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Hall DL, Wagner LI, Lebel S, Smith AB, Bergerot CD, Park ER. Guidelines needed for the management of fear of cancer recurrence in adult survivors of cancer in the United States: A consensus statement. Cancer 2024; 130:2739-2742. [PMID: 38630904 DOI: 10.1002/cncr.35326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
Fear of cancer recurrence remains unaddressed in guidelines for managing anxiety and depression in adult cancer survivors in the United States. To ensure comprehensive psychosocial care, guidelines are needed for the clinical management of fear of cancer recurrence, including recommendations for screening, referral, and treatment pathways.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lynne I Wagner
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Allan Ben Smith
- The Daffodil Center, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Cristiane D Bergerot
- Oncoclinicas & Co - Medica Scientia Innovation Research (MEDSIR), Sao Paulo, Brazil
| | - Elyse R Park
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Park SY. Psychometric Characteristics of the Fear of Cancer Recurrence Inventory-Severity Subscale Among Korean Cancer Survivors. J Prev Med Public Health 2024; 57:319-326. [PMID: 38853579 PMCID: PMC11309832 DOI: 10.3961/jpmph.24.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/11/2024] [Accepted: 04/24/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVES Despite the importance of choosing and using a valid assessment tool for fear of cancer recurrence (FCR) for early detection and interventions, the validity of the FCR inventory has yet to be thoroughly investigated in Korea. This study explored the psychometric properties of the Fear of Cancer Recurrence Inventory-Severity (FCRI-S) subscale and assessed its applicability to cancer survivors in Korea. METHODS The survey involved 93 Korean individuals who had survived cancer. The reliability of the FCRI-S subscale was assessed using Cronbach's α and composite reliability (CR). Confirmatory factor analysis (CFA), along with tests for discriminant and convergent validity, was conducted to evaluate the construct validity of the FCRI-S subscale. RESULTS The FCRI-S subscale showed excellent internal consistency (Cronbach's α=0.88; CR=0.89). CFA showed a good factor structure for the FCRI-S subscale, and the correlations of the FCRI-S subscale with FCR-related measures (r=0.69 to 0.80) and other psychosocial measures (r=-0.23 to 0.37) confirmed both the convergent and discriminant validity of the FCRI-S subscale. CONCLUSIONS This study confirmed the robust psychometric characteristics of the FCRI-S subscale among cancer survivors in Korea. The use of the FCRI-S subscale would be helpful for health professionals to rapidly screen FCR levels in clinical settings.
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Affiliation(s)
- So-Young Park
- Ewha Institute for Age Integration Research, Ewha Womans University, Seoul, Korea
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Wang LL, Xu RH. Development of a rapid tool for screening financial toxicity based on the comprehensive score for financial toxicity. J Cancer Policy 2024; 40:100475. [PMID: 38552715 DOI: 10.1016/j.jcpo.2024.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE This study aimed to use item response theory (IRT) to develop and validate a short version of the Chinese COmprehensive Score for financial Toxicity (COST-S-C) in patients with cancer. METHODS A total of 500 patients with cancer participated in the survey. Confirmatory factor analysis (CFA) was used to assess the factor structure of the COST-S-C. A two-parameter IRT model was used to examine the item fit of the COST-S-C. Item discrimination, item characteristic curves (ICCs), item information curves (IICs), and item fit were estimated. Differential item functioning (DIF) was assessed for participants' gender and age. Reliability, convergent and discriminant validity was examined as well as estimating the optimal cut-off points of the COST-S-C. RESULTS The CFA results supported the bi-factor structure of the COST-S-C. The IRT analysis findings revealed that several items showed problems with the ICCs, providing little information in terms of IICs as well as poor discrimination. Item 5 showed a negligible DIF problem with age. A valid 3-item COST-S-C scale and its optimal cut-off point was developed. CONCLUSIONS The COST-S-C is a valid and quick screening tool used to distinguish patients with cancer who report significant financial toxicity in various medical settings.
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Affiliation(s)
- Ling-Ling Wang
- Center for Health policy and management studies, Nanjing University, Nanjing, China; Department of Blood Transfusion Medicine, Jinling Hospital, School of Medicine, Nanjing, University Nanjing, China
| | - Richard Huan Xu
- Department of Rehabilitation Sciences, Faculty of Health and Social Science, the Hong Kong Polytechnic University, Hong Kong, China; JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China.
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Lucas AR, Pan JH, Ip EH, Hall DL, Tooze JA, Levine B, Mohr DC, Penedo FJ, Cella D, Wagner LI. Validation of the Lee-Jones theoretical model of fear of cancer recurrence among breast cancer survivors using a structural equation modeling approach. Psychooncology 2023; 32:256-265. [PMID: 36468339 PMCID: PMC10107857 DOI: 10.1002/pon.6076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Alexander R Lucas
- Department of Health Behavior and Policy, Internal Medicine - Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jun-Hao Pan
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Edward H Ip
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel L Hall
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet A Tooze
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beverly Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David C Mohr
- Department of Preventive Medicine and Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Frank J Penedo
- Departments of Medicine and Psychology, University of Miami, Miami, Florida, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Supporting routine cognitive reactivity assessment during the perinatal period: psychometric testing of the Chinese version of the Leiden Index of Depression Sensitivity. BMC Pregnancy Childbirth 2022; 22:911. [PMID: 36474194 PMCID: PMC9727893 DOI: 10.1186/s12884-022-05233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is critical to find optimal forms to identify perinatal depression (PND) and its vulnerable factors and make them more applicable to depression screening. This study aims to evaluate the reliability and validity of the Chinese version of the Leiden Index of Depression Sensitivity (LEIDS-RR-CV) among perinatal women in China and determine the cut-off values for screening for high-risk depression. METHODS Women in their third trimester of pregnancy and six weeks postpartum completed the LEIDS-RR-CV and a diagnostic reference standard online. We assessed the LEIDS-RR-CV using classical test theory (CTT) and item response theory (IRT). We also assessed the test performance for cut-off scores using receiver operator characteristic analysis to further screen for high-risk depression at each time point. RESULTS In total, 396 (third trimester) and 321 (six weeks postpartum) women participated. Cronbach's alpha, two-week test-retest reliability, and marginal reliability for the scale were all greater than 0.8. It showed a five-factor model; the cut-off values were 58 (third trimester) and 60 (six weeks postpartum). The areas under the curve were acceptable (≥ 0.7), and the LEIDS-RR-CV was positively correlated with the total Edinburgh Postnatal Depression Scale (EPDS) score (r = 0.52 and 0.56, p = 0.00), indicating its predictive validity. An IRT analysis further confirmed its discriminative validity. CONCLUSIONS The LEIDS-RR-CV was found to be reliable, valid, and can be used to quantify cognitive reactivity among perinatal Chinese women and for screening for high-risk depression during this period.
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Xu RH, Yu S, Yang Y, Ng S, Xu B, Dong D. Psychometric evaluation of the Fear of Cancer Recurrence Inventory (FCRI) and development of a short version in patients with follicular lymphoma. Disabil Rehabil 2022; 44:7508-7515. [PMID: 34623949 DOI: 10.1080/09638288.2021.1985631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the psychometric properties of the Chinese Fear of Cancer Recurrence Inventory (FCRI-C) in follicular lymphoma (FL) survivors. MATERIALS AND METHODS A nationwide cross-sectional study was conducted online between July and September 2020. The following psychometric properties of the FCRI-C were evaluated: construct, convergent, and discriminant validity, and reliability. Item variance was assessed using differential item functioning (DIF). A short version of the FCRI-C was developed using a two-parameter item response theory (IRT) model. The patterns of response scale, item fit, and item information were assessed. The receiver operating characteristic (ROC) curve was used to determine the clinical cut-off point for the FCRI-C. RESULTS A total of 326 FL survivors completed the questionnaire. The confirmatory factor analysis supported the bi-factor structure of the FCRI-C. The IRT analysis confirmed a 10-item short version of the FCRI-C. Satisfactory convergent and discriminant validity were underpinned by a priori hypotheses. Cronbach's alpha of 0.95 and intraclass correlation coefficient of 0.82 indicated good internal consistency and test-retest reliability. The ROC curve determined a cut-off point of 83 and 20 for the full and short versions, respectively. CONCLUSIONS The FCRI-C used to measure and screen the levels of FCR in Chinese FL survivors was found to be valid and reliable.Implications for RehabilitationThe Chinese Fear of Cancer Recurrence Inventory (FCRI-C) is a reliable and valid measure to evaluate the fear of cancer recurrence (FCR) in follicular lymphoma survivors.The short version of the FCRI-C provides a rapid screening tool for the clinical detection of FCR in patients.The cut-off point of the FCRI-C could differentiate patients between "high" and "low" levels of FCR in clinical practice.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.,JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siyue Yu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yifan Yang
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Shamay Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China.,Institute of Hematology, Medical College of Xiamen University, Xiamen, Fujian, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Eden M, Hainsworth R, Gordon LG, Epton T, Lorigan P, Rhodes LE, Marais R, Green AC, Payne K. Cost-effectiveness of a policy-based intervention to reduce melanoma and other skin cancers associated with indoor tanning. Br J Dermatol 2022; 187:105-114. [PMID: 35141876 PMCID: PMC9541204 DOI: 10.1111/bjd.21046] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The use of indoor tanning devices causes melanoma and other skin cancers with resulting morbidity, mortality and increased healthcare costs. Policymakers require robust economic evidence to inform decisions about a possible ban of such devices to mitigate these burdens. OBJECTIVES To assess the health costs and consequences of introducing a policy-based intervention across England to ban commercial indoor tanning with an accompanying public information campaign. METHODS A cost-effectiveness analysis, adopting a healthcare system perspective, was conducted using a decision model to track a national cohort of 18-year-olds over a lifetime time horizon. A nationwide ban on commercial indoor tanning combined with a public information campaign (the policy-based intervention) was compared with the status quo of availability of commercial indoor tanning. The expected costs (currency, GBP; price year, 2019) and quality-adjusted life-years (QALYs) were calculated. Net monetary benefit (NMB) (net benefit measured in cost compared with an accepted threshold) and net health benefit (NHB) (net gain in QALYs compared with an accepted threshold) of implementation were calculated. A probabilistic sensitivity analysis was used to calculate the probability that the intervention was cost-effective. RESULTS Compared with the current situation, a ban on commercial indoor tanning combined with a public information campaign would result in 1206 avoided cases of melanoma, 207 fewer melanoma deaths and 3987 averted cases of keratinocyte cancers over the lifetime of all 18-year-olds (n = 618 873) living in England in 2019. An additional 497 QALYs would be realized along with healthcare cost-savings of £697 858. This intervention would result in an NMB of £10.6m and an NHB of 530 QALYS. Multiple sensitivity analyses confirmed the robustness of the findings. At a cost-effectiveness threshold of £20 000, there is a 99% likelihood of this policy-based intervention being cost-effective. CONCLUSIONS The implementation of a ban on commercial indoor tanning across England with an accompanying public information campaign would be an effective use of healthcare resources.
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Affiliation(s)
- Martin Eden
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health SciencesThe University of ManchesterManchesterUK
| | - Rob Hainsworth
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health SciencesThe University of ManchesterManchesterUK
| | - Louisa G. Gordon
- Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
- School of NursingQueensland University of Technology (QUT)BrisbaneAustralia
- School of Public HealthUniversity of QueenslandBrisbaneAustralia
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health SciencesThe University of ManchesterManchesterUK
| | - Paul Lorigan
- The Christie NHS Foundation TrustManchesterUK
- Division of Cancer Sciences, School of Medical SciencesThe University of ManchesterManchesterUK
| | - Lesley E. Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and HealthThe University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | - Richard Marais
- Cancer Research UK Manchester InstituteThe University of ManchesterManchesterUK
| | - Adele C. Green
- Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
- Cancer Research UK Manchester InstituteThe University of ManchesterManchesterUK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health SciencesThe University of ManchesterManchesterUK
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Luigjes‐Huizer YL, Tauber NM, Humphris G, Kasparian NA, Lam WWT, Lebel S, Simard S, Smith AB, Zachariae R, Afiyanti Y, Bell KJL, Custers JAE, de Wit NJ, Fisher PL, Galica J, Garland SN, Helsper CW, Jeppesen MM, Liu J, Mititelu R, Monninkhof EM, Russell L, Savard J, Speckens AEM, van Helmondt SJ, Vatandoust S, Zdenkowski N, van der Lee ML. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psychooncology 2022; 31:879-892. [PMID: 35388525 PMCID: PMC9321869 DOI: 10.1002/pon.5921] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/14/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
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).
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Affiliation(s)
- Yvonne L. Luigjes‐Huizer
- Helen Dowling InstituteBilthovenThe Netherlands
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Nina M. Tauber
- Unit for Psychooncology and Health PsychologyAarhus University and Aarhus University HospitalAarhusDenmark
| | | | - Nadine A. Kasparian
- Cincinnati Children's Center for Heart Disease and Mental HealthHeart Institute and the Division of Behavioral Medicine & Clinical PsychologyCincinnati Children's Hospital Medical Center and Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Wendy W. T. Lam
- Division of Behavioural SciencesSchool of Public Health, and LKS Faculty of Medicine Jockey Club Institute of Cancer CareUniversity of Hong KongHong KongChina
| | - Sophie Lebel
- Faculty of Social SciencesUniversity of OttawaOttawaOntarioCanada
| | - Sébastien Simard
- Université du Québec à Chicoutimi (UQAC)Centre Intersectoriel en santé durableQuébecQuébecCanada
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research and South West Sydney Clinical CampusesUNSWSydneyNew South WalesAustralia
| | - Robert Zachariae
- Unit for Psychooncology and Health PsychologyAarhus University and Aarhus University HospitalAarhusDenmark
| | - Yati Afiyanti
- Department of Maternity and Women HealthFaculty of NursingUniversitas IndonesiaDepokIndonesia
| | - Katy J. L. Bell
- Sydney School of Public HealthFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - José A. E. Custers
- Department of Medical PsychologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Niek J. de Wit
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Peter L. Fisher
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Jacqueline Galica
- Division of Cancer Care and EpidemiologyQueen's UniversityKingstonOntarioCanada
| | - Sheila N. Garland
- Department of PsychologyFaculty of ScienceMemorial UniversitySt. John'sNewfoundlandCanada
| | - Charles W. Helsper
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Mette M. Jeppesen
- Department of Gynaecology and ObstetricsOdense University HospitalOdenseDenmark
| | - Jianlin Liu
- Research DivisionInstitute of Mental HealthSingaporeSingapore
| | | | - Evelyn M. Monninkhof
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Lahiru Russell
- Centre for Quality and Patient Safety Research & Institute for Health TransformationSchool of Nursing and MidwiferyDeakin UniversityGeelongVictoriaAustralia
- Centre for Quality and Patient Safety Research – Eastern Health PartnershipBox HillVictoriaAustralia
| | - Josée Savard
- School of PsychologyUniversité LavalCHU de Québec‐Université Laval Research CenterUniversité Laval Cancer Research CentreQuebecQuébecCanada
| | - Anne E. M. Speckens
- Department of PsychiatryRadboud University Medical CentreNijmegenThe Netherlands
| | - Sanne J. van Helmondt
- Helen Dowling InstituteBilthovenThe Netherlands
- Department of Medical and Clinical PsychologyCenter of Research on Psychology in Somatic diseasesTilburg UniversityTilburgThe Netherlands
| | - Sina Vatandoust
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Nicholas Zdenkowski
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Marije L. van der Lee
- Helen Dowling InstituteBilthovenThe Netherlands
- Department of Medical and Clinical PsychologyCenter of Research on Psychology in Somatic diseasesTilburg UniversityTilburgThe Netherlands
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Thompson JR, Smith AL, Lo SN, Kasparian NA, Saw RP, Dieng M, Seaman L, Martin LK, Guitera P, Milne D, Schmid H, Cust AE, Bartula I. Protocol for the implementation of a stepped-care model to address fear of cancer recurrence in patients previously diagnosed with early-stage (0-II) melanoma. BMJ Open 2022; 12:e054337. [PMID: 35241467 PMCID: PMC8896053 DOI: 10.1136/bmjopen-2021-054337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/04/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Fear of cancer recurrence (FCR) is commonly reported by patients diagnosed with early-stage (0-II) melanoma and can have a significant impact on daily functioning. This study will pilot the implementation of the Melanoma Care Program, an evidence-based, psychological intervention to reduce FCR, into routine practice, using a stepped-care model. METHODS AND ANALYSIS Intervention effectiveness and level of implementation will be investigated using a hybrid type I design. Between 4 weeks before and 1 week after their next dermatological appointment, patients with melanoma will be invited to complete the Fear of Cancer Recurrence Inventory Short-Form, measuring self-reported FCR severity. Using a stepped-care model, clinical cut-off points will guide the level of support offered to patients. This includes: (1) usual care, (2) Melanoma: Questions and Answers psychoeducational booklet, and (3) three or five psychotherapeutic telehealth sessions. This longitudinal, mixed-methods pilot implementation study aims to recruit 108 patients previously diagnosed with stage 0-II melanoma. The primary effectiveness outcome is change in FCR severity over time. Secondary effectiveness outcomes include change in anxiety, depression, stress, health-related quality of life and melanoma-related knowledge over time. All outcomes are measured at baseline, within 1 week of the final telehealth session, and 6 and 12 months post-intervention. Implementation stakeholders at each study site and interested patients will provide feedback on intervention acceptability and appropriateness. Implementation stakeholders will also provide feedback on intervention cost, feasibility, fidelity and sustainability. These outcomes will be measured throughout implementation, using questionnaires and semistructured interviews/expert group discussions. Descriptive statistics, linear mixed-effects regression and thematic analysis will be used to analyse study data. ETHICS AND DISSEMINATION Ethics approval was granted by the Sydney Local Health District-Royal Prince Alfred Zone (2020/ETH02518), protocol number: X20-0495. Results will be disseminated through peer-reviewed journals, conference presentations, social media and result summaries distributed to interested participants. TRIAL REGISTRATION DETAILS: (ACTRN12621000145808).
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Affiliation(s)
- Jake R Thompson
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
| | - Andrea L Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Robyn Pm Saw
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Linda Seaman
- Consumer Representative, Sydney, New South Wales, Australia
| | - Linda K Martin
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Donna Milne
- Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Helen Schmid
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Iris Bartula
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
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Tutelman PR, Chambers CT, Heathcote LC, Fernandez CV, Flanders A, Patton M, Schulte FSM, Guilcher GMT, Simard S, MacLeod J, Stern M. Measuring Fear of Cancer Recurrence in Survivors of Childhood Cancer: Development and Preliminary Validation of the FCRI-Child and FCRI-Parent Versions. Psychooncology 2022; 31:911-919. [PMID: 35018689 DOI: 10.1002/pon.5879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) for survivors of childhood cancer aged 8-18 years (FCRI-C) and their parents (FCRI-P) to self-report on their own FCR and to examine the initial psychometric properties. METHODS The FCRI-SF was adapted through expert panel input and cognitive interviews with child survivors <18 years. The factor structure, internal consistency and construct and criterion validity of the FCRI-C and FCRI-P were examined in 124 survivors of childhood cancer (43% female; Mage =14.58 years, SD=2.90) and 106 parents (90% mothers). RESULTS All FCRI-SF items were retained for the FCRI-C with simplified language. The internal consistencies of the FCRI-C (α= .88) and FCRI-P (α= .83) were good. Exploratory factor analyses yielded one-factor structures for both measures. Higher scores on the FCRI-C and FCRI-P were associated with greater intolerance of uncertainty and pain catastrophizing. Higher child FCR was also related to more hypervigilance to bodily symptoms. Parents with higher FCR reported contacting their child's doctors and nurses and scheduling medical appointments for their child more frequently. Children reported significantly lower FCR compared to parents. CONCLUSIONS The FCRI-C and FCRI-P demonstrated strong reliability and preliminary validity. This study offers preliminary data to support the use of the FCRI-C and FCRI-P to measure FCR in survivors of childhood cancer aged 8-18 years and their parents. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California, USA
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Flanders
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sébastien Simard
- Department of Health Sciences, Centre intersectoriel en santé durable (CIUSD), Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | | | - Maya Stern
- Patient Partner, Toronto, Ontario, Canada
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11
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Kan JM, Dieng M, Butow PN, Mireskandari S, Tesson S, Menzies SW, Costa DSJ, Morton RL, Mann GJ, Cust AE, Kasparian NA. Identifying the 'Active Ingredients' of an Effective Psychological Intervention to Reduce Fear of Cancer Recurrence: A Process Evaluation. Front Psychol 2021; 12:661190. [PMID: 34163405 PMCID: PMC8215538 DOI: 10.3389/fpsyg.2021.661190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Psychological interventions targeting fear of cancer recurrence (FCR) are effective in reducing fear and distress. Process evaluations are an important, yet scarce adjunct to published intervention trials, despite their utility in guiding the interpretation of study outcomes and optimizing intervention design for broader implementation. Accordingly, this paper reports the findings of a process evaluation conducted alongside a randomized controlled trial of a psychological intervention for melanoma patients. Methods: Men and women with a history of Stage 0-II melanoma at high-risk of developing new primary disease were recruited via High Risk Melanoma Clinics across Sydney, Australia and randomly allocated to receive the psychological intervention (n = 80) or usual care (n = 84). Intervention participants received a tailored psycho-educational resource and three individual psychotherapeutic sessions delivered via telehealth. Qualitative and quantitative data on intervention context, processes, and delivery (reach, dose, and fidelity), and mechanisms of impact (participant responses, moderators of outcome) were collected from a range of sources, including participant surveys, psychotherapeutic session audio-recordings, and clinical records. Results: Almost all participants reported using the psycho-educational resource (97%), received all intended psychotherapy sessions (96%), and reported high satisfaction with both intervention components. Over 80% of participants would recommend the intervention to others, and a small proportion (4%) found discussion of melanoma-related experiences confronting. Perceived benefits included enhanced doctor-patient communication, talking more openly with family members about melanoma, and improved coping. Of potential moderators, only higher FCR severity at baseline (pre-intervention) was associated with greater reductions in FCR severity (primary outcome) at 6-month follow-up (primary endpoint). Conclusions: Findings support the acceptability and feasibility of a psychological intervention to reduce FCR amongst individuals at high risk of developing another melanoma. Implementation into routine melanoma care is an imperative next step, with FCR screening recommended to identify those most likely to derive the greatest psychological benefit.
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Affiliation(s)
- Janice M Kan
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Shab Mireskandari
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Stephanie Tesson
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, The University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia.,School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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12
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Wagner LI, Tooze JA, Hall DL, Levine BJ, Beaumont J, Duffecy J, Victorson D, Gradishar W, Leach J, Saphner T, Sturtz K, Smith ML, Penedo F, Mohr DC, Cella D. Targeted eHealth Intervention to Reduce Breast Cancer Survivors' Fear of Recurrence: Results from the FoRtitude Randomized Trial. J Natl Cancer Inst 2021; 113:1495-1505. [PMID: 34057469 PMCID: PMC8244801 DOI: 10.1093/jnci/djab100] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, “FoRtitude,” to reduce FoR using cognitive behavioral skills training and telecoaching. Methods BCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content [HMC]) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided. Results FCRI scores [SD] decreased statistically significantly from baseline to postintervention (T0 = 53.1 [17.4], T2 = 41.9 [16.2], P < .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score [SD] = 26.6 [7.2] vs 21.0 [10.5], P < .001). Conclusions BCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
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Affiliation(s)
- Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Daniel L Hall
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | | | - Jenna Duffecy
- Department of Psychiatry, University of Illinois, Chicago, IL
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - William Gradishar
- Department of Medicine/Division of Hematology & Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Frank Penedo
- Departments of Medicine and Psychology, University of Miami, Coral Gables, FL
| | - David C Mohr
- Department of Preventive Medicine and Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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13
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Examining Predictors of Fear of Cancer Recurrence Using Leventhal's Commonsense Model: Distinct Implications for Oncology Nurses. Cancer Nurs 2021; 44:3-12. [PMID: 31868820 DOI: 10.1097/ncc.0000000000000760] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a common concern for survivors. Oncology nurses have a unique opportunity to identify survivors at increased risk of heightened FCR. Understanding predictors of FCR would be useful for this purpose; however, results about FCR predictors are inconsistent. OBJECTIVE To examine empirically inconsistent predictors of FCR as guided by Leventhal's Commonsense Model. METHODS A cross-sectional survey design was used to assess FCR, sociodemographic and clinical characteristics, and characteristics of the self (self-esteem and generalized expectancies) among cancer survivors. Structural equation modeling was used to examine predictors of FCR. RESULTS Among 1001 participants, the mean time since diagnosis was 9.07 years, and most were diagnosed with breast cancer (65.93%). The strongest predictor of higher FCR was belief that knowing someone with a recurrence affects one's own level of FCR, although knowing someone with a recurrence actually predicted lower FCR. Other significant predictors of higher FCR were having 1 or more symptoms attributed to cancer, lower self-esteem, younger age, female gender, lower pessimism, longer time since diagnosis, and active follow-up at the survivorship clinic. CONCLUSION Cancer survivors' perceptions are among an important series of variables that may predict higher levels of FCR. Oncology nurses are uniquely situated to identify the subset of cancer survivors with levels of FCR requiring professional intervention. IMPLICATIONS FOR PRACTICE Oncology nurses can use the predictors indicated in this study to identify survivors with greatest need for coping with FCR to facilitate expedient intervention and/or referral to psychosocial providers.
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14
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Maheu C, Singh M, Tock WL, Eyrenci A, Galica J, Hébert M, Frati F, Estapé T. Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research. Front Psychol 2021; 12:644932. [PMID: 33912113 PMCID: PMC8072115 DOI: 10.3389/fpsyg.2021.644932] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice. Inclusion Criteria: We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs. Methods and Analysis: The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings. Findings: After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty. Conclusion: While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted.
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Affiliation(s)
- Christine Maheu
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Mina Singh
- Faculty of Health, School of Nursing, York University, Toronto, ON, Canada
| | - Wing Lam Tock
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Asli Eyrenci
- Department of Psychology, Faculty of Humanities and Social Sciences, Maltepe University, Istanbul, Turkey
| | - Jacqueline Galica
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, ON, Canada
| | - Maude Hébert
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Francesca Frati
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, QC, Canada
| | - Tania Estapé
- Psychosocial Oncology Department, Fundació per l'Educació i la Formació en Càncer (FEFOC) Fundació, Barcelona, Spain
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15
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van Helmondt SJ, van der Lee ML, Bisseling EM, Lodder P, de Vries J. Factor structure of the Fear of Cancer Recurrence Inventory (FCRI): Comparison of international FCRI factor structure data and factor analysis of the Dutch FCRI-NL using three predominantly breast cancer samples. Eur J Cancer Care (Engl) 2021; 30:e13431. [PMID: 33763943 PMCID: PMC8519082 DOI: 10.1111/ecc.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 12/03/2020] [Accepted: 02/25/2021] [Indexed: 11/27/2022]
Abstract
Objective Factor structure results of Fear of Cancer Recurrence Inventory (FCRI) translations are inconclusive. Through investigating the factor structure, this study aimed to improve the FCRI and its usability. Therefore, we did a comprehensive comparison of the factor structure results of all translations, by exploring and improving the structure of the Dutch FCRI‐NL and by testing this new factor structure in two patient samples. Methods To compare factor structure results of FCRI translations, we did a literature search using PubMed and Google Scholar. We performed exploratory factor analysis (EFA) in a mixed cancer sample. The confirmatory factor analyses (CFAs) were secondary analyses performed in two randomized controlled trial samples: consecutive breast cancer patients and distressed, mainly breast cancer patients. Results All translations showed comparable and reasonable factor structure results; however, the FCRI factor structure can be improved. The EFA resulted in a four‐factor solution: fear of cancer recurrence (FCR) severity, cognitive coping, impact of FCR on functioning and behavioural coping. However, the 4‐factor CFAs did not fit the sample 2 and 3 data well. Conclusion Further exploring the FCRI‐NL factor structure did not result in a psychometrically stronger FCRI‐NL. Therefore, we recommend retaining the 7‐factor FCRI‐NL.
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Affiliation(s)
- Sanne Jasperine van Helmondt
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands
| | - Marije Liesbeth van der Lee
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands
| | - Else Maria Bisseling
- Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands.,Department of Psychiatry, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Admiraal de Ruyter Hospital (Adrz), Goes, The Netherlands
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16
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Smith AB, Costa D, Galica J, Lebel S, Tauber N, van Helmondt SJ, Zachariae R. Spotlight on the Fear of Cancer Recurrence Inventory (FCRI). Psychol Res Behav Manag 2020; 13:1257-1268. [PMID: 33376421 PMCID: PMC7762428 DOI: 10.2147/prbm.s231577] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI's increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.
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Affiliation(s)
- Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
| | - Daniel Costa
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline Galica
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, Ontario, Canada
| | - Sophie Lebel
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nina Tauber
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Sanne Jasperine van Helmondt
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Scientific Research Department, Helen Dowling Institute, Bilthoven, the Netherlands
| | - Robert Zachariae
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
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17
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Lisy K, Lai-Kwon J, Ward A, Sandhu S, Kasparian NA, Winstanley J, Boyle F, Gyorki D, Lacey K, Bishop J, Jefford M. Patient-reported outcomes in melanoma survivors at 1, 3 and 5 years post-diagnosis: a population-based cross-sectional study. Qual Life Res 2020; 29:2021-2027. [PMID: 32140919 DOI: 10.1007/s11136-020-02464-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE There is a lack of population-based data describing patient reported outcomes (PROs) in melanoma survivors which could guide the development of interventions and resources. This study assessed overall quality of life (QoL), self-reported symptoms and unmet information needs in melanoma survivors 1, 3 or 5 years post-diagnosis. METHODS A cross-sectional postal survey was conducted in Victoria, Australia, with eligible melanoma survivors identified from a population-based cancer registry. Patient-reported outcome measures included the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and self-reported symptoms, difficulties and information needs. Associations between demographic, disease and care-related factors and QoL were also assessed. RESULTS A total of 476 melanoma survivors participated in the study (response rate 46.5%). Anxiety and depressive symptoms were more prevalent in survivors compared to the general population (30.7% vs 21.6%; p < 0.01). Fear of cancer recurrence (48.3%) and fear of cancer spreading (37.8%) were the most commonly reported symptom items, and approximately one in five melanoma survivors had unmet information needs related to psychological aspects of living with melanoma. Recurrent melanoma, living in a nursing home, chronic comorbidities, and melanoma diagnosed at > 2 mm thickness were associated with lower QoL. CONCLUSION A large proportion of melanoma survivors reported ongoing quality of life deficits, fear of cancer recurrence, as well as unmet information needs up to 5 years after diagnosis. Patients may benefit from tailored informational resources and interventions that address the psychological aspects of living with and beyond melanoma.
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Affiliation(s)
- Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Andrew Ward
- The Social Research Centre, Melbourne, VIC, Australia
| | - Shahneen Sandhu
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and the Developing Mind, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julie Winstanley
- Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, University of Sydney, Sydney, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, University of Sydney, Sydney, NSW, Australia
| | - David Gyorki
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Karen Lacey
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Jim Bishop
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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18
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Murphy MJ, Newby JM, Butow P, Loughnan SA, Joubert AE, Kirsten L, Allison K, Shaw J, Shepherd HL, Smith J, Andrews G. Randomised controlled trial of internet-delivered cognitive behaviour therapy for clinical depression and/or anxiety in cancer survivors (iCanADAPT Early). Psychooncology 2019; 29:76-85. [PMID: 31659822 DOI: 10.1002/pon.5267] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 09/26/2019] [Accepted: 10/13/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate internet-delivered cognitive behavioural therapy (iCBT) on clinical depression and/or anxiety, distress, fear of cancer recurrence, and quality of life in cancer survivors. METHODS Random assignation of 114 participants to iCBT or treatment-as-usual (TAU). The clinician-supervised iCBT program (iCanADAPT Early) consisted of eight lessons over 16 weeks. Self-report questionnaires occurred at baseline, midpoint, and posttreatment for both groups with 3-month follow-up for iCBT participants. A mixed modelling approach to compare groups occurred. RESULTS iCBT was superior to TAU on all outcome measures at posttreatment. Compared with TAU, the iCBT group showed a significant decrease over time in anxiety and depression symptoms (primary outcome, Hospital Anxiety and Depression Scale, Hedges g = 1.51). Additionally the iCBT group had significantly lower general distress (Kessler-10, g = 1.56), fear of cancer recurrence (Fear of Cancer Recurrence Inventory, g = 0.39), and significantly higher quality of life (Functional Assessment of Cancer Therapy-General, g = 0.74) at posttreatment compared with the TAU group. High adherence and satisfaction were found for iCBT with low clinician time. CONCLUSION Clinician-supervised iCBT has significant benefits for cancer survivors with clinical depression and anxiety disorders.
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Affiliation(s)
- M J Murphy
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - J M Newby
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia.,School of Psychology, Faculty of Science, UNSW, NSW, Australia
| | - P Butow
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - S A Loughnan
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - A E Joubert
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - L Kirsten
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia.,Nepean Cancer Care Centre, NSW, Australia
| | - K Allison
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - J Shaw
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - H L Shepherd
- Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia
| | - J Smith
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
| | - G Andrews
- Clinical Research Unit for Anxiety and Depression, UNSW, NSW, Australia
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19
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Dieng M, Khanna N, Kasparian NA, Costa DSJ, Butow PN, Menzies SW, Mann GJ, Cust AE, Morton RL. Cost-Effectiveness of a Psycho-Educational Intervention Targeting Fear of Cancer Recurrence in People Treated for Early-Stage Melanoma. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:669-681. [PMID: 31228015 DOI: 10.1007/s40258-019-00483-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the cost effectiveness of a newly developed psycho-educational intervention to reduce fear of cancer recurrence (FCR) in early-stage melanoma patients. METHODS A within-trial cost-effectiveness and cost-utility analysis was conducted from the Australian health system perspective using data from linked Medicare records. Outcomes included FCR, measured with the severity subscale of the FCR Inventory; quality-adjusted life years (QALYs) measured using the preference-based instrument, Assessment of Quality of Life-8 Dimensions (AQoL-8D) and 12-month survival. An incremental cost-effectiveness ratio (ICER) was calculated for two economic outcomes: (1) cost per additional case of 'high' FCR avoided and (2) cost per QALY gained. Means and 95% CIs around the ICER were generated from non-parametric bootstrapping with 1000 replications. RESULTS A total of 151 trial participants were included in the economic evaluation. The mean cost of the psycho-educational intervention was AU$1614 per participant, including intervention development costs. The ICER per case of high FCR avoided was AU$12,903. The cost-effectiveness acceptability curve demonstrated a 78% probability of the intervention being cost effective relative to the control at a threshold of AU$50,000 per extra person avoiding FCR. The ICER per QALY gained was AU$116,126 and the probability of the intervention being cost effective for this outcome was 36% at a willingness to pay of AU$50,000 per QALY. CONCLUSION The psycho-educational intervention reduced FCR at 12 months for people at high risk of developing another melanoma and may represent good value for money. For the QALY outcome, the psycho-educational intervention is unlikely to be cost effective at standard government willingness-to-pay levels. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (CTRN12613000304730).
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Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building, Level 6, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia.
| | - Nikita Khanna
- NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building, Level 6, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Nadine A Kasparian
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Kensington, Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Phyllis N Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, Sydney, NSW, 2050, Australia
| | - Graham J Mann
- Melanoma Institute Australia, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research and Melanoma Institute Australia, Sydney School of Public Health, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre and Melanoma Institute Australia, The University of Sydney, Camperdown, Sydney, NSW, Australia
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20
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Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, Wilhelm LR, Monahan PO, LaPradd ML, Champion VL, Miller KD, Giesler RB. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial. Cancer 2019; 126:211-218. [PMID: 31539169 DOI: 10.1002/cncr.32518] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/07/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS. METHODS Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis. RESULTS Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress. CONCLUSIONS Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.
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Affiliation(s)
- Shelley A Johns
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Patrick V Stutz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tasneem L Talib
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Andrea A Cohee
- Indiana University School of Nursing, Indianapolis, Indiana
| | - Kathleen A Beck-Coon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Nursing, Indianapolis, Indiana
| | - Linda F Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura R Wilhelm
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Charleston, West Virginia
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michelle L LaPradd
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Kathy D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Research and Clinical Trials, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - R Brian Giesler
- Department of Psychology, Butler University, Indianapolis, Indiana
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21
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Huang FF, Li H, Lei Y, Li Q, Chen B. Adaptation and validation of the Chinese version of the modified Leiden index of depression sensitivity. J Affect Disord 2019; 256:458-467. [PMID: 31254721 DOI: 10.1016/j.jad.2019.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The revised Leiden index of depression sensitivity (LEIDS-RR) is commonly used worldwide to measure a marker of depression vulnerability termed cognitive reactivity (CR). However, the optimal cut-off scores for this scale and for the Chinese version of LEIDS-RR (LEIDS-RR-CV) are unknown. OBJECTIVES The main aims were to examine the psychometric properties of the LEIDS-RR and establish appropriate cut-off scores for the Chinese population. METHODS Psychometric evaluation was performed for 330 healthy individuals and 330 depression patients in remission, by incorporating classical test theory and item response theory (IRT) methods. Receiver operating characteristic curve analysis was used to determine the optimal LEIDS-RR-CV cut-off. RESULTS Cronbach's α, two-week test-retest reliability, and marginal reliability for the LEIDS-RR-CV were 0.92, 0.40, and 0.96, respectively. Confirmatory factor analysis validated the five-factor model, and the cut-off values to screen a population at risk of depression were 60 and 55 for the healthy individuals and patients, respectively. Patients had higher CR than healthy individuals (t = 6.10, p = 0.00), and this was positively correlated with the total CES-D Scale score (r = 0.52, p = 0.00), also confirmed by IRT analysis, indicating the discriminative and concurrent validity of the scale. LIMITATIONS The generalizability of these findings may be limited given the sampling method and the fact that all patients were recruited from a tertiary hospital. CONCLUSIONS The 26-item LEIDS-RR-CV is a reliable and valid instrument to assess CR in Chinese populations. It can be used for screening at-risk populations and in epidemiological studies to guide the development of tailored intervention strategies.
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Affiliation(s)
- Fei Fei Huang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China.
| | - Hong Li
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China; Fujian Provincial Hospital, Fuzhou, China
| | - Yang Lei
- School of Nursing, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Qi Li
- Neurosurgery Department, 900 Hospital, Fuzhou, Fujian, China
| | - Bin Chen
- Psychiatric Department, Fuzhou Fourth Hospital, Fuzhou, Fujian, China
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22
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Spring B, Stump T, Penedo F, Pfammatter AF, Robinson JK. Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change. Health Psychol 2019; 38:840-850. [PMID: 31436465 PMCID: PMC6709684 DOI: 10.1037/hea0000760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. METHOD We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. RESULTS Findings indicate that no entity in the health care system self-identifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. CONCLUSIONS To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Tammy Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | | | - June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine
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23
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Dieng M, Morton RL, Costa DSJ, Butow PN, Menzies SW, Lo S, Mann GJ, Cust AE, Kasparian NA. Benefits of a brief psychological intervention targeting fear of cancer recurrence in people at high risk of developing another melanoma: 12-month follow-up results of a randomized controlled trial. Br J Dermatol 2019; 182:860-868. [PMID: 30965384 DOI: 10.1111/bjd.17990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with melanoma want and need effective interventions for living with fear of cancer recurrence (FCR). OBJECTIVES This study reports the 12-month outcomes of a brief, psychological intervention designed to reduce FCR in people at high risk of developing another primary melanoma compared with usual care. METHODS In this two-arm randomized controlled trial, adults previously diagnosed with stage 0, I or II melanoma were randomly allocated to the intervention (n = 80) or control (usual care) arm (n = 84). The trial was registered with the Australian and New Zealand Clinical Trials Registry on 19 March 2013 (registration: ACTRN12613000304730). The intervention comprised a 76-page psychoeducational resource and three individually tailored, telephone-based sessions with a psychologist, scheduled at specific time points around participants' dermatological appointments. The primary outcome was the level of self-reported fear of new or recurrent melanoma assessed at 12 months postintervention using the severity subscale of the Fear of Cancer Recurrence Inventory. RESULTS Compared with the control arm, the intervention group reported significantly lower FCR at 12 months postintervention; the between-group mean difference was -1·41 for FCR severity [95% confidence interval (CI) -2·6 to -0·2; P = 0·02] and -1·32 for FCR triggers (95% CI -2·6 to -0·02; P = 0·04). The odds ratio for FCR severity scores ≥13 (54% intervention, 63% control) was 0·59 (95% CI 0·30-1·14, P = 0·12). There were no differences between groups in secondary outcomes, such as anxiety, depression or health-related quality of life. CONCLUSIONS The previously reported 6-month benefits of this brief, patient-centred psychological intervention in reducing FCR were found to continue 12 months postintervention, with no known adverse effects, supporting implementation as part of routine melanoma care.
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Affiliation(s)
- M Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, NSW, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - R L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, NSW, Australia
| | - D S J Costa
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, NSW, Australia
| | - P N Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, NSW, Australia
| | - S W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, NSW, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, NSW, Australia
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, NSW, Australia.,Institute for Research and Medical Consultations, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - G J Mann
- Melanoma Institute Australia, The University of Sydney, NSW, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Australia
| | - A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, NSW, Australia
| | - N A Kasparian
- Melanoma Institute Australia, The University of Sydney, NSW, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.,Harvard Medical School, Boston, MA, U.S.A
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24
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Dieng M, Kasparian NA, Cust AE, Costa DSJ, Tran A, Butow PN, Menzies SW, Mann GJ, Morton RL. Sensitivity of Preference-Based Quality-of-Life Measures for Economic Evaluations in Early-Stage Melanoma. JAMA Dermatol 2019; 154:52-59. [PMID: 29188268 DOI: 10.1001/jamadermatol.2017.4701] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The diagnosis of a life-threatening disease like melanoma can affect all aspects of a person's life, including health-related quality of life (HRQOL) and psychological aspects of melanoma such as fear of cancer recurrence (FCR). Economic evaluations of psychological interventions require preference-based (utility) instruments that are sensitive to changes in well-being and HRQOL; however, very few studies have evaluated the sensitivity of these instruments when used for people with melanoma. Objective To compare utility scores from the multiple-attribute instrument Assessment of Quality of Life-8-Dimension Scale (AQoL-8D) with the mapped utility scores of the Functional Assessment of Cancer Therapy-Melanoma (FACT-M) and to investigate the sensitivity of both instruments in identifying the influence of FCR on HRQOL. Design, Setting, and Participants This assessment of data from a randomized clinical trial of a psychoeducational intervention to reduce FCR, conducted at 3 high-risk melanoma clinics in Australia, evaluated 164 patients with early-stage melanoma and a high risk of developing a second primary melanoma. Main Outcomes and Measures The FACT-M and AQoL-8D were used to assess HRQOL and FCR among the study participants. Concurrent validity was assessed by comparing the total and subdomain scores of the 2 instruments, and the strength of associations was assessed using Pearson correlation coefficient. Convergent validity was assessed by comparing participants' HRQOL, demographic, and clinical characteristics using the χ2 test and F statistic. Both the FACT-M and AQoL-8D utilities were regressed on FCR Inventory (FCRI) severity scores to estimate the effect of elevated FCR on HRQOL. Results A total of 164 participants completed the baseline questionnaires, but only 163 met all inclusion criteria and underwent the full analysis: 72 were women; 91 were men; and mean (SD) age was 58.2 (12.1) years. Both the AQoL-8D and FACT-M instruments showed good concurrent validity and could differentiate between relevant subgroups including level of FCRI severity. The AQoL-8D and FACT-M utilities were strongly correlated (r2 = 0.57). Respondents had a mean (SD) AQoL-8D utility of 0.77 (0.2), and a mean (SD) FACT-M utility score of 0.76 (0.07). High levels of FCRI severity were associated with a decrease in utility of 0.12 (95% CI, -0.19 to -0.05) as measured by AQoL-8D, and a decrease of 0.03 (95% CI, -0.05 to -0.01) as measured by the FACT-M. Conclusions and Relevance For economic evaluations of psychological interventions in melanoma, the AQoL-8D and FACT-M are valid measures of utility; however, the AQoL-8D demonstrates greater sensitivity to FCRI severity. Our results suggest a significant association between FCR and HRQOL.
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Affiliation(s)
- Mbathio Dieng
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia.,Melanoma Institute Australia, University of Sydney, North Sydney, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Anh Tran
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia
| | - Phyllis N Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Graham J Mann
- Melanoma Institute Australia, University of Sydney, North Sydney, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Rachael L Morton
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia
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25
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The fear of cancer recurrence literature continues to move forward: a review article. Curr Opin Support Palliat Care 2019; 12:40-45. [PMID: 29251693 DOI: 10.1097/spc.0000000000000323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The volume of literature addressing fear of cancer recurrence (FCR) is rapidly increasing. A summary of key developments in the research and treatment of FCR was published by Sharpe et al. in 2017, and the current review focuses on works published thereafter. RECENT FINDINGS A comprehensive literature review was conducted to provide an up-to-date summary of peer-reviewed publications focusing on FCR. The search consisted of the most recent FCR reports published between 2016 and 2017, which can be broadly categorized as: methods of assessment; associations with FCR; FCR and caregivers; and FCR interventions. SUMMARY FCR assessments continue to undergo revisions, which may have positive implications for clinicians and researchers seeking shorter measures to assess the FCR of their patients and study participants. However, research is needed to determine if a shorter FCR measure could be created using items that measure the construct alone, yet still retaining optimal sensitivity and specificity, or also with its determinants and consequences. Doing so would result in either unidimensional or multidimensional measure of FCR. Notwithstanding these matters in FCR assessment, the state of the literature continues to advance our understanding about characteristics of survivors with highest FCR, which is useful to identify patients in need of FCR interventions. These empirical results are useful to further investigate the theoretical distinctions of FCR.
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26
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Wagner T, Augustin M, Blome C, Forschner A, Garbe C, Gutzmer R, Hauschild A, Heinzerling L, Livingstone E, Loquai C, Schadendorf D, Terheyden P, Mueller-Brenne T, Kähler KC. Fear of cancer progression in patients with stage IA malignant melanoma. Eur J Cancer Care (Engl) 2018; 27:e12901. [PMID: 30126009 DOI: 10.1111/ecc.12901] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/25/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022]
Abstract
We aimed to determine the prevalence and importance of fear of cancer progression (FoP) in melanoma patients with stage IA tumours to assess psychosocial and demographic factors associated with severity of FoP and to determine the relationship of FoP and quality of life (QoL). One hundred and thirty-six patients with stage IA melanoma completed the short version of the Fear of Progression Questionnaire (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS) and the EORTC-QLQ-C30. We found a mean FoP-Q-SF sum score of 30.2 points (±8.4 points SD). In this study, 33% of patients reported high FoP at or above the cutoff-value of 34 points. Higher FoP was found in women (p < 0.01), young (p = 0.03) and employed (p = 0.02) patients. Being confronted with a cancer diagnosis in closely related persons predicted higher FoP (p < 0.01). FoP correlated positively with the HADS anxiety (r = 0.50, p < 0.01) and depression scales (r = 0.26, p < 0.01) and negatively with the EORTC-QLQ-C30 global health state (r = -0.32, p < 0.01). FoP is considerably prevalent in low-risk melanoma patients and associated with reduced QoL, cancer in related persons, women sex and participation in working life. Considerably high levels of FoP, even in patients with low-risk malignancies, underline the need for psychosocial support and psychotherapeutic interventions for melanoma patients.
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Affiliation(s)
- Tobias Wagner
- German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Blome
- German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Forschner
- Department of Dermatology, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Axel Hauschild
- Department of Dermatology, Skin Cancer Center, University of Kiel, Kiel, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | | | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Patrick Terheyden
- Department of Dermatology, University Hospital (UKSH), Luebeck, Germany
| | | | - Katharina C Kähler
- Department of Dermatology, Skin Cancer Center, University of Kiel, Kiel, Germany
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27
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Shilling V, Starkings R, Jenkins V, Cella D, Fallowfield L. Development and validation of the patient roles and responsibilities scale in cancer patients. Qual Life Res 2018; 27:2923-2934. [PMID: 30051259 PMCID: PMC6208586 DOI: 10.1007/s11136-018-1940-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The Patient Roles and Responsibilities Scale (PRRS) was developed to enable a broader evaluation of the impact of cancer and cancer treatment, measuring 'real world' roles and responsibilities such as caring for others and financial and employment responsibilities. Here, we report the development and initial validation. METHODS The 29-item PRRS was developed from the thematic analysis of two interview studies with cancer patients and caregivers. In the evaluation study, participants completed the PRRS alongside the Social Difficulties Inventory (SDI), the main criterion measure for concurrent validity, and the Functional Assessment of Cancer Therapy - General and WHO Quality of Life-BREF (WHOQOL-BREF) for additional convergent validity data. Questionnaires were completed at baseline, 7-days (PRRS only) and 2 months. Demographic data and patient characteristics were collected at baseline. RESULTS One hundred and thirty-five patients with stage III/IV breast, lung or gynaecological cancer or melanoma completed the PRRS at least once. Five items performed poorly and were removed from the scale. The final 16 core items selected comprised 3 dimensions: family well-being, responsibilities and social life, and financial well-being, identified in principal component analysis, accounting for 61.5% of total variance. Missing data (0.6%) and floor/ceiling effects were low (0%/1.5%). Cronbach's alpha was 0.9 for the PRRS-16; 0.79-0.87 for the subscales. PRRS showed good test-retest reliability (ICC-0.86), sensitivity to change and the predicted pattern of correlation with validation measures r = |0.65-0.77|. The standalone 7-item jobs and careers subscale requires further validation. CONCLUSIONS Initial evaluation shows that the PRRS is psychometrically robust with potential to inform the evaluation of new treatments in clinical trials and real-world studies.
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Affiliation(s)
- Valerie Shilling
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK.
| | - Rachel Starkings
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
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Russell L, Ugalde A, Milne D, Krishnasamy M, O Seung Chul E, Austin DW, Chambers R, Orellana L, Livingston PM. Feasibility of an online mindfulness-based program for patients with melanoma: study protocol for a randomised controlled trial. Trials 2018; 19:223. [PMID: 29653555 PMCID: PMC5899401 DOI: 10.1186/s13063-018-2575-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a melanoma diagnosis are at risk of recurrence, developing a new primary or experiencing disease progression. Previous studies have suggested that fear of a cancer recurrence is clinically relevant in this group of patients and, if not addressed, can lead to distress. Mindfulness-based interventions have been shown to alleviate symptoms of anxiety and depression among various groups of cancer patients. Online mindfulness-based interventions have the potential to reach people unable to attend face-to-face interventions due to limitations such as cancer-related illness, transportation or time constraints. This study aims to (1) examine whether individuals with a melanoma diagnosis are willing to participate and adhere to a 6-week online mindfulness-based intervention and (2) explore potential benefits of the program on fear of cancer recurrence, worries, rumination, perceived stress and trait mindfulness to inform the design of a clinical trial. METHODS/DESIGN This is a single-site randomised controlled trial of a feasibility study. Seventy-five participants with stage 2c or 3 melanoma will be recruited from a melanoma outpatient clinic and randomised (2:1) either to an online mindfulness-based program (intervention) or to usual care (control). The intervention is a 6-week program specifically developed for this study. It consists of videos describing the concept of mindfulness, short daily guided meditation practices (5-10 min), automated meditation reminders and instructions for applying mindfulness in daily life to enhance wellbeing. All participants will complete questionnaires at baseline and at 6-week post-randomisation. Participants in the control group will be given access to the online program at the end of the study. Primary outcomes are overall recruitment; retention; extent of questionnaire completion; and usability and acceptability of, and adherence to, the program. The secondary outcomes are fear of cancer recurrence, worries, rumination, perceived stress and trait mindfulness measured using validated instruments. DISCUSSION This feasibility study will evaluate participants' satisfaction with the program and identify barriers to recruitment and adherence. The recruitment and data collection process will highlight methodological aspects to address in the planning of a larger scale study assessing the impact of an online mindfulness-based intervention on fear of cancer recurrence and wellbeing. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12617000081314 . Registered on 16 January 2017.
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Affiliation(s)
- Lahiru Russell
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Geelong, Australia.
| | - Anna Ugalde
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Geelong, Australia
| | - Donna Milne
- Skin and Melanoma Services/Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Eric O Seung Chul
- Deakin University, School of Psychology, Faculty of Health, Geelong, Australia
| | - David W Austin
- Deakin University, School of Psychology, Faculty of Health, Geelong, Australia
| | - Richard Chambers
- Campus Community Division, Monash University, Clayton, Australia
| | - Liliana Orellana
- Deakin University, Biostatistics Unit, Faculty of Health, Geelong, Australia
| | - Patricia M Livingston
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Geelong, Australia
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Humphris GM, Watson E, Sharpe M, Ozakinci G. Unidimensional scales for fears of cancer recurrence and their psychometric properties: the FCR4 and FCR7. Health Qual Life Outcomes 2018; 16:30. [PMID: 29471823 PMCID: PMC5822647 DOI: 10.1186/s12955-018-0850-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 01/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The assessment of fear of recurrence (FCR) is crucial for understanding an important psychological state in patients diagnosed and treated for cancer. The study aim was to determine psychometric details of a seven question self-report scale (FCR7) and a short form (FCR4) based upon items already used in various extensive measures of FCR. METHODS Two consecutive samples of patients (breast and colorectal) were recruited from a single specialist cancer centre. The survey instrument contained the FCR7 items, Hospital Anxiety and Depression Scale (HADS), and demographic details. Clinical information was obtained from patient hospital records. Statistical analyses were performed using classical test and item response theory approaches, to demonstrate unidimensional factor structure and testing key parameters. Construct validity was inspected through nomological and theoretical prediction. RESULTS Internal consistency was demonstrated by alpha coefficients (FCR4: 0.93 and FCR7: 0.92). Both scales (FCR7 & FCR4) were associated with the HADs subscales as predicted. Patients who experienced chemotherapy, minor aches/pains, thought avoidance of cancer and high cancer risk belief were more fearful. Detailed inspection of item responses profile provided some support for measurement properties of scales. CONCLUSION The internal consistency, and pattern of key associations and discriminability indices provided positive psychometric evidence for these scales. The brief measures of FCR may be considered for audit, screening or routine use in clinical service and research investigations.
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Affiliation(s)
- G. M. Humphris
- School of Medicine, University of St Andrews, St Andrews, Fife, Scotland
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland
| | - E. Watson
- School of Medicine, University of St Andrews, St Andrews, Fife, Scotland
| | - M. Sharpe
- Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX England
| | - G. Ozakinci
- School of Medicine, University of St Andrews, St Andrews, Fife, Scotland
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van Helmondt SJ, van der Lee ML, de Vries J. Translation and validation of the Dutch version of the Fear of Cancer Recurrence Inventory (FCRI-NL). J Psychosom Res 2017; 102:21-28. [PMID: 28992893 DOI: 10.1016/j.jpsychores.2017.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study objectives are to translate the FCRI in Dutch, and to explore the factor structure and the psychometric qualities of the Dutch translation of the Fear of Cancer Recurrence Inventory (FCRI-NL). METHOD The original French-Canadian FCRI had been forward-backward translated into English by the developers, and this method was also used to translate the English version of the FCRI into Dutch. Patients were recruited via patient organizations between July 2011 and October 2013. To replicate the original 7-factor structure of the FCRI, confirmatory factor analysis (CFA) was performed. To examine the psychometric qualities, reliability (Cronbach's alpha), test-retest reliability (intra-class correlations; ICC), and convergent and divergent validity (Spearman's correlations) were calculated. RESULTS From 290 cancer patients, 255 (88%) were eligible for analysis (aged 51.0±9.8years, 88.6% women). CFA showed a reasonable yet suboptimal fit of the hypothesized model to the data. The FCRI-NL has good reliability (Cronbach's α=0.93 for the total scale and α=0.75-0.92 for the subscales) and test-retest reliability (ICC=0.84 for the total scale and ICC=0.56-0.87 for the subscales). Convergent (r=0.53-0.66 for the FCRI-NL and r=0.48-0.57 for the FCRI-SF-NL) and divergent (r=-0.20--0.07 for the FCRI-NL and r=-0.28--0.17 for the FCRI-SF-NL) validity was demonstrated. CONCLUSION The FCRI-NL seems to have sufficient psychometric properties. However, the FCRI-NL total score should be interpreted with caution. The Severity subscale (FCRI-SF-NL) may be a valuable screening tool for fear of cancer recurrence severity in clinical care.
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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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Dieng M, Kasparian NA, Mireskandari S, Butow P, Costa D, Morton R, Mann G, Menzies S, Cust A. Psychoeducational intervention for people at high risk of developing another melanoma: a pilot randomised controlled trial. BMJ Open 2017; 7:e015195. [PMID: 29018064 PMCID: PMC5652456 DOI: 10.1136/bmjopen-2016-015195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Information and psychological needs have been reported as one of the greatest areas of unmet needs for patients with melanoma. To respond to these needs, we developed the Melanoma Care Intervention, a developed psychoeducational intervention for people at high risk of developing another melanoma comprising of a newly developed melanoma educational booklet and individually tailored telephone support sessions provided by trained psychologists. The purpose of this study was to investigate the acceptability and feasibility of the Melanoma Care Intervention. METHODS Twenty-four adults (14 men, 10 women, mean age: 58 years, SD: 12.2) at high risk of developing a subsequent primary melanoma were recruited and randomly assigned 1:1 to the intervention (a psychoeducational booklet, a Cancer Council booklet on melanoma and up to five telephone-based sessions with a psychologist) or usual care (Cancer Council booklet only). Acceptability, feasibility, fear of cancer recurrence and secondary psychosocial outcomes were assessed at baseline, 1 and 6 months. RESULTS Satisfaction and perceived benefits were rated highly for all intervention components, particularly the telephone-based psychology sessions (mean satisfaction and benefits: both 9.27 out of 10, SD=2.41). The quality of information and support provided throughout the trial was rated as 'high' by the intervention group, with a mean score of 4.6 out of a possible 5 (SD=0.9) and 4.2 (SD=1.2) for the control group. CONCLUSIONS The intervention was feasible and acceptable for improving psychological adjustment. Timely access to effective, evidence-based, psychological care is a recognised need for people with melanoma. The intervention is designed to directly address this need in a way that is feasible in a clinical setting, acceptable to patients and health professionals. TRIAL REGISTRATION NUMBER The trial was registered with the Australian and New Zealand Clinical Trials Registry on 19/03/2013 (Registration Number: ACTRN12613000304730).
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Affiliation(s)
- Mbathio Dieng
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - N A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Shab Mireskandari
- Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Costa
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Rachael Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Graham Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
- Melanoma Institute Australia, The University of Sydney, North Sydney, Australia
| | - Scott Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, Australia
- The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Anne Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
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Bell KJ, Mehta Y, Turner RM, Morton RL, Dieng M, Saw R, Guitera P, McCaffery K, Low D, Low C, Jenkins M, Irwig L, Webster AC. Fear of new or recurrent melanoma after treatment for localised melanoma. Psychooncology 2017; 26:1784-1791. [DOI: 10.1002/pon.4366] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/01/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Katy J.L. Bell
- The School of Public Health; The University of Sydney; Sydney New South Wales Australia
- Center for Evidence Based Practice; Bond University; Gold Coast Queensland Australia
| | - Yachna Mehta
- Australia New Zealand Melanoma Trials Group; Melanoma Institute Australia; Sydney New South Wales Australia
| | - Robin M. Turner
- School of Public Health and Community Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre; The University of Sydney; Sydney New South Wales Australia
| | - Mbathio Dieng
- The School of Public Health; The University of Sydney; Sydney New South Wales Australia
- Macquarie University; Sydney New South Wales Australia
| | - Robyn Saw
- Melanoma Institute Australia; Sydney New South Wales Australia
- Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
- Division of Surgery; Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Pascale Guitera
- Melanoma Institute Australia; Sydney New South Wales Australia
- Discipline of Dermatology; The University of Sydney; Sydney New South Wales Australia
- The Sydney Melanoma Diagnostic Centre; Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Kirsten McCaffery
- The School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Donald Low
- Cancer Voices NSW; Sydney New South Wales Australia
| | - Cynthia Low
- Cancer Voices NSW; Sydney New South Wales Australia
| | - Marisa Jenkins
- The School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Les Irwig
- The School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Angela C. Webster
- The School of Public Health; The University of Sydney; Sydney New South Wales Australia
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Dieng M, Butow PN, Costa DS, Morton RL, Menzies SW, Mireskandari S, Tesson S, Mann GJ, Cust AE, Kasparian NA. Psychoeducational Intervention to Reduce Fear of Cancer Recurrence in People at High Risk of Developing Another Primary Melanoma: Results of a Randomized Controlled Trial. J Clin Oncol 2016; 34:4405-4414. [DOI: 10.1200/jco.2016.68.2278] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose People with a history of melanoma commonly report a fear of cancer recurrence (FCR), yet psychologic support is not routinely offered as part of ongoing melanoma care. This randomized controlled trial examined the efficacy of a psychoeducational intervention to reduce FCR and improve psychologic adjustment in this patient group compared with usual care. Methods The intervention comprised a newly developed psychoeducational resource and three telephone-based psychotherapeutic sessions over a 1-month period timed in accordance with dermatologic appointments. Participants were randomly assigned to intervention (n = 80) or usual care (n = 84). Assessments were completed at baseline, 1 month, and 6 months after dermatologic appointments. Linear mixed models were used to examine differences between treatment and control groups for patient-reported outcomes, including FCR, anxiety, stress, depression, melanoma-related knowledge, health behaviors, satisfaction with melanoma care, unmet needs, and health-related quality of life. Results At 6 months, the intervention group reported lower FCR severity, trigger, and distress scores than the control group in the baseline-adjusted models; the between-group mean difference was −1.9 for FCR severity (95% CI, −3.1 to −0.7; P = .002), −2.0 for FCR triggers (95% CI, −3.3 to −0.7; P = .003), and −0.7 for FCR distress (95% CI, −1.3 to −0.1; P = .03). The decrease in FCR severity (but not triggers or distress) remained statistically significant after adjustment for other covariates ( P = .04). At 6 months, the intervention group also reported lower stress (−1.6; 95% CI, −3.1 to −0.2; P = .03) and improved melanoma-related knowledge (1.7; 95% CI, 0.8 to 2.6; P < .001) compared with the control group. No differences were found between groups for other secondary outcomes. Conclusion This newly developed evidence-based psychoeducational intervention was effective in reducing FCR and stress and increasing melanoma-related knowledge in people at high risk for another melanoma.
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Affiliation(s)
- Mbathio Dieng
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Phyllis N. Butow
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Daniel S.J. Costa
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Rachael L. Morton
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Scott W. Menzies
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Shab Mireskandari
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Stephanie Tesson
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Graham J. Mann
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Anne E. Cust
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Nadine A. Kasparian
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
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Huang FF, Yang Q, Han XY, Zhang JP, Lin T. Development and validation of a self-efficacy scale for postoperative rehabilitation management of lung cancer patients. Psychooncology 2016; 26:1172-1180. [PMID: 27723943 DOI: 10.1002/pon.4296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 09/29/2016] [Accepted: 10/07/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of this study was to develop a Self-Efficacy Scale for Rehabilitation Management designed specifically for postoperative lung cancer patients (SESPRM-LC) and to evaluate its psychometric properties. PATIENTS AND METHODS Based on the concept of self-management of chronic disease, items were developed from literature review and semistructured interviews of 10 lung cancer patients and screened by expert consultation and pilot testing. Psychometric evaluation was done with 448 postoperative lung cancer patients recruited from 5 tertiary hospitals in Fuzhou, China, by incorporating classical test theory and item response theory methods. RESULTS A 6-factor structure was illustrated by exploratory factor analysis and confirmed by confirmatory factor analysis, explaining 60.753% of the total variance. The SESPRM-LC achieved Cronbach's α of 0.694 to 0.893, 2-week test-retest reliability of 0.652 to 0.893, and marginal reliability of 0.565 to 0.934. The predictive and criterion validities were demonstrated by significant association with theoretically supported quality-of-life variables (r = 0.211-0.392, P < .01), and General Perceived Self-efficacy Scale (r = 0.465, P < .01), respectively. Item response theory analysis showed that the SESPRM-LC offers information about a broad range of self-efficacy measures and discriminates well between patients with high and low levels of self-efficacy. CONCLUSIONS We demonstrated initial support for the reliability and validity of the 27-item SESPRM-LC, as a developmentally appropriate instrument for assessing self-efficacy among lung cancer patients during postoperative rehabilitation.
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Affiliation(s)
- Fei-Fei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Qing Yang
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA
| | - Xuan Ye Han
- Department of Neurosurgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing-Ping Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ting Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
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“Melanoma: Questions and Answers.” Development and evaluation of a psycho-educational resource for people with a history of melanoma. Support Care Cancer 2016; 24:4849-4859. [DOI: 10.1007/s00520-016-3339-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
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