Influence of Cancer Worry on Four Cancer Related Health Protective Behaviors among a Nationally Representative Sample: Implications for Health Promotion Efforts

Cancer worry at higher-risk sample of hereditary cancer in Spain

BACKGROUND

Few studies have examined the prevalence of cancer worry in the general and at-risk population. The objective of this study was to describe the prevalence of cancer worry in a sample of individuals at increased risk of developing hereditary cancer, determine differences in cancer worry by socio-demographic characteristics and assess the relationship between cancer worry and psychological distress.

METHODS

A cross-sectional study was designed with 895 patients. The Cancer Worry Scale (CWS), Hospital Anxiety and Depression Scale (HADS) for psychological distress and sociodemographic characteristics were examined. The multiple linear regression model was developed to explore what variables were predicted for cancer worry. To identify variables associated with higher cancer worry scores, a logistic model was fitted.

RESULTS

In the at-higher-risk sample of hereditary cancer, the mean of CWS was 10.20 (SD: 3.70). The significant predictors for cancer worry were gender, age, previous psychiatric treatment, patients affected by cancer and having children. In the sample, 38% of patients had higher scores on cancer worry, the variables associated were patients affected by cancer compared, women, widow/divorced participants, less than secondary school, patients with previous psychiatric treatment and patients less than 55 years old. Using the HADS cutoff score 29% of the sample showed significant psychological distress, more anxiety (35%) than depressive (22%) symptomatology. Psychological distress showed a higher variability (36%) on cancer worry.

CONCLUSION

Findings highlighted distinctive profiles in socio-demographic characteristics according to the degree of cancer worry; therefore, genetic counseling should continue to be provided to address cancer worry and relieve psychological distress.

Breast Cancer Prevention Practices and Knowledge in Italian and Chinese Women in Italy: Clinical Checkups, Free NHS Screening Adherence, and Breast Self-Examination (BSE)

Breast cancer remains a significant global concern, underscoring the critical need for early detection and prevention strategies. Primary and secondary preventive measures, such as routine screenings and behaviors like breast self-examination (BSE), play a crucial role in facilitating early diagnosis. While the National Health System (NHS) in Italy offers free regular screenings for women aged 50-69, there is a lack of clarity regarding the participation of both Italian and Chinese women residing in Italy in these screening programs. This study aims to bridge this knowledge gap by thoroughly assessing the involvement in regular clinical check-ups and the types of screening employed, the adherence to free screenings offered by the NHS, and the practice of BSE among women aged 50-69 of these two groups. Furthermore, it investigates their knowledge and perceptions regarding breast cancer and BSE. Results reveal disparities in breast cancer control practice between Italian and Chinese women in Italy: the former demonstrates higher adherence to clinical checkups (53% vs. 3%, p < 0.001), while both groups show low participation in free NHS screenings (70% vs. 4%, p < 0.001). Additionally, Chinese women reported significantly lower frequency of mammography (96% vs. 33%, p < 0.001) and ultrasound (69% vs. 16%, p < 0.001). The frequency of BSE also differed substantially, with 47% of Chinese women never performing BSE compared to 12% of Italian women (p < 0.001). This comprehensive exploration provides valuable insights, attitudes, and knowledge into the disparities and potential areas for improvement in breast cancer prevention, thus contributing to the overall well-being of these communities. The findings highlight the necessity for educational initiatives aimed at improving awareness and participation in screenings, particularly among the Chinese population. These initiatives could have profound implications for patient education by equipping women with the knowledge and skills necessary to engage in proactive health behaviors.

How does patient-centered communication work? Trend analysis of mediation through cancer worry and health self-efficacy, 2011-2020

This study proposed and tested the cross-sectional effects of patient-centered communication (PCC) on cancer screening behaviors via an affective-cognitive sequential chain of mediation through cancer worry and health self-efficacy. Cross-sectional data were analyzed from four iterations of the Health Information National Trends Survey (2011, 2014, 2017, and 2020). The results found that lowered cancer worry following PCC does not show a cross-sectional positive effect in promoting cancer screening behaviors, while enhanced health self-efficacy as a subsequent state is a facilitator of screening behaviors. The findings further demonstrated increased PCC, a rise in cancer worry, and a sustained level of health self-efficacy. Also, our research has identified an upward trend in cancer screening behaviors from 2011 to 2017, followed by a notable decrease in 2020. These insights underscore the nuanced ways PCC can foster cancer screening behaviors, emphasizing the importance of emotional and cognitive aspects in clinical settings.

Breast Cancer Prevention: The Key Role of Population Screening, Breast Self-Examination (BSE) and Technological Tools. Survey of Italian Women

Breast cancer is the most common tumor among women worldwide and still remains the leading cause of death in women in Italy. Although survival from this pathology has increased, this disease and its treatment can have lasting or delayed effects that can greatly affect a woman's quality of life. Primary and secondary prevention are currently the best strategies to combat this cancer: improved lifestyle, early adherence to screening, Breast Self-Examination (BSE), and even now the use of technology, have become among the most important tools to ensure increasingly early diagnosis of this disease, which is a major cause of suffering and premature mortality in women. Indeed, early diagnosis of the disease can lead to a good prognosis and a high survival rate. This study investigates the attitude of Italian women to perform clinical checkups aimed at cancer prevention, particularly adherence to free screening programs offered by the National Health Service (NHS) for women in the 50-69 age group. The knowledge, use and emotional approach toward BSE as a screening tool and the use of dedicated apps for this purpose are also investigated. Low adherence to screening programs, lack of BSE practice, and nonuse of dedicated apps are just some of the results observed in this study. Therefore, it becomes essential to spread the culture of prevention, cancer awareness and the importance of screening throughout life.

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.

Determinants of Protective Healthcare Services Awareness among Female Syrian Refugees in Turkey

War-related migration may deprive people of access to a regular healthcare system and cause new diseases to be battled. Since refugee women are more vulnerable to diseases during this period, protective healthcare services awareness is critical for early disease diagnosis. Following the civil war that triggered the migration of millions of Syrians, an extensive survey was undertaken in coordination with the World Health Organization Country Office in Turkey to explore the health status of Syrian refugees in Turkey. Employing the survey data, we aimed to investigate the determinants of the awareness of protective health services (Pap smear test, mammogram, HIV test) among female Syrian refugees. Logit regression analysis was applied in order to investigate the determinants of the awareness of protective health services among the female refugee population. The results revealed a notably low rate of awareness of protective health services among female Syrian refugees. Furthermore, the association of explanatory variables, including socioeconomic factors, healthcare use, and health literacy with the protective health services awareness, was found to be significant.

Cancer Fatalism and Cancer Information Seeking Among Black Women: Examining the Impact of Aretha Franklin's Death on Cancer Communication Outcomes

Information seeking is often heightened following news coverage of cancer announcements from prominent celebrities or public figures. While scholars have sought to explicate the mechanisms influencing cancer information seeking following celebrity health announcements, the focus has primarily been on cognitive and emotional factors. Other influences such as sociocultural constructs have largely been ignored in this domain. Additionally, few studies have examined the health communication behaviors of minority individuals. The purpose of this study was to examine Black women's information seeking behaviors as a response to the death of the singer Aretha Franklin from pancreatic cancer and the role of fatalistic beliefs about cancer in the information seeking process. Using a survey conducted a few weeks after Franklin's death (N = 164), we found moderate amounts of pancreatic cancer information seeking, with almost 30% of women looking for information. Younger Black women were much more likely to search for information after Franklin's death than older women. Moreover, while we found fatalistic beliefs to be associated with pancreatic cancer information seeking, the findings were driven by younger women. In particular, younger women were more likely to seek pancreatic cancer information regardless of their beliefs about cancer. This study advances the understanding of cancer information seeking among Black women. Implications for cancer communication with Black women are discussed.

Few changes shown in cancer information-seeking behaviour among young adults in China between 2012 and 2017

BACKGROUND

The increasing incidence of cancer among young adults (18-40 years old) is of concern in China.

OBJECTIVES

This study aims to examine the influence of cancer information-seeking behaviours (CISB) on young adults' worries about cancer and participation in screening.

METHODS

This study analysed data from two probability sample surveys conducted in 2012 and 2017 in China. The questions in the questionnaire remained the same for better comparison. The sample size was 1212 in the 2012 survey, and 2178 in the 2017 survey.

RESULTS

From 2012 to 2017, among young adults, there was a decline in cancer information seeking, diversity of cancer information sought and cancer worry, while an improvement in cancer information-seeking experience was found. Also, CISB had significant associations with cancer worry and health screening over the 5 years.

DISCUSSION

The level of young adults' cancer information seeking remains low in China, and this group is not fully aware of their potential risks of getting cancer.

CONCLUSION

Although young adults find the experience of looking for cancer information easier in 2017, health campaigns may be necessary to encourage young adults to find out more about their cancer risks, and to participate more in health screening.

Single item to assess for worry for cancer: Initial evidence of validity and reliability

OBJECTIVE

To translate into Spanish and evaluate the evidence of content validity, construct validity and reliability of the Cancer Worry Chart as a single item measure of worry for cancer.

METHOD

The Spanish translation of the Cancer Worry Chart was done with the back-translation procedure. The participants were 165 healthy people with a family history of cancer who responded to the Cancer Worry Chart and the Cancer Worry Scale (CWS).

RESULTS

Translation back-translation allows a Spanish version of the Cancer Worry Chart whose content is clear, coherent and relevant (V>.70). Evidence of construct validity is reported based on 3 criteria: (a) an adequate adjustment of the one-dimensional model formed by the Cancer Worry Chart and the items of the CWS performed with the structural equations method (χ²_S-B=23.38; df=14; χ²_S-B/df=1.67; CFI=.988; RMSEA=.064); (b) a significant correlation between the Cancer Worry Chart and the CWS (r=.76 [IC95%: .68-.90]); (c) ascending averages in the CWS score as the groups formed by each response option of the Cancer Worry Chart express a greater degree of worry (F=55.72; p=.000; ω²=.57). The reliability of the Cancer Worry Chart is above what is recommended (α_{single item}=.84).

CONCLUSION

The Spanish version of the Cancer Worry Chart showed satisfactory evidence of content validity, construct validity and reliability to measure, briefly, quickly and generally, the worry for cancer in healthy people with a family history of cancer.

Theory-based training to promote breast cancer screening among women with breast cancer worries: randomized controlled trial

BACKGROUND

Breast cancer worries are important determinants in relation to behavior favoring breast cancer screening.

OBJECTIVE

To determine the effect of theory-based training to promote breast cancer screening among women with high and low levels of breast cancer worries.

DESIGN AND SETTING

Randomized controlled trial, conducted in two family health centers.

METHODS

In total, 285 women were recruited. Women with low levels of breast cancer worries were included in the first intervention group (112 women) and the first control group (112 women), while women with high levels of breast cancer worries were included in the second intervention group (37 women) and the second control group (43 women). Theory-based training to promote breast cancer screening was given to intervention groups. The women's willingness to undergo breast cancer screening and breast cancer worry scores were evaluated at 1, 3 and 6 months.

RESULTS

The women in the low cancer-worry intervention group performed breast self-examination more in months 1 and 6 following the training, and the women in the high cancer-worry control group performed breast self-examination more in month 3 (P < 0.05). No difference between the women who had low or high levels of breast cancer worries were observed in relation to breast self-examination, clinical breast examination or mammography (P > 0.05).

CONCLUSION

The level of worry did not affect the success of theory-based training, and the training was partially effective with regard to willingness to undergo breast cancer screening.

Single item to assess for worry for cancer: Initial evidence of validity and reliability

OBJECTIVE

To translate into Spanish and evaluate the evidence of content validity, construct validity and reliability of the Cancer Worry Chart as a single item measure of worry for cancer.

METHOD

The Spanish translation of the Cancer Worry Chart was done with the back-translation procedure. The participants were 165 healthy people with a family history of cancer who responded to the Cancer Worry Chart and the Cancer Worry Scale (CWS).

RESULTS

Translation back-translation allows a Spanish version of the Cancer Worry Chart whose content is clear, coherent and relevant (V˃.70). Evidence of construct validity is reported based on 3 criteria: a) an adequate adjustment of the one-dimensional model formed by the Cancer Worry Chart and the items of the CWS performed with the structural equations method (χ2S-B=23.38; df=14; χ2S-B/df=1.67; CFI=.988; RMSEA=.064); b) a significant correlation between the Cancer Worry Chart and the CWS (r= .76 [IC95%: .68-.90]); c) ascending averages in the CWS score as the groups formed by each response option of the Cancer Worry Chart express a greater degree of worry (F=55.72; P=.000; ω2=.57). The reliability of the Cancer Worry Chart is above what is recommended (αsingle item=.84).

CONCLUSION

The Spanish version of the Cancer Worry Chart showed satisfactory evidence of content validity, construct validity and reliability to measure, briefly, quickly and generally, the worry for cancer in healthy people with a family history of cancer.

Food Label Literacy and Use among US Adults Diagnosed with Cancer: Results from a National Representative Study

For those diagnosed with cancer, lifestyle factors including diet can be more important than ever. However, lack of nutrition-related knowledge can pose a significant barrier to healthy eating. Food labels guide consumers in selecting appropriate portion sizes-that is, caloric content-and ensuring adequate intake of nutrients. Data from the 2013-2014 HINTS were used to examine (a) differences in food label use and food label literacy between respondents ever had a cancer diagnosis and those never had a diagnosis; (b) sociodemographic correlates and health-related correlates of food label use and literacy, in a context of cancer diagnosis; and (c) potential association between food label use/literacy and each of two dietary choices, eating vegetables and fruits and limiting intake of sugary drinks, again, in a context of cancer diagnosis. Data was analyzed via SPSS version 24.0, and cross tabulations using Pearson's Chi-square test and logistic regressions. Income, gender and non-participation in support groups were associated with food label literacy (p<.05). Confidence to take care of self was associated with food label use (p<.05). Relationships were observed between using food labels and curtailing soda intake (b = -.368, p<.05), eating relatively more fruits (b = .558, p<.05), and eating relatively more vegetables (b = .558, p<.05). The overall models predicting consumption of soda [x2 (2) = 13.70, p = .001, Nagelkerke R-square = .059], of fruits [x2 (2) = 33.87, p < .001, Nagelkerke R-square = .136], and of vegetables [x2 (2) = 36.08, p < .001, Nagelkerke R-square = .144] was statistically significant. Implications for research and practice can be found in results linking food label use to better quality diets. They include the usefulness of nutrition education interventions targeting lower-income men with cancer diagnoses; one lesson should be the use of food labels.

The role of emotions in cancer patients' decision-making

Introduction

Despite the attempt to make decisions based on evidence, doctors still have to consider patients' choices which often involve other factors. In particular, emotions seem to influence the way that options and the surrounding information are interpreted and used.

Objective

The objective of the present review is to provide a brief overview of research on decision making and cancer with a specific focus on the role of emotions.

Method

Thirty-nine studies were identified and analysed. Most of the studies investigated anxiety and fear. Worry was the other psychological factor that, together with anxiety, played a crucial role in cancer-related decision-making.

Results

The roles of fear, anxiety and worry were described for detection behaviour, diagnosis, choice about prevention and curative treatments and help-seeking behaviour. Results were inconsistent among the studies. Results stressed that cognitive appraisal and emotional arousal (emotion's intensity level) interact in shaping the decision. Moderate levels of anxiety and worry improved decision-making, while low and high levels tended to have no effect or a hindering effect on decision making. Moderating factors played an under-investigated role.

Conclusions

Decision making is a complex non-linear process that is affected by several factors, such as, for example, personal knowledge, past experiences, individual differences and certainly emotions. Research studies should investigate further potential moderators of the effect of emotions on cancer-related choice. Big data and machine learning could be a good opportunity to test the interaction between a large amount of factors that is not feasible in traditional research. New technologies such as eHealth and virtual reality can offer support for the regulation of emotions and decision making.