Psychology, The University of Sydney, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Allan Ben Smith
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Joanna E Fardell
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Jane Turner
- Mental Health Centre, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jemma Gilchrist
- Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Jane Beith
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, Australia
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Petricone-Westwood D, Jones G, Mutsaers B, Leclair CS, Tomei C, Trudel G, Dinkel A, Lebel S. A Systematic Review of Interventions for Health Anxiety Presentations Across Diverse Chronic Illnesses. Int J Behav Med 2018; 26:3-16. [DOI: 10.1007/s12529-018-9748-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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105
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Yang Y, Sun H, Liu T, Zhang J, Wang H, Liang W, Chen Y, Zhang B. Factors associated with fear of progression in chinese cancer patients: sociodemographic, clinical and psychological variables. J Psychosom Res 2018; 114:18-24. [PMID: 30314574 DOI: 10.1016/j.jpsychores.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Fear of progression (FoP) is a widespread problem among cancer patients and is considered to be one of the most distressing psychological consequences of cancer. The aim of this study was to investigate the association of sociodemographic, clinical, and psychological variables to FoP in Chinese cancer patients. METHODS In this cross-sectional study, six hundred and thirty-six cancer patients were recruited. All participants were asked to complete a personal information sheet, the Chinese version of Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder Questionnaire (GAD-7). Descriptive statistics and hierarchical multiple regression was conducted to analyze the data. RESULTS Hierarchical multiple regression revealed that childhood severe illness experience (P = .011), stress (P < .001), anxiety (P < .001), depressive symptom (P < .001) and personality (P = .042) were independently predictive of higher FoP. The final regression model explained up to 40.0% (adjusted R square: 38.8%) of the observed variance. CONCLUSION There are a number of factors that increase the likelihood of the development of FoP. The findings underline the necessity to provide effective psychological intervention for patients with high FoP in the future.
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Affiliation(s)
- Yuan Yang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Centre, Guangdong General Hospital, Guangzhou, Guangdong 510080, China
| | - Ting Liu
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Jingying Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Hongmei Wang
- Department of Radiotherapy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Weijiang Liang
- Department of Oncology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China
| | - Yu Chen
- Nursing School, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Bin Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong 510515, China.
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Abstract
BACKGROUND The improved survival rate for breast cancer has increased the number of women living with the diagnosis for more than 5 years. Limited studies have focused on the care needs for long-term healthy survivors of breast cancer. OBJECTIVE The aims of this study were to understand the care needs of long-term breast cancer survivors and identify related factors that influence these needs. METHODS A convenience sampling with a correlational study design was used. Women at least 20 years old, who were given a diagnosis of breast cancer at least 5 years, were recruited from 2 hospital clinics in southern Taiwan. A self-administered questionnaire measuring cancer survivors' unmet needs was administered after obtaining informed consent. Binary logistic regression was used to examine variables associated with unmet care needs. RESULTS Of the 192 women participating, the highest unmet needs related to existential survivorship. The most frequently endorsed unmet need was for an ongoing case manager. Fear of recurrence was associated with 3 aspects including existential survivorship, comprehensive cancer, and quality-of-life unmet needs (odds ratio, 1.14-1.21). CONCLUSIONS Even 5 years after the diagnosis and completion of therapy, women continue to report unmet needs. Evaluating women's fear of recurrence to identify high-risk women with unmet needs is critical to providing quality care. IMPLICATION FOR PRACTICE Developing appropriate survivorship care programs combined with managing concerns regarding recurrence by a nursing case manager is needed.
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107
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Miaskowski C, Paul SM, Mastick J, Abrams G, Topp K, Smoot B, Kober KM, Chesney M, Mazor M, Mausisa G, Schumacher M, Conley YP, Sabes JH, Cheung S, Wallhagen M, Levine JD. Associations Between Perceived Stress and Chemotherapy-Induced Peripheral Neuropathy and Otoxicity in Adult Cancer Survivors. J Pain Symptom Manage 2018; 56:88-97. [PMID: 29524582 PMCID: PMC6015523 DOI: 10.1016/j.jpainsymman.2018.02.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 11/22/2022]
Abstract
CONTEXT The most common adverse effects from neurotoxic chemotherapy are chemotherapy-induced neuropathy (CIPN), hearing loss, and tinnitus. Although associations between perceived stress and persistent pain, hearing loss, and tinnitus are documented, no studies have examined these associations in cancer survivors who received neurotoxic chemotherapy. OBJECTIVES In this cross-sectional study, we evaluated for associations between perceived stress and the occurrence of CIPN, hearing loss, and tinnitus, in 623 adult cancer survivors who received platinum and/or taxane compounds. METHODS Survivors completed self-report measures of hearing loss, tinnitus, and perceived stress (i.e., Impact of Events Scale-Revised [IES-R]). Separate logistic regression analyses were done for each neurotoxicity to evaluate whether each of the IES-R subscale (i.e., intrusion, avoidance, hyperarousal) and total scores made a significant independent contribution to neurotoxicity group membership. RESULTS Of the 623 survivors in this study, 68.4% had CIPN, 34.5% reported hearing loss, and 31.0% reported tinnitus. Older age, higher body mass index, poorer functional status, being born prematurely, cancer diagnosis, and higher intrusion (P = 0.013), hyperarousal (P = 0.014), and total (P = 0.047) IES-R scores were associated with CIPN. Older age, being male, poorer functional status, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.007) score were associated with hearing loss. Being male, having less education, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.029) score were associated with tinnitus. CONCLUSION These findings suggest that increased levels of perceived stress are associated with the most common chemotherapy-induced neurotoxicities.
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Affiliation(s)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Margaret Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Melissa Mazor
- School of Nursing, University of California, San Francisco, California, USA
| | - Grace Mausisa
- School of Nursing, University of California, San Francisco, California, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Steven Cheung
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret Wallhagen
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA; School of Dentistry, University of California, San Francisco, California, USA
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Fait K, Vilchinsky N, Dekel R, Levi N, Hod H, Matetzky S. Cardiac-disease-induced PTSD and Fear of illness progression: Capturing the unique nature of disease-related PTSD. Gen Hosp Psychiatry 2018; 53:131-138. [PMID: 29779574 DOI: 10.1016/j.genhosppsych.2018.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/01/2018] [Accepted: 02/26/2018] [Indexed: 01/09/2023]
Abstract
According to Edmondson's Enduring Somatic Threat (EST) Model of PTSD Due to Acute Life-Threatening Medical Events, the nature of PTSD in the context of illness may differ from the nature of "traditional" PTSD in that it includes future-oriented alongside past-related intrusive thoughts. Yet almost no empirical studies to date have assessed the putative future-oriented quality of cardiac-disease-induced PTSD (CDI-PTSD). In the current study, we assessed the hypothesized associations between CDI-PTSD and fear of illness progression (FoP) - a novel theoretical conceptualization of patients' future-related anxieties. We hypothesized that FoP would be positively associated with CDI-PTSD, and especially with its specific items of intrusive thoughts. Patients (N = 112) were interviewed three months post-hospitalization for an acute coronary event via use of the PSS-SR-5 (to assess PTSD symptomatology), the FoP-Q-SF (to assess fear of illness progression), and the HADS (to assess anxiety and depression levels). Results indicated a strong positive association between CDI-PTSD and FoP, even when controlling for anxiety and depression. As hypothesized, the concepts of CDI-PTSD and fear of illness progression were strongly associated both at the level of the clusters as well as at the level of the specific items. The current study provides an initial empirical validation of the EST Model, especially regarding the future-oriented nature of PTSD resulting from acute cardiovascular disease.
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Affiliation(s)
- Keren Fait
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.
| | - Rachel Dekel
- The Louis & Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
| | - Nitza Levi
- RN, Leviev Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
| | - Hanoch Hod
- Leviev Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Shlomi Matetzky
- Leviev Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Hay JL, Baser RE, Westerman JS, Ford JS. Prevalence and Correlates of Worry About Medical Imaging Radiation Among United States Cancer Survivors. Int J Behav Med 2018; 25:569-578. [PMID: 29872990 DOI: 10.1007/s12529-018-9730-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for survivors. The aims of this paper are to describe cancer survivors' level of worry about medical imaging radiation (MIR) and to identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust. METHOD This cross-sectional study used the 2012-2013 Health Information National Trends Survey of US adults conducted by the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic regression analysis was used to evaluate factors associated with higher MIR worry (reporting "some" or "a lot" of MIR worry). RESULTS Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in unadjusted analysis. CONCLUSION Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns of worry could aid efforts to improve these individuals' survivorship care and education.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA.
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joy S Westerman
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA
| | - Jennifer S Ford
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA
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110
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Bazzi AR, Clark MA, Winter MR, Ozonoff A, Boehmer U. Resilience Among Breast Cancer Survivors of Different Sexual Orientations. LGBT Health 2018; 5:295-302. [PMID: 29878863 DOI: 10.1089/lgbt.2018.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Resilience could help protect the psychosocial wellbeing of sexual minority women (SMW) experiencing stressors from both breast cancer and sexual minority status; however, little research has assessed resilience among breast cancer survivors of different sexual orientations. METHODS From 2011 to 2012, we surveyed a national sample of breast cancer survivors matched on sexual orientation, age, and cancer status. RESULTS Among heterosexual (n = 339) and sexual minority (n = 201) breast cancer survivors (n = 540 overall), multivariable regression analyses revealed that more social support (coefficient: 0.87; 95% confidence interval [CI]: 0.56-1.19), fighting spirit combined with helplessness/hopelessness (coefficient: 0.30; 95% CI: 0.13-0.47), and fatalism (coefficient: 0.40; 95% CI: 0.14-0.65) were associated with greater resilience. Mental health counseling before breast cancer diagnosis and anxious preoccupation following cancer diagnosis were associated with reduced resilience (coefficient: -2.50; 95% CI: -3.83 to -1.18; and -0.46; 95% CI: -0.60 to -0.32). Although sexual orientation was not independently associated with resilience, among SMW, those who were unemployed had reduced resilience compared with those who were employed (coefficient: -3.52; 95% CI: -5.75 to -1.28), whereas there was no association between employment and resilience among heterosexual women. CONCLUSION These findings suggest that social support and other factors associated with resilience could be leveraged by interventions to improve the health and wellbeing of diverse cancer survivors.
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Affiliation(s)
- Angela R Bazzi
- 1 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
| | - Melissa A Clark
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Shrewsbury, Massachusetts
| | - Michael R Winter
- 3 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Al Ozonoff
- 4 Center for Patient Safety and Quality Research, Boston Children's Hospital , Boston, Massachusetts.,5 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts
| | - Ulrike Boehmer
- 1 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
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111
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Krok-Schoen JL, Naughton MJ, Bernardo BM, Young GS, Paskett ED. Fear of recurrence among older breast, ovarian, endometrial, and colorectal cancer survivors: Findings from the WHI LILAC study. Psychooncology 2018; 27:1810-1815. [PMID: 29644766 DOI: 10.1002/pon.4731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine the prevalence of and factors associated with fear of recurrence (FCR) following treatment for breast, ovarian, endometrial, and colorectal cancer among older women. METHODS Participants were enrolled in the Women's Health Initiative Life and Longevity After Cancer study. Descriptive statistics and multivariate logistic regression models were used to assess the association of demographic, clinical, and quality of life variables with survivors' FCR, dichotomized as <14 (low) or ≥14 (high) using the Cancer Worry Scale. RESULTS Out of the 4259 participants, 3124 (73.3%) were diagnosed with breast cancer, 559 (13.1%) with colorectal cancer, 493 (11.6%) with endometrial cancer, and 83 (2%) with ovarian cancer. There were no significant differences in FCR by cancer type (P = .75), with a mean scale score of 10.8 ± 2.87 for all participants combined. Approximately 16% (n = 679) were in the high FCR group. Multivariable analyses indicated that being younger at diagnosis, reporting a symptom score of ≥8, receipt of chemotherapy, and lower self-rated health were significantly associated with high FCR. Women who were widowed or never married were less likely to report high FCR. CONCLUSIONS Fear of recurrence was experienced by a small but important proportion of older, long-term cancer survivors and is associated with multiple demographic and clinical variables. These results will better inform researchers and clinicians regarding the individuals who are at risk of FCR.
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Affiliation(s)
- Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Michelle J Naughton
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Gregory S Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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113
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Şengün İnan F, Üstün B. Fear of Recurrence in Turkish Breast Cancer Survivors: A Qualitative Study. J Transcult Nurs 2018; 30:146-153. [DOI: 10.1177/1043659618771142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose: Fear of recurrence (FOR) of cancer is a distressing symptom and can negatively affect breast cancer survivors’ quality of life and psychological well-being. The purpose of this qualitative study was to explore Turkish breast cancer survivors’ experiences related to FOR. Design: The data were collected through semistructured interviews, which were conducted with 12 breast cancer survivors. Results: The data were categorized into four themes: the quality of fear, triggers, effects on life, and coping. FOR survivors’ lives in multiple aspects, and the women found it difficult to manage their fear. Implications: Nurses should be aware of FOR in survivors during follow-up care. In addition, it is essential to consider the impact of FOR on life, and survivors should be referred to appropriate resources and support services.
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114
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Bazzi AR, Clark MA, Winter M, Tripodis Y, Boehmer U. Recruitment of breast cancer survivors and their caregivers: implications for dyad research and practice. Transl Behav Med 2018; 7:300-308. [PMID: 27154790 DOI: 10.1007/s13142-016-0400-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Breast cancer survivors' informal caregivers experience adverse health outcomes and could benefit from interventions. Studies of caregivers' participation in research, to date, have assumed heterosexuality. The aim of this study is to identify factors associated with caregiver participation among survivors with diversity in sexual orientation. We recruited breast cancer survivors into a telephone survey and asked them to invite a caregiver. Logistic regression identified factors associated with caregivers' participation. Among 297 survivors, 12 (4 %) had no caregivers, 82 (28 %) refused to provide caregiver information, 203 (68 %) provided caregiver contact, and 167 (56 %) had caregivers participate. Caregiver participation was more likely among sexual minority than heterosexual survivors (aOR: 1.89; 95 % CI: 1.08, 3.32), dyads with higher cohesion, and among caregivers who were partners. Caregiver participation was less likely among survivors with lower education and higher comorbidity. Findings provide insight into recruitment of diverse dyads into cancer survivorship research that will ultimately inform intervention design.
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Affiliation(s)
- Angela Robertson Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA
| | - Melissa A Clark
- Warren Alpert School of Medicine and School of Public Health, Brown University, Providence, RI, USA
| | - Michael Winter
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA.
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Cupit-Link M, Syrjala KL, Hashmi SK. Damocles' syndrome revisited: Update on the fear of cancer recurrence in the complex world of today's treatments and survivorship. Hematol Oncol Stem Cell Ther 2018; 11:129-134. [PMID: 29476707 DOI: 10.1016/j.hemonc.2018.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/20/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE/BACKGROUND Improvements in curative treatments for many types of cancer have emerged over the past several decades, resulting in a growing population of long-term cancer survivors - of both adult and childhood cancers. Despite this incredible medical achievement, long-term survivors of cancer face a unique fear: the fear of relapse. METHODS We conducted a review of the literature for data on fear of relapse among cancer survivors. RESULTS The fear of cancer recurrence is present in survivors of childhood and adult cancers as well as family members and often leads to psychological sequelae. CONCLUSION Literature on the fear of cancer recurrence has begun to emerge. However, herein we provide a unique approach through the use of a metaphor: Cicero's story of Damocles' sword. We aim to outline the many fear-related and emotional challenges faced by cancer survivors with an extensive review of studies demonstrating such challenges.
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Affiliation(s)
| | - Karen L Syrjala
- Biobehavioral Sciences Department, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Chung S, Youn S, Choi B. Assessment of Cancer-Related Dysfunctional Beliefs about Sleep for Evaluating Sleep Disturbance in Cancer Patients. SLEEP MEDICINE RESEARCH 2017. [DOI: 10.17241/smr.2017.00073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, Tesson S, O’Connell R, Girgis A, Gebski VJ, Asher R, Mihalopoulos C, Bell ML, Zola KG, Beith J, Thewes B. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. J Clin Oncol 2017; 35:4066-4077. [DOI: 10.1200/jco.2017.73.1257] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Methods Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age > 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Results Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented; 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P < .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. Conclusion This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-therapy and 3 and 6 months later and in many secondary outcomes immediately post-therapy. Cancer-specific distress (total) remained more improved at 3- and 6-month follow-up.
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Affiliation(s)
- Phyllis N. Butow
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jane Turner
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jemma Gilchrist
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Louise Sharpe
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Allan Ben Smith
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Joanna E. Fardell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Stephanie Tesson
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Rachel O’Connell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Afaf Girgis
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Val J. Gebski
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Rebecca Asher
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Cathrine Mihalopoulos
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Melanie L. Bell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Karina Grunewald Zola
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jane Beith
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Belinda Thewes
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
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Zeissig SR, Weyer-Elberich V, Emrich K, Binder H, Fischbeck S, Imruck BH, Friedrich-Mai P, Beutel ME, Blettner M. Recruiting former melanoma patients via hospitals in comparison to office-based dermatologists in a register-based cohort study that required indirect contact. BMC Med Res Methodol 2017; 17:150. [PMID: 29166870 PMCID: PMC5700464 DOI: 10.1186/s12874-017-0425-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/14/2017] [Indexed: 11/17/2022] Open
Abstract
Background There are detailed reviews about different recruitment strategies, but not with regard to differences between recruitment of hospital-based versus office-based physicians. Within this study, the two different recruitment schemes are compared. Advantages and disadvantages of different ways of recruitment in registry-based studies are discussed. Methods In a cross-sectional cancer-registry-based study, long-term melanoma patients were contacted by dermatologists rather than directly by the registry on the basis of the legal situation. Logistic regression models and generalized estimating equations were used to assess effects of various patient and physician characteristics on participation and data quality. Especially differences between hospital-based versus office-based dermatologists are evaluated. Results Seventy two out of 112 contacted dermatologists took part in the study (64.3%). The cooperation proportion was 52.2% (689 participants/1320 contacted patients). Participants and non-participants differed regarding age and sex, but not regarding other social demographic factors and cancer stage. We did not observe a difference in patient participation between hospital-based versus office-based dermatologists (OR 1.08 [CI 0.84–1.39]; p = 0.57). However, medical data provided by the cancer registry were better for participants registered and recruited by hospitals. Conclusions In cohort studies with epidemiological cancer registries, recruitment via physicians has potential disadvantages and is more complex. If this indirect way of contact is mandatory, we recommend recruitment procedures including hospital-based rather than office-based physicians. However, physician characteristics were not associated with outcome.
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Affiliation(s)
- S R Zeissig
- Cancer Registry of Rhineland-Palatinate, Grosse Bleiche 46, 55116, Mainz, Germany. .,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - V Weyer-Elberich
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - K Emrich
- Cancer Registry of Rhineland-Palatinate, Grosse Bleiche 46, 55116, Mainz, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - H Binder
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - S Fischbeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - B H Imruck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - P Friedrich-Mai
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - M E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - M Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Muzzatti B, Giovannini L, Flaiban C, Cattaruzza N, Annunziata MA. Cognitive functioning in long-term cancer survivorship: A survey utilizing both standardized neuropsychological and self-report measures. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 26:173-180. [PMID: 29099636 DOI: 10.1080/23279095.2017.1387551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Since long-term cancer survivorship is a reality for an increasing number of people, understanding their cognitive functioning is useful for both research and clinical purposes. This study described the cognitive functioning of Italian long-term cancer survivors, using both an objective standardized battery and a self-report questionnaire. A total of 136 Italian adults 5+ years free from cancer and its treatments were administered the Esame Neuropsicologico Breve, the Self-Assessment Scale of Cognitive Functioning, and assessments of other psychological dimensions. A total amount of 15% of the sample showed impaired performance on 2+ of the assessed cognitive functions, and 32% had 1+ impaired function. The subjective perception of their cognitive functioning was worse in the present sample, compared to the normative data (p < 0.001). Cognitive functioning, objectively and subjectively measured were significantly correlated (p = 0.006). The number of tests scored outside the normal range correlated positively with depression (p = 0.042) and negatively with both the estimated total IQ (p < 0.001) and with estimated performance IQ (p = 0.001). Self-perceived cognitive functioning correlated positively (p < 0.001) with depression, anxiety, and fatigue. These data document how cognitive difficulties may remain for a long time in cancer patients, who are likely to continue to subjectively perceive themselves as impaired, although sometimes to a greater extent than objective impairment.
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Affiliation(s)
- Barbara Muzzatti
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
| | - Lorena Giovannini
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
| | - Cristiana Flaiban
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
| | - Nicoletta Cattaruzza
- a Centro di Riferimento Oncologico , Unit of Oncological Psychology , Aviano , Italy
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Liao YC, Liao WY, Sun JL, Ko JC, Yu CJ. Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study. Support Care Cancer 2017; 26:989-996. [PMID: 29019055 DOI: 10.1007/s00520-017-3919-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress. METHODS A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts. RESULTS Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance. CONCLUSIONS Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.
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Affiliation(s)
- Yu-Chien Liao
- Department of Nursing, Yuanpei University of Medical Technology, 306, Yuanpei Street, Hsinchu, 30015, Taiwan.
| | - Wei-Yu Liao
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Jia-Ling Sun
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
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Shim EJ, Lee JW, Min YH. Does depression decrease the moderating effect of self-efficacy in the relationship between illness perception and fear of progression in breast cancer? Psychooncology 2017; 27:539-547. [DOI: 10.1002/pon.4532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Eun-Jung Shim
- Department of Psychology; Pusan National University; Busan Korea
| | - Jong Won Lee
- Department of Surgery; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Yul Ha Min
- College of Nursing; University of Gachon; Incheon Korea
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Cruickshank S, Steel E, Fenlon D, Armes J, Scanlon K, Banks E, Humphris G. A feasibility study of the Mini-AFTER telephone intervention for the management of fear of recurrence in breast cancer survivors: a mixed-methods study protocol. Pilot Feasibility Stud 2017; 4:22. [PMID: 28748105 PMCID: PMC5520363 DOI: 10.1186/s40814-017-0161-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background Fear of recurrence (FoR) is a major concern for patients following treatment for primary breast cancer, affecting 60–99% of breast cancer survivors. Mini-AFTER is a brief intervention developed to address this fear, that breast care nurses are ideally placed to deliver. However, their interest in delivering such an intervention is unknown and crucial to its introduction. This study aims to assess the perceived feasibility of the Mini-AFTER telephone intervention for implementation by breast care nurses to manage moderate levels of fear of recurrence among breast cancer survivors. Methods A sequential explanatory mixed-methods design will be used, informed by normalisation process theory (NPT). The design will be guided by the stages of NPT. Specifically, understanding and evaluating the process (implementation) that would enable an intervention, such as the Mini-AFTER, not only to be operationalised and normalised into everyday work (embedded) but also sustained in practice (integration). Phase 1: all members on the UK Breast Cancer Care Nursing Network database (n = 905) will be emailed a link to a web-based survey, designed to investigate how breast cancer survivors’ FoR is identified and managed within current services and their willingness to deliver the Mini-AFTER. Phase 2: a purposive sample of respondents (n = 20) will be interviewed to build upon the responses in phase 1 and explore breast care nurses’ individual views on the importance of addressing fear of recurrence in their clinical consultations, interest in the Mini-AFTER intervention, the content, skills required and challenges to deliver the intervention. Discussion This study will provide information about the willingness of breast care nurses (BCNs) to provide a structured intervention to manage fear of recurrence. It will identify barriers and facilitators for effective delivery and inform the future design of a larger trial of the Mini-AFTER intervention.
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Affiliation(s)
- Susanne Cruickshank
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Emma Steel
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Deborah Fenlon
- College of Health and Human Sciences, Swansea University, Swansea, SA2 8PP UK
| | - Jo Armes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, SE1 8WA UK
| | - Karen Scanlon
- Breast Cancer Care, Central Office-Kennington Business Park Chester House, 1-3 Brixton Road, London, SW9 6DE UK
| | - Elspeth Banks
- National Cancer Research Institute, 407 St John Street, London, EC1V 4AD UK
| | - Gerald Humphris
- School of Medicine, University of St Andrews, St Andrews, KY16 9AJ UK
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Thewes B, Husson O, Poort H, Custers JAE, Butow PN, McLachlan SA, Prins JB. Fear of Cancer Recurrence in an Era of Personalized Medicine. J Clin Oncol 2017; 35:3275-3278. [PMID: 28723231 DOI: 10.1200/jco.2017.72.8212] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Belinda Thewes
- Belinda Thewes, Olga Husson, Hanneke Poort, Jose A.E. Custers, Radboud University Medical Center, Nijmegen, the Netherlands; Phyllis N. Butow, The University of Sydney, Sydney, New South Wales, Australia; Sue-Anne McLachlan, St Vincent's Hospital, Melbourne, and The University of Melbourne, Parkville, Victoria, Australia; and Judith B. Prins, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Olga Husson
- Belinda Thewes, Olga Husson, Hanneke Poort, Jose A.E. Custers, Radboud University Medical Center, Nijmegen, the Netherlands; Phyllis N. Butow, The University of Sydney, Sydney, New South Wales, Australia; Sue-Anne McLachlan, St Vincent's Hospital, Melbourne, and The University of Melbourne, Parkville, Victoria, Australia; and Judith B. Prins, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanneke Poort
- Belinda Thewes, Olga Husson, Hanneke Poort, Jose A.E. Custers, Radboud University Medical Center, Nijmegen, the Netherlands; Phyllis N. Butow, The University of Sydney, Sydney, New South Wales, Australia; Sue-Anne McLachlan, St Vincent's Hospital, Melbourne, and The University of Melbourne, Parkville, Victoria, Australia; and Judith B. Prins, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jose A E Custers
- Belinda Thewes, Olga Husson, Hanneke Poort, Jose A.E. Custers, Radboud University Medical Center, Nijmegen, the Netherlands; Phyllis N. Butow, The University of Sydney, Sydney, New South Wales, Australia; Sue-Anne McLachlan, St Vincent's Hospital, Melbourne, and The University of Melbourne, Parkville, Victoria, Australia; and Judith B. Prins, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Phyllis N Butow
- Belinda Thewes, Olga Husson, Hanneke Poort, Jose A.E. Custers, Radboud University Medical Center, Nijmegen, the Netherlands; Phyllis N. Butow, The University of Sydney, Sydney, New South Wales, Australia; Sue-Anne McLachlan, St Vincent's Hospital, Melbourne, and The University of Melbourne, Parkville, Victoria, Australia; and Judith B. Prins, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sue-Anne McLachlan
- Belinda Thewes, Olga Husson, Hanneke Poort, Jose A.E. Custers, Radboud University Medical Center, Nijmegen, the Netherlands; Phyllis N. Butow, The University of Sydney, Sydney, New South Wales, Australia; Sue-Anne McLachlan, St Vincent's Hospital, Melbourne, and The University of Melbourne, Parkville, Victoria, Australia; and Judith B. Prins, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith B Prins
- Belinda Thewes, Olga Husson, Hanneke Poort, Jose A.E. Custers, Radboud University Medical Center, Nijmegen, the Netherlands; Phyllis N. Butow, The University of Sydney, Sydney, New South Wales, Australia; Sue-Anne McLachlan, St Vincent's Hospital, Melbourne, and The University of Melbourne, Parkville, Victoria, Australia; and Judith B. Prins, Radboud University Medical Center, Nijmegen, the Netherlands
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Yang Y, Wen Y, Bedi C, Humphris G. The relationship between cancer patient's fear of recurrence and chemotherapy: A systematic review and meta-analysis. J Psychosom Res 2017; 98:55-63. [PMID: 28554373 DOI: 10.1016/j.jpsychores.2017.05.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The study aim was to provide an overview of the current evidence available on the link between chemotherapy (CTX) and fear of cancer recurrence (FoR). METHODS PubMED, Medline, Embase, PsycINFO and Web of Science databases were searched to identify relevant studies. Two authors independently selected and assessed the studies regarding eligibility criteria. Meta-analysis of suitable studies was conducted, and quality rated. RESULTS Forty eligible studies were included in the systematic review and twenty-nine of them were included in further meta-analysis. Meta-analysis of the available data confirmed a weak relationship between CTX and FoR (29 studies, 30,176 patients, overall r=0.093, 95% CI: 0.062, 0.123, P˂0.001). CONCLUSIONS The meta-analysis demonstrates a weak but significant relationship between cancer patient's FoR and the receipt of chemotherapy. However, these results should be interpreted with caution. Further investigation is warranted to explore possible mechanisms of FoR increase in patients who receive chemotherapy. Longitudinal studies assessing the trajectory of FoR during chemotherapy are also warranted.
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Affiliation(s)
- Yuan Yang
- Department of Psychiatry and Psychology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Yunhong Wen
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Carolyn Bedi
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Gerry Humphris
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK; School of Medicine, University of St Andrews, St Andrews, UK.
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125
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Inhestern L, Beierlein V, Bultmann JC, Möller B, Romer G, Koch U, Bergelt C. Anxiety and depression in working-age cancer survivors: a register-based study. BMC Cancer 2017; 17:347. [PMID: 28526007 PMCID: PMC5438539 DOI: 10.1186/s12885-017-3347-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background Anxiety and depression can be a long-term strain in cancer survivors. Little is known about the emotional situation of cancer survivors who have to deal with work- and family-related issues. The purpose of this study was to investigate anxiety and depression in working-age cancer survivors and associated factors. Methods A register-based sample of 3370 cancer survivors (25 to 55 years at time of diagnosis) diagnosed up to six years prior to the survey was recruited from two German cancer registries. Demographic and medical characteristics as well as self-reported measures were used. Results Overall, approximately 40% of the survivors reported moderate to high anxiety scores and approximately 20% reported moderate to high depression scores. Compared to the general population, working-age cancer survivors were more anxious but less depressed (p < .001). Subgroups with regard to time since diagnosis did not differ in anxiety or depression. Anxiety and depression in cancer survivors were associated with various variables. Better social support, family functioning and physical health were associated with lower anxiety and depression. Conclusions Overall, we found higher anxiety levels in cancer survivors of working-age than in the general population. A considerable portion of cancer survivors reported moderate to high levels of anxiety and depression. The results indicate the need for psychosocial screening and psycho-oncological support e.g. in survivorship programs for working-age cancer survivors. Assessing the physical health, social support and family background might help to identify survivors at risk for higher emotional distress.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany.
| | - Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Johanna Christine Bultmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Birgit Möller
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
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An Analysis of the Decisions Made for Contralateral Prophylactic Mastectomy and Breast Reconstruction. Plast Reconstr Surg 2017; 138:29-40. [PMID: 27348637 DOI: 10.1097/prs.0000000000002263] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Little is known about the role breast reconstruction plays in decisions made for contralateral prophylactic mastectomy. This study explores factors critical to patient medical decision-making for contralateral prophylactic mastectomy and reconstruction among women with early stage, unilateral breast cancer. METHODS A mixed methods approach was used to gain an understanding of patients' choices and experiences. Patients with stage 0 to III unilateral breast cancer who underwent reconstruction were recruited, and semistructured interviews were conducted. Patient-reported outcomes were evaluated using the Concerns About Recurrence Scale and the BREAST-Q. RESULTS Thirty patients were enrolled; 13 (43 percent) underwent unilateral mastectomy and 17 (57 percent) underwent contralateral prophylactic mastectomy. Three broad categories emerged from patient interviews: medical decision-making, quality of life after mastectomy, and breast reconstruction expectations. Patients who chose contralateral prophylactic mastectomy made the decision for mastectomy based primarily on worry about recurrence. Quality of life after mastectomy was characterized by relief of worry, especially in patients who chose contralateral prophylactic mastectomy [n = 14 (82.4 percent)]. Patients' desires for symmetry, although not the primary reason for contralateral prophylactic mastectomy, played a role in supporting decisions made. Levels of worry after treatment were similar in both groups (72.7 percent). Patients with contralateral prophylactic mastectomy had higher mean scores for satisfaction with breast (82.4 versus 70.6) and satisfaction with outcome (89.9 versus 75.2). CONCLUSIONS The choice for contralateral prophylactic mastectomy is greatly influenced by fear of recurrence, with desires for symmetry playing a secondary role in decisions made.
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Kirkman M, Apicella C, Graham J, Hickey M, Hopper JL, Keogh L, Winship I, Fisher J. Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer. BMC Womens Health 2017; 17:26. [PMID: 28381301 PMCID: PMC5382471 DOI: 10.1186/s12905-017-0383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/30/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer. METHODS Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory. RESULTS It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion. CONCLUSIONS The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.
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Affiliation(s)
- Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jillian Graham
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
| | - Martha Hickey
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - John L. Hopper
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Winship
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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128
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The use of a patient-reported outcome questionnaire to assess cancer survivorship concerns and psychosocial outcomes among recent survivors. Support Care Cancer 2017; 25:2405-2412. [DOI: 10.1007/s00520-017-3646-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/17/2017] [Indexed: 01/08/2023]
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Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Schmid-Höpfner S, Waldmann A, Zeissig SR, Brenner H, Arndt V. Progredienzangst ≥5 Jahre nach Krebsdiagnose. DER ONKOLOGE 2017. [DOI: 10.1007/s00761-017-0188-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Matthews H, Semper H. ‘Dropped from the system’: the experiences and challenges of long-term breast cancer survivors. J Adv Nurs 2017; 73:1355-1365. [DOI: 10.1111/jan.13237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Hannah Matthews
- Faculty of Health and Life Sciences; Centre for Technology Enhanced Health Research; Coventry University; UK
| | - Heather Semper
- School of Psychology, Sport and Exercise; Staffordshire University; Stoke on Trent UK
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131
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Lichtenthal WG, Corner GW, Slivjak ET, Roberts KE, Li Y, Breitbart W, Lacey S, Tuman M, DuHamel KN, Blinder VS, Beard C. A pilot randomized controlled trial of cognitive bias modification to reduce fear of breast cancer recurrence. Cancer 2017; 123:1424-1433. [PMID: 28055119 DOI: 10.1002/cncr.30478] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The most common, persistent concern among survivors of breast cancer is the fear that their disease will return, yet to the authors' knowledge, few interventions targeting fear of cancer recurrence (FCR) have been developed to date. The current pilot study examined the feasibility, acceptability, and preliminary efficacy of a home-delivered cognitive bias modification intervention to reduce FCR. The intervention, called Attention and Interpretation Modification for Fear of Breast Cancer Recurrence (AIM-FBCR), targeted 2 types of cognitive biases (ie, attention and interpretation biases). METHODS A total of 110 survivors of breast cancer were randomized to receive 8 sessions of 1 of 2 versions of AIM-FBCR or a control condition program. Computer-based assessments of cognitive biases and a self-report measure of FCR were administered before the intervention, after the intervention, and 3 months after the intervention. RESULTS Improvements in health worries (P = .019) and interpretation biases (rates of threat endorsement [P<.001] and reaction times for threat rejection [P = .007]) were found in those survivors who received AIM-FBCR compared with the control arm. Although only 26% of participants who screened into the study agreed to participate, the trial otherwise appeared feasible and acceptable, with 83% of those who initiated the intervention completing at least 5 of 8 sessions, and 90% reporting satisfaction with the computer-based program used. CONCLUSIONS The results of the current pilot study suggest the promise of AIM-FBCR in reducing FCR in survivors of breast cancer. Future research should attempt to replicate these findings in a larger-scale trial using a more sophisticated, user-friendly program and additional measures of improvement in more diverse samples. Cancer 2017;123:1424-1433. © 2016 American Cancer Society.
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Affiliation(s)
- Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Geoffrey W Corner
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Elizabeth T Slivjak
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kailey E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephanie Lacey
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Malwina Tuman
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine N DuHamel
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victoria S Blinder
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts
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Hefner J, Berberich S, Lanvers E, Sanning M, Steimer AK, Kunzmann V. New insights into frequency and contents of fear of cancer progression/recurrence (FOP/FCR) in outpatients with colorectal carcinoma (CRC) receiving oral capecitabine: a pilot study at a comprehensive cancer center. Patient Prefer Adherence 2017; 11:1907-1914. [PMID: 29180853 PMCID: PMC5694194 DOI: 10.2147/ppa.s142784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fear of cancer progression/recurrence (FOP/FCR) is considered one of the most prevalent sources of distress in cancer survivors and associated with lower quality of life and functional impairment. Detailed measures of FOP/FCR are needed because little is known about the knowledge of FOP/FCR, its associations with the patient-doctor relationship, and the rate of adequate therapy. Colorectal cancer (CRC) is one of the most prevalent cancer entities, and oral capecitabine is widely prescribed as treatment. Therefore, we initiated a pilot study to expand the literature on FOP/FCR in CRC outpatients receiving capecitabine and to generate hypotheses for future investigations. METHODS This study included 58 patients treated at a comprehensive cancer center. FOP/FCR was assessed with the Fear of Progression Questionnaire (FOP-Q-SF). Satisfaction with the relationships with doctors was assessed with the Patient-Doctor Relationship Questionnaire-9 (PRDQ-9). Levels of side effects were rated by the patients on a visual analog scale. Clinical data were extracted from the charts. RESULTS A total of 19 out of 58 patients (36%) suffered from FOP/FCR according to our assessment. Levels of FOP/FCR seemed to be mostly moderate to high. Only four out of the 19 distressed patients (21%) were treated accordingly. Typical side effects of oncological treatment were associated with higher FOP/FCR. Satisfaction with doctor-patient relationships was not associated with FOP/FCR. Regarding single items of FOP/FCR, three out of the five most prevalent fears were associated with close relatives. DISCUSSION FOP/FCR occurred frequently in more than one in three patients, but was mostly untreated in this sample of consecutive outpatients with CRC receiving oral capecitabine. In detail, most fears were related to family and friends. In addition to an unmet need of patients, our data indicate sources of distress not considered thus far. If replicated in larger studies, results may help to inform intervention development and improve patient care.
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Affiliation(s)
- Jochen Hefner
- Section of Psychosomatic Medicine, Department of Internal Medicine II, University of Wuerzburg
- Correspondence: Jochen Hefner, Section of Psychosomatic Medicine, Department of Internal Medicine II, University of Wuerzburg, Oberdürrbacher Str 6, 97080 Wuerzburg, Germany, Tel +49 931 40160, Fax +49 931 640160, Email
| | | | - Elena Lanvers
- Children’s Hospital of the City of Cologne, North Rhine-Westphalia
| | - Maria Sanning
- Faculty of Medicine, University of Wuerzburg, Bavaria
| | | | - Volker Kunzmann
- Section of Clinical Oncology, Department of Internal Medicine II, University of Wuerzburg, Bavaria, Germany
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King MT, Winters ZE, Olivotto IA, Spillane AJ, Chua BH, Saunders C, Westenberg AH, Mann GB, Burnett P, Butow P, Rutherford C. Patient-reported outcomes in ductal carcinoma in situ: A systematic review. Eur J Cancer 2016; 71:95-108. [PMID: 27987454 DOI: 10.1016/j.ejca.2016.09.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/15/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
Ductal carcinoma in situ (DCIS) is a pre-invasive breast cancer with excellent prognosis but with potential adverse impacts of diagnosis and treatment on quality of life and other patient-reported outcomes (PROs). We undertook a systematic review to synthesise current evidence about PROs following diagnosis and treatment for DCIS. We searched five electronic databases (from database inception to November 2015), cross-referenced and contacted experts to identify studies that reported PROs after DCIS treatment. Two reviewers independently applied inclusion and quality criteria, and extracted findings. Of 2130 papers screened, 23 were eligible, reporting 17 studies. Short- and long-term PRO evidence about differences between DCIS treatment options was lacking. Evidence pooled across treatments indicated core aspects of quality of life (physical, role, social, emotional function, pain, fatigue) and psychological distress (anxiety, depression) were impacted significantly initially, with most aspects returning to population norms by 6-12 months, and all by 2 years post-operatively. Fears of recurrence and dying from breast cancer were exaggerated, occurred early and persisted for many years. Sexuality and body image impacts were generally low and resolved within 1-3 months after surgery. A minority of women experienced considerable impact, including depression and sexual issues associated with body image problems. Well-powered PRO studies are required to track recovery trajectories and long-term impacts of the range of contemporary and emerging local and systemic treatments for DCIS. PRO data would enable care providers to prepare patients for short-term sequelae and enable patients who have treatment options to exercise preferences in choosing among them.
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Affiliation(s)
- Madeleine T King
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Psycho-oncology Co-operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia.
| | - Zoë E Winters
- Patient Reported & Clinical Outcomes Research Group, University of Bristol, UK
| | | | - Andrew J Spillane
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Boon H Chua
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | | | - A Helen Westenberg
- Department of Radiation Oncology, Radiotherapiegroep, Arnhem, The Netherlands
| | - G Bruce Mann
- Royal Melbourne and Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | - Phyllis Butow
- Psycho-oncology Co-operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia
| | - Claudia Rutherford
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Psycho-oncology Co-operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia
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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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Shearer R, Rashid M, Hubbard G, Abbott N, Daltrey I, Mullen R. Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation. Gland Surg 2016; 5:385-90. [PMID: 27563559 DOI: 10.21037/gs.2016.03.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite being suitable for breast conservation surgery (BCS) a proportion of women choose mastectomy. This study aimed to assess the pre-operative pathological and geographic factors associated with choosing mastectomy rather than BCS in a single centre that serves a large geographical area encompassing urban, rural and remote island populations. METHODS A retrospective analysis of all patients suitable for BCS between January 2011 and December 2013 was undertaken. Pre-operative pathological features were compared using the Pearson chi squared test as was distance to the treatment centre from the patient's home. A questionnaire was sent to all those who chose mastectomy to identify the factors that influenced their decision. RESULTS A total of 446 patients suitable for BCS were identified of which 46 (11%) chose to undergo mastectomy. Patients choosing mastectomy were more likely to present symptomatically (P=0.009), have tumours larger than 20 mm at diagnostic imaging (P=0.001) and have positive axillary staging (P=0.004). Patients choosing mastectomy were more likely to live remotely (P=0.051). Those patients who chose mastectomy felt this gave a better long-term outcome (18 patients, 44%) and peace of mind (14 patients, 34%). CONCLUSIONS Adverse pre-operative pathological features were associated with patients choosing mastectomy rather than BCS. There was a trend for patients who chose mastectomy to live remotely from the treatment centre. Patients choosing mastectomy most commonly cited a better long-term outcome and peace of mind as the reason behind their decision. Understanding what influences a patient's surgical choice will allow clinicians and patients to engage in a fully informed pre-operative decision making process.
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Affiliation(s)
- Rosalyn Shearer
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Majid Rashid
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Gill Hubbard
- The University of Stirling, The Centre for Health Sciences, Inverness, UK
| | - Nick Abbott
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Ian Daltrey
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Russell Mullen
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
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Yang Y, Cameron J, Humphris G. The relationship between cancer patient's fear of recurrence and radiotherapy: a systematic review and meta-analysis. Psychooncology 2016; 26:738-746. [DOI: 10.1002/pon.4224] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Yuan Yang
- School of Medicine; University of St Andrews; St Andrews UK
| | - Josie Cameron
- Edinburgh Cancer Centre; Western General Hospital; Edinburgh UK
| | - Gerry Humphris
- School of Medicine; University of St Andrews; St Andrews UK
- Edinburgh Cancer Centre; Western General Hospital; Edinburgh UK
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Manne SL, Myers-Virtue S, Kissane D, Ozga ML, Kashy DA, Rubin SC, Rosenblum NG, Heckman CJ. Group-based trajectory modeling of fear of disease recurrence among women recently diagnosed with gynecological cancers. Psychooncology 2016; 26:1799-1809. [PMID: 27421919 DOI: 10.1002/pon.4223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/21/2016] [Accepted: 07/10/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fear of cancer recurrence is an important clinical phenomenon and is associated with decrements in life domains. The study goals were to characterize patterns of global fear of recurrence (FOR) and 4 domains of fear (health, role, womanhood, and death worry) over time in women who were diagnosed with gynecological cancer and to identify demographic, medical, and psychological predictors of FOR. METHOD One hundred eighteen women participating in the usual care arm of a randomized trial completed the Concerns about Recurrence scale as well as measures of depressive symptoms, cancer-specific distress, coping, coping efficacy, and social network responses at 4 time points. The majority of the sample was diagnosed with stage 3 ovarian cancer. RESULTS Group-based trajectory modeling identified subgroups of women with high-stable (49.1%), high-decreasing (25.3%), and low-stable (25.5%) trajectories for global FOR. For role worries, 3 similar group trajectories were identified. For health worries, modeling identified subgroups with high-decreasing (19.1%) and low-increasing (80.9%) trajectories. For womanhood worries, modeling identified subgroups with high-increasing (15.7%) and low-decreasing (84.2%) trajectories. Young age, metastatic cancer, depression, cancer distress, holding back, and lower coping efficacy were associated with the high-stable global FOR and at least 1 domain of FOR. CONCLUSION Almost half of the women recently diagnosed with gynecological cancer evidence persistently elevated FOR over the 6-month period postdiagnosis. Psychological interventions to reduce FOR may be more effective if they focus on teaching patients coping skills, as well as greater comfort expressing cancer-specific concerns to others.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Shannon Myers-Virtue
- Temple University Maurice H. Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | - David Kissane
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Monash University, Clayton, Victoria, Australia
| | - Melissa L Ozga
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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van Helmondt SJ, van der Lee ML, de Vries J. Study protocol of the CAREST-trial: a randomised controlled trial on the (cost-) effectiveness of a CBT-based online self-help training for fear of cancer recurrence in women with curatively treated breast cancer. BMC Cancer 2016; 16:527. [PMID: 27455846 PMCID: PMC4960756 DOI: 10.1186/s12885-016-2562-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/14/2016] [Indexed: 12/12/2022] Open
Abstract
Background One of the most prevalent long-term consequences of surviving breast cancer is fear of cancer recurrence (FCR), which is associated with higher (mental) healthcare costs and lower surveillance rates. The majority of breast cancer survivors report a need for professional help in dealing with FCR. An easy-accessible and cost-effective evidence‐based psychological intervention for reducing FCR is lacking. In the current study an online self-help training to reduce FCR will be evaluated. In addition, the secondary aim of this study is to identify factors that predict whether women can benefit from the online self-help training or not. Methods/Design A multi-centre, parallel-groups, randomised controlled trial will be conducted to evaluate the (cost-) effectiveness of the CAREST-trial. A sample of 454 women with curatively treated breast cancer will be recruited from 8 hospitals in the Netherlands. Participants will be randomised to the intervention or usual care group (1:1). Self-report measures will be completed at baseline, 3 (post-intervention), 9, and 24 months. Primary outcome is FCR severity; secondary outcomes are healthcare costs, health status, and psychological distress. The online tailored self-help training “Less fear after cancer” is based on cognitive behavioural therapy and consists of 2 basic modules (psycho-education; basic principles of cognitive behavioural therapy) and 4 optional modules (rumination; action; relaxation; reassurance) to choose from. Each module consists of an informative part (texts, videos, audio files) and a practical part (exercises). For every patient, the intervention will be available for three months. Personal online support by an e-mail coach is available. Discussion Online self-help training may be an easy-accessible and cost-effective treatment to reduce the impact of FCR at an early stage in a large group of breast cancer survivors. A strength is the 24 months follow-up period in the health economic evaluation. The results of the study will provide information on the possible strengths and benefits of online self-help training for FCR in breast cancer survivors. Trial registration This study is registered at the Netherlands Trial Register (NTR4119, date registered: August 15, 2013).
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Affiliation(s)
| | | | - Jolanda de Vries
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, St Elisabeth Hospital, Tilburg, The Netherlands
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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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140
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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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141
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Trends in cancer survivors' experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS). J Cancer Surviv 2016; 10:1067-1077. [PMID: 27193357 DOI: 10.1007/s11764-016-0550-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, and exchanging information, represent a central aspect of survivors' care experience that has not been systematically investigated. METHODS Nationally representative data from four administrations of the Health Information National Trends Survey (HINTS) was merged with combined replicate weights using the jackknife replication method. Linear and logistic regression models were used to assess (1) characteristics of cancer survivors (N = 1794) who report suboptimal patient-centered communication and (2) whether survivors' patient-centered communication experience changed from 2007 to 2013. RESULTS One third to one half of survivors report suboptimal patient-centered communication, particularly on core functions of providers helping manage uncertainty (48 %) and responding to emotions (49 %). In a fully adjusted linear regression model, survivors with more education (Wald F = 2.84, p = .04), without a usual source of care (Wald F = 11.59, p < .001), and in poorer health (Wald F = 9.08, p < .001) were more likely to report less patient-centered communication. Although ratings of patient-centered communication improved over time (p trend = .04), this trend did not remain significant in fully adjusted models. CONCLUSIONS Despite increased attention to survivorship, many survivors continue to report suboptimal communication with their health care providers. IMPLICATIONS FOR CANCER SURVIVORS Survivorship communication should include managing uncertainty about future risk and address survivors' emotional needs. Efforts to improve patient-centered communication should focus on survivors without a usual source of care and in poorer health.
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142
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When fear of cancer recurrence becomes a clinical issue: a qualitative analysis of features associated with clinical fear of cancer recurrence. Support Care Cancer 2016; 24:4207-18. [PMID: 27169700 DOI: 10.1007/s00520-016-3248-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a common experience for cancer survivors. However, it remains unclear what characteristics differentiate non-clinical from clinical levels of FCR. The goal of this study was to investigate the potential hallmarks of clinical FCR. METHODS A convenience sample of 40 participants (n = 19 female) was drawn from another study (Lebel et al. in Qual Life Res 25:311-321. doi: 10.1007/s11136-015-1088-2 , 2016). The semi-structured interview for fear of cancer recurrence (Simard and Savard in J Cancer Surviv 9:481-491. doi: 10.1007/s11764-015-0424-4 , 2015) was used to identify participants with non-clinical and clinical FCR and qualitative analysis of these interviews was performed. RESULTS Individuals with clinical FCR reported the following features: death-related thoughts, feeling alone, belief that the cancer would return, experiencing intolerance of uncertainty, having cancer-related thoughts and imagery that were difficult to control, daily and recurrent, lasted 30 minutes or more, increased over time, caused distress and impacted their daily life. Triggers of FCR and coping strategies did not appear to be features of clinical FCR as they were reported by participants with a range of FCR scores. CONCLUSIONS While features of clinical FCR found in this analysis such as intrusive thoughts, distress and impact on functioning confirmed previous FCR research, other features spontaneously emerged from the interviews including "death-related thoughts," "feeling alone," and "belief that the cancer will return." The participants' descriptions of cancer-specific fear and worry suggest that FCR is a distinct phenomenon related to cancer survivorship, despite similarities with psychological disorders (e.g., Anxiety Disorders). Future research investigating the construct of FCR, and the distinguishing features of clinical FCR across a range of cancer types and gender is required.
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143
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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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Halbach SM, Enders A, Kowalski C, Pförtner TK, Pfaff H, Wesselmann S, Ernstmann N. Health literacy and fear of cancer progression in elderly women newly diagnosed with breast cancer--A longitudinal analysis. PATIENT EDUCATION AND COUNSELING 2016; 99:855-862. [PMID: 26742608 DOI: 10.1016/j.pec.2015.12.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study aims to investigate the distribution of health literacy levels and the association of health literacy with fear of cancer progression (FoP) over the course of cancer treatment in a sample of elderly women newly diagnosed with breast cancer. METHODS The analyses are part of a prospective, multicenter cohort-study (PIAT) that took place in Germany between 2013 and 2014. Elderly women (aged 65 years and older) newly diagnosed with breast cancer completed validated measures of health literacy and FoP directly after the breast cancer surgery and 40 weeks later. Multivariate random-effects regression analysis for longitudinal data was applied to estimate the association of health literacy with FoP considering socio-demographic, clinical and psychosocial characteristics of the patients. RESULTS About half of the elderly breast cancer patients in our sample were classified as having limited health literacy (inadequate and problematic levels). Inadequate and problematic health literacy were significantly associated with higher levels of FoP in the elderly breast cancer patients. CONCLUSION Limited health literacy is an independent risk factor for increased FoP. PRACTICE IMPLICATIONS Enhancing health literacy could contribute to reducing patients' cancer-related fears.
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Affiliation(s)
- Sarah Maria Halbach
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
| | - Anna Enders
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | | | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | | | - Nicole Ernstmann
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Maheu C, Lebel S, Courbasson C, Lefebvre M, Singh M, Bernstein LJ, Muraca L, Benea A, Jolicoeur L, Harris C, Ramanakumar AV, Ferguson S, Sidani S. Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer. BMC Cancer 2016; 16:291. [PMID: 27112319 PMCID: PMC4845394 DOI: 10.1186/s12885-016-2326-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/20/2016] [Indexed: 01/31/2023] Open
Abstract
Background Clinically significant levels of fear of cancer recurrence (FCR) affect up to 49 % of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT). Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention. Methods Sixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. Measurements: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. Analysis: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant’s trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted. Discussion Our Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC. Trial registration Dr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).
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Affiliation(s)
- Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, Quebec, J7V 0E2, Canada. .,Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Christine Courbasson
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | - Monique Lefebvre
- Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, K1H 8L6, Canada
| | - Mina Singh
- School of Nursing, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Lori J Bernstein
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada
| | - Linda Muraca
- Auxiliary Breast Health Program, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, M5S 1B2, Canada
| | - Lynne Jolicoeur
- Integrated Cancer Program, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada
| | - Cheryl Harris
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | | | - Sarah Ferguson
- Obstetrics and Gynecology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, M5B 2K3, Canada
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Ahmed K, Marchand E, Williams V, Coscarelli A, Ganz PA. Development and pilot testing of a psychosocial intervention program for young breast cancer survivors. PATIENT EDUCATION AND COUNSELING 2016; 99:414-420. [PMID: 26456635 PMCID: PMC4779394 DOI: 10.1016/j.pec.2015.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/23/2015] [Accepted: 09/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To describe the development, pilot testing, and dissemination of a psychosocial intervention addressing concerns of young breast cancer survivors (YBCS). METHODS Intervention development included needs assessment with community organizations and interviews with YBCS. Based on evidence-based models of treatment, the intervention included tools for managing anxiety, fear of recurrence, tools for decision-making, and coping with sexuality/relationship issues. After pilot testing in a university setting, the program was disseminated to two community clinical settings. RESULTS The program has two distinct modules (anxiety management and relationships/sexuality) that were delivered in two sessions; however, due to attrition, an all day workshop evolved. An author constructed questionnaire was used for pre- and post-intervention evaluation. Post-treatment scores showed an average increase of 2.7 points on a 10 point scale for the first module, and a 2.3 point increase for the second module. Qualitative feedback surveys were also collected. The two community sites demonstrated similar gains among their participants. CONCLUSIONS The intervention satisfies an unmet need for YBCS and is a possible model of integrating psychosocial intervention with oncology care. PRACTICE IMPLICATIONS This program developed standardized materials which can be disseminated to other organizations and potentially online for implementation within community settings.
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Affiliation(s)
- Kauser Ahmed
- UCLA Simms-Mann Center for Integrative Oncology, Los Angeles, USA
| | - Erica Marchand
- UCLA Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | - Victoria Williams
- UCLA Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | - Anne Coscarelli
- UCLA Simms-Mann Center for Integrative Oncology, Los Angeles, USA
| | - Patricia A Ganz
- UCLA Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, USA.
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147
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Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other. J Cancer Surviv 2016; 10:802-13. [PMID: 26899851 DOI: 10.1007/s11764-016-0526-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to identify explanatory factors of fear of recurrence (FOR) in breast cancer survivors of different sexual orientations and their caregivers and to assess the directionality in the survivor and caregiver dyads' FOR. METHODS We recruited survivors of non-metastatic breast cancer of different sexual orientations and invited their caregivers into this study. Using a telephone survey, we collected data from 167 survivor and caregiver dyads. Using simultaneous equation models and a stepwise selection process, we identified the significant determinants of survivors' and caregivers' FOR and determined the directionality of survivors' and caregivers' FOR. Weighting the model by the inverse propensity score ensured that differences by sexual orientation in age and proportion of life in the caregiver-survivor relationship were accounted for. RESULTS Caregivers' FOR predicted survivors' FOR, and sexual orientation had a significant effect on survivors' FOR, in that sexual minority women reported less FOR than heterosexual women. Other determinants of survivors' FOR included their medical characteristics, coresidence with caregivers, and caregivers' social support and use of counseling. Caregivers' FOR was related to their social support and survivors' medical characteristics. CONCLUSIONS This study suggests a need for caregiver interventions. Because survivors' FOR is affected by caregivers' FOR, caregiver interventions will likely benefit survivors' FOR. IMPLICATIONS FOR CANCER SURVIVORS Both sexual minority and heterosexual breast cancer survivors' FOR are affected by their caregivers' FOR, which suggests that the caregivers of breast cancer survivors are central for the survivors' well-being and shall therefore be integrated into the care process.
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148
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Factors associated with depressive symptoms in young long-term breast cancer survivors. Qual Life Res 2016; 25:1991-7. [PMID: 26883816 DOI: 10.1007/s11136-016-1241-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE Long-term breast cancer survivors frequently report distress (i.e., depressive symptoms) that impacts their quality of life. Previous studies have found that negative social interactions ("social constraints") from partners contribute to long-term, unresolved cycling of intrusive thoughts and cognitive avoidance, resulting in psychological distress. However, these relationships have not been tested in long-term breast cancer survivors. Furthermore, the effect of partners' depressive symptoms on the survivors' depressive symptoms has not been tested within the context of these relationships. Therefore, the purpose of this study was to test relationships between breast cancer survivors' depressive symptoms and (1) social constraints, cognitive avoidance, and intrusive thoughts, and (2) partners' depressive symptoms. METHODS Data were from a cross-sectional descriptive study of breast cancer survivors (N = 222) 3-8 years post-diagnosis and their partners, who completed surveys assessing demographic characteristics, social constraints, intrusive thoughts, cognitive avoidance, and depressive symptoms. Structural equation modeling confirmatory path analyses were conducted to determine significant relationships between survivors' depressive symptoms and all other variables. RESULTS Our model fits the data well. Breast cancer survivors' depressive symptoms were predicted by social constraints and intrusive thoughts. The relationship between survivors' depressive symptoms and partners' depressive symptoms was close but not significant. CONCLUSIONS As hypothesized, depressive symptoms were predicted by social constraints and intrusive thoughts. Further research is needed to understand the possible relationship between survivors' long-term depressive symptoms and cognitive avoidance and partners' depressive symptoms. Our findings highlight the negative impact of social constraints from partners on psychological outcomes in long-term breast cancer survivors.
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149
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Zdenkowski N, Forbes JF, Boyle FM, Kannourakis G, Gill PG, Bayliss E, Saunders C, Della-Fiorentina S, Kling N, Campbell I, Mann GB, Coates AS, Gebski V, Davies L, Thornton R, Reaby L, Cuzick J, Green M. Observation versus late reintroduction of letrozole as adjuvant endocrine therapy for hormone receptor-positive breast cancer (ANZ0501 LATER): an open-label randomised, controlled trial. Ann Oncol 2016; 27:806-12. [PMID: 26861603 DOI: 10.1093/annonc/mdw055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the effectiveness of adjuvant endocrine therapy in preventing breast cancer recurrence, breast cancer events continue at a high rate for at least 10 years after completion of therapy. PATIENTS AND METHODS This randomised open label phase III trial recruited postmenopausal women from 29 Australian and New Zealand sites, with hormone receptor-positive early breast cancer, who had completed ≥4 years of endocrine therapy [aromatase inhibitor (AI), tamoxifen, ovarian suppression, or sequential combination] ≥1 year prior, to oral letrozole 2.5 mg daily for 5 years, or observation. Treatment allocation was by central computerised randomisation, stratified by institution, axillary node status and prior endocrine therapy. The primary outcome was invasive breast cancer events (new invasive primary, local, regional or distant recurrence, or contralateral breast cancer), analysed by intention to treat. The secondary outcomes were disease-free survival (DFS), overall survival, and safety. RESULTS Between 16 May 2007 and 14 March 2012, 181 patients were randomised to letrozole and 179 to observation (median age 64.3 years). Endocrine therapy was completed at a median of 2.6 years before randomisation, and 47.5% had tumours of >2 cm and/or node positive. At 3.9 years median follow-up (interquartile range 3.1-4.8), 2 patients assigned letrozole (1.1%) and 17 patients assigned observation (9.5%) had experienced an invasive breast cancer event (difference 8.4%, 95% confidence interval 3.8% to 13.0%, log-rank test P = 0.0004). Twenty-four patients (13.4%) in the observation and 14 (7.7%) in the letrozole arm experienced a DFS event (log-rank P = 0.067). Adverse events linked to oestrogen depletion, but not serious adverse events, were more common with letrozole. CONCLUSION These results should be considered exploratory, but lend weight to emerging data supporting longer duration endocrine therapy for hormone receptor-positive breast cancer, and offer insight into reintroduction of AI therapy. CLINICAL TRIALS NUMBER Australian New Zealand Clinical Trials Registry (www.anzctr.org.au), ACTRN12607000137493.
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Affiliation(s)
- N Zdenkowski
- Australia and New Zealand Breast Cancer Trials Group, Waratah School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Waratah School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - F M Boyle
- Australia and New Zealand Breast Cancer Trials Group, Waratah School of Medicine and Public Health, University of Newcastle, Callaghan, Australia Patricia Ritchie Centre for Cancer Care and Research, North Sydney
| | | | - P G Gill
- Department of Surgery, Royal Adelaide Hospital, Adelaide
| | - E Bayliss
- Department of Medical Oncology, Royal Perth Hospital, Perth
| | - C Saunders
- School of Surgery, University of Western Australia, Crawley
| | | | - N Kling
- Department of Surgery, St John of God Hospital, Bunbury, Australia
| | - I Campbell
- Breast Care Centre, Waikato Hospital, Hamilton, New Zealand
| | - G B Mann
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville
| | - A S Coates
- Australia and New Zealand Breast Cancer Trials Group, Waratah National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - V Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - L Davies
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - R Thornton
- Australia and New Zealand Breast Cancer Trials Group, Waratah
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Waratah
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - M Green
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville
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Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv 2016; 10:663-73. [PMID: 26782171 DOI: 10.1007/s11764-015-0512-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/25/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is prevalent among survivors. However, a comprehensive and universally accepted theoretical framework of FCR to guide intervention is lacking. This paper reviews theoretical frameworks previously used to explain FCR and describes the formulation of a novel theoretical framework for FCR. METHODS A systematic review of the literature was undertaken to identify conceptual frameworks or theories applied to FCR. MEDLINE, PubMED, CINAHL, AMED, PsycINFO and Web of Science were searched. Identified conceptual frameworks were reviewed for strength of evidence supporting their validity. RESULTS Of 558 papers initially identified, 16 made reference to six different conceptual frameworks relating to FCR. The most comprehensive and evidence-based theoretical approach is the Common Sense Model (CSM). Other approaches have limited evidence supporting their application to FCR. Two theoretical approaches developed in the context of emotional disorders that appear to be highly relevant to FCR: the Self-Regulatory Executive Function (S-REF) model and Relational Frame Theory were combined with the CSM to produce a novel cognitive processing account of FCR. CONCLUSIONS Few conceptual frameworks have been used consistently to guide FCR research, and not all frameworks are empirically well supported, suggesting that further discussion regarding the conceptualisation of FCR is needed. The novel theoretical framework for FCR presented highlights the multidimensional nature of FCR and the importance of cognitive processing and metacognitions in the development and maintenance of FCR. IMPLICATIONS FOR CANCER SURVIVORS The novel theoretical formulation of FCR outlined here provides a much-needed comprehensive framework to further investigate and address FCR in cancer survivors.
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