Reminders of cancer risk and pain catastrophizing: relationships with cancer worry and perceived risk in women with a first-degree relative with breast cancer

Pain in Long-Term Cancer Survivors: Prevalence and Impact in a Cohort Composed Mostly of Breast Cancer Survivors

Cancer survival is becoming more common which means that there is now a growing population of cancer survivors, in whom pain may be common. However, its prevalence has hardly been addressed systematically. We aimed to assess the prevalence and explore the pathophysiology and impact of pain on health outcomes in cancer survivors. We conducted a retrospective-prospective cohort study in cancer-free patients diagnosed with cancer at least five years before the study start date. We used multivariable regression to establish the association of patients' cancer characteristics with pain, and then the association of patients' pain features with health outcomes and related symptoms. Between March and July 2021, 278 long-term cancer survivors were evaluated. Almost half of them (130/278, 46.8%) had pain, of whom 58.9% had a probable neuropathic component, but only 18 (13.8%) were taking specific drugs for neuropathic pain. A history of surgery-related pain syndrome in breast cancer patients was more than twice as frequent in the pain cohort. Post-chemotherapy and post-radiotherapy pain syndromes were uncommon. Pain was associated with lower QoL, emotional functioning, professional performance, and disability scores. Pain is a frequent health determinant in cancer survivors. Referral to specialised pain services may be a reasonable move in some cases.

Cardiovascular disease risk perceptions and influencing factors among Chinese systemic lupus erythematosus patients

BACKGROUND

Systemic Lupus Erythematosus patients (SLE) are at a higher risk of cardiovascular events than the general population. This study aimed to investigate the risk perception of cardiovascular disease (CVD) and to analyze its influence factors among Chinese SLE patients.

METHODS

This was a cross-sectional study. Convenience sampling was used to select 201 patients with SLE who had attended the outpatient and inpatient departments of the Department of Rheumatology and Immunology at the First Affiliated Hospital of the University of Science and Technology of China from November 2022 to March 2023. The following were used in the study: the Chinese version of the Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire, the Social Support Rating Scale, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Health Literacy Management Scale, and sociodemographic and disease-related data.

RESULTS

The mean (standard deviation) risk perception score of CVD patients with SLE was 57.18 ± 13.02. A Pearson correlation analysis showed that CVD risk perceptions were positively correlated with health literacy (r = 0.152, p < .05) and depression (r = 0.277, p < .05), and negatively correlated with social support (r = -0.393, p < .05) and psychological resilience (r = -0.374, p < .05). A multiple linear regression analysis showed that body mass index (BMI), family history, health literacy, depression, social support, and psychological resilience were the main factors influencing CVD risk perceptions among Chinese SLE patients (p < .05).

CONCLUSIONS

Body mass index, family history, health literacy, depression, social support, and psychological resilience influenced CVD risk perceptions among Chinese SLE patients. Healthcare workers should objectively and accurately assess the levels of CVD risk perception among SLE patients, identify the risk factors of CVD, adopt effective health risk communication strategies to help patients develop appropriate risk perceptions, and raise risk awareness to adopt active coping approaches to reduce risk.

Treating persistent pain after breast cancer: practice gaps and future directions

This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in non-cancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.

Breast Cancer Worry in U.S. Female First-degree Relatives: Moderating Role of Daily Spiritual Experiences

Female first degree relatives of breast cancer patients experience worry because of their own increased breast cancer risk. The aim in the present study was to examine the role of daily spiritual experiences as a potential protective factor against breast cancer worry. We hypothesized that daily spiritual experiences would moderate the relationship between relatives' stage of disease and breast cancer worry. Sixty-three mothers, daughters or sisters of breast cancer survivors completed surveys assessing relative's disease characteristics and their own demographics, fear of breast cancer, and daily spiritual experiences. All participants were living in the midwestern United States. Results showed that daily spiritual experiences moderated the relationship between stage of disease and breast cancer worry. Low scores on daily spiritual experiences were associated with more worry when relatives had advanced disease, and high scores on daily spiritual experiences was associated with less worry when relatives had advanced disease. Findings suggest the need to focus on this population when providing support services to families of patients.

Experience of Pain and Unpleasantness during Mammography Screening: A Cross-Sectional Study on the Roles of Emotional, Cognitive, and Personality Factors

BACKGROUND

Breast cancer is the most frequent cause of malignant tumors among women worldwide. Its successful prevention depends on the degree of participation in screening programs, which can be influenced by psychological factors, including fear.

METHOD

A cross-sectional study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Twenty-six healthy women aged 50-69 years took part in this study, all of whom were summoned for routine mammography screening and were randomly selected. Prior mammography screening, breast pain intensity, unpleasantness (visual analog scale), and psychological (catastrophizing, state anxiety, and fear of pain) and personality (neuroticism, psychoticism, and extraversion) variables were evaluated. Pain, unpleasantness, and state anxiety were further evaluated pre- and post-mammography screening.

RESULTS

During the mammography screening, pain and unpleasantness levels were higher than those observed pre- and post-screening. Residual unpleasantness remained post-screening. State anxiety was positively associated with pain, and psychoticism with unpleasantness, as reported by participants during the mammography screening.

CONCLUSIONS

Anxiety levels influence the pain experienced in association with the mammography procedure. Women subjected to mammography screenings might benefit from relaxation strategies aimed at reducing anxiety to pre-mammography levels and, by extension, pain and unpleasantness during mammography. The inclusion of these strategies in breast cancer prevention campaigns could improve the rates of mammography reattendance, and therefore, benefit cancer prevention efforts.

Predictors of perceived risk in first-degree relatives of patients with rheumatoid arthritis

OBJECTIVES

To define variables associated with perceived risk of developing rheumatoid arthritis (RA) in first-degree relatives (FDRs) of patients with RA.

METHODS

Patients with RA and their FDRs were invited to complete cross-sectional surveys. FDR and index patient responses were linked. FDRs' perceived absolute risk, comparative risk, experiential risk and worry about risk were assessed using 5-point Likert scales. FDR predictor variables included demographics, illness perceptions and psychosocial variables. Patient predictors of FDR perceived risk were assessed. Binary logistic regression examined the relationship between FDR characteristics and perceived risk of RA. Generalised estimating equations assessed whether patient variables predicted FDR's perceived risk.

RESULTS

396 FDRs returned a survey. 395 FDRs provided sufficient data and were included in analysis. Paired data from 213 patients were available for 291 of these FDRs. All measures of perceived risk were inter-correlated. 65.2% of FDRs perceived themselves to be 'likely' or 'very likely' to develop RA in their lifetime. Relationship with index patient, high health anxiety, female gender, long perceived RA duration, high perceived concern about RA, negative perceived emotional impact of RA and low perceptions of how well treatment would control RA were all associated with increased FDRs' perceived risk. Patient characteristics did not associate with FDRs' risk perceptions.

CONCLUSIONS

FDRs' perceived risk of RA was high. Key predictors included being a child of a patient with RA, higher health anxiety and lower perceptions of RA treatment control. An understanding of these predictors will inform the development of tailored risk communication resources and preventive clinical strategies for RA.

Validation of pain catastrophizing scale on breast cancer survivor

INTRODUCTION

Pain catastrophizing scale (PCS) is the most used scale to measure pain catastrophizing. In breast cancer survivors (BCS), pain catastrophizing is related to upper-limbs dysfunction and disability. This study aimed to assess the internal consistency, internal structure, and convergent validity of the Spanish version of the PCS in Spanish BCS.

MATERIAL AND METHODS

Breast cancer survivors were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The psychometric properties were evaluated with analysis factor structure by maximum likelihood extraction (MLE), internal consistency, and construct validity by confirmatory factor analysis (CFA).

RESULTS

Factor structure was three-dimensional, and one item was removed due to cross-loading. The new 12-item PCS showed a high internal consistency for the total score (α = 0.91) and a good homogeneity, and CFA revealed a satisfactory fit. PCS showed an acceptable correlation with FACS (r = 0.53, p < 0.01).

CONCLUSION

Pain catastrophizing scale is a valid and reliable instrument to evaluate pain catastrophizing in Spanish BCS. This tool may help clinicians in the management of pain by assessing pain and by measuring the effect of interventions.

The relationship between the fear of breast cancer, risk factors, and early diagnosis behaviors of women by age groups

PURPOSE

This study investigates the relationship between fear of breast cancer, risk factors, and early diagnosis behavior of women aged 20 or above.

METHOD

It is a descriptive cross-sectional study.

FINDINGS

It was found that 17.3% of the women conducted breast self-examination, 14.0% underwent clinical breast examination, and that 9.3% of them underwent mammography. The predictors regularly affecting early diagnosis behaviors were identified through logistic regression. Different predictors for breast cancer diagnostic behaviors were found in each age group.

PRACTICE IMPLICATIONS

This study is important in terms of taking into account the age factor in the practices aiming to increase the diagnostic behavior of healthcare personnel, especially nurses.

CONCLUSION

It was concluded that there were different predictors of breast cancer diagnostic behaviors in both age groups of the women in the study.

Breast Cancer Perception Scale: Psychometric Development Study

Objective

The Breast Cancer Perception Scale was developed using a well-supported theory, thought to be associated with breast cancer prevention behaviors. The aim of this study is to develop the Breast Cancer Perception Scale based on the Health Belief Model and conduct psychometric analysis.

Materials and Methods

The study was conducted with women aged 20 or above with a methodological design. The scale study was conducted with 572 women who were not diagnosed with breast cancer and willing to participate in the study.

Results

The results of the exploratory factor analysis revealed that the scale is made up of six sub-dimensions (perceived knowledge, perceived treatment belief, the perceived need for a health check, perceived stigma, perceived fear, perceived risk) and 24 items, which explain the 74.36% of the total variance. The model obtained from the confirmatory factor analysis was within the limits of the acceptable fit index and factor loads between 0.655 and 0.998. Cronbach's alpha reliability coefficient of the scale sub-dimensions was determined as 0.815-0.950.

Conclusion

The overall psychometric evaluation results of the Breast Cancer Perception Scale found it to be a valid and reliable instrument that can be associated with multi-dimensional cases, such as healthy life behaviors in women, breast cancer diagnostic behaviors, family history, traumatic experiences regarding breast cancer, and the level of breast cancer knowledge.

"The effects of cancer on a family are way beyond the person who's had it": The experience and effect of a familial cancer diagnosis on the health behaviours of family members

PURPOSE

People who are first-degree relatives of cancer patients are at an increased risk of developing cancer themselves. Despite this, relatives of cancer patients do not always make beneficial changes to their health behaviours. This study aimed to answer the following questions: (1) do the health behaviours of people who are first-degree relatives of cancer survivors change following cancer diagnosis, and if so, how, and why, (2) what motivations/barriers exist for first-degree relatives when seeking to engage with health promoting behaviours, and (3) what do first-degree relatives believe healthcare organisations can do to improve uptake of healthy lifestyle changes.

METHOD

Nine biological first-degree relatives of cancer survivors living in Ireland (6 children, 2 siblings, 1 parent) participated in semi-structured interviews which were later thematically analysed.

RESULTS

Findings revealed four superordinate themes: Being Conscious/Aware, Limited Lifestyle Changes, Psychosocial Consequences of Experience, and Unmet Needs, with each of these themes having two to three subordinate themes. Patient and public involvement emphasised Unmet Needs, including needs for information and family support, as the theme that was most reflective of participants' lived experience.

CONCLUSIONS

Results suggest that while family members tend not to change their lifestyle behaviours following cancer diagnosis, they do seem to make changes to their medical behaviours. Additionally, they can be negatively impacted by the experience in several other ways. Identifying means of support will allow relatives to cope better post diagnosis.

Assessing the clinical utility of genetic risk scores for targeted cancer screening

Background

Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention.

Methods

This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups.

Results

The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results.

Conclusions

Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.