Quality of life in patients attending a low-risk gynaecological oncology follow-up clinic

Model of predicting fear of cancer recurrence in patients with digestive tract cancer: A cross-sectional study

AIMS

To investigate the incidence of fear of cancer recurrence in patients with digestive tract cancers analyse its influencing factors, and further establish a visual risk prediction model.

DESIGN

A cross-sectional study.

METHODS

A cross-sectional survey was conducted among 570 patients with digestive tract tumours admitted to a local hospital, from May 2023 to December 2023 by convenient sampling method. Univariate analysis and logistic analysis were performed on the influencing factors, and the risk prediction nomogram model of fear of cancer recurrence in patients with digestive tract cancer was constructed by using R 4.1.3 software. ROC curve was used to evaluate the differentiation of the nomogram model. The calibration curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the consistency of the model. This study was reported using the TRIPOD checklist.

RESULTS

In this study, 272 (47.7%) patients developed fear of recurrence. The risk prediction model of recurrence fear column chart for digestive tract cancer patients incorporated six variables of gender, therapy, alimentary tract haemorrhage, pain, depression and social support. The C-statistic was (.976), and the calibration curve showed that the predicted probability was more in line with the actual probability of occurrence, and the decision curve showed that the predictive model had better practicality.

CONCLUSION

The column-line diagram prediction model constructed in this study is effective and facilitates timely intervention and management by healthcare professionals based on their risk factors.

IMPACT

Nomogram is helpful to calculate the risk probability of FCR in patients with digestive tract cancer, identify FCR patients in time, and formulate comprehensive and personalized countermeasures, to provide a good quality of life and prolong the survival cycle of patients with digestive tract cancer.

PATIENT OR PUBLIC CONTRIBUTION

Participants were hospitalized patients or patients with digestive tract cancer undergoing follow-up. First of all, before the investigation and research, a team is formed to discuss the concept, research purpose, method, significance, etc., and determine the research tools. Second, by reasonably explaining the study to patients to seek informed consent from the patient and sign it, patients filled in the questionnaire independently. For patients with low education levels who could not fill in the questionnaire, the team members made objective explanations to help them choose reasonable options.

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

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

Assessment of quality of life (QOL) in cancer patients attending oncology unit of a Teaching Hospital in Bangladesh

BACKGROUND

The quality of life (QoL) of a cancer patient is their perception of their physical, functional, psychological, and social well-being. QoL is one of the most important factors to consider when treating someone with cancer and during follow-up. The aim of this study was to understand the state of QoL among cancer patients in Bangladesh and to determine the factors that affect it.

METHODS

This cross-sectional study was conducted on 210 cancer patients who attended the oncology unit of Delta Medical College & Hospital, Dhaka during the period between 1 May 2022 and 31 August 2022. Data were collected using the Bengali version of the European Organization for Research and Treatment of Cancer (EORTC) questionnaire.

RESULTS

The study reported a high number of female cancer patients (67.6%), who were married, Muslims by religion, and non-residents of Dhaka. Breast cancer was more common among women (31.43%), while lung and upper respiratory tract cancer was more prevalent among men (19.05%). The majority of the patients (86.19%) were diagnosed with cancer in the past year. The overall mean score for functional scales was higher for physical functioning (54.92) whereas it was lower for social functioning (38.89). The highest score on the symptom scale was for financial problems (63.02), while the lowest was for diarrhea (33.01). The overall QoL score of cancer patients in the study was 47.98 and it was lower for males (45.71) compared to females (49.10).

CONCLUSIONS

The overall QoL was poor among Bangladeshi cancer patients compared to those in developed countries. A low QoL score was observed for social and emotional functions. Financial difficulty was the main reason behind the lower QoL score on the symptom scale.

Exploring the experiences and priorities of women with a diagnosis of ovarian cancer

PURPOSE

Ovarian cancer is the third most common gynaecological cancer among women, yet remains under-researched. Past studies suggest that women who present with ovarian cancer have more supportive care needs compared to women experiencing other gynaecological cancers. This study explores the experiences and priorities of women with a diagnosis of ovarian cancer and whether age may influence these needs and experiences.

METHODS

Participants were recruited by a community organization, Ovarian Cancer Australia (OCA), via a social media campaign promoted on Facebook. Participants were asked to rank priorities around living with ovarian cancer, and to endorse which supports and resources they had used to address those priorities. Distributions of priority rankings and resource use were compared by age (19-49 vs. 50+ years).

RESULTS

Two hundred and eighty-eight people completed the consumer survey and most respondents were 60-69 years (33.7%). Priorities did not vary by age. Fear of cancer recurrence was identified by 51% respondents as the most challenging aspect of having ovarian cancer. Compared with older respondents, a higher proportion of young participants were more inclined to use a mobile app version of the OCA resilience kit (25.8% vs 45.1%, p=0.002) and expressed interest in using a fertility preservation decision aid (2.4% vs 25%, p<0.001).

CONCLUSION

Fear of recurrence was participants' primary concern, presenting an opportunity to develop interventions. Information delivery needs to consider age-specific preferences to better reach the target audience. Fertility is more important to younger women and a fertility preservation decision aid may address this need.

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

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

Quality of life and fear of cancer recurrence in patients and survivors of non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is a common haematological cancer that is comprised of approximately 30 subtypes, of which Waldenström Macroglobulinemia (WM) is a rare incurable form. It is typically managed using a watch-and-wait strategy that can contribute to illness uncertainty which may result in fear of cancer recurrence (FCR) and poor health-related quality of life (QOL). However, few studies have examined the correlates of FCR and QOL in NHL patients, including WM patients. One-hundred males and 92 females with a mean age of 62.7 years who were an average of 6.8 years from diagnosis completed the online questionnaire which asked about demographics, medical history, QOL, FCR, stress, anxiety and depression. Few NHL patients reported significant stress or affective distress, most had moderate-high QOL and 41% experienced recent FCR, relative to published cut-off scores. Poorer QOL was related to depression symptoms, FCR, higher illness burden (i.e. comorbidity) and fewer personal resources (i.e. unemployed), whereas FCR was related to shorter time since diagnosis and more depressive symptoms. Results suggest that FCR and depressive symptoms may adversely impact QOL, whereas a recent cancer diagnosis and depression-related pessimism may contribute to FCR.

Chinese Version of the Assessment of Survivor Concerns Scale for Gynecological Cancer Survivors: A Psychometric Study in Taiwan

Background:

Most gynecological cancer survivors outlive the acute stage, and many reach permanent survival. However, the fear of cancer recurrence (FCR) is stressful and affects quality of life.

Purpose:

This study was designed to validate a Chinese version of the Assessment of Survivor Concerns (ASC) questionnaire in terms of its ability to assess FCR in gynecological cancer survivors.

Methods:

A two-stage study procedure was employed. The first stage involved the translation of the ASC questionnaire from English into Chinese using the methods proposed by Guillemin, which include translation, back-translation, consensus meetings, and a trial of potential users. In the second stage, a pilot study was completed with 37 gynecological cancer survivors followed by a psychometric property study with 287 gynecological cancer survivors. Construct validity was determined using confirmatory factor analysis (CFA) with structural equation modeling. Convergent validity was determined using composite reliability and the average variance extracted values of the ASC model. Discriminant validity was determined by comparing the model fitness of the ASC model against the model fitness of a one-construct model. Concurrent criterion validity was assessed using the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30 as the auxiliary instrument. Reliability was determined by measuring the internal consistency reliability using Cronbach's α in addition to the 3-week test–retest reliability with a 95% confidence interval of the intraclass correlation coefficient.

Results:

The process of translation and back-translation was performed to ensure the conceptual equivalence of the Chinese version with the original ASC questionnaire. For CFA, the fit indices of the ASC model (χ² = 9.87, p > .05; root mean square error of approximation = .03. comparative fit index = 1, nonnormed fit index = 1) indicated appropriate model fitness. For convergent validity, the composite reliability and average variance extracted values of the ASC model were satisfactory. For discriminant validity, the model fitness of the ASC model was significantly improved over the one-construct model. For concurrent criterion validity, the ASC scores correlated negatively with the scores of the global quality of life and the five functions (physical, role, cognition, emotions, and social) of the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30, as hypothesized. For reliability, the Cronbach's α and the 95% confidence interval of intraclass correlation coefficient for the ASC model were .91 and [.18, .68], respectively.

Conclusions/Implications for Practice:

The Chinese version of the ASC questionnaire is a valid and reliable instrument that is suitable for assessing FCR in gynecological cancer survivors in clinical and research settings.

A correlation study of fear of cancer recurrence, illness representation, self-regulation, and quality of life among gynecologic cancer survivors in Taiwan

OBJECTIVE

The purpose of this study was to examine the correlations among fear of cancer recurrence (FCR), illness representation (IR), self-regulation (SR), and quality of life (QOL) in gynecologic cancer survivors.

MATERIALS AND METHODS

A cross-sectional study was conducted with 287 participants recruited from a medical center in northern Taiwan. Four questionnaires, the Assessment of Survivor Concerns (ASC), the Brief Illness Perception Questionnaire (BIPQ), the Self-Regulation Questionnaire (SRQ), and the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire-Core 30-item (EORTC QLQ-C30), were used to assess FCR, IR, SR, and QOL respectively. Data pertaining to socio-demographic characteristics and self-reported medical status was also collected from the participants. Stepwise regression analysis was performed to identify predictors of QOL.

RESULTS

The results showed that FCR (r = -.21, P < .01) and IR (r = -.44, P < .01) was negatively correlated with global QOL subscale of the EORTC QLQ-C30. SR, IR, and health status in the self-reported medical status explained 39% of the variance in global QOL, with SR of the largest.

CONCLUSIONS

Our findings provided valuable information to healthcare professionals about the ability of SR to affect QOL and negative impacts of FCR and IR on gynecologic cancer survivors.

The effect of cognitive emotion regulation strategies on gynecologic oncology: comparison between a clinical and a non-clinical sample

OBJECTIVE

This study aimed to examine the differences of cognitive emotion regulation (CER) strategies between patients with gynecologic cancer and non-clinical individuals.

METHODS

A cohort of 329 female adults was recruited in this study. About 179 patients with gynecologic cancer were allocated to the clinical group and 150 healthy women were allocated to the non-clinical group. All the participants completed a demographic survey and the Chinese version of Cognitive Emotion Regulation Questionnaire (CERQ-C).

RESULTS

There were statistically significant group differences in the CER strategies used between the two groups. The most prevalent discrepancies of the CER strategies across the two samples were the self-blame, rumination, putting into perspective, catastrophizing, and blaming others. Further logistic regression analyzes indicated that these four strategies have significant and independent contributions to the prediction of group membership. In particular, a higher reported use of self-blame and blaming others, and a lower reported use of acceptance and putting into perspective, were observed for the clinical group. The CER strategies in the clinical group, which differentiated it from the non-clinical group, accounted for 23.9% of the variance, after controlling for the non-dominant variables.

CONCLUSION

The implications of certain CER strategies may be a useful target for prevention and intervention of psychological distress on patients with gynecologic cancer.

Factors associated with fear of progression in chinese cancer patients: sociodemographic, clinical and psychological variables

OBJECTIVE

Fear of progression (FoP) is a widespread problem among cancer patients and is considered to be one of the most distressing psychological consequences of cancer. The aim of this study was to investigate the association of sociodemographic, clinical, and psychological variables to FoP in Chinese cancer patients.

METHODS

In this cross-sectional study, six hundred and thirty-six cancer patients were recruited. All participants were asked to complete a personal information sheet, the Chinese version of Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder Questionnaire (GAD-7). Descriptive statistics and hierarchical multiple regression was conducted to analyze the data.

RESULTS

Hierarchical multiple regression revealed that childhood severe illness experience (P = .011), stress (P < .001), anxiety (P < .001), depressive symptom (P < .001) and personality (P = .042) were independently predictive of higher FoP. The final regression model explained up to 40.0% (adjusted R square: 38.8%) of the observed variance.

CONCLUSION

There are a number of factors that increase the likelihood of the development of FoP. The findings underline the necessity to provide effective psychological intervention for patients with high FoP in the future.

Fear of cancer recurrence trajectory during radiation treatment and follow-up into survivorship of patients with breast cancer

BACKGROUND

Fear of cancer recurrence (FCR) has been shown to be higher in patients treated with external beam radiotherapy (RT) compared to those untreated. However, little is known about the dynamics of patient's FCR during and after RT. The aim of this study was to examine FCR levels in a longitudinal panel design with breast cancer patients receiving RT.

METHODS

Consecutive newly-diagnosed breast cancer patients (n = 94) attending a single cancer centre were invited to complete a 7-item FCR scale (FCR7) that was collected weekly by paper instrument and at a follow-up phone call 6-8 weeks after completion of RT. Descriptive statistics, and Latent Growth Curve Modelling (LGCM) were utilised to analyse the data.

RESULTS

Women who were younger, single/separated, had chemotherapy, had extra boost radiation treatment, taking Herceptin and treated by 4-field technique reported higher recurrence fear at baseline. There was strong evidence of substantial variation in the trajectory of FCR (z = - 3.54, p < .0001). The average trajectory of FCR over RT was negative (unstandardized estimate = - 0.59) and associated with FCR follow-up level (standardised estimate = 0.36, z = 3.05, p < .002), independent of baseline recurrence fears.

CONCLUSION

Patients vary in their trajectory of recurrence fears over RT which predicts FCR approximately 2 months following treatment. Review appointments by therapy radiographers presents an opportunity to intervene in FCR trajectories.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02599506 . Prospectively registered on 11th March 2015.

The relationship between cancer patient's fear of recurrence and chemotherapy: A systematic review and meta-analysis

OBJECTIVE

The study aim was to provide an overview of the current evidence available on the link between chemotherapy (CTX) and fear of cancer recurrence (FoR).

METHODS

PubMED, Medline, Embase, PsycINFO and Web of Science databases were searched to identify relevant studies. Two authors independently selected and assessed the studies regarding eligibility criteria. Meta-analysis of suitable studies was conducted, and quality rated.

RESULTS

Forty eligible studies were included in the systematic review and twenty-nine of them were included in further meta-analysis. Meta-analysis of the available data confirmed a weak relationship between CTX and FoR (29 studies, 30,176 patients, overall r=0.093, 95% CI: 0.062, 0.123, P˂0.001).

CONCLUSIONS

The meta-analysis demonstrates a weak but significant relationship between cancer patient's FoR and the receipt of chemotherapy. However, these results should be interpreted with caution. Further investigation is warranted to explore possible mechanisms of FoR increase in patients who receive chemotherapy. Longitudinal studies assessing the trajectory of FoR during chemotherapy are also warranted.

The psychosocial needs of gynaecological cancer survivors: A framework for the development of a complex intervention

PURPOSE

To develop and pilot test an intervention targeting the women's psychosocial needs during the follow-up period after surgical treatment for gynaecological cancer.

METHODS

The project consisted of four phases. Phase 1 involved development of an intervention on the basis of meetings with key healthcare professionals, a literature review and six semi-structured interviews with women who attended the existing follow-up program. The Guided Self-Determination (GSD) method developed in diabetes care was identified as an appropriate framework for the intervention. GSD consists of reflection sheets for patients and advanced professional communication skills. The GSD method was adapted to women in a follow-up program after gynaecologic cancer treatment (GSD-GYN-C). Phase 2 involved primary pilot testing of the intervention and the findings were used to modify the intervention in phase 3. This modification involved the development of additional reflection sheets and a fidelity assessment tool. A systematic training program was arranged for the GSD-GYN-C-nurses. Phase 4 involved secondary pilot testing where nurses and women confirmed the applicability of GSD-GYN-C and final adjustments were made. Selected measurements were tested for sensitivity during pilot testing. Data from phase 2 and 4 were also used to select the primary outcome and calculate power for a future randomized clinical trial (RCT).

RESULTS

Pilot testing supported our hypothesis that GSD-GYN-C may be transferable and useful to survivors of gynaecological cancer.

CONCLUSION

GSD-GYN-C was developed and validated and is now ready for evaluation in an RCT.

An exploratory analysis of fear of recurrence among African-American breast cancer survivors

BACKGROUND

Fear of recurrence (FOR) is a psychological concern that has been studied extensively in cancer survivors but has not been adequately examined in African-American breast cancer survivors.

PURPOSE

This exploratory study describes the extent and nature of FOR in African-American breast cancer survivors. FOR is examined in relation to socio-demographic characteristics, treatment-related characteristics, psychological distress, and quality of life (QOL).

METHODS

Participants completed questionnaires assessing FOR, psychological distress, QOL, and demographic and treatment characteristics. Pearson r correlations, t tests, and ANOVAs were used to determine the association between FOR and demographic and treatment-related characteristics. Hierarchical multiple regression models were performed to investigate the degree to which FOR dimensions account for the variance in QOL and psychological distress.

RESULTS

Fifty-one African-American breast cancer survivors participated in this study. The mean age of participants was 64.24 (SD = 12.3). Overall fears as well as concerns about death and health were rated as low to moderate. Role worries and womanhood worries were very low. Inverse relationships were observed between age and FOR dimensions. FOR was positively correlated with measures of psychological distress and negatively correlated with QOL. FOR significantly accounted for a portion of the variance in QOL and distress after controlling for other variables.

CONCLUSIONS

This study suggests that African-American women in this sample demonstrated some degree of FOR. Results indicate that FOR among African-American breast cancer survivors decreases with age and time since diagnosis and co-occurs with psychological distress as well as diminished quality of life.

Quality of life and menopausal and sexual symptoms in gynecologic cancer survivors: a cohort study

OBJECTIVES

The aims of this study were to investigate the frequency of menopausal and sexual symptoms and the proportion of sexually active women and to assess and identify quality of life (QOL) predictors in gynecologic cancer survivors.

METHODS

A prospective case series following a cohort of women under radiation therapy was conducted, including 107 women (aged 21-75 y) with gynecologic cancer (cervical or endometrial cancer) who underwent pelvic radiotherapy in the Radiotherapy Division of the Women's Integral Healthcare Center at the Universidade Estadual de Campinas. Adverse effects of radiotherapy were evaluated using the Common Terminology Criteria Adverse Event Scale. QOL was measured using the abbreviated version of the World Health Organization's Quality of Life instrument before radiotherapy (T0) and at 4 months (T1), 1 year (T2), and 3 years (T3) after radiotherapy. QOL scores were assessed over time using the Wilcoxon signed-rank test. Multiple linear regression analysis was used to identify QOL predictors.

RESULTS

A decrease in the frequency of vaginal dryness (26.7% in T0 vs 8.3% in T3; P < 0.01) and an increase in the proportion of sexually active women (21.5% in T0 vs 44.2% in T3; P < 0.01) were observed. A significant increase in QOL scores was observed in the psychological domain and general health and overall QOL. Dyspareunia negatively affected the physical (P < 0.01), psychological (P < 0.01), and social relationship domains (P < 0.01); overall QOL (P = 0.01); and general health (P = 0.04). Family income was positively related to environment domain (P < 0.01), overall QOL (P = 0.04), and general health (P < 0.01).

CONCLUSIONS

Data derived from this study indicated that gynecologic cancer survivors had a lower frequency of vaginal dryness and a higher proportion of these women were sexually active 3 years after completion of radiotherapy. Furthermore, QOL improved and dyspareunia negatively affected various QOL dimensions.

Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy?

BACKGROUND

Oncology follow-up has traditionally prioritised disease surveillance and the assessment and management of symptoms associated with cancer and its treatment. Over the past decade, the focus on late effects of treatment has increased, particularly those that have an adverse effect on long-term function and quality of life. The aim of this research was to explore factors that influence the identification of treatment-induced female sexual difficulties in routine oncology follow-up after radical pelvic radiotherapy.

METHODS

A structured observation schedule was used to systematically record topics discussed in 69 radiotherapy follow-up consultations observed over a 5-month period.

RESULTS

Analysis suggests that physical toxicity assessment focused on bowel (81%) and bladder (70%) symptoms. Vaginal toxicity was discussed less frequently (42%) and sexual issues were explored in only 25% of consultations. Formal recording of radiation toxicity through assessment questionnaires was limited to patients participating in clinical trials. Surveillance activity and the management of active physical symptoms predominated and psychosocial issues were addressed in only 42% of consultations.

INTERPRETATION

Female sexual morbidity after pelvic radiotherapy remains a neglected aspect of routine follow-up and cancer survivorship. Developments in both individual practice and service provision are necessary if the identification and management of treatment-induced female sexual difficulties is to be improved.

Quality of life and adverse events after radiotherapy in gynecologic cancer survivors: a cohort study

PURPOSE

To evaluate quality of life (QOL) in gynecologic cancer survivors after radiotherapy (RT), investigate the frequency of adverse events and demonstrate an association between these symptoms and QOL.

METHODS

A prospective cohort study of 95 women aged 21-75 years undergoing RT for gynecologic cancer was carried out. QOL was assessed by the WHOQOL-BREF before, at 4 months, 1 year and 3 years after RT and adverse events were evaluated following RT by the (CTCAE) v 3.0 scale. QOL scores were assessed by the Wilcoxon signed rank test over time. Multiple linear regression analysis was used to identify predictors of QOL.

RESULTS

The most frequent adverse events were pain (64.2%) and dyspareunia (45.9%). A significant increase in QOL scores was observed in the psychological domain, general health and overall QOL. Pain was negatively associated with the physical, psychological and social relationship domains (p < 0.01); dyspareunia with the physical and social relationship (p < 0.01); decreased sexual interest with the psychological (p < 0.01). Higher family income was positively associated with the psychological domain and general health (p < 0.01).

CONCLUSIONS

Results suggested that QOL improved after RT in women with gynecologic cancer. Adverse events, such as pain, dyspareunia and decreased sexual interest had a negative impact on QOL.

Sexual self schema as a moderator of sexual and psychological outcomes for gynecologic cancer survivors

Gynecologic cancer patients are at high risk for emotional distress and sexual dysfunction. The present study tested sexual self schema as an individual difference variable that might be useful in identifying those at risk for unfavorable outcomes. First, we tested schema as a predictor of sexual outcomes, including body change stress. Second, we examined schema as a contributor to broader quality of life outcomes, specifically as a moderator of the relationship between sexual satisfaction and psychological statue (depressive symptoms and quality of life). A cross-sectional design was used. Gynecologic cancer survivors (N = 175) 2-10 years post treatment were assessed during routine follow up. In regression analyses controlling for sociodemographic variables, patients' physical symptoms/signs as evaluated by nurses, health status, and extent of partner sexual difficulties, sexual self schema accounted for significant variance in the prediction of current sexual behavior, responsiveness, and satisfaction. Moreover, schema moderated the relationship between sexual satisfaction and psychological outcomes, suggesting that a positive sexual self schema might "buffer" patients from depressive symptoms when their sexual satisfaction is low. Furthermore, the combination of a negative sexual self schema and low sexual satisfaction might heighten survivors' risk for psychological distress, including depressive symptomatology. These data support the consideration of sexual self schema as a predictor of sexual morbidity among gynecologic cancer survivors.

The impact of radiotherapy late effects on quality of life in gynaecological cancer patients

The aims of this study were to assess changes in quality of life (QoL) scores in relation to radical radiotherapy for gynaecological cancer (before and after treatment up to 3 years), and to identify the effect that late treatment effects have on QoL. This was a prospective study involving 225 gynaecological cancer patients. A QoL instrument (European Organisation for the Research and Treatment of Cancer QLQ-C30) and late treatment effect questionnaire (Late Effects Normal Tissues - Subjective Objective Management Analysis) were completed before and after treatment (immediately after radiotherapy, 6 weeks, 12, 24 and 36 months after treatment). Most patients had acute physical symptoms and impaired functioning immediately after treatment. Levels of fatigue and diarrhoea only returned to those at pre-treatment assessment after 6 weeks. Patients with high treatment toxicity scores had lower global QoL scores. In conclusion, treatment with radiotherapy for gynaecological cancer has a negative effect on QoL, most apparent immediately after treatment. Certain late treatment effects have a negative effect on QoL for at least 2 years after radiotherapy. These treatment effects are centred on symptoms relating to the rectum and bowel, for example, diarrhoea, tenesmus and urgency. Future research will identify specific symptoms resulting from late treatment toxicity that have the greatest effect on QoL; therefore allowing effective management plans to be developed to reduce these symptoms and improve QoL in gynaecological cancer patients.

Emotional distress impacts fear of the future among breast cancer survivors not the reverse

INTRODUCTION

Fear of the future is one of the most stressful aspects of having cancer. Research to date has conceptualized fear of the future as a precursor of distress or stress-response symptoms. Yet it is equally plausible that distress would predict increased fear of the future or that they would have a reciprocal influence on each other. The purpose of the present study was to examine the bidirectional relations between fear of the future and distress as well as intrusion and avoidance among breast cancer survivors at 3, 7, 11, and 15 months after diagnosis.

METHODS

We used a bivariate latent difference score model for dynamic change to examine these bidirectional relationships among 146 early-stage breast cancer survivors. Using Lisrel version 8.80, we examined four models testing different hypothesized relationships between fear of the future and distress and intrusion and avoidance.

RESULTS

Based on model fit evaluation, our data shows that decreases in distress over time lead to a reduction of fear of the future but that changes in fear do not lead to changes in distress. On the other hand, there is no relationship between changes in fear of the future and intrusion and avoidance over time.

DISCUSSION

Ongoing fear of the future does not appear to be a necessary condition for the development of stress-response symptoms.

IMPLICATIONS FOR CANCER SURVIVORS

Future studies need to explore the role of distressing emotions in the development and exacerbation of fear of the future among cancer survivors.

Concerns of former breast cancer patients about disease recurrence: a validation and prevalence study

OBJECTIVE

The present study has three aims: first, to evaluate the psychometric properties of the Dutch version of the CARS (CARS-DLV). Second, to measure the prevalence of concerns about disease recurrence in former breast cancer patients and identify potential predictors and third, to establish how fear of recurrence was effecting quality of life.

METHODS

A prospective study was carried out on breast cancer patients (n=136) who had undergone curative treatment. Eligible patients completed an extensive questionnaire consisting of the CARS (fear of recurrence), HADS (anxiety and depression), BPI (pain), RAND (quality of life), LOT (optimism) and the PCS (catastrophizing).

RESULTS

This study confirmed the good internal consistency, test-retest stability and construct validity of the CARS (Dutch Language version). Moderate to high levels of fear of disease recurrence were found in 56% of 136 breast cancer survivors. Worries about health and death were the most prominent. Pain was a strong predictor of overall fear and of fear on the four sub domains of the CARS. The prevalence of fear decreased significantly with age. Education level, living arrangements and time since the last treatment did not predict the prevalence of overall fear. Fear of recurrence was negatively correlated with quality of life.

CONCLUSION

The CARS-DLV proved to be a valuable instrument to measure women's' concerns about breast cancer recurrence. More than half of former breast cancer patients indicated moderate to severe concerns about disease recurrence. Health and death worries were the most prominent. The levels of worry were independent of the time since diagnosis.

Impact of radical prostatectomy positive surgical margins on fear of cancer recurrence: results from CaPSURE

PURPOSE

Fear of cancer recurrence (FCR) is a significant source of distress in men with prostate cancer and could affect clinical decision-making, especially in those with positive margins following radical prostatectomy (RP). We examined the influence of positive surgical margin status on fear of cancer recurrence in men undergoing radical prostatectomy.

METHODS

Five hundred eight-four men underwent RP from 1999 to 2002 in CaPSURE, a prospective, longitudinal, national cohort. All men had both baseline and follow-up assessment of FCR using a validated Kornblith scale. Statistical analysis included chi(2) test, Wald test, and linear as well as repeated measures ANOVA mixed model.

RESULTS

One hundred sixty (27%) men had positive surgical margins. Baseline FCR and clinical variables did not differ based on margin status. Men with positive margins experienced greater FCR after RP than negative margins (OR, 1.94, 95% CI, 1.22-3.07). Men who had received adjuvant therapy experienced greater FCR (OR, 2.78, 95% CI, 1.21-6.39). Repeated measures analysis showed greater FCR over time (14-month mean follow-up, range 2-31 months) for positive vs. negative margins (P = 0.02). This difference in fear widened over time. There were no significant differences in health-related quality of life scores based on margin status.

CONCLUSION

Positive surgical margin status is associated with greater fear of cancer recurrence, a difference not alleviated by adjuvant therapy use. Men with positive margins remain more fearful over the course of several years compared with those with negative margins. Clinicians should be aware of the potential stressful impact of positive surgical margins.

Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator

BACKGROUND

Continuing symptoms and poor health following cancer treatments may alter meaning in life for cancer survivors. Gynecologic cancer survivors are particularly troubled with physical sequelae. In addition, for the most common sites of disease, such as breast and gynecologic cancers, the prevalence of depression is also high.

PURPOSE

This study tests meaning in life as a mechanism for the relationship between physical symptoms and depressive symptoms.

METHODS

Gynecologic cancer survivors (N = 260) participated. Measures of physical sequelae (nurse rated symptoms/signs, patient-reported gynecologic symptoms), meaning in life (harmony, life purpose, spirituality, and conversely, confusion and loss), and depressive symptoms were obtained at the time of a routine clinical follow-up visit 2-10 years following the completion of treatment. Latent variables were defined, and structural equation modeling tested a mediator model.

RESULTS

Analyses support partial mediation. That is, survivors with more physical sequelae also reported lower levels of meaning in life, which was associated with higher levels of depressive symptoms.

CONCLUSIONS

Gynecologic cancer patients have been neglected in psychosocial research, and findings highlight the importance of existential issues in their lives. While many adjust well, those with persistent physical functioning deficits may experience depressive symptoms. By appreciating the role of meaning in their experience, we may help survivors foster their own growth and perspectives important for their future.

Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre

The purpose of the present study is to determine the impact of illness characteristics and psychopathological comorbidity on the quality of life (QoL) of radio-oncological patients in health-related and individual dimensions. Sixty-three of 93 eligible patients (40 women and 23 men) were included in the study during their radiation therapy visit to an outpatient centre annexed to a community hospital in Southern Bavaria, Germany. In a semi-structured interview, we elicited individually relevant life domains rated by the patients according to the 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting'. In addition, the participants completed the 'European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30' and the 'Hospital Anxiety and Depression Scale'. We also assessed the demand for psychotherapy and utilization of psycho-oncological services. In total, 9.5% of the examined patients suffer from clinically relevant anxiety and/or depression [total Hospital Anxiety and Depression Scale (HADS) score >19]. There was a weak positive correlation between Karnofsky's Performance Status and QoL. Anxiety and depression were significantly correlated with impaired QoL, especially with impaired individual QoL. There was no association between psychopathological comorbidity and the requirement for psycho-oncological support. Conversely, patients who report difficulties in accepting help had a significantly lower QoL. Psychopathological comorbidity has a considerable influence on QoL of patients undergoing radiotherapy. Measuring the individual QoL appears as an adapted needs assessment and helps the psychotherapist in focusing on the patient's problems and desires. Furthermore, the patient's QoL is a main target in providing or planning mental health care in non-university oncological services.

Vaginal dilation associated with pelvic radiotherapy: a UK survey of current practice

This paper presents results from the first UK national survey of patient information and interventions related to vaginal dilation in pelvic radiotherapy (RT). The aim was to elicit current practice with regard to the target population, content/process of patient education, and the evaluation of compliance in relation to this intervention. A 38-item questionnaire was sent to all RT departments (n= 65) and a convenience sample of specialist gynecological oncology nurses (n= 166), with response rates of 62% (n= 40) and 31% (n= 52), respectively. Data analysis (via SPSS v11) used both descriptive and inferential statistics. Divergence of opinion was evident regarding the specific target audience for dilator education, and only a limited number of elements of vaginal dilator technique achieved consensus. Sixty-seven percent of respondents stated they carried out a wider sexual health assessment associated with the provision of dilator information, although its content varied considerably. Results suggest the provision of vaginal dilation advice may benefit from being placed in the wider context of assessing treatment impact on women's sexual health, raising the profile of appropriate psychosexual assessment, and intervention in clinical oncology practice. Further research could determine the efficacy of vaginal dilation in preventing development of vaginal stenosis among women receiving pelvic RT.

Psychosexual function and impact of gynaecological cancer

A diagnosis of gynaecological cancer and its treatment are usually associated with many physical and psychological changes, both as a result of the diagnosis itself and of the usual treatments of surgery, radiotherapy and/or several months of chemotherapy. Patients often experience symptoms such as fatigue, abdominal swelling and pain, and suffer from emotional distress and disturbances of their life style. Sexual functioning can also be affected. Often there are physiological difficulties, such as vaginal dryness, together with psychological distress and relationship problems. This chapter discusses the ways in which gynaecological cancer can impact sexual functioning, and presents findings from a research project that was undertaken to begin to understand how sexual functioning can be affected by ovarian cancer. The article also makes recommendations for how health-care professionals can help women to cope better with psychosexual dysfunction following a diagnosis of a gynaecological cancer.

Sexual function after treatment for gynecological malignancy

PURPOSE OF REVIEW

This review summarizes current knowledge about the nature of sexual dysfunction in gynecological cancers, highlighting recent publications on disease effects, treatment effects, and communication issues.

RECENT FINDINGS

Recent studies have shown the impact of radiotherapy on sexual function in cervical cancer and have highlighted differences in the levels and duration of sexual problems in women with early stage compared with advanced, recurrent, or persistent disease. Qualitative studies in cervical and endometrial cancer have highlighted women's concerns in relation to femininity, fears of sexual relations, and the importance of communication with the woman's partner. Similar findings have been obtained in studies of ovarian cancer. Predictors of sexual function in ovarian cancer have been suggested by a recent study, with risk factors for poorer sexual functioning being age, treatment, time since treatment, poor self esteem/body image, physical symptoms, poor performance status, depression, and anxiety. Similar risk factors have been highlighted in vulval cancer. Communication issues have been discussed, with some preliminary exploration of the benefits of group therapy and psychosexual counseling.

SUMMARY

Recent research is helping us to understand more about the impact of the different types of gynecological cancer and its treatment on sexual functioning, with information being provided about key risk factors and predictors of sexual dysfunction that can be used to guide appropriate advice and support. The assessment and treatment of sexual functioning must become part of the standard care of women diagnosed with gynecological cancer.

Fear of Cancer Recurrence in Patients Undergoing Definitive Treatment for Prostate Cancer: Results From CaPSURE

PURPOSE

Contemporary cancer treatments have resulted in patients living longer but with the risk of disease recurrence. Studies suggest that fear of recurrence is a significant burden. We described fear of cancer recurrence in patients with prostate cancer undergoing treatment with radical prostatectomy (RP), radiation (XRT) or brachytherapy (BT).

MATERIALS AND METHODS

A total of 519 patients (326 RP, 53 XRT, 140 BT) were identified from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor), a national longitudinal registry of men with prostate cancer. To be included in the study patients had to complete at least 1 pretreatment and 2 posttreatment health related quality of life questionnaires and have complete clinical information. Fear of cancer recurrence was assessed with a validated 5-item scale, and was described at baseline and up to 2 years after treatment. Multivariate linear regression was performed to determine significant predictors of fear of cancer recurrence.

RESULTS

Men receiving XRT were older and had worse clinical disease characteristics than patients treated with RP or BT. For all groups fear of cancer recurrence was more severe before treatment and improved after treatment but did not change substantially in the 2 years thereafter. Regression revealed that only general health and mental health were important predictors of fear of cancer recurrence. No other general or disease specific health related quality of life domains or clinical characteristics contributed appreciable explanatory power.

CONCLUSIONS

Fear of prostate cancer recurrence imposes a substantial burden in patients before and after treatment. Understanding the fear of cancer recurrence associated with different treatments can help physicians better counsel patients and promote psychological well-being.

The clinical nurse specialist in gynaecological oncology-the role in vulval cancer

Gynaecological malignancy has an immense impact on the well-being of women. In order for these women clearly to understand their disease, investigations, treatment options and prognosis, it is essential that high-quality information be delivered in an appropriate environment. Effective communication is the essence of good relationships between the health professional and the patient. Patients' psychological, social and sexual rehabilitation following treatment for gynaecological cancer demand a holistic, pro-active approach by professionals who are skilled in the provision of this care. Within a multidisciplinary team (MDT), the clinical nurse specialist (CNS) is in a key position to be able to address these often complex and sensitive issues. This chapter explores the unique role of the CNS in the care of gynaecological cancer patients, and the care of vulval cancer patients in particular. The successful development of medical/nursing partnerships enables women with gynaecological cancer to gain proper access to essential expert knowledge and information and thereby to make informed decisions.

Sexual dysfunction after treatment for gynaecologic and breast malignancies

PURPOSE OF REVIEW

This review summarizes current knowledge about the nature of sexual dysfunction in gynaecologic and breast cancers, highlighting recent publications on treatment effects and communication issues.

RECENT FINDINGS

In both gynaecologic and breast cancer, sexual dysfunction causes much distress to patients, from the time of diagnosis through to long-term follow-up. It appears that younger women in particular experience difficulties related to loss of reproductive function and relationship problems, plus more abrupt vaginal changes, than older women. Chemotherapy has been shown to be associated with short and long-term effects on sexual functioning and quality of life in breast cancer, and it is anticipated that this would extend to gynaecologic cancers also. The addition of endocrine treatments to chemotherapy in breast cancer appears not to affect levels of sexual functioning, although this may depend on the age of the woman. Sexual self-schema appears to be an important concept in predicting sexual dysfunction. Communication with women about sexual issues is vital, but evidence suggests this is lacking.

SUMMARY

We are beginning to understand more about the sexual implications of different treatments and to identify factors which predict sexual dysfunction. More research is still required to identify how sexual dysfunction is affected in different groups of women and how best to help women who experience sexual difficulties. Recent findings suggest that there is a need to increase communication and support about sexual issues.