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Bak R, Junker T, Jensen JB, Pelant T, Haase RN, Zachariae R, Nielsen TK. A comparative analysis of fear of cancer recurrence in patients with small renal masses: Active surveillance versus cryoablation. Acta Oncol 2024; 63:573-579. [PMID: 39037075 DOI: 10.2340/1651-226x.2024.40418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate and compare the fear of cancer recurrence (FCR) in patients diagnosed with a small renal mass (SRM) and managed with either active surveillance (AS) or minimal invasive renal cryoablation (CA). PATIENTS/MATERIAL AND METHODS A total of 398 patients with SRMs (263 AS and 135 CA patients) were retrospectively identified across three institutions and invited to complete the Fear of Cancer Recurrence-Short Form (FCRI-SF) questionnaire. RESULTS No statistically significant differences in FCRI-SF score were observed between the AS (mean = 10.9, standard deviation [SD] = 6.9) and CA (mean = 10.2, SD = 7.2) (p = 0.559) patients, with the mean scores of both groups being below the suggested clinically significant cut-off of 16. A total of 25% of AS and 28% of CA patients reported sub-clinical or clinical levels of FCR (FCRI-SF score > 16). Within the AS group, a weak negative association between FCR severity and age was observed (r = -0.23, p = 0.006), and a statistically significant difference in FCRI-SF score between patients aged more or less than 73 years (p = 0.009). INTERPRETATION FCR levels were comparable between AS and CA patients, suggesting that treatment decisions should prioritise clinical factors. Up to 28% of AS and CA patients report clinically significant FCR, highlighting the importance of considering the possibility of FCR, especially in younger patients.
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Affiliation(s)
- Rasmine Bak
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Theresa Junker
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark; Radiological Research and Innovation Unit, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Odense University Hospital, Odense, Denmark
| | - Jørgen B Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tau Pelant
- Department of Urology, Regional Hospital Gødstrup, Gødstrup, Denmark
| | - Rikke N Haase
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Robert Zachariae
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Tommy K Nielsen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Aalborg University Hospital, Aalborg, Denmark
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Giguère L, Mutsaers B, Harris C, Smith A'B, Humphris GM, Costa D, Kogan CS, Simard S, Lebel S. The Ottawa clinical fear of recurrence instruments: A screener, self-report, and clinical interview. Psychooncology 2024; 33:e6364. [PMID: 38824493 DOI: 10.1002/pon.6364] [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: 11/30/2023] [Revised: 04/21/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Clinical fear of cancer recurrence (FCR) was recently defined by a group of experts during a Delphi study. Five criteria were agreed upon, namely: (a) high levels of preoccupation, (b) high levels of worry, (c) that are persistent, (d) hypervigilance and hypersensitivity to physical sensations that e) may result in functional impairment. No existing instruments comprehensively capture all these criteria for clinical FCR. METHODS To remedy this gap, a set of three patient-reported outcome instruments including a one-item screener, self-report questionnaire, and semi-structured clinical interview, named the Ottawa Clinical Fear of Recurrence instruments, were developed. To do so, the research team first conducted a literature review of potential items. Additional FCR experts discussed the content of the screener and interview. The self-report's items were assessed for content validity by the same expert panel using Likert ratings and the Content Validity Index to narrow down the number of items. The three instruments were piloted with a group of cancer survivors to assess face validity following the European Organization for Research and Treatment of Cancer recommendations. RESULTS The literature review and content validity assessment led to a final draft pre-pilot of 23 potential items for the self-report questionnaire. The instruments were piloted. Pilot study participants suggested changing wording and response options (particularly for the self-report) for greater clarity. CONCLUSIONS Based on the feedback received, minor modifications were made, mostly for the self-report. In general, content and face validity for the three instruments were good for both experts and cancer survivors.
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Affiliation(s)
- Lauriane Giguère
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Cheryl Harris
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Cancer Therapeutics Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Allan 'Ben' Smith
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | | | - Daniel Costa
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sébastien Simard
- Department of Health Sciences, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Curran L, Mahoney A, Hastings B. A Systematic Review of Trajectories of Clinically Relevant Distress Amongst Adults with Cancer: Course and Predictors. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10011-x. [PMID: 38704756 DOI: 10.1007/s10880-024-10011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 05/07/2024]
Abstract
To improve interventions for people with cancer who experience clinically relevant distress, it is important to understand how distress evolves over time and why. This review synthesizes the literature on trajectories of distress in adult patients with cancer. Databases were searched for longitudinal studies using a validated clinical tool to group patients into distress trajectories. Twelve studies were identified reporting trajectories of depression, anxiety, adjustment disorder or post-traumatic stress disorder. Heterogeneity between studies was high, including the timing of baseline assessments and follow-up intervals. Up to 1 in 5 people experienced persistent depression or anxiety. Eight studies examined predictors of trajectories; the most consistent predictor was physical symptoms or functioning. Due to study methodology and heterogeneity, limited conclusions could be drawn about why distress is maintained or emerges for some patients. Future research should use valid clinical measures and assess theoretically driven predictors amendable to interventions.
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Affiliation(s)
- Leah Curran
- Health@Business Research Network, School of Management and Governance, University of New South Wales, High Street, Kensington, Australia.
- The Kinghorn Cancer Centre, St Vincent's Hospital Network, 370 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Network, 390 Victoria Street, Darlinghurst, Australia
- School of Psychiatry, University of New South Wales, High Street, Kensington, Australia
| | - Bradley Hastings
- Health@Business Research Network, School of Management and Governance, University of New South Wales, High Street, Kensington, Australia
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Hampton J, Alam A, Zdenkowski N, Rowe C, Fradgley E, O'Neill CJ. Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review. Thyroid 2024; 34:541-558. [PMID: 38368547 DOI: 10.1089/thy.2023.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background: Despite excellent survival rates, health-related quality of life detriments are common in differentiated thyroid cancer survivors and can be driven by fear of cancer recurrence (FCR). This review aims to report the incidence of FCR in thyroid cancer survivors and synthesize evidence regarding contributing factors. An overview and appraisal of the range of tools used to measure FCR is presented. Methods: A systematic review of the English literature was performed. The search across six electronic databases generated 3414 studies. Two reviewers independently screened the citations and full-text articles, of which 31 were included. The data were extracted independently by two reviewers. Results: The incidence of FCR was reported in 27/31 studies and ranged from 15% to 91%. Direct comparisons regarding incidence and severity of FCR were not possible due to heterogeneity in cut-points used to define FCR. A total of eight validated tools were used to measure FCR across all studies, with five studies using self-developed nonvalidated items. There was minimal repetition of validated tools and no clear consensus as to a preferred survey tool. Factors influencing FCR were reported in 11 studies. There was minimal overlap of factors influencing FCR. Risk factors contributing to increased FCR reported in more than one study included young age and an upcoming clinical appointment. Male gender and higher education levels were reported in more than one article as protective. No literature evaluating interventions to address FCR in thyroid cancer survivors was found. Conclusion: FCR is common in thyroid cancer survivors, but significant heterogeneity in the current evidence base limits assessment of incidence, severity, or risk factors. There is a need to use validated tools to assess FCR in both research and clinical contexts. Reliable assessment of FCR may permit routine assessment of FCR in clinical practice and allow interventions to be prospectively evaluated to optimize the holistic well-being of thyroid cancer survivors.
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Affiliation(s)
- Jacob Hampton
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Ahmad Alam
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Christopher Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Endocrinology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Elizabeth Fradgley
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine J O'Neill
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Zhao H, Zhou Y, Che CC, Chong MC, Zheng Y, Hou Y, Chen C, Zhu Y. Marital Self-Disclosure Intervention for the Fear of Cancer Recurrence in Chinese Patients With Gastric Cancer: Protocol for a Quasiexperimental Study. JMIR Res Protoc 2024; 13:e55102. [PMID: 38684089 PMCID: PMC11091802 DOI: 10.2196/55102] [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: 12/02/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and psychological problems. We considered the "intimacy and relationship processes in couples' psychosocial adaptation" model. OBJECTIVE The study aims to examine the effectiveness of a marital self-disclosure intervention for improving the level of fear of cancer recurrence and the dyadic coping ability among gastric cancer survivors and their spouses. METHODS This is a quasiexperimental study with a nonequivalent (pretest-posttest) control group design. The study will be conducted at 2 tertiary hospitals in Taizhou City, Jiangsu Province, China. A total of 42 patients with gastric cancer undergoing chemotherapy and their spouses will be recruited from each hospital. Participants from Jingjiang People's Hospital will be assigned to an experimental group, while participants from Taizhou People's Hospital will be assigned to a control group. The participants in the experimental group will be involved in 4 phases of the marital self-disclosure (different topics, face-to-face) intervention. Patients will be evaluated at baseline after a diagnosis of gastric cancer and reassessed 2 to 4 months after baseline. The primary outcome is the score of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for patients. The secondary outcomes are the scores of the FoP-Q-SF for partners and the Dyadic Coping Inventory. RESULTS Research activities began in October 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 12 months. The primary results of this study are anticipated to be announced in June 2024. CONCLUSIONS This study aims to assess a marital self-disclosure intervention for improving the fear of cancer recurrence in Chinese patients with gastric cancer and their spouses. The study is likely to yield desirable positive outcomes as marital self-disclosure is formulated based on evidence and inputs obtained through stakeholder interviews and expert consultation. The study process will be carried out by nurses who have received psychological training, and the quality of the intervention will be strictly controlled. TRIAL REGISTRATION ClinicalTrials.gov NCT05606549; https://clinicaltrials.gov/study/NCT05606549. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55102.
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Affiliation(s)
- Haiyan Zhao
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Ye Zhou
- Chinese Nursing Journals Publishing House Co, Ltd, Beijing, China
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yu Zheng
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Yuzhu Hou
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Canjuan Chen
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
| | - Yantao Zhu
- Nursing Department, Jingjiang People's Hospital, Taizhou, China
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Nic Giolla Chomhaill C, Ward J, Dowling M. Fear of recurrence in women with ovarian cancer: A qualitative evidence synthesis. Eur J Oncol Nurs 2024; 68:102487. [PMID: 38113769 DOI: 10.1016/j.ejon.2023.102487] [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: 09/08/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Approximately 80% of ovarian cancers recur after first-line treatments. Women with ovarian cancer (OC) are therefore particularly vulnerable to experiencing fear of cancer recurrence (FCR). This study aimed to synthesise experiences of fear of cancer recurrence among women living with ovarian cancer. METHOD A qualitative evidence synthesis (QES) was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. A systematic search of seven databases was undertaken to identify all available qualitative research exploring fear of cancer recurrence in women with OC. Thematic synthesis of extracted data from included studies was undertaken and managed in NVivo. RESULTS Twenty-two papers reporting on eighteen studies were included in the synthesis. Three main themes were developed (triggers, responses, and coping) and included ten subthemes. FCR was triggered by factors relating to awareness of prognosis, treatment, and negative communication. Women responded to FCR by performing body checking and protecting their families. FCR led to adverse effects on women's wellbeing as it exacerbated uncertainty about their future. Women attempted to cope with FCR through seeking support, regaining control, and redirecting negative thoughts and actions. CONCLUSIONS Women use a variety of approaches to manage their fear of recurrence. Further research on the most appropriate interventions for FCR tailored specifically to the needs of women with OC is needed.
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Affiliation(s)
| | - Jana Ward
- Occupational Therapy Department, Galway University Hospital, Ireland.
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland.
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7
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Lu Q, Liu Q, Fang S, Ma Y, Zhang B, Li H, Song L. Relationship between fear of progression and symptom burden, disease factors and social/family factors in patients with stage-IV breast cancer in Shandong, China. Cancer Med 2024; 13:e6749. [PMID: 38457242 PMCID: PMC10923048 DOI: 10.1002/cam4.6749] [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: 11/23/2022] [Revised: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE To assess fear of progression (FoP)'s relationship with symptom burden and disease and social/family factors, as well as, determine the status of FoP in women with stage-IV breast cancer in Shandong, China. METHODS Two hundred and sixteen women were recruited from the department of breast cancer internal medicine, Shandong Cancer Hospital and Institute. Data for this observational study were collected between October 2020 and January 2021 using the MD Anderson Symptom Inventory, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and a participant information scale. SPSS 23.0 was used for statistical analysis. RESULTS After excluding invalid responses, the data of 200 participants were analysed. The average total FoP-Q-SF score was 29.39 ± 9.39 (95% confidence interval, 21.81-27.64). The FoP level among the participants was relatively low. For disease and social/family factors, FoP statistically significantly differed by satisfaction with family emotional support and the Eastern Cooperative Oncology Group (ECOG) score. The ECOG score was positively correlated with FoP. Furthermore, symptom burden was positively correlated with FoP. CONCLUSIONS Among patients with stage-IV breast cancer, satisfaction with family emotional support, ECOG score and symptom burden play key roles in FoP. Interventions, including providing appropriate emotional support from family, improving physical fitness and relieving symptom burden, must be considered in future studies, which may improve patients' overall physical and mental status and provide a supportive therapeutic environment.
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Affiliation(s)
- Qianrun Lu
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Qiuyue Liu
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Shu Fang
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Yujin Ma
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Baoxuan Zhang
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Huihui Li
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Lihua Song
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
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Deuning-Smit E, Custers JAE, Braam CIW, Hermens RPMG, Prins JB. Toward implementation of an evidence-based intervention for fear of cancer recurrence: Feasibility in real-world psycho-oncology practice. Psychooncology 2024; 33:e6297. [PMID: 38282226 DOI: 10.1002/pon.6297] [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: 09/27/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Few evidence-based interventions addressing high levels of fear of cancer recurrence (FCR) have been implemented. Understanding how these might be implemented is crucial to bridge the research-practice gap. This study investigated the feasibility of implementing the blended Survivors' Worries of Recurrent Disease (SWORD) intervention in real-world psycho-oncology practice. METHODS SWORD was offered for 15 months (2021-2022) as the standard care for clinical FCR in a university hospital, a general hospital, and psycho-oncological center. We evaluated using a mixed-methods design six feasibility outcomes based on Bowen's framework: demand, limited effectiveness, degree of execution, acceptability, practicality, and integration. Anonymous data were collected for all oncology patients on referral. Study participants completed questionnaires before and after treatment, including the Cancer Worry Scale (CWS-6) as the primary measure of effectiveness. Qualitative data included interviews with patients and psychologists, and field notes. RESULTS Regarding demand, 81 of 644 patients referred (13%) were eligible for SWORD. The uptake of SWORD was 79% (n = 63/80) and the completion rate 73% (n = 46/63). SWORD was effective in reducing FCR (p < 0.001, ηp2 = 0.694). Regarding execution, a variability in the length, planning and number of treatment sessions was found between different settings. Adherence to the treatment manual's content was high (89%). Regarding acceptability, most patients were satisfied with SWORD (average 8.2/10) and psychologists valued the blended format. Psychologists reported SWORD was practical to deliver given their knowledge and skills. Although differences between settings were found, SWORD integrated well into practice. Referral for FCR and a reluctance to contract new eHealth providers were barriers for implementation. CONCLUSIONS Despite differences between healthcare settings, the implementation of SWORD was evaluated well. The feasibility of SWORD in different settings should inform a national implementation strategy.
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Affiliation(s)
- Esther Deuning-Smit
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cheyenne I W Braam
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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Wu VS, Sabud T, Smith A‘B, Lambert SD, Descallar J, Lebel S, Bamgboje-Ayodele A. The Evaluation of the Suitability, Quality, and Readability of Publicly Available Online Resources for the Self-Management of Fear of Cancer Recurrence. Curr Oncol 2023; 31:66-83. [PMID: 38248090 PMCID: PMC10814354 DOI: 10.3390/curroncol31010005] [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: 10/16/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Cancer survivors often rely on the internet for health information, which has varying levels of readability, suitability, and quality. There is a need for high-quality online self-management resources for cancer survivors with fear of cancer recurrence (FCR). This study evaluated the readability, suitability, and quality of publicly available online FCR self-management resources. A Google search using FCR-related keywords identified freely available FCR self-management resources for cancer survivors in English. Resource readability (reading grade level), suitability, and quality were evaluated using relevant assessment tools. Descriptive statistics and cluster analysis identified resources with higher suitability and quality scores. Mean resource (n = 23) readability score was grade 11 (SD = 1.6, Range = 9-14). The mean suitability score was 56.0% (SD = 11.4%, Range = 31.0-76.3%), indicating average suitability and the mean quality score was 53% (SD = 11.7%, Range = 27-80%), indicating fair quality. A cluster of 15 (65%) resources with higher suitability and quality scores was identified. There were no significant associations between suitability or quality scores and the type of organisation that published the resources. Online FCR self-management resources varied in readability, suitability and quality. Resources with higher quality and suitability scores relative to other resources are identified for use by healthcare professionals and cancer survivors. Resources that are more culturally appropriate, with lower reading grade levels and detailed self-management strategies are needed.
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Affiliation(s)
- Verena Shuwen Wu
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Tiyasha Sabud
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Allan ‘Ben’ Smith
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW 2006, Australia
| | - Sylvie D. Lambert
- Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada;
- St. Mary’s Research Centre, Montreal, QC H3T 1M5, Canada
| | - Joseph Descallar
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Adeola Bamgboje-Ayodele
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Heathcote LC, Webster SN, Loecher N, Spunt SL, Simon P, Pradhan P, Coutts-Bain D, Sharpe L, Tutelman PR, Simons LE. The bodily threat monitoring scale: Development and preliminary validation in adult and childhood cancer survivors. Psychooncology 2023; 32:1885-1894. [PMID: 37916988 DOI: 10.1002/pon.6236] [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: 09/15/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Bodily threat monitoring is a core clinical feature of Fear of cancer recurrence (FCR) and is targeted in psycho-oncology treatments, yet no comprehensive self-report measure exists. The aim of this study was the theory-informed development and initial validation of the Bodily Threat Monitoring Scale (BTMS). METHODS Adult survivors of breast and gynaecological cancers (Study 1: N = 306, age = 37-81 years) and childhood cancer survivors (Study 2: N = 126, age = 10-25 years) completed the BTMS, designed to assess how individuals monitor for and interpret uncertain symptoms as indicating that something is wrong with their body. Participants completed measures to assess construct and criterion validity of the BTMS, and childhood cancer survivors (Study 2) completed the BTMS again 2 weeks later to assess test-retest reliability. RESULTS The 19-item BTMS demonstrated excellent internal consistency across adult and childhood cancer samples (α = 0.90-0.96). Factor analyses indicated two subscales capturing 1. Monitoring of bodily sensations and 2. Threatening interpretations of bodily sensations. Two-week stability estimates were acceptable. For construct validity, the BTMS correlated with body vigilance and anxiety sensitivity. The BTMS also demonstrated criterion validity, yielding significant associations with FCR, intolerance of uncertainty, help-seeking behaviours, and quality of life. The BTMS was associated with FCR while controlling for body vigilance and anxiety sensitivity, indicating a unique contribution of this theory-informed measure. CONCLUSIONS The BTMS shows evidence of sound psychometric properties and could be used to elucidate the role of bodily threat monitoring in the maintenance and management of FCR.
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Affiliation(s)
- Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Sarah N Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nele Loecher
- Department of Psychology and Behavioral Sciences, St Jude's Children's Research Hospital, Memphis, Tennessee, USA
| | - Sheri L Spunt
- Department of Pediatric Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Pamela Simon
- Department of Pediatric Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Poorva Pradhan
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Daelin Coutts-Bain
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Magnani C, Smith AB, Rey D, Sarradon-Eck A, Préau M, Bendiane MK, Bouhnik AD, Mancini J. Fear of cancer recurrence in young women 5 years after diagnosis with a good-prognosis cancer: the VICAN-5 national survey. J Cancer Surviv 2023; 17:1359-1370. [PMID: 35318569 DOI: 10.1007/s11764-022-01193-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is frequent in survivors, but less is known about FCR in long-term survivors with very low risk of relapse. Our aim was to estimate the prevalence and clinical and socio-behavioural factors associated with FCR in young women 5 years after diagnosis of a good-prognosis cancer. METHODS Using data from the VICAN-5 survey, conducted in 2015-2016 amongst a national representative French sample of cancer survivors, we included women with non-metastatic melanoma, breast, or thyroid cancer, aged 55 years or under at diagnosis, who experienced no disease progression in the 5 years post-diagnosis. Multinomial logistic regression was used to identify factors associated with FCR, characterised using a three-level indicator: no, mild, and moderate/severe FCR. RESULTS Amongst the 1153 women included, mean age was 44 years at diagnosis, and 81.8% had breast cancer, 12.5% thyroid cancer, and 5.8% melanoma. Five years after diagnosis, 35.4% reported no FCR, 46.0% mild FCR, and 18.6% moderate/severe FCR. Women with thyroid cancer were less likely to suffer from mild or moderate/severe FCR, while cancer-related treatment sequelae, fatigue, and anxiety were more likely. Limited health literacy was associated with mild FCR. Women who reported only occasionally consulting a general practitioner (GP) for the management of their cancer had a higher probability of FCR. CONCLUSION Moderate/severe FCR affected nearly 20% of young female long-term survivors diagnosed with a good-prognosis cancer, particularly those reporting cancer-related sequelae, suffering from fatigue or anxiety, with breast cancer or melanoma (versus thyroid cancer), and consulting a GP only occasionally for cancer management. IMPLICATIONS FOR CANCER SURVIVORS Given the recognised impact of FCR on quality of life, it is essential to detect it as early as possible, and to implement targeted interventions in routine care.
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Affiliation(s)
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research, New South Wales, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Liverpool, Australia
| | - Dominique Rey
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Aline Sarradon-Eck
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
- Institut Paoli-Calmettes, SESSTIM, Marseille, France
| | - Marie Préau
- Unité UMR 1296 «Radiations: Défense, Santé, Environnement», Lyon, France
- Institut de Psychologie, Université Lumière Lyon 2, Bron, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Marseille, France.
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS Labellisée Ligue 2019, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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12
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Shi Y, Dai J, Kuai B, Su X, Yang R, Gong S, Guo Y. Impact of fear of recurrence in patients with cancer on caregivers' psychological health: A meta-analysis. Asia Pac J Oncol Nurs 2023; 10:100299. [PMID: 37780398 PMCID: PMC10534230 DOI: 10.1016/j.apjon.2023.100299] [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: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
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.
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Affiliation(s)
- Yue Shi
- School of Medicine (School of Nursing), Nantong University, Nantong, China
| | - Jingjing Dai
- Department of Oral Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Benxin Kuai
- School of Medicine (School of Nursing), Nantong University, Nantong, China
| | - Xiaoqin Su
- School of Medicine (School of Nursing), Nantong University, Nantong, China
| | - Runze Yang
- School of Medicine (School of Nursing), Nantong University, Nantong, China
| | - Shujin Gong
- School of Medicine (School of Nursing), Nantong University, Nantong, China
| | - Yujie Guo
- School of Medicine (School of Nursing), Nantong University, Nantong, China
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13
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Rasmussen LA, Jensen H, Pedersen AF, Vedsted P. Healthcare use and fear of recurrence in adult cancer survivors at 2.5 years after a cancer diagnosis: a nationwide register study in Denmark. J Cancer Surviv 2023:10.1007/s11764-023-01459-1. [PMID: 37704918 DOI: 10.1007/s11764-023-01459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To investigate the association between fear of cancer recurrence (FCR) and healthcare use in general practice among cancer survivors. METHODS We linked nationwide register data to survey data on FCR in cancer survivors at 2.5 years after a cancer diagnosis. Multiple regression models were used to analyse the association between high FCR level and quartiles of healthcare use at 18-30 months before the cancer diagnosis (habitual healthcare use) and between high FCR level and healthcare use at 18-30 months after the cancer diagnosis (survivorship healthcare use). RESULTS We included 1538 cancer survivors in the study. High habitual healthcare use was associated with a high level of FCR (odds ratio = 2.07 (95% confidence interval (CI): 1.36-3.15)) for the 4th quartile of healthcare use compared to the 1st quartile. A high FCR score was also associated with higher healthcare use during cancer survivorship (incidence rate ratio (IRR) = 1.26 (95% CI: 1.14-1.40)). This association remained statistically significant when adjusting for habitual healthcare use (IRR = 1.20 (95% CI: 1.09-1.33)). CONCLUSION High healthcare use before the cancer diagnosis was associated with high FCR during survivorship. This indicates that FCR is partly explained by a general (pre-diagnostic) health concern. High FCR predicted high healthcare use during cancer survivorship, even when adjusting for habitual healthcare use. IMPLICATIONS FOR CANCER SURVIVORS Our results suggest that FCR in cancer survivors is triggered by a general high level of health concern, and the cancer diagnosis may further exacerbate this concern.
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Affiliation(s)
| | - Henry Jensen
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | | | - Peter Vedsted
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark
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14
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Liu S, Zhang Y, Miao Q, Zhang X, Jiang X, Chang T, Li X. The Mediating Role of Self-Perceived Burden Between Social Support and Fear of Progression in Renal Transplant Recipients: A Multicenter Cross-Sectional Study. Psychol Res Behav Manag 2023; 16:3623-3633. [PMID: 37693331 PMCID: PMC10488562 DOI: 10.2147/prbm.s424844] [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: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose To explore the mechanism of social support and fear of progression (FoP) in renal transplant recipients (RTRs) and the self-perceived burden that acts as a mediator between social support and FoP. Patients and Methods Sociodemographic and clinical characteristics, the Social Support Rating Scale (SSRS), the Self-Perceived Burden Scale (SPBS), and the Fear of Progression-Questionnaire-Short Form (FoP-Q-SF) were used. Structural equation modeling (SEM) was used to examine the mediating role of self-perceived burden. Results Our results showed that social support was negatively related to the self-perceived burden (r = -0.28, p < 0.001) and FoP (r = -0.37, p < 0.001). Moreover, we determined that self-perceived burden was positively related to FoP (r = 0.58, p < 0.001) and that the indirect effect of social support on FoP via self-perceived burden was significant (β = -0.172, 95% CI: -0.253, -0.097), and with a mediating effect value of 36.9%. Conclusion The FoP in RTRs is a concern. Higher social support and lower self-perceived burden can reduce the risk of FoP. Healthcare professionals (HCPs) should assist RTRs in correctly evaluating an individual's social support system, helping them optimize social support to reduce the self-perceived burden and the development of FoP.
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Affiliation(s)
- Sainan Liu
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Ying Zhang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Qi Miao
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xu Zhang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xiaoyu Jiang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Tiantian Chang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xiaofei Li
- Transplantation and Hepatobiliary Department, The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
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15
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Tauber NM, O'Toole MS, Jensen AB, Butow PN, Thewes B, Elkjaer E, Knutzen S, von Heymann A, Johansen C, Zachariae R. ConquerFear-Group: A randomized controlled trial of an online-delivered group-based psychological intervention for fear of cancer recurrence in breast cancer survivors. Psychooncology 2023; 32:1424-1432. [PMID: 37489745 DOI: 10.1002/pon.6193] [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: 04/13/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a distressing concern among cancer survivors. Interventions to address FCR need to be effective but also accessible and low cost. This randomized controlled trial evaluated the efficacy of an online group-based psychological intervention for FCR (ConquerFear-Group). METHODS Eligible breast cancer (BC) survivors had completed primary treatment 3 months-5 years previously, were ≥18 years, and scored ≥22 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Participants were randomized to online ConquerFear-Group (focusing on metacognitive strategies, values-clarification, and education about follow-up behavior) or online group-based relaxation training (active control). Questionnaires were completed at baseline (T1), 1 week post-intervention (T2), three (T3) and six (T4) months later. The primary outcome was FCR (FCRI total). A number of secondary and process outcomes were also collected. Treatment effects were evaluated with mixed linear models. RESULTS Of 866 eligible BC survivors, 475 (55%) completed the FCR screening, and 85 (18%) were randomized to ConquerFear-Group or relaxation training (2 × 6 groups). Compared with control participants, ConquerFear-Group participants experienced larger reductions in FCR (Cohen's d = 0.47, p = 0.001) and FCR severity (d = 0.57, p < 0.001), as well as mindfulness and decentering from baseline through follow-up, and improvements in emotion regulation (T2), worry (T2, T3) and rumination (T2) at some time points. CONCLUSIONS The results demonstrated statistically significant and stable effects of ConquerFear-Group on FCR that were maintained over a 6-month period. It is suggested to investigate the program in a real-life setting, where a pragmatic trial can further demonstrate feasibility and effectiveness.
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Affiliation(s)
- Nina M Tauber
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mia S O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Anders B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus, Denmark
| | - Phyllis N Butow
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Belinda Thewes
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Emma Elkjaer
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Sofie Knutzen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus, Denmark
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Liu J, Griva K, Mahendran R. Latent Profiles of Fear of Cancer Recurrence and Associations with Physical and Mental Health Outcomes. Ann Behav Med 2023; 57:743-752. [PMID: 37203254 DOI: 10.1093/abm/kaad023] [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] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a multidimensional construct; however, few studies have meaningfully integrated FCR severity (i.e., level of fear) with FCR-related concepts (e.g., triggers). PURPOSE The present study determined (a) latent profiles of FCR; (b) socio-demographic variations between identified profiles; (c) interactions between identified profiles and resilience and rumination on chronic physical disorders, depressive/anxiety symptoms, and quality of life. METHODS The present study is a secondary data analysis of which 404 cancer survivors were included in this study. All participants completed the Fear of Cancer Recurrence Inventory and measures of resilience, rumination, depressive/anxiety symptoms, and quality of life. RESULTS Latent profile analysis identified three distinct profiles based on varying levels of FCR and FCR-related concepts; Profile 1 "Low FCR" (n = 108; 26.4%), Profile 2 "Moderate FCR, High coping" (n = 197; 49.4%), and Profile 3 "High FCR, distress and impairment" (n = 99; 24.3%). Profile 3 was associated with younger age and history of radiotherapy. Latent profiles of FCR significantly interacted with resilience and rumination on depressive/anxiety symptoms. CONCLUSIONS Latent profile analysis integrates FCR severity and FCR-related concepts to support a nuanced understanding of FCR. Our results suggest specific points of intervention, which extend beyond addressing FCR severity.
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Affiliation(s)
- Jianlin Liu
- Research Division, Institute of Mental Health, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore
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17
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Bae KR, Ahn Y, Park JW, Kim SJ. Exploring Fear of Cancer Recurrence (FCR) in cancer survivors from a medical social work perspective: A qualitative study of medical social workers in South Korea. PLoS One 2023; 18:e0288059. [PMID: 37410785 DOI: 10.1371/journal.pone.0288059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Fear of Cancer Recurrence (FCR) in cancer survivors has been insufficiently addressed despite its imperativeness in cancer journey. Although several studies have investigated healthcare professionals' experience with FCR in cancer survivors, a medical social work perspective has rarely been reflected. This study aimed to explore Korean medical social workers' experience with intervening FCR in cancer survivors. METHODS Snowball sampling recruited 12 experienced medical social workers intervening with cancer survivors at tertiary or university cancer hospitals in South Korea. Individual and focus-group interviews (FGI) were conducted with the medical social workers. The interviews were recorded, transcribed, and analyzed by using an inductive qualitative content analysis. RESULTS Content analysis of the interviews extracted the following major themes regarding FCR in cancer survivors. First, when and how FCR among cancer survivors emerged at the early stage of medical social work interventions was identified. Second, how medical social workers dealt with FCR in cancer survivors was illustrated. Third, the responses of cancer survivors to medical social work interventions for FCR were assessed. Finally, the internal and external issues underlying the medical social work interventions for FCR among cancer survivors were revealed and discussed. CONCLUSION Based on the results, this study suggested the implications on dealing with FCR in cancer survivors in the realm of medial social work profession. Furthermore, it expanded the discussion about FCR in cancer survivors from cancer hospitals to community.
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Affiliation(s)
- Ka Ryeong Bae
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Yeojin Ahn
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
| | - Joung Won Park
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Division of Social Work, Samsung Medical Center, Seoul, South Korea
| | - Seok-Joo Kim
- Department of Social Welfare, College of Social Sciences, Daegu University, Gyeongbuk, South Korea
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18
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Jung W, Park J, Jeong A, Cho JH, Jeon YJ, Shin DW. Fear of cancer recurrence and its predictors among patients with non-small cell lung cancer (NSCLC). J Cancer Surviv 2023:10.1007/s11764-023-01419-9. [PMID: 37351732 DOI: 10.1007/s11764-023-01419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a multidimensional phenomenon among cancer survivors. This cross-sectional study aimed to identify the prevalence of FCR and its predictors among survivors of non-small cell lung cancer (NSCLC) in Korea. METHODS Participants who finished NSCLC treatment one or more months prior completed the Korean version of Fear of Cancer Recurrence Inventory-Short Form (K-FCRI-SF) and the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) at single tertiary hospital in Korea. Multivariate-adjusted logistic regression and stepwise backward selection were used to determine the potential predictors of FCR. RESULTS Of the total 949 participants (mean age 63.4 ± 8.8 years, 44.3% women), 55.8% had high FCR. Female (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.06-1.95), pathologic stage III (aOR 1.97, 95% CI 1.18-3.30), poor overall quality of life (aOR 1.42, 95% CI 1.03-1.95), poor emotional functioning (aOR 3.91, 95% CI 2.64-5.81), poor social functioning (aOR 1.87, 95% CI 1.31-2.68), and severe dyspnea (aOR 2.91, 95% CI 1.03-8.21) were independent predictors of high FCR. Old age (≥ 70 years) was included in the final model (aOR 0.74, 95% CI 0.51-1.06) but did not show clinical significance. CONCLUSIONS Our study demonstrated that high FCR was prevalent in NSCLC patients in Korea. To prevent this, we suggest screening and early detection of FCR based on sex, pathologic stage, quality of life, emotional and social functioning, and dyspnea. IMPLICATIONS FOR CANCER SURVIVORS Screening and early detection of FCR based on sex, pathologic stage, quality of life, emotional and social functioning, and dyspnea is suggested.
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Affiliation(s)
- Wonyoung Jung
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Medicine, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Junhee Park
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Ansuk Jeong
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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19
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Banks H, Webb K, Sharpe L, Shaw J. A qualitative exploration of fear of cancer recurrence in caregivers. Psychooncology 2023. [PMID: 37157172 DOI: 10.1002/pon.6149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is one of the most common unmet needs for cancer patients and caregivers. Yet little is known about the potentially unique nature of caregiver FCR. Our research aimed to address this gap by qualitatively exploring the features and impact of caregiver FCR. METHODS Eighteen semi-structured telephone interviews with cancer caregivers were conducted to explore the content and impact of caregiver fears and worries about cancer recurrence or progression. Data analysis used a Framework Approach. RESULTS Qualitative analysis identified three themes (1) fear of the patient suffering, (2) the need to protect the patient from a recurrence and/or cancer-related distress, and (3) caregiver's sense of unpreparedness and uncertainty. Underpinning these themes was an overarching sense of personal responsibility for the life of the patient. This overarching theme was identified as a key driver of caregivers' personal and patient-centred fears. CONCLUSIONS Our findings confirm the conceptual differences between patient and caregiver FCR. Future research must therefore acknowledge the unique experiences of caregivers and prioritise the development of empirically driven theoretical models, instruments, and interventions for caregiver FCR.
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Affiliation(s)
- Hannah Banks
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Kyra Webb
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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20
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Almeida SN, Elliott R, Silva ER, Sales CMD. Developing an emotion‐focused therapy model for fear of cancer recurrence: A case‐level task analysis. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023. [DOI: 10.1002/capr.12624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Susana N. Almeida
- Psychology Service Portuguese Institute of Oncology of Porto Francisco Gentil, E.P.E. Porto Portugal
- University of Maia – ISMAI Maia Portugal
| | - Robert Elliott
- Counselling Unit, School of Psychological Sciences and Health University of Strathclyde Glasgow UK
| | - Eunice R. Silva
- Psychology Service Portuguese Institute of Oncology of Porto Francisco Gentil, E.P.E. Porto Portugal
| | - Célia M. D. Sales
- Faculty of Psychology and Education Science at the University of Porto (FPCEUP), Center for Psychology at the University of Porto (CPUP) University of Porto Porto Portugal
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21
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Deuning-Smit E, Custers JAE, Kwakkenbos L, Hermens RPMG, Prins JB. Evaluating the capacity of the distress thermometer to detect high fear of cancer recurrence. Psychooncology 2023; 32:266-274. [PMID: 36385563 PMCID: PMC10099705 DOI: 10.1002/pon.6066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Fear of cancer recurrence (FCR) is common and burdensome to patients, but often remains undetected. Oncology professionals report need for tools to improve FCR detection in routine care. Oncology care guidelines recommend the Distress Thermometer (DT) for distress screening, but it has not been validated for FCR. This study evaluated the capacity of the DT and accompanying problem list to detect FCR. METHODS Amalgamated data of two studies with 149 breast cancer and 74 colorectal cancer survivors were used. We evaluated the Dutch DT including the DT score, problem list fears item and emotional domain score using Receiver Operating Characteristic analyses. The Dutch Cancer Worry Scale-6 (CWS-6) was used as reference measure, with validated cut-off scores ≥10 and ≥12 for high FCR. Sensitivity, specificity, negative and positive predictive values were calculated. RESULTS The DT score showed poor performance in discriminating between low and high FCR. The recommended cut-off ≥4 had low sensitivity (65% for CWS-6≥10; 72% for CWS-6 ≥12) and specificity (67% and 58%). No other cut-off had an acceptable combination of sensitivity and specificity. The fears item had low sensitivity (29% and 44.9%) and high specificity (95% and 94%). The emotional domain score had fair performance in discriminating between low and high FCR but there was no cut-off with acceptable sensitivity and specificity. CONCLUSION The DT as currently recommended in oncology care guidelines is not suitable to effectively detect FCR in routine care. To improve patients access to psychosocial care, it should be investigated how FCR-specific measures can be integrated in oncology practice.
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Affiliation(s)
- Esther Deuning-Smit
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Kwakkenbos
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Clinical Psychology, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc Center for Mindfulness, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Bergerot CD, Ferreira LN, Molina LNM, Pagung LB, Pedersen BDS, de Andrade TG, Machado RHI, Freitas ANDS, Barreto LHCT, de Araujo LL, Tumeh IBRG, Vieira NBS, Lee D, Philip EJ, Neto JNM, Buso MM, Simard S, Ozakinci G, Humphris G, Bergerot PG, Smith AB. Fear of cancer recurrence among Brazilian patients with cancer: Translation and cultural adaptation of FCR4/7 and FCRI-SF measures. J Psychosom Res 2023; 165:111125. [PMID: 36610336 DOI: 10.1016/j.jpsychores.2022.111125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Fear of cancer recurrence or progression (FCR) is considered one of the most common unmet needs among patients with cancer. This study sought to translate and evaluate the psychometric properties of the Fear of Cancer Recurrence scale (FCR4/7) and Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). METHODS This study involved three phases: (1) translation and cultural adaptation of the FCR4/7 and FCRI-SF measures, (2) validity and reliability testing of the Portuguese version of these measures, and (3) examining patient's perceptions of these measures. Eligible patients were diagnosed with localized breast cancer, and patients with metastatic cancer. Descriptive analyses were collated, and psychometric analysis were conducted (confirmatory factor analysis). RESULTS A total of 200 patients were recruited (100 patients with localized and 100 patients with metastatic cancer). A significant proportion of patients reported moderate to severe FCR (FCR7: 32.0% and FCRI-SF: 43.0%). Female gender, younger age and metastatic cancer were associated with higher levels of FCR. Psychometric analyses suggested that the Portuguese versions of the FCR4/7 and FCRI-SF were valid, unidimensional in nature, with acceptable reliability coefficients across all scales. In a sub-sample qualitative analysis (n = 75), most patients were satisfied with the relevance of both measures. CONCLUSION Our findings suggest the Portuguese versions of the FCR4/7 and FCRI-SF are valid tools to assess FCR among patients with localized and metastatic cancer. Future research can now extend our understanding of FCR and assess this construct among Portuguese speaking patients, to guide the development of effective and targeted interventions for patients globally.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - David Lee
- University of New Mexico, Albuquerque, NM, USA
| | - Errol J Philip
- University of California San Francisco, San Francisco, CA, USA
| | - João Nunes Matos Neto
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasília, DF, Brazil
| | - Marco Murilo Buso
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasília, DF, Brazil
| | - Sebastien Simard
- Health Science Department, Université du Québec à Chicoutimi (UQAC), Saguenay, QC, Canada
| | - Gozde Ozakinci
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, United Kingdom
| | - Gerald Humphris
- Population and Behavioural Sciences, School of Medicine, University of St. Andrews, Scotland, United Kingdom
| | - Paulo Gustavo Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasília, DF, Brazil.
| | - Allan Ben Smith
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia.
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23
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Sorscher S. Is It Time to Expand Our Definition of "Clinical Utility"? Cancer Control 2023; 30:10732748231170483. [PMID: 37057688 PMCID: PMC10108406 DOI: 10.1177/10732748231170483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 04/15/2023] Open
Abstract
Currently, genetic tests that predict cancer risk or risk of recurrence in patients who have had their cancer treated with curative intent must have proven "clinical utility" to be recommended by the organizations responsible for publishing the standard-of-care guidelines for cancer care.Based on the current definition of clinical utility, most patients are denied testing for cancer-predisposing genes or pathogenic germline variants even though germline testing has been proven as highly accurate in identifying pathogenic germline variant carriers, there are measures recommended to prevent and diagnose early cancers associated with particular PGVs, and disparities in patient access to genetic tests are well described.Similarly, despite dozens of studies demonstrating that detected circulating tumor DNA (ctDNA) after curative intention therapy of different cancer types is a highly accurate biomarker that predicts recurrence, the major organizations that publish guidelines for cancer monitoring after curative intention therapy recommend against using ctDNA assays to detect minimal residual disease and thereby predict recurrence for all solid tumor malignancies.Here, the primary reasons that these genetic tests are considered to lack proven clinical utility and the primary evidence suggesting that a broader definition of clinical utility should be considered are discussed. By expanding the definition of clinical utility, many patients will benefit from the information gained from having these genetic tests.
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24
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Deuning-Smit E, Kolsteren EEM, Kwakkenbos L, Custers JAE, Hermens RPMG, Prins JB. Barriers and facilitators for implementation of the SWORD evidence-based psychological intervention for fear of cancer recurrence in three different healthcare settings. J Cancer Surviv 2022:10.1007/s11764-022-01285-x. [DOI: 10.1007/s11764-022-01285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
Fear of cancer recurrence (FCR) interventions are effective, but few are implemented. This study aimed to identify barriers and facilitators for implementing the evidence-based blended SWORD intervention in routine psycho-oncological care.
Methods
Semi-structured interviews with 19 cancer survivors and 18 professionals from three healthcare settings assessed barriers and facilitators in six domains as described by the determinant frameworks of Grol and Flottorp: (1) innovation, (2) professionals, (3) patients, (4) social context, (5) organization, and (6) economic and political context.
Results
In the innovation domain, there were few barriers. Facilitators included high reliability, accessibility, and relevance of SWORD. In the professional domain, physicians and nurses barriers were lack of self-efficacy, knowledge, and skills to address FCR whereas psychologists had sufficient knowledge and skills, but some were critical towards protocolized treatments, cognitive behavioral therapy, or eHealth. Patient domain barriers included lack of FCR awareness, negative expectations of psychotherapy, and unwillingness/inability to actively engage in treatment. A social context domain barrier was poor communication between different healthcare professionals. Organization domain barriers included inadequate referral structures to psychological services, limited capacity, and complex legal procedures. Economic and political context domain barriers included lack of a national implementation structure for evidence-based psycho-oncological interventions and eHealth platform costs.
Conclusions
Implementation strategies should be targeted at patient, professional, organizational and economic and political domains. Identified barriers and facilitators are relevant to other researchers in psycho-oncology that aim to bridge the research-practice gap.
Implications for cancer survivors
This study contributes to the implementation of evidence-based psychological interventions for cancer survivors, who can benefit from these services.
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25
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Riggauer J, Blaser D, Elicin O, Gahl B, Giger R, Mueller SA. Risk Factors for Fear of Recurrence in Head and Neck Cancer Patients. Laryngoscope 2022. [DOI: 10.1002/lary.30340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Julia Riggauer
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
| | - Daniela Blaser
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
| | - Olgun Elicin
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of Radiation Oncology, Inselspital Bern University Hospital Bern Switzerland
| | - Brigitta Gahl
- Clinical Trials Unit University of Bern Bern Switzerland
| | - Roland Giger
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
| | - Simon Andreas Mueller
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
- Department of Otolaryngology, Head & Neck Surgery University Hospital Zurich, University of Zurich Zurich Switzerland
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26
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Tran MJ, Jefford M, Smith B, Lynch F, Dhillon HM, Shaw J, McDowell L, White A, Halloran C, Wiesenfeld D, Ftanou M. Study protocol for the evaluation of Fear-Less: a stepped-care program for fear of cancer recurrence in survivors with early-stage disease. Pilot Feasibility Stud 2022; 8:177. [PMID: 35948952 PMCID: PMC9364569 DOI: 10.1186/s40814-022-01123-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a significant unmet need amongst cancer survivors and is consistently associated with psychological distress and impaired quality of life. Psychological interventions for FCR, such as ConquerFear, have demonstrated efficacy in reducing FCR and improving emotional wellbeing. Unfortunately, there are barriers to the uptake of evidence-based FCR treatments in clinical practice. A stepped-care FCR treatment model may overcome these barriers and has demonstrated potential in people with advanced melanoma. This study aims to evaluate the acceptability, feasibility, and impact of a stepped-care FCR treatment model (Fear-Less) in people with other cancer types, who have completed treatment with curative intent. METHODS Sixty people with early-stage cancer (defined as individuals who have received treatment with curative intent and with no metastatic disease) will be screened for FCR using the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Individuals reporting moderate FCR (FCRI-SF between 13 and 21) will be offered a clinician-guided self-management resource; those reporting high FCR (FCRI-SF ≥ 22) will be offered individual therapy according to the ConquerFear protocol. Participants will complete purpose-built evaluation surveys assessing their FCR screening and intervention experiences. Clinicians will also complete a survey regarding their experiences of the treatment model. Fear-Less will be evaluated in terms of (1) acceptability (i.e., patient and clinician experience), (2) feasibility (i.e., referral uptake, treatment adherence, and time taken to screen and deliver interventions), and (3) impact (i.e., pre- to post-intervention FCR changes). DISCUSSION The Fear-Less stepped-care model is a novel framework for screening FCR and stratifying survivors to the appropriate level of treatment. Our study will provide an indication of whether Fear-Less is a feasible and acceptable FCR model of care amongst survivors with early-stage disease and inform further investigations of this model. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12622000818730 .
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Affiliation(s)
- Mei Jun Tran
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research and South West Sydney Clinical Campuses, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Lynch
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Joanne Shaw
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan White
- Consumer Representative, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Consumer Representative, Continence Foundation of Australia, Melbourne, Victoria, Australia
| | - Clare Halloran
- Consumer Representative, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Wiesenfeld
- Director Head and Neck Tumour Stream, Melbourne Health and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Lead in Research and Education Head and Neck, VCCC Alliance, Melbourne, Victoria, Australia.,Honorary Clinical Professor, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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27
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Interventions addressing fear of cancer recurrence: challenges and future perspectives. Curr Opin Oncol 2022; 34:279-284. [PMID: 35730523 DOI: 10.1097/cco.0000000000000837] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Fear of cancer recurrence (FCR) is a common concern among cancer survivors and support for FCR is one of the most cited unmet needs. High FCR was found to be related to increased use of healthcare services, specifically primary healthcare and medical consultations, and lower quality of life. In the past decade screening instruments for FCR and interventions have been developed and proven effective. RECENT FINDINGS Systematic reviews and meta-analyses have shown that psychological treatments are effective for reducing FCR. The cost-effectiveness of FCR interventions could be increased by considering stepped or matched models for supportive care. Despite availability of evidence-based interventions, the proposed care models are not implemented and most cancer survivors still do not benefit from supportive care. SUMMARY The time is right to focus on implementation of FCR interventions into clinical practice. The complexity of optimizing FCR care is characterized by barriers and facilitators in the domains of patients, healthcare professionals, healthcare organizations and the broader economic, and political context. The main challenge for future research is to address these issues so that former investments in high-quality FCR intervention research will pay out in actual practice changes in the benefit of cancer survivors.
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28
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Adashek JJ, Jordan A, Redwine LS, Tyson DM, Thompson Z, Pabbathi S. Pan-cancer analysis of fear of cancer recurrence among cancer survivors. ESMO Open 2022; 7:100528. [PMID: 35780591 PMCID: PMC9463169 DOI: 10.1016/j.esmoop.2022.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/19/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) is a phenomenon estimated to affect a large portion of cancer survivors. This study sought to determine whether patients from a National Cancer Institute-designated institution had their clinical needs met relating to FCR. Patients and methods Patients referred to the survivorship clinic completed The Clinical Needs Assessment Tool for Cancer Survivors (CNAT-CS). Correlations between responses were calculated and univariable and multivariable logistic regression was used to identify predictors of met or unmet needs related to FCR. Results Of 647 patients, 241 (37.2%) reported they did not have clinical needs related to FCR and 386 (59.7%) reported they had clinical needs related to FCR but that the needs had been met. Only 20 (3.09%) reported that clinical needs relating to FCR were unmet. According to univariate logistic regression, sex had no impact on FCR (P = 0.8427), nor did years since diagnosis (P = 0.1014). Results of multivariable regression indicate that the odds ratio of reported FCR as an unmet need (versus not a need) is 0.939; the odds decreased by 6% (P = 0.0023) for every year increase in age. For each unit increase in distress score, the odds of reporting FCR as an unmet need increased by 32% (P = 0.0007). Conclusions This study is unique in not only examining the presence of FCR but also whether patients reported that their needs were met for FCR. The study found that most patients had clinical needs for FCR, but the needs were met at the time of the survey. Patients who report higher distress scores are more likely to report FCR as an unmet need. Therefore, cancer survivors reporting high distress scores in clinic visits should be evaluated for FCR. FCR is common among cancer survivors; it can be seen as a met or unmet need by each patient. Identifying factors that influence fear of cancer recurrence as a need met or not include age and distress score. Recognizing FCR as an unmet need is paramount to develop clinics and mitigation strategies to ameliorate this need.
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Affiliation(s)
- J J Adashek
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - A Jordan
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - L S Redwine
- Department of Family Medicine and Community Health, University of Miami, Miami, USA
| | - D Martinez Tyson
- College of Public Health, University of South Florida, Tampa, USA
| | - Z Thompson
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - S Pabbathi
- Individualized Cancer Management, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA.
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29
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Braun SE, Willis KD, Mladen SN, Aslanzadeh F, Lanoye A, Langbein J, Reid M, Loughan AR. Introducing FCR 6 – Brain: Measuring Fear of Cancer Recurrence in Brain Tumor Patients and Their Caregivers. Neurooncol Pract 2022; 9:509-519. [PMID: 36388416 PMCID: PMC9665059 DOI: 10.1093/nop/npac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Fear of cancer recurrence (FCR) is a psychological consequence of cancer diagnosis that impacts quality of life in neuro-oncology. However, the instruments used to assess FCR have not been tested for validity in patients with brain tumors. The present study explored the psychometric properties of a brief FCR scale in patients with primary brain tumor (PBT) and their caregivers.
Methods
Adult patients with PBT (n = 165) and their caregivers (n = 117) completed the FCR–7-item scale (FCR7) and measures of psychological functioning. Exploratory factor analyses (EFA) were conducted for both patient and caregiver FCR7. Convergent validity, prevalence, the difference between FCR in patients and caregivers, and relationships with relevant medical and demographic variables were explored.
Results
EFAs revealed a single factor with one item demonstrating poor loading for both patients and caregivers. Removal of the item measuring hypervigilance symptoms (checking for physical signs of tumor) greatly improved the single factor metrics. The amended scale (FCR6-Brain) demonstrated good convergent validity. Caregiver FCR was significantly higher than patient. Clinical guidance to identify clinically significant FCR was introduced. Age, gender, and time since diagnosis were related to FCR, with higher FCR in younger women more recently diagnosed.
Conclusions
The FCR6-Brain is the first validated instrument to assess FCR in this population and should be used to identify individuals at risk for FCR and guide development of future psychotherapeutic interventions. This study highlights the distinct characteristics of FCR in neuro-oncology. Symptoms of hypervigilance in PBT patients need further investigation.
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Affiliation(s)
- Sarah Ellen Braun
- Virginia Commonwealth University, Department of Neurology : Richmond VA
- Virginia Commonwealth University, Massey Cancer Center : Richmond, VA
| | - Kelcie D Willis
- Virginia Commonwealth University, Department of Psychology: Richmond, Virginia , Richmond, VA
| | - Samantha N Mladen
- Virginia Commonwealth University, Department of Psychology: Richmond, Virginia , Richmond, VA
| | - Farah Aslanzadeh
- Baltimore VA Medical Center, Department of Neuropsychology , Baltimore, MD
| | - Autumn Lanoye
- Virginia Commonwealth University, Massey Cancer Center : Richmond, VA
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy : Richmond, VA
| | - Jenna Langbein
- Virginia Commonwealth University School of Medicine: Richmond , VA
| | - Morgan Reid
- Virginia Commonwealth University, Department of Psychology: Richmond, Virginia , Richmond, VA
| | - Ashlee R Loughan
- Virginia Commonwealth University, Department of Neurology : Richmond VA
- Virginia Commonwealth University, Massey Cancer Center : Richmond, VA
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30
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Bergerot CD, Philip EJ, Bergerot PG, Siddiq N, Tinianov S, Lustberg M. Fear of Cancer Recurrence or Progression: What Is It and What Can We Do About It? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35561298 DOI: 10.1200/edbk_100031] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with cancer face a trajectory marked by emotional and physical distress that can be associated with both diagnosis and treatment. Fear of cancer recurrence or progression has been considered one of the most common unmet needs reported by patients diagnosed with both localized and metastatic disease. Fear of cancer recurrence or progression has been defined as the "fear, worry, or concern relating to the possibility that cancer will come back or progress." Often overlooked by health care teams, fear of cancer recurrence or progression has been associated with impaired quality of life and psychosocial adjustment, elevated emotional distress, and a range of physical symptoms. Several interventions for fear of cancer recurrence or progression are currently under investigation. Early recognition, support, and validation of feelings associated with fear of cancer recurrence or progression, and appropriate referrals to psychosocial oncology, can be beneficial for many patients. Assessing patients early in their cancer trajectory, and at important milestones, including a change in therapies, at the end of active treatment, and during follow-up visits, can help identify individuals at risk and help individuals engage in supportive programs.
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Affiliation(s)
| | - Errol J Philip
- University of California San Francisco, San Francisco, CA
| | - Paulo Gustavo Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasília, DF, Brazil
| | - Namrah Siddiq
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
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31
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Shen Z, Xie J, Ruan C, Li C. Mediating effect of ill perception on the relationship between social constraints and fear of cancer recurrence among adolescent and young adult survivors who underwent hematopoietic stem cell transplantation. Asia Pac J Oncol Nurs 2022; 9:100060. [PMID: 35619654 PMCID: PMC9126777 DOI: 10.1016/j.apjon.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianfei Xie
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Chunhong Ruan
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Corresponding authors.
| | - Chengyuan Li
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Corresponding authors.
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32
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Sharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J. Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct. Health Psychol Rev 2022; 17:301-320. [PMID: 35132937 DOI: 10.1080/17437199.2022.2039744] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - M Michalowski
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - B Richmond
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - R E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - J Shaw
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006.,Psycho-Oncology Co-operative Group (POCOG), The University of Sydney, NSW 2006
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33
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Bu X, Jin C, Fan R, Cheng ASK, Ng PHF, Xia Y, Liu X. Unmet needs of 1210 Chinese breast cancer survivors and associated factors: a multicentre cross-sectional study. BMC Cancer 2022; 22:135. [PMID: 35109799 PMCID: PMC8811964 DOI: 10.1186/s12885-022-09224-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Breast cancer survivors (BCSs) often have potential unmet needs. Identification of the specific needs of BCSs is very significant for medical service provision. This study aimed to (1) investigate the unmet needs and quality of life (QoL) of BCSs in China, (2) explore the diverse factors associated with their unmet needs, and (3) assess the association between their unmet needs and QoL. Methods A multicentre, cross-sectional survey was administered to 1210 Chinese BCSs. The Cancer Survivor Profile-Breast Cancer and the Functional Assessment of Cancer Therapy-Breast scale were administered to survivors who gave informed consent to participate. Data were analysed using t-test, ANOVA, multiple regression analysis, and Pearson correlations. Results The 1192 participants completed questionnaires (response rate 98.51%). Our study reveals that the most prevalent unmet needs were in the ‘symptom burden domain’. The unmet needs of BCSs depend on eleven factors; age, time since diagnosis, education level, occupation, payment, family income status, stage of cancer, treatment, family history of cancer, pain, and physical activities. To ensure the provision of high-quality survivorship care and a high satisfaction level, more attention should be paid to actively identifying and addressing the unmet needs of BCSs. The problem areas identified in the Cancer Survivor Profile for breast cancer were negatively associated with all subscales of QoL except the health behaviour domain, with the correlation coefficient ranging from − 0.815 to − 0.011. Conclusion Chinese BCSs exhibit a high demand for unmet needs in this study, and the most prevalent unmet needs were in the ‘symptom burden domain’. There was a significant association between patients’ unmet needs (as defined in the Cancer Survivor Profile for breast cancer) and QoL. Future research should focus on enhancements to survivorship or follow-up care to address unmet needs and further improve QoL.
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Affiliation(s)
- Xiaofan Bu
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Xiangya School of Nursing, Central South University, Changsha, China
| | - Cai Jin
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Department of Nursing, Hunan Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - Rongrong Fan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Peter H F Ng
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yimin Xia
- Department of Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiangyu Liu
- Department of Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
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Deuning‐Smit E, Custers JAE, Miroševič Š, Takes RP, Jansen F, Langendijk JA, Terhaard CHJ, Baatenburg de Jong RJ, Leemans CR, Smit JH, Kwakkenbos L, Verdonck‐de Leeuw IM, Prins JB. Prospective longitudinal study on fear of cancer recurrence in patients newly diagnosed with head and neck cancer: Course, trajectories, and associated factors. Head Neck 2022; 44:914-925. [PMID: 35084079 PMCID: PMC9305148 DOI: 10.1002/hed.26985] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/06/2021] [Accepted: 01/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background This study assessed the course of fear of cancer recurrence (FCR) in patients newly diagnosed with head and neck cancer (HNC), identified FCR trajectories and factors associated with FCR trajectories. Methods Six hundred and seventeen HNC patients from the NET‐QUBIC cohort study completed the Cancer Worry Scale‐6 at diagnosis, 3 and 6 months post‐treatment. FCR trajectories were identified using Latent Class Growth Analysis. Associations were explored between FCR trajectories and baseline demographic and medical variables, coping and self‐efficacy. Results Overall, FCR decreased slightly between baseline and 3 months post‐treatment and remained stable up to 6 months. Two FCR trajectories were identified: “high stable” (n = 125) and “low declining” (n = 492). Patients with high stable FCR were younger, reported more negative adjustment, passive coping, and reassuring thoughts, and less avoidance. Conclusions The majority of HNC patients have low declining FCR after diagnosis, but one in five patients experience persistent high FCR up to 6 months post‐treatment.
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Affiliation(s)
- Esther Deuning‐Smit
- Department of Medical Psychology Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen The Netherlands
| | - José A. E. Custers
- Department of Medical Psychology Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen The Netherlands
| | - Špela Miroševič
- Department of Family Medicine Faculty of Medicine, University of Ljubljana Ljubljana Slovenia
| | - Robert P. Takes
- Department of Otorhinolaryngology—Head and Neck Surgery Radboud University Medical Center Nijmegen The Netherlands
| | - Femke Jansen
- Department of Otolaryngology—Head and Neck Surgery Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Department of Clinical, Neuro and Development Psychology Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Johannes A. Langendijk
- Department of Radiation Oncology University Medical Center Groningen, University of Groningen Groningen The Netherlands
| | | | - Robert J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery Erasmus Cancer Institute, ErasmusMC Rotterdam The Netherlands
| | - C. René Leemans
- Department of Otolaryngology—Head and Neck Surgery Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Johannes H. Smit
- Department of Psychiatry Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Linda Kwakkenbos
- Department of Medical Psychology Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen The Netherlands
- Clinical Psychology, Behavioural Science Institute Radboud University Nijmegen The Netherlands
| | - Irma M. Verdonck‐de Leeuw
- Department of Otolaryngology—Head and Neck Surgery Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Department of Clinical, Neuro and Development Psychology Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Judith B. Prins
- Department of Medical Psychology Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen The Netherlands
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Luo X, Li W, Chen Y, Sun H, Humphris G, Liu T, Zhang J, Yang Y, Zhang B. Fear of Recurrence in Chinese Cancer Patients: Prevalence, Correlates, and Network Analysis. Front Psychiatry 2022; 13:803543. [PMID: 35197876 PMCID: PMC8859333 DOI: 10.3389/fpsyt.2022.803543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a significant issue for most cancer patients. Until now, a detailed investigation of the structure of FCR and the interaction among its constituent elements is lacking. This study aims to investigate the phenomenon of FCR by means of network analysis in Chinese cancer patients. METHODS This is a multi-center, cross-sectional study that included 996 cancer patients from southern China. All participants were assessed by the 7-item Chinese version Fear of Cancer Recurrence Scale (FCR-7). Multivariate logistic regression, and network analyses were conducted. Central symptoms (nodes) in the FCR network were identified. RESULTS Among the 996 patients, 543 (54.52%) reported moderate FCR, and 137 (13.76%) reported high FCR. Chemotherapy (OR = 2.954, P = 0.016), and childhood severe illness experience (OR = 2.331, P = 0.016) were positively associated with high FCR, while higher monthly income (OR = 0.403, P = 0.046) was negative associated with high FCR. The node #FCR2 (Worried/anxious about recurrence) was the most central node within the FCR network (Strength = 1.190), while node #FCR6 (Examining for physical signs) was the least central node (Strength = 0.373). The edge FCR1-FCR2 ("Afraid"-"Worried/anxious") was the thickest and most saturated edge in the network. After controlling for age and gender, an almost identical network was obtained with respect to edges magnitude and strength. CONCLUSION Fear of recurrence is a frequently reported issue among Chinese cancer patients. Patients with chemotherapy and childhood severe illness experience were more vulnerable and should be particularly monitored. Compared to behavioral component (i.e., body checking, overscreening and overtreatment) and cognitive component (i.e., intrusions), emotional component (i.e., worry/anxious) is more central to identify FCR and might be potential targets for further interventions.
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Affiliation(s)
- Xian Luo
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Wengao Li
- Department of Psychiatry, 999 Brain Hospital, Guangzhou, China
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Gerry Humphris
- Department of Health Psychology, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Ting Liu
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jingying Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yuan Yang
- Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
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36
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Pradhan P, Sharpe L, Menzies RE. Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors. Cancer Manag Res 2021; 13:8953-8965. [PMID: 34880676 PMCID: PMC8645945 DOI: 10.2147/cmar.s294114] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background Fear of cancer recurrence or progression (FCR) is common amongst cancer survivors and an important minority develop clinically significant levels of FCR. However, it is unclear how current clinical services might best support the growing numbers of cancer survivors. Purpose The aim of this study is to develop recommendations for future research in the management of FCR and propose a model of care to help manage FCR in the growing population of cancer survivors. Methods This is a narrative review and synthesis of empirical research relevant to managing FCR. We reviewed meta-analyses, systematic reviews and individual studies that had investigated interventions for FCR. Results A recent, well-conducted meta-analysis confirmed a range of moderately effective treatments for FCR. However, many survivors continued to experience clinical levels of FCR after treatment, indicating a clear need to improve the gold standard treatments. Accessibility of interventions is arguably a greater concern. The majority of FCR treatments require face-to-face therapy, with highly skilled psycho-oncologists to produce moderate changes in FCR. With increasing numbers of cancer survivors, we need to consider how to meet the unmet need of cancer survivors in relation to FCR. Although there have been attempts to develop minimal interventions, these are not yet sufficiently well supported to warrant implementation. Attempts to help clinicians to provide information which might prevent the development of clinically significant FCR have shown some early promise, but research is needed to confirm efficacy. Conclusion The next decade of research needs to focus on developing preventative approaches for FCR, and minimal interventions for those with mild-to-moderate symptoms. When evidence-based approaches to prevent FCR or manage moderate levels of FCR are available, stepped care approaches that could meet the needs of survivors could be implemented. However, we also need to improve existing interventions for severe FCR.
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Affiliation(s)
- Poorva Pradhan
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
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A systematic mixed studies review of fear of cancer recurrence in families and caregivers of adults diagnosed with cancer. J Cancer Surviv 2021; 16:1184-1219. [PMID: 34762248 DOI: 10.1007/s11764-021-01109-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022]
Abstract
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.
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Dinkel A, Marten-Mittag B, Kremsreiter K. Association Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer. Front Psychol 2021; 12:648623. [PMID: 34456783 PMCID: PMC8384960 DOI: 10.3389/fpsyg.2021.648623] [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: 01/01/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Fear of progression (FoP), or fear of cancer recurrence (FCR), is characterized by worries or concerns about negative illness-related future events. Actually, to worry is a common cognitive process that, in its non-pathological form, belongs to daily life. However, worry can also become pathological appearing as a symptom of mental disorders. This study aimed at investigating the associations among daily worry, pathological worry, and FoP in patients with cancer. Methods: This is a cross-sectional study that includes 328 hospitalized patients with cancer. Patients filled out the FoP Questionnaire (FoP-Q), the Worry Domains Questionnaire (WDQ) for the assessment of daily worry, and the Penn State Worry Questionnaire (PSWQ) for the assessment of pathological worry. Depressive, anxiety, and somatic symptoms were measured with modules of the Patient Health Questionnaire [Patient Health Questionnaire-Depressive Symptoms (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-Somatic Symptoms (PHQ-15)]. Furthermore, a structured clinical interview was conducted for the assessment of anxiety disorders. The hierarchical multiple linear regression analysis was used to identify factors independently associated with FoP. Results: Mean age of the participants was M = 58.5 years (SD = 12.8), and 64.6% were men. FoP and worry were significantly intercorrelated (r = 0.58–0.78). The level of FoP was most strongly associated with daily worry (β = 0.514, p < 0.001), followed by pathological worry (β = 0.221, p < 0.001). Further significant determinants were younger age and depressive and anxiety symptoms. Clinical variables were not independently associated with FoP. The final model explained 74% of the variance. Discussion: Fear of progression is strongly associated with daily worry and pathological worry. These results bring up the question of whether FoP is an expression of a general tendency to worry. Whether a general tendency to worry, in fact, represents an independent vulnerability factor for experiencing FCR/FoP needs to be investigated in a longitudinal research design.
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Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katrin Kremsreiter
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, University Medical Center Mannheim, Mannheim, Germany
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Williams JTW, Pearce A, Smith A'B. A systematic review of fear of cancer recurrence related healthcare use and intervention cost-effectiveness. Psychooncology 2021; 30:1185-1195. [PMID: 33880822 DOI: 10.1002/pon.5673] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/02/2021] [Accepted: 03/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common and burdensome psychological condition affecting cancer survivors. This systematic review aims to synthesise current evidence regarding: (1) FCR-related healthcare usage and costs and (2) the cost-effectiveness of FCR treatments. METHODS We searched MEDLINE, CINAHL, Cochrane and other electronic databases using MeSH headings and keywords for cancer, FCR and costs from their inception to September 2019. Identified studies were screened for eligibility. Original, peer-reviewed journal articles reporting quantitative data from samples of adults treated for cancer written in English were included. Quality was appraised using the Drummond checklist for economic evaluations or the relevant Joanna Briggs Institute Critical Appraisal Tool. RESULTS Data from 11 studies were extracted and synthesised. Seven studies addressed the costs of FCR and suggested an increase in the use of primary and secondary healthcare. Four studies addressed the cost-effectiveness of different FCR treatments and suggest that some treatments may cost-effectively reduce FCR and improve quality of life. Reviewed treatments had an incremental cost-effectiveness ratio between AU$3,233 and AU$152,050 per quality-adjusted life year gained when adjusted to 2019 Australian dollars. All studies were of sufficient quality to be synthesised in this review. CONCLUSIONS FCR appears to be associated with greater use of certain healthcare resources, and FCR may be treated cost-effectively. Thus, appropriate FCR treatments may not only reduce the individual burden, but also the strain on the healthcare system. Further high-quality research is needed to confirm this and ensure the future implementation of efficient and sustainable FCR treatments.
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Affiliation(s)
| | - Alison Pearce
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Allan 'Ben' Smith
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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40
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Peikert ML, Inhestern L, Krauth KA, Escherich G, Rutkowski S, Kandels D, Schiekiera LJ, Bergelt C. Fear of progression in parents of childhood cancer survivors: prevalence and associated factors. J Cancer Surviv 2021; 16:823-833. [PMID: 34302272 PMCID: PMC9300493 DOI: 10.1007/s11764-021-01076-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/14/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Recent research demonstrated that fear of progression (FoP) is a major burden for adult cancer survivors. However, knowledge on FoP in parents of childhood cancer survivors is scarce. This study aimed to determine the proportion of parents who show dysfunctional levels of FoP, to investigate gender differences, and to examine factors associated with FoP in mothers and fathers. METHODS Five hundred sixteen parents of pediatric cancer survivors (aged 0-17 years at diagnosis of leukemia or central nervous system (CNS) tumor) were consecutively recruited after the end of intensive cancer treatment. We conducted hierarchical multiple regression analyses for mothers and fathers and integrated parent-, patient-, and family-related factors in the models. RESULTS Significantly more mothers (54%) than fathers (41%) suffered from dysfunctional levels of FoP. Maternal FoP was significantly associated with depression, a medical coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and lower family functioning (adjusted R2 = .30, p < .001). Paternal FoP was significantly associated with a lower level of education, depression, a family coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and fewer siblings (adjusted R2 = .48, p < .001). CONCLUSIONS FoP represents a great burden for parents of pediatric cancer survivors. We identified associated factors of parental FoP. Some of these factors can be targeted by health care professionals within psychosocial interventions and others can provide an indication for an increased risk for higher levels of FoP. IMPLICATIONS FOR CANCER SURVIVORS Psychosocial support targeting FoP in parents of childhood cancer survivors is highly indicated.
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Affiliation(s)
- Mona L Peikert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Konstantin A Krauth
- Department of Pediatrics, Pediatric Hematology and Oncology, Klinik Bad Oexen, Oexen 27, 32549, Bad Oeynhausen, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniela Kandels
- Swabian Children's Cancer Center, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Louis J Schiekiera
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Individual courses and determinants of fear of cancer recurrence in long-term breast cancer survivors with and without recurrence. Support Care Cancer 2021; 29:7647-7657. [PMID: 34137933 PMCID: PMC8549971 DOI: 10.1007/s00520-021-06329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/30/2021] [Indexed: 11/05/2022]
Abstract
Objective This study investigated the prevalence, individual courses, and determinants of fear of cancer recurrence (FoR) in long-term breast cancer survivors (BCSs) with and without recurrence. Methods A total of 184 breast cancer survivors were surveyed at four measurement time points: during hospitalization (T1), 10 weeks (T2), 40 weeks (T3), and 5–6 years (T4) after hospital discharge. Descriptive statistics, chi-square tests, and logistic regression were performed. Results Respondents were females and 57 years old, on average. At T1, T3, and T4, 54.8%, 31.6%, and 29.7% of BCSs, respectively, were classified as having dysfunctional levels of FoR. Dysfunctional FoR decreased from T1 to T3 (χ2(1) = 17.11, p = 0.000; N = 163) and remained stable afterwards. Eight subgroups of individual courses of FoR over time could be described: (1) constant functional FoR; (2) constant dysfunctional FoR; (3) improving from dysfunctional to functional FoR from T1 to T3; (4) improving from dysfunctional to functional FoR from T3 to T4; (5) worsening from functional to dysfunctional FoR from T1 to T3; (6) worsening from functional to dysfunctional FoR from T3 to T4; (7) dysfunctional FoR at T1 and T4, and functional FoR in between; and (8) functional FoR at T1 and T4, and dysfunctional FoR in between. Logistic regression analysis revealed that being divorced/widowed, showing high levels of fatigue, being treated by chemotherapy, and having low confidence in treatment were associated with dysfunctional FoR 5 to 6 years after diagnosis (Nagelkerkes’ Pseudo-R2 = 0.648). Conclusions The findings reveal that FoR is a significant issue in long-term BCSs and has the potential to become a persistent psychological strain. We emphasize the need for increased awareness of FoR among BCSs and the need for support programs.
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Diekmann A, Schellenberger B, Reck S, Heuser C, Geiser F, Wirtz M, Ansmann L, Ernstmann N. Is patient participation in multidisciplinary tumor conferences associated with their fear of progression? Psychooncology 2021; 30:1572-1581. [PMID: 34004041 DOI: 10.1002/pon.5733] [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: 02/11/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE Previous studies found that some breast cancer patients in Germany are invited to participate in a multidisciplinary tumor conference (MTC) during the discussion of their own case. MTCs are regular meetings of a treatment team in which the diagnosis and treatment plan of cancer patients are discussed. Psychological consequences concerning the patients' participation in an MTC have not been examined yet. This study examines the association between patients' participation in MTC and patients' fear of progression (FoP). METHODS This analysis is part of a larger project named "Patient participation in multidisciplinary tumor conferences in Breast Cancer Care" (PINTU) which is a multicenter observational mixed-methods study. The study was conducted in six breast and gynecological cancer centers in North Rhine-Westphalia, Germany. Data were collected from 2018 to 2020 by patient survey at three time points. Patients with (n = 81) and without (n = 120) MTC participation were compared. FoP was measured with a 12-item short form of the FoP Questionnaire (FoP-Q-SF) at all three measurement time points. Data analysis included descriptive statistics, a one-way repeated variance analysis (ANOVA), and a one-way repeated ANCOVA using the propensity score as a covariate. RESULTS Data of n = 201 patients were included in the analysis. In general, FoP scores decreased in both groups from T0 to T2 (F = 36.539, p < 0.001, η2 = 0.155). Non-participating patients did not differ with regard to their FoP from patients who participated in an MTC before and after participation. The results of AN(C)OVA revealed no significant effects concerning the influence of patient participation in an MTC on FoP (F = 0.014, p = 0.907, η2 = <0.001 and (F = 0.013, p = 0.909, η2 = <0.001). CONCLUSION Since the FoP is not influenced by participation, the findings do not support recommendations for or against patient participation in an MTC. Further research should focus on the question of which patient groups might benefit from participation in an MTC with regard to which outcome variables.
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Affiliation(s)
- Annika Diekmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Sebastian Reck
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University Hospital Bonn, Bonn, Germany
| | - Markus Wirtz
- Department of Research Methods, University of Education, Freiburg, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
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Dalton K, Waterman M, Wassersug R, Garland SN. Fear of cancer recurrence in males diagnosed with breast cancer. Support Care Cancer 2021; 29:6183-6186. [PMID: 34023951 DOI: 10.1007/s00520-021-06307-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a significant problem for individuals diagnosed with a variety of different cancers. To date, FCR has not been studied in males with breast cancer. The objective of this study was to examine the severity of FCR in males with breast cancer. METHODS Males with breast cancer participated in an anonymous online survey and completed the Fear of Cancer Recurrence Inventory-Short Form scale (FCRI-SF). A frequency analysis was used to determine the percentage of participants that fell above or below the clinical cutoff for significant FCR. Regressions explored associations between FCR, age, cancer stage, time since diagnosis, and self-health rating. RESULTS Fifty-nine participants completed the FCRI-SF. The mean age of the sample was 63.5 and 93% reported their race as white. The mean FCR score was 23.9 and 61% reported clinically significant FCR. More than 80% of the sample experienced at least problematic levels of FCR. Increasing age was associated with decreased FCR. CONCLUSION Results of this study suggest that FCR is prevalent in men with breast cancer but larger studies with representative samples should be undertaken to better assess the prevalence of FCR in this population and compare it with other groups of patients. More attention is needed to understand the psychological distress experienced by men diagnosed and treated for breast cancer.
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Affiliation(s)
- Kathryn Dalton
- Department of Psychology, Faculty of Science, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada
| | - Meghan Waterman
- Department of Psychology, Faculty of Science, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada
| | - Richard Wassersug
- Department of Cellular & Physiological Science, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada.
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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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Custers JAE, Davis L, Messiou C, Prins JB, van der Graaf WTA. The patient perspective in the era of personalized medicine: What about scanxiety? Cancer Med 2021; 10:2943-2945. [PMID: 33837668 PMCID: PMC8085965 DOI: 10.1002/cam4.3889] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/05/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- José A E Custers
- Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Christina Messiou
- The Royal Marsden Hospital Foundation Trust and The Institute of Cancer Research, London, UK
| | - Judith B Prins
- Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Han PKJ, Gutheil C, Hutchinson RN, LaChance JA. Cause or Effect? The Role of Prognostic Uncertainty in the Fear of Cancer Recurrence. Front Psychol 2021; 11:626038. [PMID: 33519656 PMCID: PMC7843433 DOI: 10.3389/fpsyg.2020.626038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) is an important cause of suffering for cancer survivors, and both empirical evidence and theoretical models suggest that prognostic uncertainty plays a causal role in its development. However, the relationship between prognostic uncertainty and FCR is incompletely understood. Objective To explore the relationship between prognostic uncertainty and FCR among patients with ovarian cancer (OC). Design A qualitative study was conducted utilizing individual in-depth interviews with a convenience sample of patients with epithelial ovarian cancer who had completed first-line treatment with surgery and/or chemotherapy. Semi-structured interviews explored participants’ (1) understanding of their prognosis; (2) experiences, preferences, and attitudes regarding prognostic information; and (3) strategies for coping with prognostic uncertainty. Inductive qualitative analysis and line-by-line software-assisted coding of interview transcripts was conducted to identify key themes and generate theoretical insights on the relationship between prognostic uncertainty and FCR. Results The study sample consisted of 21 participants, nearly all of whom reported experiencing significant FCR, which they traced to an awareness of the possibility of a bad outcome. Some participants valued and pursued prognostic information as a means of coping with this awareness, suggesting that prognostic uncertainty causes FCR. However, most participants acknowledged fundamental limits to both the certainty and value of prognostic information, and engaged in various strategies aimed not at reducing but constructing and maintaining prognostic uncertainty as a means of sustaining hope in the possibility of a good outcome. Participants’ comments suggested that prognostic uncertainty, fear, and hope are connected by complex, bi-directional causal pathways mediated by processes that allow patients to cope with, construct, and maintain their uncertainty. A provisional dual-process theoretical model was developed to capture these pathways. Conclusion Among patients with OC, prognostic uncertainty is both a cause and an effect of FCR—a fear-inducing stimulus and a hope-sustaining response constructed and maintained through various strategies. More work is needed to elucidate the relationships between prognostic uncertainty, fear, and hope, to validate and refine our theoretical model, and to develop interventions to help patients with OC and other serious illnesses to achieve an optimal balance between these states.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States.,Tufts University School of Medicine, Boston, MA, United States
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States
| | - Rebecca N Hutchinson
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States.,Tufts University School of Medicine, Boston, MA, United States.,Palliative Medicine Program, Maine Medical Center, Portland, ME, United States
| | - Jason A LaChance
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States.,Tufts University School of Medicine, Boston, MA, United States.,Division of Gynecologic Oncology, Maine Medical Center, Portland, ME, United States
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47
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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: 38] [Impact Index Per Article: 9.5] [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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Nahm SH, Blinman P, Butler S, Tan SYC, Vardy J. Factors associated with fear of cancer recurrence in breast and colorectal cancer survivors: A cross-sectional study of cancer survivors. Asia Pac J Clin Oncol 2020; 17:222-229. [PMID: 33079491 DOI: 10.1111/ajco.13434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Abstract
AIM To define the prevalence and severity of fear of cancer recurrence and identify factors associated with fear of cancer recurrence in breast cancer and colorectal cancer survivors attending the Sydney Cancer Survivorship Clinic. METHODS A cross-sectional study was performed using prospectively collected data. Survivors completed questionnaires assessing quality of life (Functional Assessment of Cancer Therapy-General and symptoms (Distress Thermometer, Patient's Disease and Treatment Assessment Form)). Survivors were assessed by a clinical psychologist for the presence of fear of cancer recurrence. Clinical and quality of life variables were evaluated for associations with fear of cancer recurrence. RESULTS Overall, 315 survivors (181 breast cancer, 134 colorectal cancer) were included. In total, 201 survivors (64%) had fear of cancer recurrence according to psychology assessment, and of the 118 that had fear of cancer recurrence severity recorded, 64 (54%) were rated as moderate-severe. On univariate analysis, fear of cancer recurrence was associated with younger age (P < 0.001), higher distress thermometer score (P = 0.001) and poorer overall wellbeing (P < 0.001). On multivariate analysis, younger age (P = 0.043), being bothered by side effects of treatment (P = 0.023), feeling sad (P = 0.020) and greater worry that their condition will get worse (P = 0.017) were independently associated with fear of cancer recurrence. CONCLUSIONS Fear of cancer recurrence is common in breast and colorectal cancer survivors, and moderate-severe in over half. Fear of cancer recurrence was independently associated with younger age, feeling sad, being more bothered by side effects.
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Affiliation(s)
- Sharon H Nahm
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Prunella Blinman
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Sue Butler
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - S Y Cindy Tan
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Janette Vardy
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia.,Concord Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia
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49
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Smith AB. Integrating fear of cancer recurrence screening into routine care: opportunities and challenges. Psychooncology 2020; 30:134-137. [PMID: 32976657 DOI: 10.1002/pon.5558] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/28/2020] [Accepted: 09/23/2020] [Indexed: 01/16/2023]
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, Ontario, Canada
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50
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Vandraas KF, Reinertsen KV, Kiserud CE, Lie HC. Fear of cancer recurrence among young adult cancer survivors-exploring long-term contributing factors in a large, population-based cohort. J Cancer Surviv 2020; 15:497-508. [PMID: 32989672 PMCID: PMC8272704 DOI: 10.1007/s11764-020-00943-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Fear of cancer recurrence (FCR) may be debilitating, yet knowledge of FCR among the growing population of long-term young adult cancer survivors (YACS) is scarce. We explored risk of FCR and associated factors in a nation-wide, population-based cohort of YACS. METHODS All 5-year survivors diagnosed at the ages of 19-39 years with breast cancer (BC), malignant melanoma (MM), colorectal cancer (CRC), leukemia (LEU), or non-Hodgkin lymphoma (NHL) between 1985 and 2009 in Norway were identified by the Cancer Registry of Norway and completed the cross-sectional comprehensive NOR-CAYACS health survey. Univariate and multivariate linear regression modeling was performed. RESULTS In total, 936 survivors were included, with an average of 16 years since diagnoses. BC was the most prevalent cancer form (38.4%), followed by MM (24.7%), NHL (15.6%), CRC (11.8%), and LEU (9.6%). Survivors worried most about getting another cancer (74%), and (20%) reported quite a bit or a lot of FCR. BC and MM survivors had the highest FCR scores. Post-traumatic stress symptoms (PTSS) had the strongest association with FCR (Std B 0.21, p < 0.01), above demographic and clinical variables. CONCLUSIONS FCR is prevalent even among long-term YACS, including survivors of MM with favorable prognoses. IMPLICATIONS FOR CANCER SURVIVORS Attention to ongoing risks of PTSS and FCR in this growing survivor population is warranted to optimize future survivorship care.
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Affiliation(s)
- Kathrine F Vandraas
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.
| | - Kristin V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Hanne C Lie
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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