Fear of recurrence in long-term breast cancer survivors-still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the cancer survivorship--a multi-regional population-based study

The impact of fear of cancer recurrence on the quality of life of breast cancer patients: A longitudinal study of the mediation effect of cortisol and hope

OBJECTIVE

This longitudinal study sought to explore the impact of cortisol and hope levels on Fear of Cancer Recurrence (FCR) and Quality of Life (QOL) in a cohort of 552 breast cancer patients from three centers in Wuhan City.

METHOD

A longitudinal study involving 552 breast cancer patients from three centers in Wuhan City utilized Chinese versions of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Herth Hope Index (HHI), and the Functional Assessment of Cancer Therapy-Breast (FACT-B) scale. Cortisol levels were measured thrice daily, and data was collected longitudinally three times. Data analysis was conducted using SPSS 26.0 and Mplus 8.3, employing a longitudinal path model constructed via the cross-lagged method.

RESULTS

The results showed there were significant correlations between FCR, cortisol levels, and QOL at different time points. A significant mediating model was found with outcomes related to hope levels. Specifically, FCR predicted a decrease in hope levels (β = -0.163, p < 0.001), which in turn led to a decrease in overall QOL (β = -0.078, p < 0.001), with a mediation effect accounting for 10.34%. Although there were correlations between FCR, cortisol levels, and QOL at different time points, further analysis revealed that cortisol levels did not exhibit a mediating effect between the two (95% confidence interval: -0.002 to 0.001).

CONCLUSION

This study demonstrated there were significant correlations among FCR, QOL, and hope levels. Considering hope as a crucial mediator between FCR and QOL, potential intervention strategies for optimizing the QOL of breast cancer patients are proposed.

Satisfaction with and perceived benefits of needs-assessment related to rehabilitation after chemotherapy among patients with breast cancer

PURPOSE

To investigate satisfaction with and perceived benefits of a model of needs-assessment related to rehabilitation (NARR) in women with early breast cancer after (neo)adjuvant chemotherapy.

MATERIALS AND METHODS

Mixed methods were applied using survey (N = 200) along with interviews (N = 20). The survey included measurement of distress and self-assessed need of and satisfaction with the NARR. Type of experienced side/late effects were registered along with numbers of and reasons for referrals to rehabilitation. Individual semi-structured interviews were conducted. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed with thematic analysis.

RESULTS

Overall, 217 patients participated in a NARR and 200 (92%) accepted participation in the survey. Furthermore, 20/37 (54%) invited patients were interviewed. After the NARR, 39 patients (20%) were referred to rehabilitation. While satisfaction was high, findings regarding distress and need of the NARR were equivocal and indicated a need for talking about experiences throughout the cancer trajectory.

CONCLUSIONS

While only 20% had rehabilitation needs, satisfaction with the NARR was high and patients benefitted from being confirmed in normality of their experiences. It is recommended to address patients' side/late effects after chemotherapy for early breast cancer to identify rehabilitation needs, reduce distress, and improve quality of life.

A Novel Intervention to Reduce Fear of Progression and Trauma Symptoms in Advanced Cancer Using Written Exposure to Worst-Case Scenarios

Background: Adults with advanced cancer experience profound future uncertainty, reflected in elevated fear of cancer progression (FoP) and cancer-related trauma symptoms. These symptoms are associated with physical symptom burden and poorer quality of life, and few interventions exist to manage them. Objective: To develop and pilot a written exposure-based coping intervention (EASE) focused on worst-case scenarios among adults with advanced cancer reporting elevated cancer-related trauma symptoms or FoP. Design: A single-arm intervention development and pilot trial. Participants: The trial enrolled 29 U.S. adults with stage III or stage IV solid tumor cancer (n = 24) or incurable or higher-risk blood cancer (n = 5) reporting elevated cancer-related trauma symptoms or FoP. Among those screened, 74% were eligible, with an eligible-to-enrolled rate of 85%. Design/Measurements: EASE was delivered over five 1:1 videoconferencing sessions. Feasibility and acceptability were evaluated via attendance, surveys, and exit interviews. Outcomes were assessed at five time points through 3-month (FU1, main assessment of interest) and 4.5-month (FU2) follow-up. Results: Participant and interventionist feedback was used to iteratively refine EASE. Among participants, 86% (25/29) completed all five sessions and FU1; surveys and exit interviews indicated high acceptability. Primary outcomes of cancer-related trauma symptoms and FoP improved significantly from pre to both follow-ups by predominantly large effect sizes. Secondary outcomes of anxiety, depression, hopelessness, fear of death/dying, and fatigue, and most process measures improved significantly by FU1 or FU2. Conclusions: EASE, a novel adaptation of written exposure therapy, is a promising approach to reducing FoP and cancer-related trauma symptoms among adults with advanced cancer that warrants further study.

Fear of recurrence in postoperative lung cancer patients: Trajectories, influencing factors and impacts on quality of life

AIMS

To investigate the trajectory, influencing factors and dynamic relationships between fear of cancer recurrence (FCR) and quality of life (QOL) in lung cancer patients.

DESIGN

Prospective longitudinal study.

METHODS

Longitudinal data from 310 lung cancer patients across three hospitals in China were assessed at 1, 3, 6 and 12 months postoperatively (T1 -T4 ). Descriptive statistics characterised patient demographics, clinical characteristics, levels of FCR and QOL. A linear mixed-effects model was employed to analyse FCR trajectories, identify influencing factors on these trajectories, and predict the impact of FCR on QOL.

RESULTS

FCR changed significantly over time, with a slight decrease during T1 -T2 , an increase at T3 and gradual decline at T4 . Higher fear levels were associated with female sex, suburban or rural residency, being a family breadwinner, presence of comorbidities and negative coping behaviours, and low family resilience. QOL negatively correlated with FCR, and FCR predicted lower QOL.

CONCLUSIONS

At 3 and 6 months postoperatively, lung cancer patients, especially women, suburban or rural residents, family breadwinners, those with comorbidities, negative coping behaviours and low family resilience, reported high levels of FCR. Healthcare providers should pay special attention to lung cancer patients especially during the period of 3-6 months post-surgery and offer tailored interventions to improve their QOL.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Understanding the FCR trajectories, its influencing factors and its negative impacts on QOL can guide the development of targeted interventions to reduce fear and enhance well-being in patients with cancer.

IMPACT

Identifying the trajectories and influencing factors of fear of lung cancer recurrence in patients at different time points informs future research on targeted interventions to improve QOL.

REPORTING METHOD

The study adhered to the guidelines outlined in the Statement on Reporting Observational Longitudinal Research.

The level of cancer-related concerns and affecting factors in Turkish cancer survivors: A cross-sectional study

AIM

To examine and compare the level of cancer-related concerns and affecting factors between cancer survivors who completed their treatment and those still receiving treatment.

DESIGN

The study has a cross-sectional comparative design.

METHODS

Convenience sampling was used and the study included 350 Turkish cancer survivors. Data were collected between March and June 2022 online with a descriptive characteristics form and the Assessment of Survivor Concerns. Obtained data were analysed with numbers, percentages, mean values, t-test and multiple linear regression analysis.

RESULTS

The cancer survivors who completed their treatment had a significantly higher level of concerns than those who were still on treatment. Female cancer survivors, cancer survivors with less than 5-year time elapsing after diagnosis and gynaecological cancer survivors with completed cancer treatment can also have a higher level of cancer-related concerns.

CONCLUSION

Cancer survivors who have completed their treatment have a higher level of concerns than those who still receive treatment. Gender, time elapsing after diagnosis and type of cancer affect the level of concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses should evaluate psychosocial care and needs of cancer survivors in addition to their physical care. Raising awareness about the concerns of the cancer survivors with completed treatment in addition to those still receiving treatment and providing holistic care to them can reduce their concerns.

IMPACT

It is of great importance to be aware of the factors likely to increase cancer-related concerns during and after cancer treatment. This study identifies cancer-related concerns in cancer survivors who completed or were still receiving treatment and provides a comparison with other studies in the literature.

REPORTING METHOD

We have adhered to STROBE statement using STROBE checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement.

Assessment of the Relationship between Fear of Cancer Recurrence, Spiritual Well-Being, and Mental Health among Cancer Patients: A Cross-Sectional Study

The purpose of this study was to examine the relationship between fear of cancer recurrence, spiritual well-being, and mental health among cancer patients. The study involved 217 patients undergoing chemotherapy. Data were collected with the following instruments: a demographic and clinical information recording form, the fear of cancer recurrence inventory, the Athens insomnia scale, the FACIT-Sp-12 scale for the assessment of spirituality, and the HADS scale for the assessment of mental health. For statistical analysis, SPSS statistical software was used, with the significance threshold set at 0.05;andtl number, t-test, one-way ANOVA, and multiple regression tests were used. The sample consisted of 217 cancer patients with a mean age of 63.7 years (SD = 11.6 years), 39.2% male and 60.8% female. The minimum value on the scale of fear of cancer recurrence was 0 and the maximum was 33 points, with a mean value of 14.1 points (SD = 8.2 points). The hospital scale of anxiety and depression was correlated, both in the dimension of anxiety and in the dimension of depression, significantly and positively with the scale of fear of cancer recurrence. Thus, greater fear of recurrence was associated with greater anxiety and depression. On the contrary, the correlations of anxiety and depression with the dimensions and the overall chronic disease treatment rating scale were significant and negative. So, greater spiritual well-being, in each domain and overall, were associated with less anxiety and depression. Finally, less fear of cancer recurrence was associated with finding greater meaning in life, greater peace, and overall greater spiritual well-being. In summary, fear of cancer recurrence is a predictor of psychological distress in cancer patients. However, spirituality can prevent the development of mental illness and FCR.

Home-based cognitive bias modification training for reducing maladaptive fear in patients with suspected acute coronary syndrome: a pilot randomized clinical trial

BACKGROUND

Patients evaluated in an emergency department for suspected acute coronary syndromes (ACS; e.g., myocardial infarction) often experience a lingering fear of recurrence, which may adversely affect their mental health and adherence to recommended health behaviors. Cognitive bias modification training (CBMT) is an acceptable, easy-to-use intervention that reduces fear of recurrence in cancer patients, and reduces fear and anxiety in other populations, providing an alternative to psychotherapy or counseling-based approaches. Feasibility testing is needed to assess whether a cardiac-related version of CBMT is acceptable to patients with elevated threat perceptions related to their suspected ACS.

METHODS

We developed a tablet-based CBMT intervention tailored to reduce cardiac-related fear of recurrence. In this double-blinded feasibility trial, patients with elevated threat perceptions related to a recent suspected ACS were randomized either to a 4-week, 8-session, tablet-delivered intervention (CBMT) group or to a sham attention control group. Feasibility outcomes included the proportion of eligible patients who enrolled, drop-out rate, intervention compliance rate, acceptability/pleasantness and usability ratings, and task engagement (i.e., accuracy, response time).

RESULTS

Of 49 eligible patients with suspected ACS and elevated threat perceptions recruited from NewYork-Presbyterian Hospital, over half (53.1%) enrolled after receiving a description of study procedures. Of the 26 randomized patients (mean age 59.15 years, 50% women), 2 patients (7.7%) dropped out. Additionally, 4 (15.4%) enrolled patients were not able to complete the tablet tasks, either due to difficulties with the technology or an inability to process the visually presented linguistic information at a sufficient speed. Still, among patients who returned the tablets (19 returned/20 received; 95%), most completed all assigned tablet tasks (intervention or control; 10/19; 52.6%), reporting that the tablets were easy to use and that the tasks were pleasant to complete.

CONCLUSION

Current findings suggest that cardiac-related CBMT is a promising and generally acceptable intervention for suspected ACS patients with cardiac-related threat perceptions which are akin to fear of recurrence. Nevertheless, challenges related to tablet usage indicate that the intervention user-experience should be further refined to optimize usability.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov on 2/25/2019; NCT03853213. Registered with the Open Science Framework on 11/20/2017; https://osf.io/k7g8c/ .

Trajectories of fear of cancer recurrence and its influence factors: A longitudinal study on Chinese newly diagnosed cancer patients

OBJECTIVE

The fear of cancer recurrence (FCR) is an ongoing and common psychological problem faced by cancer patients. The objective of this study was to explore the variation trend of FCR and its influencing factors in Chinese newly diagnosed cancer patients from admission to 2 months after discharge. Demographic and tumor characteristics, as well as experiential avoidance (EA), were used as predictors.

METHOD

A longitudinal design and a consecutive sampling method were used to select 266 newly diagnosed cancer patients admitted to a tertiary cancer hospital in China from July to December 2022. Measurements of FCR and EA were obtained at admission (T1), 1 month after discharge (T2), and 2 months post-discharge (T3). Generalized estimating equations were used to identify factors associated with FCR for longitudinal data analysis.

RESULTS

A total of 266 participants completed the follow-up. Both FCR and EA scores of patients with newly diagnosed cancer showed a significant trend of first increasing and then decreasing at baseline and follow-up (p < 0.001). The junior secondary and less education level, rural residence, advanced tumor and high EA level were risk factors for higher FCR.

CONCLUSIONS

Our findings suggest that the FCR levels of most newly diagnosed cancer patients in China are different at the three time points and affected by different factors, with the highest level at 1 month after discharge. These results have significant implications for future identifying populations in need of targeted intervention based on their FCR trajectories.

Out-of-pocket payments and loss of income among long-term breast cancer survivors in Germany: a multi-regional population-based study

PURPOSE

This study aims to examine the magnitude of out of pocket (OOP) payments and income loss, as well as to identify socioeconomic and clinical factors among long-term breast cancer (BC) survivors in Germany.

METHODS

We examine data from 2654 long-term BC survivors in Germany that participated in the "CAncEr Survivorship - A multi-Regional population-based study" (CAESAR) and who were at least 5 years post diagnosis. BC-related OOP payments and income loss both within the 12 months prior to the survey were analyzed. Two-part regression models were performed to identify socioeconomic and clinical factors.

RESULTS

OOP payments were incurred by 51.9% of survivors with a total mean spending of 566 euros. Income loss was present among 9.6% of survivors and averaged 5463 euros among those reporting such. Socioeconomic and clinical factors associated with higher OOP payments (p ≤ 0.05) included age at time of diagnosis (65-79 years), education (10-11 years), (early) retirement, stage of diagnosis (stage III), time from diagnosis (more than 10 years), comorbidities (at least 1), and the use of rehabilitation services. Regarding income loss, age at time of diagnosis (50-59 years), (early) retirement, stage of diagnosis (stage II), time from diagnosis (5-7 years), comorbidities (at least 1), and receiving chemotherapy treatment were associated with higher losses.

CONCLUSIONS

For some survivors in Germany, financial burden can be considerably high despite comprehensive healthcare and support from social security.

IMPLICATIONS FOR CANCER SURVIVORS

OOP payments related to domestic help and nursing staff as well as to outpatient care are most frequent.

Psychological interventions during breast cancer rehabilitation: a randomized controlled trial comparing structured short-term psychotherapy versus non-specific group discussion

PURPOSE

Psycho-oncological treatment is recommended in cancer rehabilitation as it improves fatigue, anxiety, depression, and quality of life in breast cancer patients. The aim of our study was to compare a structured short-term psychotherapy and a non-specific group discussion provided during breast cancer rehabilitation.

METHODS

Breast cancer patients were randomly assigned to structured group short-term psychotherapy or a non-specific group discussion during breast cancer rehabilitation. The patients completed questionnaires at the beginning and end of rehabilitation and three months after rehabilitation. The primary outcome was anxiety. Secondary outcomes were depression, distress, fatigue and health-related quality of life domains.

RESULTS

In total, 160 patients (80 in both groups) were recruited and included in the analysis. There was no significant difference between both groups in the primary outcome anxiety at the end of rehabilitation (difference = -0.2; 95% CI -1.2 to 0.7) and three months after rehabilitation (difference = 0.2; 95% CI -0.9 to 1.3) and in any secondary outcome. Patients in the short-term psychotherapy group with high anxiety levels at baseline reported fewer depressive symptoms at the end of rehabilitation.

CONCLUSIONS

Our study showed no difference between structured short-term psychotherapy and a non-specific group discussion. Patients with high baseline anxiety levels were more likely to benefit from short-term structured psychotherapy. Early identification of this subgroup and symptoms of mental illness should occur after initial treatment in breast cancer patients in order to offer a structured treatment for anxiety and depressive symptoms during rehabilitation.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00017571; 08/07/2019).

Fear of cancer recurrence in young women 5 years after diagnosis with a good-prognosis cancer: the VICAN-5 national survey

PURPOSE

Fear of cancer recurrence (FCR) is frequent in survivors, but less is known about FCR in long-term survivors with very low risk of relapse. Our aim was to estimate the prevalence and clinical and socio-behavioural factors associated with FCR in young women 5 years after diagnosis of a good-prognosis cancer.

METHODS

Using data from the VICAN-5 survey, conducted in 2015-2016 amongst a national representative French sample of cancer survivors, we included women with non-metastatic melanoma, breast, or thyroid cancer, aged 55 years or under at diagnosis, who experienced no disease progression in the 5 years post-diagnosis. Multinomial logistic regression was used to identify factors associated with FCR, characterised using a three-level indicator: no, mild, and moderate/severe FCR.

RESULTS

Amongst the 1153 women included, mean age was 44 years at diagnosis, and 81.8% had breast cancer, 12.5% thyroid cancer, and 5.8% melanoma. Five years after diagnosis, 35.4% reported no FCR, 46.0% mild FCR, and 18.6% moderate/severe FCR. Women with thyroid cancer were less likely to suffer from mild or moderate/severe FCR, while cancer-related treatment sequelae, fatigue, and anxiety were more likely. Limited health literacy was associated with mild FCR. Women who reported only occasionally consulting a general practitioner (GP) for the management of their cancer had a higher probability of FCR.

CONCLUSION

Moderate/severe FCR affected nearly 20% of young female long-term survivors diagnosed with a good-prognosis cancer, particularly those reporting cancer-related sequelae, suffering from fatigue or anxiety, with breast cancer or melanoma (versus thyroid cancer), and consulting a GP only occasionally for cancer management.

IMPLICATIONS FOR CANCER SURVIVORS

Given the recognised impact of FCR on quality of life, it is essential to detect it as early as possible, and to implement targeted interventions in routine care.

Supportive care needs of breast cancer survivors with different levels of fear of cancer recurrence: A cross-sectional survey study

PURPOSE

To examine the supportive care needs of breast cancer survivors with nonclinical, subclinical, or clinical fear of cancer recurrence.

METHODS

In this cross-sectional study, 385 breast cancer survivors consented and completed a set of online questionnaires. Supportive care needs were assessed by using the 34-item Supportive Care Needs Survey. Fear of cancer recurrence was assessed by using the Fear of Cancer Recurrence Inventory.

RESULTS

One hundred eighty-four (47.8%) participants reported nonclinical fear of cancer recurrence, 147 (38.2%) reported subclinical fear of cancer recurrence, and 54 (14.0%) reported clinical fear of cancer recurrence. Higher levels of fear of cancer recurrence were associated with higher levels of supportive care needs in five domains (β = 0.30-0.60, P < 0.001) after adjusting for places of residence, education, motherhood, and time since diagnosis. Among participants with nonclinical fears of cancer recurrence, the most common needs were in the 'Health care system/Information' domain (50.5%). Among participants with subclinical or clinical fear of cancer recurrence, the most common needs were in the 'Psychological' domain (85.7% and 96.3%, respectively).

CONCLUSION

Fear of cancer recurrence was associated with supportive care needs. The most common needs among participants with subclinical or clinical fears of cancer recurrence were psychological needs.

Advances in the care of breast cancer survivors

Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.

CBT-based Online Self-help Training to Reduce Fear and Distress After Cancer (CAREST Randomized Trial): 24 Months Follow-up Using Latent Growth Models and Latent Class Analysis

BACKGROUND

Psychological distress (PD) and fear of cancer recurrence (FCR) are common consequences of surviving cancer. Online self-help training could help many cancer survivors deal with PD and FCR at low costs.

PURPOSE

To evaluate the long-term effectiveness of the CAncer REcurrence Self-help Training (CAREST trial) to reduce PD and FCR. Moreover, to evaluate the relation between FCR and PD across time and identify subgroups representing different change trajectories in FCR over time and their predictors.

METHODS

This multicenter randomized controlled trial included 262 female breast cancer survivors, assigned to online self-help training or care as usual. Participants completed questionnaires at baseline and four times during the 24-month follow-up. The primary outcomes were PD and FCR (Fear of Cancer Recurrence Inventory). Latent growth curve modeling (LGCM) and repeated measures latent class analysis (RMLCA) were performed, both according to the intention-to-treat principle.

RESULTS

LGCM showed no differences between the average latent slope in both groups for both PD and FCR. The correlation between FCR and PD at baseline was moderate for the intervention group and strong for the CAU group and did not significantly decrease over time in both groups. RMLCA revealed five latent classes and several predictors of class membership.

CONCLUSIONS

We did not find a long-term effect of the CBT-based online self-help training in reducing PD or FCR, nor in their relation. Therefore, we recommend adding professional support to online interventions for FCR. Information about FCR classes and predictors may contribute to improvement of FCR interventions.

Exploring the Unmet Supportive Care Needs of Breast Cancer Survivors Experiencing Psychological Distress: Qualitative Study

OBJECTIVES

This study aimed to explore the unmet supportive care needs of breast cancer survivors who experience psychological distress.

DATA SOURCES

A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 18 Turkish breast cancer survivors who experienced psychological distress. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study.

CONCLUSION

Three key themes emerged from data analysis: sources of psychological distress, unmet supportive care needs, and barriers to support. The survivors who experienced psychological distress defined a variety of unmet supportive care needs, in the areas of information support, psychological/emotional support, social support, and individualized health care support. They also described personal and health professional-related factors as barriers.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should assess psychosocial well-being and supportive care needs of breast cancer survivors. Survivors should be supported to discuss their experiences of symptoms in the early survival phase, and they should be referred to an appropriate supportive care resource. A multidisciplinary survivorship services model is needed to offer posttreatment psychological support routinely in Turkey. Early, effective psychological care integrated into follow-up services for survivors can be protective against psychological morbidity.

Fear of cancer recurrence in South Korean survivors of breast cancer who have received adjuvant endocrine therapy: a cross-sectional study

Introduction

Fear of cancer recurrence (FCR) is one of the most-prevalent psychological problems among cancer survivors, and younger females who have received endocrine therapy are particularly at risk of high FCR. The aim of this study was to determine the relationship between high FCR and factors related to it in South Korean patients with breast cancer who receive adjuvant endocrine therapy (AET).

Methods

This cross-sectional study recruited 326 patients with breast cancer who had received AET. All participants were asked to complete a personal information sheet, the short form of the Fear of Progression Questionnaire, and the Menopause Rating Scale. The factors associated with high FCR were analyzed using association-rule analysis.

Results

The mean FCR score was 32.24 (SD = 10.22), and 137 of the 326 (42.0%) patients had high scores (≥34). Hot flushes and sweating (moderate to extremely severe), depressed mood (moderate to extremely severe), irritability (moderate to extremely severe), invasive stage, taking tamoxifen, and being married were associated with high FCR.

Conclusion

Since FCR was common in patients with breast cancer who received AET, patients at a greater risk of experiencing FCR must be screened and supported.

Interpreting the BREAST-Q for Breast-Conserving Therapy: Minimal Important Differences and Clinical Reference Values

BACKGROUND

The BREAST-Q is an important tool for evaluating patient satisfaction and quality of life in breast-conserving therapy (BCT) patients, but its clinical utility is limited by the lack of guidance on score interpretation. This study determines reference values and the minimal important difference (MID) for the BREAST-Q BCT module.

METHODS

A retrospective review of BCT patients at Memorial Sloan Kettering Cancer Center from January 2011 to December 2021 was performed. Descriptive statistics were used to summarize median BREAST-Q scores. Distribution-based analyses estimated MIDs based on 0.2 standard deviation of baseline BREAST-Q scores and 0.2 standardized response mean of the difference between baseline and 1-year postoperative BREAST-Q scores. MIDs for different clinical groupings based on body mass index, radiation, and reexcision also were estimated.

RESULTS

Overall, 8060 patients were included for determining reference values, and 5673 patients were included for estimating MIDs. Median BREAST-Q scores trended upwards and stabilized by 2 years after surgery for all domains except Physical Well-Being of the Chest, which decreased and stabilized by 2 years. A score interpretation tool, the Real-Time Engagement and Communication Tool, was created based on 25th percentile, median, and 75th percentile scores trajectories. All MID estimates ranged from 3 to 5 points; 4 points was determined to be appropriate for use in clinical practice and research.

CONCLUSIONS

Reference values and MIDs are crucial to BREAST-Q score interpretation, which can lead to improved clinical evaluation and decision making and improved research methodology. Future research should validate this study's findings in different patient cohorts.

A non-inferiority randomized phase III trial of standard immunotherapy by checkpoint inhibitors vs. reduced dose intensity in responding patients with metastatic cancer: the MOIO protocol study

BACKGROUND

Immunotherapy (IO) has become a standard of care for treating various types of metastatic cancers and has significantly improved clinical outcome. With the exception of metastatic melanoma in complete response for which treatment can be stopped at 6 months, these treatments are currently administered until either disease progression for some IO, 2 years for others, or unacceptable toxicity. However, a growing number of studies are reporting maintenance of response despite discontinuation of therapy. There is currently no evidence of a dose effect of IO in pharmacokinetic studies. Maintaining efficacy despite a reduction in treatment intensity by decreasing the frequency of administration in patients with highly selected metastatic cancer, is the hypothesis evaluated in the MOIO study.

METHOD/DESIGN

This non-inferiority, randomized phase III study aims to compare the standard regimen to a 3 monthly regimen of variousIO drugs in adult patients with metastatic cancer in partial (PR) or complete response (CR) after 6 months of standard IO dosing (except melanoma in CR). This is a French national study conducted in 36 centers. The main objective is to demonstrate that the efficacy of a three-monthly administration is not unacceptably less efficacious than a standard administration. Secondary objectives are cost-effectiveness, quality of life (QOL), anxiety, fear of relapse, response rate, overall survival and toxicity. After 6 months of standard IO, patients with partial or complete response will be randomized 1:1 between standard IO or a reduced intensity dose of IO, administered every 3 months. The randomization will be stratified on therapy line,, tumor type, IO type and response status. The primary endpoint is the hazard ratio of progression-free survival. With a planned study duration of 6 years, including 36 months enrolment time, 646 patients are planned to demonstrate with a statistical level of evidence of 5% that the reduced IO regimen is non-inferior to the standard IO regimen, with a relative non-inferiority margin set at 1.3.

DISCUSSION

Should the hypothesis of non-inferiority with an IO reduced dose intensity be validated, alternate scheduling could preserve efficacy while being cost-effective and allowing a reduction of the toxicity, with an increase in patient's QOL.

TRIAL REGISTRATION

NCT05078047.

Estimating the incidence of breast cancer recurrence using administrative data

BACKGROUND

Breast cancer is the most common cancer among women, but most cancer registries do not capture recurrences. We estimated the incidence of local, regional, and distant recurrences using administrative data.

METHODS

Patients diagnosed with stage I-III primary breast cancer in Ontario, Canada from 2013 to 2017 were included. Patients were followed until 31/Dec/2021, death, or a new primary cancer diagnosis. We used hospital administrative data (diagnostic and intervention codes) to identify local recurrence, regional recurrence, and distant metastasis after primary diagnosis. We used logistic regression to explore factors associated with developing a distant metastasis.

RESULTS

With a median follow-up 67 months, 5,431/45,857 (11.8%) of patients developed a distant metastasis a median 23 (9, 42) months after diagnosis of the primary tumor. 1086 (2.4%) and 1069 (2.3%) patients developed an isolated regional or a local recurrence, respectively. Patients with distant metastatic disease had a median overall survival of 15.4 months (95% CI 14.4-16.4 months) from the time recurrence/metastasis was identified. In contrast, the median survival for all other patients was not reached. Patients were more likely to develop a distant metastasis if they had more advanced stage, greater comorbidity, and presented with symptoms (p < 0.0001). Trastuzumab halved the risk of recurrence [OR 0.53 (0.45-0.63), p < 0.0001].

CONCLUSION

Distant metastasis is not a rare outcome for patients diagnosed with breast cancer, translating to an annual incidence of 2132 new cases (17.8% of all breast cancer diagnoses). Overall survival remains high for patients with locoregional recurrences, but was poor following a diagnosis of a distant metastasis.

Interconnectivity of fear of progression and generalized anxiety - Network analysis among a sample of hematological cancer survivors

PURPOSE

Fear of cancer progression and recurrence (FoP) and generalized anxiety disorder (GAD) are syndromes commonly seen in cancer patients. This study applied network analysis to investigate how symptoms of both concepts are interconnected.

METHODS

We used cross-sectional data from hematological cancer survivors. A regularized Gaussian graphical model including symptoms of FoP (FoP-Q) and GAD (GAD-7) was estimated. We investigated (i) the overall network structure and (ii) tested on pre-selected items whether both syndromes could be differentiated based on their worry content (cancer related vs. generalized). For this purpose, we applied a metric named bridge expected influence (BEI). Lower values mean that an item is only weakly connected with the items of the other syndrome, which can be an indication of its distinctive characteristic.

RESULTS

Out of 2001 eligible hematological cancer survivors, 922 (46%) participated. The mean age was 64 years and 53% were female. The mean partial correlation within each construct (GAD: r = .13; FoP: r = .07) was greater than between both (r = .01). BEI values among items supposed to discriminate between the constructs (e.g., worry about many things within GAD and fear not to endure treatment within FoP) were among the smallest so our assumptions were confirmed.

CONCLUSIONS

Our findings based on the network analysis support the hypothesis that FoP and GAD are different concepts within oncology. Our exploratory data needs to be validated in future longitudinal studies.

Development and psychometric properties of the Stressors in Breast Cancer Scale

Background

A diagnosis of breast cancer generates psychological stress, due not only to treatment and its side effects but also to the impact on different areas of the patient’s daily life. Although there are instruments for measuring psychological stress in the cancer context, there is currently no tool for assessing stressors specific to breast cancer.

Aims

The aim of this study was to develop the Stressors in Breast Cancer Scale (SBCS).

Method

A panel of experts evaluated the clarity and relevance of scale items, providing validity evidence based on test content. Psychometric properties of the scale were then analyzed.

Results

Validity evidence based on the internal structure of the SBCS was obtained through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), following a cross-validation strategy. The CFA supported a second-order factor model with five dimensions: physical appearance and sex strains, health and daily difficulties, interpersonal relationship strains, healthcare strains, and worries and concerns about the future. This structure was invariant across two groups distinguished by time from cancer diagnosis (less than 3 and 3 years or more from diagnosis). Reliability, based on McDonald’s omega and Cronbach’s alpha coefficients, ranged from 0.83 to 0.89 for factor scores, and reached 0.95 for total scores. Validity evidence was also provided by correlations with depression, anxiety, perceived stress, and perceived health and quality of life.

Discussion

The results support the use of the SBCS for measuring stress as a stimulus in the breast cancer context. Implications for clinical practice and research are discussed.

Predictors of the worry about cancer recurrence among women with breast cancer

INTRODUCTION

Worry about cancer recurrence is identified as the most common psychological burdens experienced by cancer patients and survivors. The present study aimed to determine the predictors of worry about cancer recurrence among women with breast cancer.

MATERIALS AND METHODS

This cross-sectional study was conducted on 166 women with breast cancer undergoing chemotherapy and radiotherapy, who referred to private and public oncology centers in Tabriz, Iran using the convenience sampling. Data collection tools were demographic and disease characteristics questionnaire, cancer worry scale, social support questionnaire, brief illness perception questionnaire, international physical activity questionnaire-short form, and The EORTC-in-patsat32. The data were analyzed using SPSS 25 software. Pearson correlation coefficient, independent t-test, ANOVA, and multivariate linear regression were used.

RESULTS

In the present study, the mean (standard deviation) of score of worry about cancer recurrence was 17.41 (7.88), ranging from 8-32. The results revealed that the type of surgery, illness perception, satisfaction with care, and place of treatment were the most important predictors of worry about cancer recurrence, which explained 44.3% of the variance.

CONCLUSION

The enhancement of satisfaction with care and training coping strategies among individuals with high perceived severity of the illness contribute to the reduction of worry about cancer recurrence and adaptation to breast cancer.

Shared-Decision-Making Experiences in Breast Cancer Care with and without Patient Participation in Multidisciplinary Tumor Conferences: A Mixed-Methods-Study

Purpose

This study aimed (1) to analyze patients' perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients' active participation in and organizational variables of MTCs with patients' perceived SDM experience directly after MTC.

Patients and Methods

From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with "patients' perceived SDM experiences in MTC" as the dependent variable.

Results

Patients' perceived SDM experiences increased at 4 weeks after MTC (p<0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p<0.001). Linear regression showed that the organizational variable "round table seating arrangement" was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=-0.38, p=0.043; beta=-0.69, p=0.010) directly after MTC.

Conclusion

Results provide first insights into patients' perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients' perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.

Related Factors with Depression and Anxiety in Mastectomized Women Breast Cancer Survivors

Breast cancer (BC) is the most common cancer diagnosis with the highest mortality rate worldwide. The aim of this study was to identify factors related to depression and anxiety in mastectomized women BC survivors. A cross-sectional study was conducted with a sample of 198 women diagnosed with BC aged 30-80 years in Mexico. Depression and anxiety were assessed using the 14-item Hospital Anxiety and Depression Scale (HADS). The results showed that 94.44% and 69.18% of the women scored more than eight points on HADS in the anxiety and depression subscales, respectively; 70.20% and 10.60% were identified as pathological. The following variables were analyzed: age, time elapsed since the start of treatment, received treatment at the time of the evaluation, type of surgery, family history, marital status and employment status. Time elapsed since surgery, having a partner, and employment showed significant results as factors associated to levels of depression and anxiety in these patients. In conclusion, it has been shown that BCSs under 50 years of age receiving some kind of treatment, without family history, without a partner, with a job, with more than secondary education and with more than 5 years since diagnosis could have higher rates of clinical depression. On the other hand, BCSs older than 50 years receiving some kind of treatment, without family history, without a partner, with a job, with more than secondary education and with more than 5 years since diagnosis, could have higher rates of clinical anxiety. In conclusion, the variables studied provide valuable information for the implementation of psychotherapy plans in healthcare systems to reduce the risk of depression and/or anxiety in women with BC who have undergone mastectomy.

Validation of the Lee-Jones theoretical model of fear of cancer recurrence among breast cancer survivors using a structural equation modeling approach

OBJECTIVE

The Lee-Jones model posits that antecedent individual and interpersonal factors predicate the development of fear of cancer recurrence (FCR) through cognitive and emotional processing, which further to behavioral, emotional, and/or physiological responses. We analyzed data from FoRtitude, a FCR intervention grounded in the Lee-Jones FCR model, to evaluate associations between FCR antecedents, resources (e.g., breast cancer self-efficacy, BCSE) and psychological and behavioral consequences.

METHODS

Women with breast cancer who completed treatment and reported clinically elevated levels of FCR were randomized into a 4-week online psychosocial intervention or contact control group. We assessed BCSE, FCR, and physical activity, anxiety and depression, or symptoms at baseline, 4 and 8 weeks. Separate structural equation models were constructed with both baseline data and change scores (baseline-8 weeks) to examine the pathways linking BCSE, FCR and: (1) physical activity; (2) anxiety and depression; and (3) symptoms (fatigue, sleep disturbance, cognitive concerns).

RESULTS

At baseline, higher levels of BCSE were associated with lower levels of FCR. Higher FCR was associated with worse psychological effects and symptoms but not behavioral response. Change models revealed that an increase in BCSE was associated with a decrease in FCR at 8-week assessment, which was associated with reductions in psychological effects. A change in BCSE was also directly associated with reductions in psychological effects.

CONCLUSIONS

Results support the Lee-Jones model as a foundation for FCR interventions among breast cancer survivors. Replicability among varied populations is needed to examine effects on behavioral outcomes of FCR such as health care utilization.

CLINICAL TRIALS REGISTRATION

NCT03384992.

Fear of cancer recurrence as a pathway from fatigue to psychological distress in mothers who are breast cancer survivors

Fatigue is prevalent and pervasive among breast cancer survivors. Mothers are particularly susceptible to fatigue due to the ongoing demands of their caring role. While fatigue has been associated with psychological distress in prior research, the pathway by which fatigue translates into psychological distress is unclear. Given the theoretical and empirical links between fatigue, fear of cancer recurrence (FCR) and psychological distress, the role of FCR in mediating the relationship between fatigue and psychological distress in mothers who are breast cancer survivors was investigated. Ninety-two mothers who were breast cancer survivors completed the Depression, Anxiety and Stress Scale, PROMIS-Cancer Fatigue Short Form and Concerns About Cancer Recurrence scale in an online survey. Mediation analysis via PROCESS was used to examine whether fatigue predicted depression, anxiety or stress through FCR. Fear of cancer recurrence mediated the relationships between fatigue and anxiety and fatigue and stress, while fatigue directly predicted depression. This study highlights FCR as a potential pathway to anxiety and stress in response to ongoing fatigue, and as a mechanism of action to reduce psychological distress among mothers who are breast cancer survivors. Future research examining this pathway from fatigue to psychological distress should also explore the nature of mothers' fears about their cancer recurring.

Neurofeedback Treatment Affects Affective Symptoms, But Not Perceived Cognitive Impairment in Cancer Patients: Results of an Explorative Randomized Controlled Trial

BACKGROUND

EEG biofeedback (NF) is an established therapy to enable individuals to influence their own cognitive-emotional state by addressing changes in brainwaves. Psycho-oncological approaches of NF in cancer patients are rare and effects are hardly studied.

OBJECTIVE

The aim of this explorative, randomized controlled trial was to test the effectiveness of an alpha and theta NF training protocol, compared to mindfulness based therapy as an established psycho-oncological treatment.

METHODS

Of initially 62 screened patients, 56 were included (inclusion criteria were cancer independent of tumor stage, age >18 years, German speaking; exclusion criteria suicidal ideation, brain tumor). Randomization and stratification (tumor stage) was conducted by a computer system. Participants got 10 sessions over 5 weeks, in (a) an NF intervention (n = 21; 13 female, 8 male; MAge = 52.95(10 519); range = 31 to 73 years)) or (b) a mindfulness group therapy as control condition (CG; n = 21; ie, 15 female, 6 male; MAge = 50.33(8708); range = 32 to 67 years)). Outcome parameters included self-reported cognitive impairment (PCI) as primary outcome, and secondary outcomes of emotional distress (DT, PHQ-8, GAD-7), fatigue (MFI-20), rumination (RSQ), quality of life (QoL, EORTC-30 QoL), self-efficacy (GSE), and changes in EEG alpha, and theta-beta band performance in the NF condition.

RESULTS

No changes in cognitive impairment were found (P = .079), neither in NF nor CG. High affective distress was evident, with 70.7% showing elevated distress and 34.1% showing severe depressive symptoms. Affective symptoms of distress (P ≤ .01), depression (P ≤ .05) and generalized anxiety (P ≤ .05) decreased significantly over time. No differences between NF and CG were found. There was a significant increase of the alpha band (P ≤ .05; N = 15) over the NF sessions. Self-efficacy predicted QoL increase in NF with P ≤ .001 and an explained variance of 48.2%.

CONCLUSION

This is the first study to investigate NF technique with regard to basic mechanisms of effectiveness in a sample of cancer patients, compared to an established psycho-oncological intervention in this field. Though there were no changes in cognitive impairment, present data show that NF improves affective symptoms comparably to mindfulness-based therapy and even more pronounced in QoL and self-efficacy.Trial registration: ID: DRKS00015773.

Study protocol of ConquerFear-HK: a randomised controlled trial of a metacognition-based, manualised intervention for fear of cancer recurrence among Chinese cancer survivors

INTRODUCTION

Fear of cancer recurrence (FCR) is a prevalent and frequently debilitating response to a cancer diagnosis, affecting a substantial proportion of cancer survivors. Approximately 30% of local Hong Kong Chinese cancer survivors in a recent survey reportedly experienced persistent high FCR over the first-year post-surgery. This was associated with lower levels of psychological well-being and quality of life. A manualised intervention (ConquerFear) developed primarily based on the Self-Regulatory Executive Function Model and the Rational Frame Theory, has been found to reduce FCR effectively among Caucasian cancer survivors. The intervention now has been adapted to a Chinese context; ConquerFear-HK. The primary aim of this study is to evaluate its efficacy vs a standard-survivorship-care control (BasicCancerCare) in FCR improvement in a randomised control trial (RCT).

METHODS AND ANALYSIS

In this RCT, using the sealed envelope method, 174 eligible Chinese cancer survivors will be randomised to either the ConquerFear-HK or BasicCancerCare intervention. Both interventions include six sessions over 10 weeks, which will be delivered via face to face or online by trained therapists. The ConquerFear-HK intervention incorporates value classification, metacognitive therapy, attentional training, detached mindfulness and psychoeducation; BasicCancerCare includes relaxation training, dietary and physical activity consultations. Participants will be assessed at prior randomisation (baseline; T0), immediately postintervention (T1), 3 months (T2) and 6 months postintervention (T3) on the measures of FCR (Fear of Cancer Recurrence Inventory) as a primary outcome; metacognition (30-item Metacognitions Quesionnaire) and cognitive attentional syndrome (Cognitive-attentional Syndrome Questionnaire) as process outcomes; psychological distress (Hospital Anxiety and Depression Scale), cancer-related distress (Chinese Impact of Events Scale), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire) and treatment satisfaction are secondary outcomes.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from HKU/HA HKW Institutional Review Board (ref: UW19-183). The patients/participants provide their written informed consent to participate in this study. The study results will be disseminated through international peer-review publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT04568226.

Are there sustained psychological impacts in women diagnosed with in-situ or early invasive breast cancers?

Purpose

The detection of a ductal carcinoma in-situ (DCIS) or an early invasive breast cancer (EIBC), particularly by population-wide mammography-screening-programs, is controversial as an unknown proportion of these cases may be due to overdiagnosis. We investigated whether women with such potentially overdiagnosed breast cancers suffer from sustained adverse psycho-social consequences.

Methods

Standardized questionnaires were mailed to 900 survivors, diagnosed with either DCIS or EIBC, requesting self-reports on quality of life using EORTC Quality of Life Questionnaire C-30. Levels of anxiety and depression were assessed using the HADS questionnaires. Item score values in the study group were compared to reference data obtained from normative studies in the German female reference population.

Results

The 577 women who returned completed questionnaires had a mean age of 65.1 years, 387 (67%) had been diagnosed by mammography screening. Median time since diagnosis was 5.9 years. There were no substantial differences between the study sample and the reference population for most of the items. While most score values were even slightly more favorable in the study group, the scores for cognitive function were moderately lower, especially among younger patients. Score values for anxiety were generally higher among younger women (50 to 59 years) from the study group, while depression scores were lower irrespective of age.

Conclusions

This study indicates that the diagnosis of DCIS or EIBC, which is predominantly a result of screening, does not seem to induce sustained, adverse psychological impacts in affected women when compared with the respective general female population. Only anxiety levels remained elevated among younger women.

Psychological interventions for women with non-metastatic breast cancer

BACKGROUND

Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015.

OBJECTIVES

To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer.  SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles.

SELECTION CRITERIA

Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes.

MAIN RESULTS

We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.  Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies.

AUTHORS' CONCLUSIONS

Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.

Fear of Cancer Recurrence and associated factors among breast cancer survivors in South India

OBJECTIVE

Fear of Cancer Recurrence (FCR) is a universal phenomenon widely reported as an unmet need among cancer survivors. The present study aims to determine the patterns of FCR and its associated factors among breast cancer survivors in South India.

METHODS

A longitudinal study was carried out with pre and post-assessment.

RESULTS

Two hundred and forty eight breast cancer survivors (BCSv) were included in the study. The main finding for the pre versus post-study was the pattern of mean scores. It is observed that in all factors, the pre-mean scores were steadily higher than the post-mean scores the predictors for FCR scores were decrease of age (p = 0.016), BCSv living in joint family (p = 0.008) and who were self-funded (p = 0.031).

CONCLUSIONS

FCR was a relatively common symptom reported by BCSv. The predictors for FCR were younger age, BCSv living in a joint family and who were self-funding for their treatment. In the pre and post-assessment, it could be concluded that BCSv has reported that the overall FCR and on other variables higher FCR mean scores were reported during the preassessment period.

Quality of life and mental health in real-world patients with resected stage III/IV melanoma receiving adjuvant immunotherapy

INTRODUCTION

Treatment with immune checkpoint inhibitors (ICI) has expanded into the adjuvant setting enhancing the importance of knowledge on the immune-related toxicities and their impact on health-related quality of life (HRQoL). Large phase 3 trials of patients with resected Stage III/IV melanoma found no effect on HRQoL during adjuvant immunotherapy. This study investigates how HRQoL was affected during and after adjuvant immunotherapy in a real-world setting.

METHODS

Patients with resected melanoma treated with adjuvant nivolumab from 2018 to 2021 in Denmark were identified using the Danish Metastatic Melanoma Database (DAMMED). The study was performed as a nationwide cross-sectional analysis as a questionnaire consisting of six different validated questionnaires on HRQoL, cognitive function, fatigue, depression, fear of recurrence, and decision regret was sent to all patients in March 2021. To evaluate HRQoL during and after adjuvant treatment, patients were divided into groups depending on their treatment status when answering the questionnaire; patients in active treatment for 0-6 months, patients in active treatment for >6 months, patients who ended treatment 0-6 months ago, and patients who ended treatment >6 months ago.

RESULTS

A total of 271/412 (66%) patients completed the questionnaire. Patients who ended therapy 0-6 months ago had the lowest HRQoL and had more fatigue. Patients in active treatment for >6 months had lower HRQoL and more fatigue than patients who started treatment 0-6 months ago. Patients ending therapy >6 months ago had higher HRQoL and less fatigue compared to patients who ended therapy 0-6 months ago. Multivariable analysis showed an association between HRQoL and treatment status, comorbidity, civil status, and employment status.

CONCLUSIONS

Adjuvant nivolumab may affect some aspects of QoL, but the influence seems temporary. Patient characteristics, such as civil status, employment status, and comorbidity were associated with HRQoL.

Psychosocial predictors of fear of cancer recurrence in a cohort of gynecologic cancer survivors

OBJECTIVE

To describe fear of cancer recurrence in a cohort of women with gynecologic cancers and to identify psychosocial predictors of elevated fear of recurrence.

METHODS

Survey data from an ongoing cohort study of gynecologic cancer survivors were used (n = 154). Relationships between fear of cancer recurrence measured by the 6-item Cancer Worry Scale in the most recent survey and psychosocial factors (cancer-related distress, depression, anxiety, hopelessness, and posttraumatic growth) assessed 6-18 months prior were examined using univariate and multivariate linear regression models, adjusting for age, cancer stage, cancer type, and time since diagnosis.

RESULTS

Most participants were ≥60 years old, diagnosed with early-stage cancer, and 2-5 years post-diagnosis. The mean score on the Cancer Worry Scale was 10.31 (SD = 3.01), and 46 individuals (30.0%) scored ≥12, indicating high fear of recurrence. In univariate analyses, greater distress (p = 0.007), anxiety (p = 0.006), hopelessness (p = 0.007), and posttraumatic growth (p = 0.0006) were significantly associated with higher scores on the Cancer Worry Scale. The associations of hopelessness and posttraumatic growth with higher Cancer Worry Scale scores remained significant after adjustment for covariates.

CONCLUSIONS

Fear of recurrence is frequent among gynecologic cancer survivors. Women who reported more distress, hopelessness, anxiety and, surprisingly, more post-traumatic growth reported more fear. These results contribute to our understanding of which cancer survivors are most at risk of elevated fear of recurrence and highlight the importance of continued focus on psychosocial well-being among cancer survivors.

Effect of Post-diagnosis Physical Activity on Breast Cancer Recurrence: a Systematic Review and Meta-analysis

PURPOSE OF REVIEW

Breast cancer (BC) recurrence dramatically decreases 5-year survival, which causes a fear of BC recurrence among a majority of BC survivors. Evidence is currently inconsistent on whether post-diagnosis recreational physical activity (rPA) can prevent BC recurrence due to the small number of included studies, as well as methodological heterogeneity among the studies. This systematic review aimed to clarify the association between post-diagnosis rPA and the risk of BC recurrence, by conducting a meta-analysis while controlling for the categories of rPA across the existing studies.

RECENT FINDINGS

Prospective cohort studies were searched, and five studies were eligible for the meta-analysis. Of 10,094 patients with BC, 1561 had recurrence during the follow-up period ranging from 12 to 156 months. The meta-analysis revealed that patients whose post-diagnosis rPA was ≥ 7.5 metabolic equivalents (MET-h/week) had a lower BC risk than patients whose rPA was 0-3 MET-h/week (hazard ratio [HR], 0.65; 95% CI, 0.58-0.73, p < 0.00001, I² = 0%). The review indicated that a post-diagnosis rPA of ≥ 7.5 MET-h/week could reduce the risk of BC recurrence by 35%. Although it is necessary to investigate randomized controlled studies in the future, this result will strengthen strategies for the care and/or treatment of patients after BC and can motivate BC survivors to participate in rPA programs after BC diagnosis.

Fear of cancer recurrence and coping attitudes of breast cancer survivors

OBJECTIVE

This study aimed to determine the fear of cancer recurrence levels and coping orientation of breast cancer survivors.

METHODS

This descriptive exploratory study was conducted using a web-based online survey. This article is written using the STROBE checklist. The study was completed with 204 women participants. Data were collected using the 'Demographic and Clinical Information Form', 'Fear of Cancer Recurrence Inventory (FCRI)' and 'Coping Orientation to Problems Experienced Inventory-Revised (COPE-R)'.

RESULTS

FCRI total score average within the scope of the study was calculated as 42.00 ± 18.88. Women's COPE-R total score average is 80.62 ± 13.20. There was a positive correlation between FCRI total score and COPE-R (r = 0.183, p = 0.009). According to the results of multiple linear regression analysis, age, education level, CAM usage, getting psychological support and COPE-R subscales (accommodation, avoidance, self-punishment) were associated with FCRI total score.

CONCLUSIONS

The fear of cancer recurrence experienced by breast cancer survivors was associated with their coping orientation. Determining the fear of cancer recurrence level and coping orientation of breast cancer survivors by healthcare professionals will guide the reduction of women's fear of cancer recurrence and further the development of adaptive coping orientation.

Distorted body schema after mastectomy with immediate breast reconstruction: a 4-month follow up study

Background

After breast cancer, some patients report residual pain-related upper limb disability without physical impairment. Although pain and altered proprioception are known to affect the working body schema (WBS), there is little available evidence investigating the WBS of breast cancer survivors (BrCS). WBS-body representations in the brain-affect the "neuromatrix" that modulates pain sensitivity and the threshold for threatening stimuli. The aim of this study was to investigate whether WBS was disrupted after mastectomy with immediate breast reconstruction (IBR) for breast cancer and whether pain and proprioceptive changes affected WBS.

Methods

Thirty-five BrCS participated in the 4-month follow-up study. They were observed at 1 and 4 months postoperatively. The main outcome measures were the left right judgement test (LRJT) results, absolute angle error, pectoralis minor length index (PMI), pain, and Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score. They were measured at each observation, and parametric tests were performed to identify the nature of WBS.

Results

Both the reaction time and accuracy of the hand LRJT were poorer than those of the foot and back LRJT (p < 0.001). The hand LRJT reaction time and accuracy were unchanged over the total follow-up period (p = 0.77 and p = 0.47, respectively). There was a weak correlation between the LRJT reaction time and PMI (r = -0.26, p = 0.07), pain severity (r = 0.37, p = 0.02), and Q-DASH score (r = 0.37, p = 0.02). There was also a weak correlation between LRJT accuracy and Q-DASH score (r = -0.31, p = 0.04). The LRJT accuracy of BrCS who underwent surgery on their dominant side was higher than that of BrCS who underwent surgery on their non-dominant side (p = 0.002). Regression analysis found a weak but significant relationship between the early hand LRJT results and late pain severity (adjusted R² = 0.179, p = 0.007). A similar relationship was found between early hand LRJT results and Q-DASH score (adjusted R² = 0.099, p = 0.039).

Conclusion

To the best of our knowledge, this is the first study providing the nature of WBS after mastectomy with IBR. In this population, it is necessary to postoperatively preserve WBS integrity for pain and upper limb disability.

The relationship between fear of recurrence and depression in patients with cancer: The role of invasive rumination and catastrophizing

Objective

To examine the relationship between fear of recurrence and depression in patients with cancer.

Materials and methods

Two hundred and fifty-nine participants completed self-report questionnaires, including the Fear of Progression Questionnaire-Short Form, Rumination Inventory, Cognitive Emotion Regulation Questionnaire (Chinese version), and Center for Epidemiological Studies Depression Scale.

Results

Fear of recurrence in patients with cancer was moderate, and the level of depression was significantly higher than that in the normal population. Fear of recurrence, invasive rumination, catastrophizing, and depression in patients with cancer were significantly positively correlated. The level of fear of recurrence was a significant positive predictor of the level of depression. Invasive rumination played a partial mediating role between fear of recurrence and depression; that is, fear of recurrence directly affected depression, and fear of recurrence indirectly affected depression through invasive rumination. Catastrophizing played a moderating role in the mediation model, in which fear of recurrence affected depression through invasive rumination.

Conclusion

Invasive rumination plays a mediating role between fear of recurrence and depression in patients with cancer. Catastrophizing moderates the relationship between fear of recurrence and depression as well as the relationship between invasive rumination and depression.

Trained lay coaches and self-care cognitive-behavioral tools improve depression outcomes

OBJECTIVES

Identify the key effective components of a depression self-care intervention.

METHODS

Secondary analysis of data from 3 studies that demonstrated effectiveness of a similar depression self-care intervention (n = 275): 2 studies among patients with chronic physical conditions and 1 among cancer survivors. The studies used similar tools, and telephone-based lay coaching. Depression remission and reduction at 6 months were assessed with either PHQ-9 (chronic condition cohorts) or CES-D (cancer survivor cohort). Multiple logistic regression was used to analyze data when the interaction p-value with cohort was < 0.10.

RESULTS

The 3 coached cohorts achieved better depression outcomes than usual care. The combination of coaching and joint use of 2 tools based on cognitive-behavioral therapy (CBT) was associated with depression remission and reduction among chronic condition cohorts but not among cancer survivors. Neither the number nor the length of coach calls were associated with outcomes in pooled data.

CONCLUSIONS

Trained lay coaching and use of CBT-based self-care tools were associated with improved depression outcomes in patients with chronic conditions but not among cancer survivors.

PRACTICE IMPLICATIONS

Trained lay coaching and CBT tools are key components of depression self-care interventions. Further research is needed on the effective components in cancer survivors.

The Correlation Between Radiotherapy and Patients' Fear of Cancer Recurrence: A Systematic Review and Meta-analysis

The purpose of this review was to explore the correlation between patients' fear of cancer recurrence (FCR) and radiotherapy. National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, SinoMed, PubMed, Web of Science, EBSCO-CINAHL, Cochrane Library, and Ovid Embase were searched to identify relevant studies. Thirty-five eligible studies were included in the systematic review, and 22 of them were included in further meta-analysis. The results of the meta-analysis showed that the level of patients' FCR was positively correlated with radiotherapy, but the correlation was weak (overall r = 0.075; 95% confidence interval [CI], 0.046-0.103; P = .000). In terms of subgroup analysis based on cancer site (breast cancer vs other types of cancer), the breast cancer group (r = 0.086; 95% CI, 0.027-0.143; P = .004), the mixed-type group (r = 0.073; 95% CI, 0.033-0.112; P = .000), and the other-type group (r = 0.071; 95% CI, 0.015-0.126; P = .013) have a positive correlation with radiotherapy. Patients' FCR positively correlated with the receipt of radiotherapy. However, because of the variability among the studies, the results have limitations. Therefore, longitudinal studies are needed to verify the trajectory of FCR over radiation therapy.

What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis

Objective

Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI‐SF). We also report on associations between FCR and clinical and demographic characteristics.

Methods

This is a systematic review and individual participant data (IPD) meta‐analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI‐SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool.

Results

IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI‐SF (range 0–36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis.

Conclusions

FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR.

The protocol was prospectively registered (PROSPERO CRD42020142185).

[Psychosocial long-term effects of cancer]

Die Inzidenz von Krebserkrankungen hat in den westlichen Industrienationen in den letzten Jahrzehnten stetig zugenommen. Die Anzahl der Neuerkrankungen liegt in Deutschland aktuellen Schätzungen zufolge bei ca. 500.000 pro Jahr. Aufgrund der verbesserten Früherkennung sowie der Fortschritte in den Behandlungsmöglichkeiten haben sich jedoch die Überlebenszeiten bei den meisten Tumorarten erhöht. In der Folge hat auch die Zahl der Langzeitüberlebenden (≥ 5 Jahre nach Diagnose oder Ende der Behandlung) zugenommen. Trotz der Erfolge der Tumortherapie können Langzeitüberlebende von verschiedenen körperlichen oder seelischen Problemen in der Folge der Erkrankung und/oder Therapie betroffen sein. Dieser Artikel gibt einen Überblick über die psychischen Folgeprobleme, insbesondere Angst, Depression, psychosoziale Aspekte der Lebensqualität, neuropsychologische Defizite sowie Erschöpfungszustände (Fatigue). In einem abschließenden Fazit werden Empfehlungen für psychosoziale Interventionen sowie für die Verbesserung der psychosozialen Versorgung von Langzeitüberlebenden gegeben.

Effects of Breast-Conserving Surgery Combined with Immediate Autologous Fat Grafting on Oncologic Safety, Satisfaction and Psychology in Patients with Breast Cancer: A Retrospective Cohort Study

Purpose

Autologous fat grafting (AFG) is a technique that can improve the appearance of breasts in surgical patients. There are currently few studies on breast-conserving surgery (BCS) combined with immediate AFG, although we believe that it could achieve satisfactory effects. Therefore, the purpose of this study is to observe the effects of BCS combined with immediate AFG on oncologic safety, satisfaction and psychology of breast cancer patients.

Patients and Methods

We retrospectively collected the data of 85 breast cancer patients from February 2018 to October 2018. After screening, 40 patients in AFG group (AG, BCS combined with immediate AFG) and 40 patients in control group (CG, BCS alone) were finally included in the study. The primary outcomes were the survival, tumor recurrence and metastasis, and BREAST-Q score of patients. The secondary outcomes were short and long-term complications, degree of depression and anxiety of patients.

Results

A total of 80 patients were included in the analysis. There was no significant difference in the clinicopathological data between the two groups (P>0.05). The average follow-up time of the two groups was 40.58±2.630 and 40.28±2.679 months. In the analysis of oncologic safety, no patients died in AG and 1 patient died in CG. In addition, there was no significant difference between the two groups in terms of the overall recurrence rate and the distribution of recurrence types (P>0.05). As for satisfaction, the BREAST-Q score of AG was significantly higher than that of CG (57.85±4.833 vs 51.93±5.045, P<0.001). In the secondary outcomes, there was no short-term complication specified in the study; in the long-term complications, the incidence of calcification in AG was not significantly higher than that in CG (P=0.065). In the analysis of depression and anxiety, there was no significant difference between the two groups (P>0.05).

Conclusion

BCS combined with immediate AFG can significantly improve patients’ satisfaction without increasing the risk of death and tumor recurrence. However, it does not seem to play a role in improving the conditions of depression and anxiety.

Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature

Background

Fear of cancer recurrence (FCR) has been addressed as a cause of emotional distress among breast cancer survivors (BCSs). This study aimed to systematically review the evidence on randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) designed to reduce FCR among BCSs.

Methods

A systematic review of published original research articles meeting the inclusion criteria was conducted. Five electronic databases, including the Cochrane Library, CINAHL, PubMed, PsycINFO, and Web of Science, were independently searched to identify relevant articles. The Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist was used to evaluate the quality of the eligible studies.

Results

Through a database search and a manual review process, seventeen quantitative studies with an RCT study design were included in the current systematic review. The interventions varied greatly in length and intensity, but the study designs and methodologies were similar. RCTs with face-to-face interventions of at least 1 month seemed to be more effective in reducing FCR outcomes and complying with than the CONSORT 2010 criteria than those with a brief online or telephone format of interventions; nevertheless, most RCT interventions appeared to be effective.

Conclusions

These findings highlight the importance of conducting well-designed CBT interventions to reduce FCR in BCSs with diverse populations at multiple sites, thereby improving the quality of research in this area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08909-y.

Prevalence and determinants of anxiety and depression in long-term breast cancer survivors

BACKGROUND

There is a significant number of long-term breast cancer survivors in Germany. However, research on the psychological challenges of cancer survivors is limited. This analysis describes prevalence, development and determinants of depression and anxiety 5 to 6 years after diagnosis and identifies predictors for an increase of anxiety and depression over time.

METHODS

Data from 164 women was collected by survey and tumour documentation during post-operative hospital stay, 40 weeks and 5 to 6 years after diagnosis. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Sankey-diagrams were created for visual presentation of prevalence over time. Logistic and linear regression models were calculated to identify determinants of anxiety and depression.

RESULTS

Respondents had higher levels of depression and anxiety 5 to 6 years than 40 weeks after the diagnosis. Lower vocational status and having children were associated with depression, surgery type was correlated with anxiety, and age, as well as comorbidities, were predictors for both anxiety and depression 5 to 6 years after diagnosis. An increase of depression over time was more likely when having children and comorbidities. An increase in anxiety was less likely after cancer recurrence.

CONCLUSIONS

Findings highlight that anxiety and depression are relevant burdens for breast cancer survivors in Germany. Several sociodemographic and clinical predictors are identified. There is need for psychosocial support after acute treatment and in the long-term. Research on psychological burdens of long-term breast cancer survivors in the identified vulnerable groups is needed.

Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct

Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.

Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression

Background and purpose

Breast cancer can be a major challenge for affected women. Knowledge of the physical function, symptoms of cancer-related fatigue, anxiety, and depression based on the cancer treatment may help to guide adequate support.

Methods

For this prospective observational study, we collected data from seventy-nine women with a mean age 54.6 ± 9.5 years prior to the onset of breast cancer treatment (T0) and after (T1/T2). Handgrip strength test (HGS), six-minute walk test (6MWT), the phase angle (PhA), the hospital anxiety and depression scale (HADS), and functional assessment of chronic illness therapy-fatigue (FACIT-F) were used to collect data from four treatment subgroups SC, surgery + chemotherapy; SCR, surgery + chemotherapy + radiation therapy; SR, surgery + radiation therapy; and S, surgery.

Results

A mixed ANOVA revealed a significant interaction between time and group for PhA, F = 8.55, p < 0.01; HGS, F = 3.59, p < 0.01; 6MWT, F = 4.47, p < 0.01; and FACIT-F, F = 2.77, p < 0.05 with most pronounced deterioration seen in group SCR (PhA 4.8°; HGS 27.5 kg, 6MWT 453.4 m, FACIT-F 33.8 points). HADS data displayed moderate anxiety and depression predominantly after treatment.

Conclusion

Our study showed that the extent of change in physical function, symptoms of fatigue, anxiety, and depression depends on the treatment conditions. The potentially higher risk of impaired function due to the prevalence of values below a critical threshold requires early initiated multidisciplinary support.

Fear-focused Self-compassion Therapy for young breast cancer patients' fear of cancer recurrence: Study protocol of a randomized controlled trial

BACKGROUND

In China, there are a growing number of young women being diagnosed with breast cancer. Fear of Cancer Recurrence (FCR) has become one of the major psychological concerns reported by young breast cancer patients. Yet, there is a lack of psychological intervention tailored for reducing FCR for Chinese young breast cancer patients. In the current study, the Fear-focused Self-compassion Therapy is developed to help Chinese young breast cancer patients to manage FCR. The therapy was developed based on FCR development theories and self-compassion related therapy. The primary objective is to evaluate the short-term and long-term effectiveness of Fear-focused Self-compassion Therapy. The secondary objective is to examine the underlying mechanisms of therapy in reducing FCR in young breast cancer patients.

METHODS

The Fear-focused Self-compassion Therapy consists of 8-week face to face group sessions. This study will be a randomized controlled trial with 160 Chinese young female breast cancer patients with severe FCR. Participants will be randomized to the therapy group or a usual care control group (1:1). Measurements will be completed at baseline, immediately completing intervention, 3, 6, and 12 months later. Primary outcomes are FCR severity, and secondary outcomes include symptoms of depression and anxiety, satisfaction with therapy, and cost-effectiveness of the therapy.

DISCUSSION

If successful, this study will provide an effective psychological intervention to treat FCR for young breast cancer patients in China, and illuminate the underlying mechanisms of the Fear-focused Self-compassion Therapy in reducing FCR.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT04965428. Registered 23rd July 2021, https://clinicaltrials.gov/ct2/show/NCT04965428?cond=fear+of+cancer+recurrence&draw=2&rank=1.

Clinical Course and Predictors of Subsequent Recurrence and Survival of Patients With Ipsilateral Breast Tumor Recurrence

Purpose

To evaluate the clinical course and long-term outcomes of patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and identify independent prognostic factors for further recurrence.

Methods

In this retrospective study, we reviewed the records of 327 patients who experienced IBTR after undergoing BCS for breast cancer at Asan Medical Center during 1990–2013. Overall survival (OS) after IBTR and cumulative incidence rates of recurrences after IBTR were calculated. The association of clinicopathological factors with survival and the development of further recurrence after IBTR was determined in multivariate analysis.

Results

At a median follow-up of 127.7 months, 97 patients experienced recurrence after IBTR. The 5-year and 10-year cumulative incidence rates of recurrence after IBTR were 32% and 41%, respectively. The 5-year and 10-year OS rates after IBTR were 86.6% and 70.3%, respectively. In multivariate analysis, hormone receptor negativity was associated with decreases in OS after IBTR (hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.18–6.78). Patients with longer disease-free interval (DFI) had decreased risks of second recurrence (HR .99, 95% CI .99–1.00), and second locoregional recurrence (LRR) (HR .98, 95% CI .97–.99). Lymphovascular invasion (LVI) of IBTR was associated with increased recurrence rates (second recurrence-free survival, HR 3.58, 95% CI 2.16–5.94; second LRR free survival, HR 5.21, 95% CI 2.77–9.78; second distant metastasis-free survival, 2.11, 95% CI 1.04–4.30) and lower survival rates (OS after IBTR, HR 4.64, 95% CI 2.23–9.67).

Conclusions

Despite subsequent recurrences during long-term follow-up, the survival rates after IBTR remained high. Patients with hormone receptor-negative tumors, shorter DFI, and tumors that present LVI of IBTR had higher risks for recurrence and poor survival rates after IBTR. The study findings may help in understanding the course and prognosis of IBTR patients and identifying high-risk IBTR to establish management strategies.