The role of daily couple communication in the relationship between illness representation and fear of cancer recurrence in breast cancer survivors and their spouses

Dyadic coping and related factors among couples with colorectal cancer: A latent profile analysis

Objective

This study aimed to identify latent subgroups of dyadic coping (DC) among colorectal cancer (CRC) patients and their spousal caregivers, and to explore the factors associated with these subgroups.

Methods

We conducted a cross-sectional study involving 268 pairs of CRC patients and their spousal caregivers. Participants completed the General Information Questionnaire, the Dyadic Coping Inventory, the Cancer-Related Communication Problems Scale, and the Fear of Progress Questionnaire-Short Form. Latent profile analysis (LPA) of DC among CRC couples was performed using Mplus 8.3. We compared couple illness communication, fear of cancer recurrence (FCR), and demographic characteristics between the identified subgroups and conducted ordinal logistic regression analysis to examine factors associated with these subgroups.

Results

The 268 pairs of CRC patients and their spousal caregivers were classified into four subgroups based on their coping levels: low-DC group (12.3%), low common-DC group (7.1%), moderate-DC group (52.6%), and high-DC group (28.0%). Disease stage, couple illness communication, and spouse's FCR were significantly associated with the four subgroups.

Conclusions

There is considerable variability in DC levels among CRC patients and their spousal caregivers. Patients with advanced disease stages, inadequate communication between spouses, and severe RCR exhibit lower levels of DC. These findings provide a theoretical basis for nursing personnel to develop personalized intervention strategies tailored to the characteristics of these subgroups.

Intensive Longitudinal Methods Among Adults With Breast or Lung Cancer: Scoping Review

BACKGROUND

Intensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological approaches for studying or monitoring experiences of oncology patients remain uncertain.

OBJECTIVE

This scoping review aims to describe to what extent intensive longitudinal methods with daily electronic assessments have been used among patients with breast or lung cancer and with which methodologies, associated outcomes, and influencing factors.

METHODS

We searched the electronic databases (PubMed, Embase, and PsycINFO) up to January 2024 and included studies reporting on the use of these methods among adults with breast or lung cancer. Data were extracted on population characteristics, intensive monitoring methodologies used, study findings, and factors influencing the implementation of these methods in research and clinical practice.

RESULTS

We identified 1311 articles and included 52 articles reporting on 41 studies. Study aims and intensive monitoring methodologies varied widely, but most studies focused on measuring physical and psychological symptom constructs, such as pain, anxiety, or depression. Compliance and attrition rates seemed acceptable for most studies, although complete methodological reporting was often lacking. Few studies specifically examined these methods among patients with advanced cancer. Factors influencing implementation were linked to both patient (eg, confidence with intensive monitoring system) and methodology (eg, option to use personal devices).

CONCLUSIONS

Intensive longitudinal methods with daily electronic assessments hold promise to provide unique insights into the daily lives of patients with cancer. Intensive longitudinal methods may be feasible among people with breast or lung cancer. Our findings encourage further research to determine optimal conditions for intensive monitoring, specifically in more advanced disease stages.

Dyadic effects of financial toxicity and social support on the fear of cancer recurrence in breast cancer patients and caregivers: an actor-partner interdependence mediation model

PURPOSE

In this study, the actor-partner interdependence mediation model (APIMeM) was applied to breast cancer patients and their caregivers to assess the factors that affect the fear of cancer recurrence. In particular, the purpose of this study was to evaluate the mediating effect of social support on financial toxicity and the fear of cancer recurrence, providing an effective basis for developing plans to reduce the level of fear of cancer recurrence.

METHODS

This study employed a cross-sectional design, and 405 dyads of breast cancer patients and their caregivers were enrolled. Financial toxicity, social support, and fear of cancer recurrence were assessed by computing comprehensive scores for financial toxicity based on patient-reported outcome measures, the Social Support Rating Scale, and the Fear of Cancer Recurrence Inventory Short Form, respectively. The data were analysed using SPSS 24.0 and AMOS 23.0.

RESULTS

The results showed that the fear of cancer recurrence of breast cancer patients and their caregivers was significantly related to dyadic financial toxicity and social support. In addition, the financial toxicity of breast cancer patients and their caregivers had significant actor effects and partner effects on the fear of cancer recurrence through dyadic social support.

CONCLUSIONS

The financial toxicity of breast cancer patients and their caregivers could produce actor and partner effects on the fear of cancer recurrence through the mediation of social support, which provided empirical support for improving reducing the level of fear of cancer recurrence among patients and caregivers at the dyadic level.

Fear of cancer recurrence and associated factors in family caregivers of patients with hematologic malignancy receiving chemotherapy: A latent profile analysis

Objective

This study identified the potential subgroups of fear of cancer recurrence (FCR) in family caregivers (FCs) of patients with hematologic malignancies receiving chemotherapy, as well as exploring factors associated with subgroups.

Methods

This was a cross-sectional study involving 206 pairs of participating patients with hematologic malignancies receiving chemotherapy and their FCs. Using Mplus 8.3 to perform the latent profile analysis of FCs' FCR, the FCs' burden, quality of life, psychological resilience, and anxiety as well as their demographic characteristics were compared between the subgroups, with a logistic regression analysis being applied to examine the factors associated with the FCR subgroups.

Results

A total of 206 FCs were classified into two subgroups: "a low level of FCR" (Class 1, 65.4%) and "a high level of FCR" (Class 2, 34.6%). Quality of life, anxiety, and frequency of chemotherapy were significantly associated with the two subgroups.

Conclusions

FCs of patients with hematologic malignancy receiving chemotherapy had two FCR subgroups, "a low level of FCR" and "a high level of FCR", in association with quality of life, anxiety, and frequency of chemotherapy. These findings provide the theoretical foundations for screening the FCR factor of FCs and conducting interventions for them.

Development and validation of the CARE-FCR: A caregiver-specific measure of fear of cancer recurrence and progression

OBJECTIVES

Fear of cancer recurring or progressing (FCR) is a concern reported by people living with cancer and caregivers alike. Whilst advances in survivor FCR have been made, less is known about caregiver FCR. As a result, measurement of caregiver FCR has relied on instruments developed for survivor populations. Findings from qualitative research indicate caregiver experiences of FCR differ. This study aimed to develop and evaluate the psychometric properties of a caregiver specific measure of FCR (CARE-FCR).

METHODS

Four-hundred and thirty-eight caregivers (56% female, Mage = 50.53 years, SD = 17.38) completed the online survey including demographic questions, information about care provided, the person they care for, as well as the CARE-FCR. Convergent validity was assessed using pre-existing measures of fear of recurrence and progression, depression, anxiety, death anxiety and meta-cognitions. The extraversion dimension of the Big Five Personality Trait questionnaire was used to assess divergent validity. The survey was completed 2 weeks later to assess test-retest reliability. Exploratory factor analysis (EFA) was used to determine factor structure, followed by confirmatory factor analysis.

RESULTS

EFA indicated a 3-factor structure: progression, recurrence, and communication. Evidence for convergent, divergent, and test-retest reliability was adequate. Internal consistency for the CARE-FCR was strong, overall Cronbach's α = 0.96 (progression = 0.94, recurrence = 0.92 and communication = 0.78).

CONCLUSIONS

We present a theoretically informed and psychometrically robust measure of caregiver FCR. The CARE-FCR facilitates quantification of caregiver FCR, capturing unique aspects specific to this population.

Dyadic association between mindfulness, family avoidance of communication about cancer and fear of cancer recurrence among breast cancer couples: A cross-sectional study

PURPOSE

The research focused on examining the dyadic relationship between mindfulness, fear of cancer recurrence (FCR), and family avoidance of communication about cancer (FACC) within breast cancer couples.

METHODS

This study utilized a cross-sectional approach to gather data from 249 breast cancer couples. Participants completed self-report measures assessing mindfulness, FCR, and FACC. The Actor-Partner Interdependence Mediation Model was applied to analyze how each individual's and their partner's mindfulness affected their own and their partner's FCR, as well as the mediating role of FACC in this relationship.

RESULTS

The study found that the average FCR score for breast cancer patients was (32.59 ± 10.05), while their spouses had a score of (34.39 ± 8.60). The bootstrap method showed that self-FACC as a mediator between mindfulness in breast cancer couples and their own FCR (patient: β = -0.044, P = 0.019; spouse: β = -0.046, P = 0.007). Patients' FACC influenced the connection between their mindfulness and spouses' FCR (β = -0.031, P = 0.030).

CONCLUSIONS

The findings highlight the potential for interventions that focus on mindfulness and communication enhancement to alleviate FCR and improve the overall well-being of breast cancer couples.

The effects of physical symptoms, self-efficacy and social constraints on fear of cancer recurrence in breast cancer survivors: Examining the mediating role of illness representations

OBJECTIVE

Fear of cancer recurrence (FCR) is common in breast cancer survivors (BCS). This study examined the mediating role of illness representations in the relationships between FCR and physical symptoms, social constraint and self-care self-efficacy.

METHODS

In this cross-sectional study, 385 women with breast cancer completed a series of questionnaires including the FCR Inventory, Social Constraints Scale-15, Cancer Survivors Self-Efficacy Scale, Illness Perception Questionnaire-Revised and European Organization for Research and Treatment Quality of Life Questionnaire-Breast Cancer. Structural equation modelling method was conduct by using a bootstrapping method.

RESULTS

Physical symptoms (β = 0.272, p < 0.01), social constraints (β = 0.130, p < 0.01), self-efficacy (β = -0.233, p < 0.01) and illness representation (β = 0.261, p < 0.01) have direct effects on FCR. The indirect effects of physical symptoms (β = 0.10, p < 0.01), social constraints (β = 0.076, p < 0.01) and self-efficacy (β = -0.025, p < 0.05) on FCR were partially mediated by illness representations.

CONCLUSIONS

In this study, the effects of physical symptoms, social constraints and self-efficacy on FCR were found to be mediated by illness representation. Reducing the impact of negative illness representations on FCR by reducing physical symptoms, increasing self-efficacy, and promoting open disclosure of cancer-related concerns may be effective in reducing FCR in BCS.

Dyadic typology of illness perceptions in human immunodeficiency virus (HIV) Serodiscordant couples

OBJECTIVE

Illness perceptions direct coping resources in the illness adaptation process. Previous studies regarding illness perception profiles have been conducted at the individual level, without considering the couple as a unit. This study aimed to investigate the dyadic topologies of illness perceptions in HIV-serodiscordant couples and the association between the identified profiles and individual- and couple-level outcomes.

METHODS

A comprehensive examination was undertaken, encompassing 231 Chinese HIV-serodiscordant couples, who voluntarily participated in this cross-sectional study during the period spanning June to October 2022. To discern various patterns of illness perception, dyadic latent profile analyses were performed, followed by the implementation of one-way analyses of variance to investigate outcome differences at both the individual and couple levels across the identified profiles.

RESULTS

We identified three distinct profiles of illness perception, namely the incongruent-but-low, congruent-but-high, and incongruent-and-high profiles. Except for the partner's sex (p < .01, Cramer' v = 0.214) and the education levels of persons living with HIV and their partners (both p < .01, Cramer' v = 0.236 for persons living with HIV and 0.198 for partners), no significant demographic differences across the various profiles were found. Furthermore, we observed significant differences in all outcomes among the different couple profiles (all p < .001). These differences were of medium-to-large magnitudes (partial η2 values ranging from 0.07 to 0.22).

CONCLUSION

A couple-centered typological approach provides a useful way of identifying the couple's configuration of illness perceptions, which will inform the provision of tailor-made treatment for couples with different profiles.

Communication with physicians and family about breast Cancer recurrence

Objective

Adequate physician-patient communication about cancer recurrence is vital to quality of life and to informed decision-making related to survivorship care. The current study was guided by a cognitive-affective framework to examine communication with family and physicians about breast cancer recurrence risk.

Methods

A survey of recently-diagnosed, early-stage breast cancer patients in Appalachia investigated physician-patient and familial communication about breast cancer recurrence risk.

Results

Over 30% of participants reported not talking to family or physicians about breast cancer recurrence risk. Younger patients reported more conversations, and speaking with physicians was associated with greater perception risk factors associated with recurrence risk. Greater worry about recurrence was associated with more communication with family and plans to talk to family, physicians, and friends about recurrence risk in the future.

Conclusion

Additional supports for patients and physicians are needed to improve understanding of breast cancer recurrence risk and risk factors for recurrence.

Innovation

Family communication about breast cancer recurrence risk is understudied. The combination of physician and family communication adds novelty to our analysis.

Couples' skills training intervention in young breast cancer patients with fear of cancer recurrence: A randomized controlled trial

PURPOSE

This study adapted the Chinese version of the Couple Skills Training intervention program to couples of young breast cancer patients in China and investigated its effects on fear of cancer recurrence (FCR), cancer-related communication, and level of hope among the couples.

METHODS

Ninety young breast cancer patients and their spouses were recruited and randomly assigned to the intervention group (45 couples) and the control group (45 couples). Couples in the intervention group received skills training and were assessed at baseline, post-intervention, and 3 months post-intervention to measure outcomes. Differences in scores between the two groups were analyzed using two-sample t-tests and generalized estimating equations (GEE) controlling for demographic and health-related variables.

RESULTS

Couples' skills training intervention effectively reduced FCR and improved cancer-related communication in young breast cancer patients compared to the control group (both p < 0.001). Spouses' expectations significantly increased (p < 0.001). At 3 months post-intervention, couples in the intervention group showed significant improvements in FCR, cancer-related communication, and hope (all p < 0.001).

CONCLUSION

Couples' skills training interventions are beneficial for helping young breast cancer patients cope with FCR. Couples-based interventions play a crucial role in addressing FCR in these patients and their spouses. Future research should consider larger samples and longer follow-up periods to enhance intervention effectiveness.

CLINICAL TRIAL CENTER REGISTRATION NUMBER

This study has also been registered with the Chinese Clinical Trial Registry (No: ChiCTR2200063327).

Familial aspects of fear of cancer recurrence: current insights and knowledge gaps

Fear of cancer recurrence is fear or worry about cancer recurrence or progress. Fear of recurrence can impact patients' quality of life and wellbeing. Cancer survivors' families support them practically and emotionally, making them a vital supplement for official healthcare. Given the well-established important role of the family in dealing with cancer, we compiled the studies that examined the relationship between family-related factors and fear of cancer recurrence (FCR) among cancer survivors (CSs). One of the foremost studies in this field is the FCR model presented by Mellon and colleagues, which included concurrent family stressors and family-caregiver FCR as factors linked to survivor FCR. Our goal was to prepare the ground for a family-based model of FCR that is more comprehensive than the one proposed by Mellon et al. sixteen years ago. The studies included those with samples of adult cancer survivors from different regions of the world. Most of the studies we reviewed are cross-sectional studies. We categorized family-related factors associated with survivor FCR into partner-related factors, including subgroups of disclosure to partner, cognitions of partner, and partner's sources of support; parenthood-related factors, including having children and parenting stress; family-related factors, including living situation, family history of cancer, family's perception of the illness, and family characteristics; and social interactions including social support, disclosure, social constraints, and attitudes of others. This review sheds light on how significant others of cancer survivors can affect and be affected by cancer-related concerns of survivors and emphasizes the necessity of further investigation of family-related factors associated with FCR.

Impact of fear of recurrence in patients with cancer on caregivers' psychological health: A meta-analysis

Objective

This study aims to quantitatively investigate the relationship between fear of cancer recurrence in patients with cancer and their caregivers' psychological health, examining the extent of the impact of this fear on caregivers.

Methods

We conducted a comprehensive search in PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO databases from inception until May 2023 for relevant English publications. Pearson correlation coefficients (r) were utilized as effect sizes to assess the overall relationship between fear of recurrence and psychological outcomes among caregivers of patients with cancer.

Results

A total of 19 eligible studies were included in the analysis. The findings revealed a moderate positive correlation between fear of recurrence in patients with cancer and caregivers' fear of recurrence and depression. A relatively weaker correlation was observed between patients' fear of recurrence and caregivers' anxiety. Due to considerable heterogeneity (I2 ​= ​91.99%, Q ​= ​212.23), the primary outcome of fear of recurrence in patients with cancer influencing caregivers' fear of recurrence was examined through subgroup analyses.

Conclusions

Our meta-analysis established a significant positive correlation between fear of recurrence in patients with cancer and negative psychological consequences among caregivers, including recurrence fear, depression, and anxiety. Future research should explore the evolution of adverse psychological outcomes in both patients with cancer and their caregivers over time and delve into the bivariate psychological impact within the patient-caregiver dyads.

Systematic review registration

PROSPERO, CRD42022383866.

Comparison of the sense of spousal support, anxiety, depression and their relationship to fear of cancer recurrence between lymphoma patients and their spouses: A cross-sectional study in China

PURPOSE

To investigate the level of fear of cancer recurrence (FCR) in spouses of patients with lymphoma and its relationship with patients' FCR, as well as the correlations between FCR, sense of spousal support (SSS), anxiety, and depression in the couples.

METHODS

A cross-sectional study of 233 couples where one partner had lymphoma was conducted from May 2021 to February 2022. Participants provided demographic information and completed the Spouse Support Inventory and Hospital Anxiety and Depression Scale. The Fear of Progression Questionnaire (for patients) and Fear of Progression Questionnaire for Partners (for spouses) were used to measure FCR. Descriptive analyses, t-tests, variance analysis, Spearman's correlation analysis, and multiple linear regression analysis was performed.

RESULTS

The prevalence of FCR, anxiety, and depression in patients was 37.7%, 68.7%, and 83.3%, respectively. The prevalence of FCR, anxiety, and depression in spouses was 56.2%, 78.1%, and 81.1%, respectively. Spouses' FCR scores were higher than those of patients, whereas patients' SSS and anxiety scores were higher than those of their spouses. Multiple linear regression analysis showed that patients' anxiety and SSS, as well as spouses' FCR were significantly associated with patients' FCR. Variables significantly associated with higher FCR among spouses were anxiety, per capita monthly household income, and patients' FCR.

CONCLUSIONS

Patients with lymphoma and their spouses have a certain degree of FCR, anxiety, and depression. FCR levels in spouses are higher than in patients.

IMPLICATIONS FOR CANCER SURVIVORS

Psychological support interventions for couples may be effective in reducing FCR and facilitating family adaptation to cancer.

Caregiver fear of cancer recurrence: A systematic review and meta-analysis of quantitative studies

OBJECTIVE

Fear of cancer recurrence (FCR) is reported by both cancer survivors and caregivers however less is known about caregiver FCR. This study aimed to (a) conduct a meta-analysis to compare survivor and caregiver FCR levels; (b) examine the relationship between caregiver FCR and depression, and anxiety; (c) evaluate psychometric properties of caregiver FCR measures.

METHODS

CINAHL, Embase, PsychINFO and PubMed were searched for quantitative research examining caregiver FCR. Eligibility criteria included caregivers caring for a survivor with any type of cancer, reporting on caregiver FCR and/or measurement, published in English-language, peer-review journals between 1997 and November 2022. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy was used to evaluate content and psychometric properties. The review was pre-registered (PROSPERO ID: CRD42020201906).

RESULTS

Of 4297 records screened, 45 met criteria for inclusion. Meta-analysis revealed that caregivers reported FCR levels as high as FCR amongst survivors, with around 48% of caregivers reporting clinically significant FCR levels. There was a strong correlation between anxiety and depression and medium correlation with survivor FCR. Twelve different instruments were used to measure caregiver FCR. Assessments using the COSMIN taxonomy revealed few instruments had undergone appropriate development and psychometric testing. Only one instrument met 50% or more of the criteria, indicating substantial development or validation components were missing in most.

CONCLUSIONS

Results suggest FCR is as often a problem for caregivers as it is for survivors. As in survivors, caregiver FCR is associated with more severe depression and anxiety. Caregiver FCR measurement has predominately relied on survivor conceptualisations and unvalidated measures. More caregiver-specific research is urgently needed.

"Your Ovaries Are Expired, Like an Old Lady" Metaphor Analysis of Saudi Arabian Women's Descriptions of Breast Cancer: A Qualitative Study

Background

Assessing and understanding the language that women use to express physical, emotional, and social concerns of breast cancer experiences can often be overlooked, even though there is evidence that effective communication between cancer patients and health care providers improves quality of life. This study aims to assess the use of metaphors in conceptualizing breast cancer experience lived by Saudi Arabian women.

Materials and Methods

This is an interpretative phenomenological qualitative study, a purposeful sample of 18 breast cancer patients at an oncology outpatient's clinic in Saudi Arabia were invited to engage in face-to-face interviews. Data was analyzed using Metaphor Identification Procedure (MIP).

Results

Four themes were constructed: dark hidden force, battling imminent death, dreaming and awakening calls, and inner and outer transformation.

Conclusion

Identifying metaphors may be beneficial toward improving communication between health care providers and breast cancer patients, who often experience difficulties expressing their needs.

Couples Coping Together: A Scoping Review of the Quantitative and Qualitative Evidence and Conceptual Work Across Three Decades

Dyadic coping (DC), how couples cope together to deal with a stressor like chronic illness, has received increased attention over the last three decades. The aim of the current study was to summarize the current state of research on DC in couples. We conducted a scoping review of qualitative, quantitative, and mixed-methods studies published between 1990 and 2020, assessing DC in couples during three decades. 5,705 studies were identified in three electronic databases and hand searches. We included 643 sources in this review (with a total of N = 112,923 study participants). Most studies were based in the global North, particularly in the US and Europe. Publication numbers increased constantly over time. A third of study designs were cross-sectional studies followed by qualitative and longitudinal studies. The most prolific DC research areas were related to DC and minor stressors and DC and major physical health stressors. Overall, DC has been established internationally as a highly relevant construct in many disciplines (clinical, social, developmental, personality psychology, social work, nursing etc.). To conclude, the review reveals that future studies should focus on predictors, trajectories, and the importance of very specific DC behaviors for personal and dyadic functioning.

A systematic mixed studies review of fear of cancer recurrence in families and caregivers of adults diagnosed with cancer

PURPOSE

Fear of cancer recurrence (FCR) may be equally prevalent, persistent and burdensome in cancer caregivers as in survivors. This systematic review evaluated FCR prevalence, severity, correlates, course, impact and interventions in cancer caregivers.

METHODS

Electronic databases were searched from 1997 to May 2021. Two reviewers identified eligible peer-reviewed qualitative or quantitative studies on FCR in adult caregivers or family members of adult cancer survivors. The risk of bias was assessed using the Cochrane Risk of Bias tools for randomised and non-randomised studies and the Mixed-Methods Appraisal Tool. A narrative synthesis and thematic synthesis occurred on quantitative and qualitative studies, respectively.

RESULTS

Of 2418 papers identified, 70 reports (59 peer-reviewed articles, 11 postgraduate theses) from 63 studies were included. Approximately 50% of caregivers experienced FCR. Younger caregivers and those caring for survivors with worse FCR or overall health reported higher FCR. Most studies found caregivers' FCR levels were equal to or greater than survivors'. Caregivers' FCR was persistently elevated but peaked approaching survivor follow-up appointments. Caregivers' FCR was associated with poorer quality of life in caregivers and survivors. Three studies found couple-based FCR interventions were acceptable, but had limited efficacy.

CONCLUSIONS

FCR in caregivers is prevalent, persistent and burdensome. Younger caregivers of survivors with worse overall health or FCR are at the greatest risk. Further research on identifying and treating caregivers' FCR is required.

IMPLICATIONS FOR CANCER SURVIVORS

Caregiver and survivor FCR are similarly impactful and appear interrelated. Addressing FCR may improve outcomes for both cancer caregivers and survivors.

Factors Associated With Fear of Cancer Recurrence in Family Caregivers of Cancer Survivors: A Systematic Review

Objective: Fear of cancer recurrence (FCR) is a significant concern for family caregivers of cancer survivors and is associated with many adverse outcomes, including increased emotional distress and poorer quality of life. Although several theoretical models have been proposed to account for FCR in cancer survivors, their applicability to caregivers is unknown. The aim of this review was to identify clinical, demographic and psychological factors that are associated with, and predict, FCR in caregivers of cancer survivors.

Method: AMED, CINAHL, Medline, PsycINFO, and Scopus were systematically searched for relevant studies reporting quantitative data on factors associated with FCR or similar constructs (e.g., worry or anxiety about cancer recurrence) in family caregivers of adult cancer survivors. Included studies were assessed for methodological quality using a standardized checklist adapted from the Agency for Healthcare Research and Quality.

Results: Sixteen studies, half of which were cross-sectional, were included and summarized narratively. Non-modifiable factors, including age (n = 6) and treatment modality (n = 4), were found to be associated with increased FCR. Significant positive associations were also reported between illness perceptions and FCR (n = 3). However, there was heterogeneity across included studies with regards to factors examined and most were conducted in the USA. There were also several methodological limitations to the included studies.

Conclusions: Research examining FCR in caregivers of cancer survivors has predominantly focused on demographic and clinical factors. Given the paucity of research exploring the psychological mechanisms underpinning FCR, future research should investigate theoretical underpinnings of FCR in caregivers of cancer survivors to support the development of psychological interventions for this population.

Systematic Review Registration: PROSPERO, identifier [CRD42019119729].

Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research

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.