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Fenech AL, Soriano EC, Asok A, Siegel SD, Morreale M, Brownlee HA, Laurenceau JP. Fear of cancer recurrence and change in hair cortisol concentrations in partners of breast cancer survivors. J Cancer Surviv 2024:10.1007/s11764-024-01631-1. [PMID: 38954249 DOI: 10.1007/s11764-024-01631-1] [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: 03/08/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Partners of breast cancer (BC) survivors report high rates of psychological distress including fear of cancer recurrence (FCR). Research suggests that partners may have poorer physical health outcomes than the general population, but little research has examined the physiological biomarkers by which distress may impact partner health outcomes. The current study examined the associations between FCR and changes in hair cortisol among BC partners. METHODS Male partners (N = 73) of early-stage BC survivors provided hair samples during two visits, one after completion of survivors' adjuvant treatment (T1) and again 6 months later (T2). Two subscales from the Fear of Cancer Recurrence Inventory and one subscale from the Concerns about Recurrence Scale comprised a latent FCR factor at T1. A latent change score model was used to examine change in cortisol as a function of FCR. RESULTS Partners were on average 59.65 years of age (SD = 10.53) and non-Hispanic White (83%). Latent FCR at T1 was positively associated (b = 0.08, SE = 0.03, p = .004, standardized β = .45) with change in latent hair cortisol from T1 to T2. CONCLUSIONS Results indicated that greater FCR was associated with increases in hair cortisol in the months following adjuvant treatment. This is one of the first studies to examine the physiological correlates of FCR that may impact health outcomes in BC partners. IMPLICATIONS FOR CANCER SURVIVORS Findings highlight the need for further research into the relationship between FCR and its physiological consequences. Interventions to address partner FCR are needed and may aid in improving downstream physical health outcomes.
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Affiliation(s)
- Alyssa L Fenech
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, USA.
| | | | - Arun Asok
- Alien Therapeutics Inc, Philadelphia, PA, USA
| | - Scott D Siegel
- Helen F. Graham Cancer Center & Research Institute, Christiana Care, Newark, DE, USA
| | - Michael Morreale
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, USA
| | - Hannah A Brownlee
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, USA
| | - Jean-Philippe Laurenceau
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, USA.
- Helen F. Graham Cancer Center & Research Institute, Christiana Care, Newark, DE, USA.
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Sheng L, Zhu Y, Liu Y, Hua H, Zhou J, Ye L. Fear of cancer recurrence and associated factors in family caregivers of patients with hematologic malignancy receiving chemotherapy: A latent profile analysis. Asia Pac J Oncol Nurs 2024; 11:100382. [PMID: 38495640 PMCID: PMC10940887 DOI: 10.1016/j.apjon.2024.100382] [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: 11/02/2023] [Accepted: 01/13/2024] [Indexed: 03/19/2024] Open
Abstract
Objective This study identified the potential subgroups of fear of cancer recurrence (FCR) in family caregivers (FCs) of patients with hematologic malignancies receiving chemotherapy, as well as exploring factors associated with subgroups. Methods This was a cross-sectional study involving 206 pairs of participating patients with hematologic malignancies receiving chemotherapy and their FCs. Using Mplus 8.3 to perform the latent profile analysis of FCs' FCR, the FCs' burden, quality of life, psychological resilience, and anxiety as well as their demographic characteristics were compared between the subgroups, with a logistic regression analysis being applied to examine the factors associated with the FCR subgroups. Results A total of 206 FCs were classified into two subgroups: "a low level of FCR" (Class 1, 65.4%) and "a high level of FCR" (Class 2, 34.6%). Quality of life, anxiety, and frequency of chemotherapy were significantly associated with the two subgroups. Conclusions FCs of patients with hematologic malignancy receiving chemotherapy had two FCR subgroups, "a low level of FCR" and "a high level of FCR", in association with quality of life, anxiety, and frequency of chemotherapy. These findings provide the theoretical foundations for screening the FCR factor of FCs and conducting interventions for them.
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Affiliation(s)
- Li Sheng
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yingying Zhu
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yajiao Liu
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Haiying Hua
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
- Department of Hematology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jingfen Zhou
- Department of Hematology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Long Ye
- Department of Hematology, Affiliated Hospital of Jiangnan University, Wuxi, China
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Ren H, Yang T, Yin X, Tong L, Shi J, Yang J, Zhu Z, Li H. Prediction of high-level fear of cancer recurrence in breast cancer survivors: An integrative approach utilizing random forest algorithm and visual nomogram. Eur J Oncol Nurs 2024; 70:102579. [PMID: 38636114 DOI: 10.1016/j.ejon.2024.102579] [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: 08/17/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE This study is the first attempt to use a combination of regression analysis and random forest algorithm to predict the risk factors for high-level fear of cancer recurrence and develop a predictive nomogram to guide clinicians and nurses in identifying high-risk populations for high-level fear of cancer recurrence. METHODS After receiving various recruitment strategies, a total of 781 survivors who had undergone breast cancer resection within 5 years in four Grade-A hospitals in China were included. Besides demographic and clinical characteristics, variables were also selected from the perspectives of somatic, cognitive, psychological, social and economic factors, all of which were measured using a scale with high reliability and validity. This study established univariate regression analysis and random forest model to screen for risk factors for high-level fear of cancer recurrence. Based on the results of the multi-variable regression model, a nomogram was constructed to visualize risk prediction. RESULTS Fatigue, social constraints, maladaptive cognitive emotion regulation strategies, meta-cognition and age were identified as risk factors. Based on the predictive model, a nomogram was constructed, and the area under the curve was 0.949, indicating strong discrimination and calibration. CONCLUSIONS The integration of two models enhances the credibility of the prediction outcomes. The nomogram effectively transformed intricate regression equations into a visual representation, enhancing the readability and accessibility of the prediction model's results. It aids clinicians and nurses in swiftly and precisely identifying high-risk individuals for high-level fear of cancer recurrence, enabling the development of timely, predictable, and personalized intervention programs for high-risk patients.
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Affiliation(s)
- Hui Ren
- Nursing Department, The First Hospital of Jilin University, Changchun, Jilin Province, China.
| | - Tianye Yang
- Department of Plastic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China.
| | - Xin Yin
- Nursing Department, The First Hospital of Jilin University, Changchun, Jilin Province, China.
| | - Lingling Tong
- China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China.
| | - Jianjun Shi
- Department of Breast Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China.
| | - Jia Yang
- Changchun Central Hospital, Changchun, Jilin Province, China.
| | - Zhu Zhu
- Department of Breast Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China.
| | - Hongyan Li
- The First Hospital of Jilin University, Changchun, Jilin Province, China.
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Zhu X, Ren G, Wang J, Yan Y, Du X. A multiple linear regression analysis identifies factors associated with fear of cancer recurrence in postoperative patients with gastric cancer. Medicine (Baltimore) 2024; 103:e35110. [PMID: 38489733 PMCID: PMC10939660 DOI: 10.1097/md.0000000000035110] [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] [Received: 10/26/2022] [Revised: 05/11/2023] [Accepted: 08/16/2023] [Indexed: 03/17/2024] Open
Abstract
To investigate the risk factors of fear of cancer recurrence (FCR) in postoperative patients with gastric cancer (GC) and provide references for targeted nursing intervention development. A total of 84 patients who underwent GC surgery were included in this study. The fear of progression questionnaire-short form and social support rating scale were conducted, and multiple linear regression was performed to identify risk factors of FCR. The score of the fear of progression questionnaire-short form in patients with GC surgery was 39.1 ± 7.6. The results of multiple linear regression showed that age, education level, occupational status, course of the disease, Tumor node metastasis staging, and social support were the influencing factors of FCR in patients with GC (P < .05). The current situation of FCR in patients with GC surgery is not optimistic. The medical staff should pay more attention to patients with low age, low education level, unemployment, short course, high tumor node metastasis staging, low social support level, and other high-risk groups, and provide social support resources to reduce the level of FCR.
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Affiliation(s)
- Xuejuan Zhu
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Guijun Ren
- Department of Hepatobiliary Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Junmin Wang
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yajuan Yan
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xian Du
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Tao L, Ma X, Yang Y, Hu X, Fu L, Li J. Investigating fear of cancer recurrence among female breast cancer survivors and their spouses in southwest China: a cross-sectional study. BMJ Open 2024; 14:e077964. [PMID: 38331853 PMCID: PMC10860109 DOI: 10.1136/bmjopen-2023-077964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Examining fear of cancer recurrence (FCR) among breast cancer survivors and their spouses, and the protective effect of family resilience on FCR among couples affected by breast cancer. DESIGN Cross-sectional survey design. SETTING Ten general grade IIIa (>500 beds) hospitals in southwest China. PARTICIPANTS Overall, 392 early breast cancer survivors and their spousal caregivers (N=392) were recruited from cancer centres in hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES Spouses' and survivors' FCR were the primary outcome measures. Family resilience and perceived stress were the secondary outcome measures. Using a convenience sampling method, we collected data on-site using paper questionnaires. The Chinese version of the Family Resilience Assessment Scale, Perceived Stress Scale, Fear of Progression Questionnaire Short Form and Fear of Progression Questionnaire-Short Form for spouses were used to evaluate the outcomes. RESULTS The model accounted for 66.3% and 53.6% of the variance in spouses' FCR and survivors' FCR, respectively. Family resilience directly negatively affected perceived stress and spouses' and survivors' FCR (β=-0.22; β=-0.13; β=-0.19). Perceived stress was a partial mediator of the association between family resilience and survivors' FCR (β=-0.070; 95% CI :-0.151 to -0.022). Spouses' FCR partially mediated the association between family resilience and survivors' FCR (β=-0.048; 95% CI= -0.092 to -0.015). Perceived stress and spouses' FCR played a significant chain-mediated role between family resilience and survivors' FCR (β=-0.061; 95% CI: -0.119 to -0.022). CONCLUSIONS Family-centred approaches to reducing survivors' perceived stress can improve the psychological well-being of couples affected by breast cancer and ultimately reduce FCR. Medical staff should consider the psychological feelings of survivors and their spousal caregivers when devising the intervention plan, which should address the families' potential and mobilise family and community resources for increasing family resilience.
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Affiliation(s)
- Lin Tao
- Cancer Day-Care Unit, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaolin Ma
- Cancer Day-Care Unit, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, China
| | - Ying Yang
- Cancer Day-Care Unit, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoxia Hu
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, Breast Center,West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lan Fu
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, Breast Center,West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Junying Li
- Thoracic Oncology Ward, Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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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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Lyu MM, Chiew-Jiat RS, Cheng KKF. The effects of physical symptoms, self-efficacy and social constraints on fear of cancer recurrence in breast cancer survivors: Examining the mediating role of illness representations. Psychooncology 2024; 33:e6264. [PMID: 38047719 DOI: 10.1002/pon.6264] [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: 03/01/2023] [Revised: 07/24/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is common in breast cancer survivors (BCS). This study examined the mediating role of illness representations in the relationships between FCR and physical symptoms, social constraint and self-care self-efficacy. METHODS In this cross-sectional study, 385 women with breast cancer completed a series of questionnaires including the FCR Inventory, Social Constraints Scale-15, Cancer Survivors Self-Efficacy Scale, Illness Perception Questionnaire-Revised and European Organization for Research and Treatment Quality of Life Questionnaire-Breast Cancer. Structural equation modelling method was conduct by using a bootstrapping method. RESULTS Physical symptoms (β = 0.272, p < 0.01), social constraints (β = 0.130, p < 0.01), self-efficacy (β = -0.233, p < 0.01) and illness representation (β = 0.261, p < 0.01) have direct effects on FCR. The indirect effects of physical symptoms (β = 0.10, p < 0.01), social constraints (β = 0.076, p < 0.01) and self-efficacy (β = -0.025, p < 0.05) on FCR were partially mediated by illness representations. CONCLUSIONS In this study, the effects of physical symptoms, social constraints and self-efficacy on FCR were found to be mediated by illness representation. Reducing the impact of negative illness representations on FCR by reducing physical symptoms, increasing self-efficacy, and promoting open disclosure of cancer-related concerns may be effective in reducing FCR in BCS.
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Affiliation(s)
- Meng-Meng Lyu
- National University of Singapore, Singapore, Singapore
| | | | - Karis Kin Fong Cheng
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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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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Wu J, Lan X, Liao Z, Chen J, Wu Y, Hu R. Comparison of the sense of spousal support, anxiety, depression and their relationship to fear of cancer recurrence between lymphoma patients and their spouses: A cross-sectional study in China. J Cancer Surviv 2023:10.1007/s11764-023-01443-9. [PMID: 37610477 DOI: 10.1007/s11764-023-01443-9] [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: 03/13/2023] [Accepted: 07/29/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE To investigate the level of fear of cancer recurrence (FCR) in spouses of patients with lymphoma and its relationship with patients' FCR, as well as the correlations between FCR, sense of spousal support (SSS), anxiety, and depression in the couples. METHODS A cross-sectional study of 233 couples where one partner had lymphoma was conducted from May 2021 to February 2022. Participants provided demographic information and completed the Spouse Support Inventory and Hospital Anxiety and Depression Scale. The Fear of Progression Questionnaire (for patients) and Fear of Progression Questionnaire for Partners (for spouses) were used to measure FCR. Descriptive analyses, t-tests, variance analysis, Spearman's correlation analysis, and multiple linear regression analysis was performed. RESULTS The prevalence of FCR, anxiety, and depression in patients was 37.7%, 68.7%, and 83.3%, respectively. The prevalence of FCR, anxiety, and depression in spouses was 56.2%, 78.1%, and 81.1%, respectively. Spouses' FCR scores were higher than those of patients, whereas patients' SSS and anxiety scores were higher than those of their spouses. Multiple linear regression analysis showed that patients' anxiety and SSS, as well as spouses' FCR were significantly associated with patients' FCR. Variables significantly associated with higher FCR among spouses were anxiety, per capita monthly household income, and patients' FCR. CONCLUSIONS Patients with lymphoma and their spouses have a certain degree of FCR, anxiety, and depression. FCR levels in spouses are higher than in patients. IMPLICATIONS FOR CANCER SURVIVORS Psychological support interventions for couples may be effective in reducing FCR and facilitating family adaptation to cancer.
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Affiliation(s)
- Junjun Wu
- The School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350108, China
| | - Xiaoyan Lan
- The School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350108, China
| | - Zhenling Liao
- The School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350108, China
| | - Jingyi Chen
- The School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350108, China
| | - Yong Wu
- Department of Hematology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
| | - Rong Hu
- The School of Nursing, Fujian Medical University, NO.1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350108, China.
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Webb K, Sharpe L, Butow P, Dhillon H, Zachariae R, Tauber NM, O'Toole MS, Shaw J. Caregiver fear of cancer recurrence: A systematic review and meta-analysis of quantitative studies. Psychooncology 2023; 32:1173-1191. [PMID: 37303263 DOI: 10.1002/pon.6176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is reported by both cancer survivors and caregivers however less is known about caregiver FCR. This study aimed to (a) conduct a meta-analysis to compare survivor and caregiver FCR levels; (b) examine the relationship between caregiver FCR and depression, and anxiety; (c) evaluate psychometric properties of caregiver FCR measures. METHODS CINAHL, Embase, PsychINFO and PubMed were searched for quantitative research examining caregiver FCR. Eligibility criteria included caregivers caring for a survivor with any type of cancer, reporting on caregiver FCR and/or measurement, published in English-language, peer-review journals between 1997 and November 2022. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy was used to evaluate content and psychometric properties. The review was pre-registered (PROSPERO ID: CRD42020201906). RESULTS Of 4297 records screened, 45 met criteria for inclusion. Meta-analysis revealed that caregivers reported FCR levels as high as FCR amongst survivors, with around 48% of caregivers reporting clinically significant FCR levels. There was a strong correlation between anxiety and depression and medium correlation with survivor FCR. Twelve different instruments were used to measure caregiver FCR. Assessments using the COSMIN taxonomy revealed few instruments had undergone appropriate development and psychometric testing. Only one instrument met 50% or more of the criteria, indicating substantial development or validation components were missing in most. CONCLUSIONS Results suggest FCR is as often a problem for caregivers as it is for survivors. As in survivors, caregiver FCR is associated with more severe depression and anxiety. Caregiver FCR measurement has predominately relied on survivor conceptualisations and unvalidated measures. More caregiver-specific research is urgently needed.
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Affiliation(s)
- Kyra Webb
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Haryana Dhillon
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-Based Decision Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Unit for Psychooncology and Health Psychology (EPoS), Aarhus University Hospital, Aarhus, Denmark
| | - Nina Møller Tauber
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Joanne Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
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Zhou Y, Che CC, Chong MC, Zhao H, Lu Y. Effects of marital self-disclosure on marital relationship and psychological outcome for cancer patients: a systematic review. Support Care Cancer 2023; 31:361. [PMID: 37249639 DOI: 10.1007/s00520-023-07826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Literature on marital self-disclosure interventions for cancer patients lacks consistency in methodology and content. Moreover, the impact of such interventions on physical and psychological health, marital relationships, and self-disclosure ability is controversial. This review aims to systematically analyze the studies of marital self-disclosure intervention, synthesize the structure and topics of marital self-disclosure, and summarize and evaluate its effects on improving physical and psychological outcomes and marital relationships in cancer patients and their spouses. METHOD This systematic review used the preferred reporting items of Systematic Reviews and Meta-Analyses (PRISMA). We conducted a systematic review of randomized controlled and quasi-experimental studies published from the establishment of the database to October 2022. Marital self-disclosure interventions were conducted with both cancer patients and their spouses. Studies published in a language other than English or Chinese, and studies below a quality grade of C were excluded. Data were extracted through a standardized data collection form, and two reviewers independently extracted and evaluated the data. The quality of the included studies was assessed using the Cochrane Handbook of Systematic Reviews of Interventions, and a third reviewer adjudicated in case of disagreement. The data were synthesized by vote counting based on direction of effect according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. RESULTS Thirteen studies were included in the review. Based on quality evaluation, three studies were categorized as grade A (good), and ten studies were grade B (moderate). Seven studies reported moderate rates of participant refusal and attrition. The structure and topics of marital self-disclosure varied across different studies. The five studies had various prespecified disclosure topics, such as fear of cancer recurrence, benefit finding, and emotional distress. The overall results suggest that marital self-disclosure interventions can improve physical and psychological health, enhance marital relationships, and increase self-disclosure ability. CONCLUSION The limited number of studies, small sample sizes, diverse intervention strategies, and methodological heterogeneity weakened the evidence base for the effectiveness of marital self-disclosure interventions. Therefore, further high-quality randomized controlled trials (RCTs) are recommended to confirm the effectiveness of such interventions. These studies should also evaluate the interventions' long-term impact, analyze optional topics and methods, identify key features, and explore the development of the best intervention program.
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Affiliation(s)
- Ye Zhou
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Chong Chin Che
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Haiyan Zhao
- Nursing Department, Jingjiang People's Hospital, Taizhou City, Jiangsu Province, China
| | - Yin Lu
- Nursing Department, Jingjiang People's Hospital, Taizhou City, Jiangsu Province, China
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12
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Profiles of social constraints and associated factors among breast cancer patients: a latent profile analysis. BMC Psychiatry 2022; 22:750. [PMID: 36451108 PMCID: PMC9714186 DOI: 10.1186/s12888-022-04407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The present study aimed to identify profiles of social constraints among Chinese breast cancer patients and to explore the variables associated with these patterns. METHODS The study recruited 133 Chinese breast cancer patients in Liaoning Province, China, between June 2021 and February 2022. The questionnaire package included the Social Constraints Scale (SCS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the Social Impact Scale (SIS). The methods of statistical analysis used included latent profile analysis (LPA) and multinomial logistic regression. RESULTS Three latent patterns of social constraints were found: class 1-the low social constraints group (51.9%), class 2-the moderate social constraints group (35.3%), and class 3-the high social constraints group (12.8%). Patients with high social support were more likely to report a low level of social constraint, while patients with a greater fear of progression were more likely to report a moderate or high level of social constraints. Significant differences existed among the latent classes identified by reference to social constraint in terms of education. CONCLUSION These results suggest that breast cancer patients' perceptions of social constraints vary and exhibit individual differences. Health care providers should take into account patients' fear of progression as well as their social support when developing interventions for patients with a high level of social constraints.
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13
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Shen Z, Shi S, Li C, Ruan C. The influence of social constraints on the quality of life of hematopoietic stem cell transplantation survivors: The chain mediating effect of illness perceptions and the fear of cancer recurrence. Front Psychol 2022; 13:1017561. [PMID: 36506995 PMCID: PMC9732518 DOI: 10.3389/fpsyg.2022.1017561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022] Open
Abstract
Objective This cross-sectional correlational study aims to explore the relationship between social constraints and the quality of life of hematopoietic stem cell transplantation (HCT) survivors. Additionally, we also seek to demonstrate the chain mediating effect of illness perceptions and the fear of cancer recurrence on this relationship. Methods Convenience sampling was employed in this study. A total of 232 HCT survivors were interviewed using the Social Constraints Scale, the Brief Illness Perception Questionnaire, the Fear of Cancer Recurrence Inventory (Short Form) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant. IBM SPSS 24.0 were used for data analyses, and PROCESS macro (Model 6) was used to examine the hypothesized chain mediation model. Results A positive relationship between social constraints and quality of life verified the mediating effect of illness perceptions and the fear of cancer recurrence on this relationship. Social constraints affect the quality of life of HCT survivors via three pathways: the mediating role of illness perceptions, the mediating role of fear of cancer recurrence and the chain mediating effect of both factors. Conclusion The chain mediating effect of illness perceptions and the fear of cancer recurrence on quality of life indicates that these two variables have important practical significance with respect to improving HCT survivors' physical and mental health. The study thus serves as a reference for health workers to improve HCT survivors' quality of life in the future.
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Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China,Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuangjiao Shi
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China,Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Chengyuan Li
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China,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,*Correspondence: Chunhong Ruan,
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14
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Fenech AL, Perndorfer C, Soriano EC, Otto AK, Brownlee HA, Morreale M, Siegel SD, Laurenceau JP. Daily partner responsiveness and everyday sleep outcomes in breast cancer survivors and their partners. Support Care Cancer 2022; 30:7561-7568. [PMID: 35676343 DOI: 10.1007/s00520-022-07195-z] [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: 01/26/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Breast cancer (BC) survivors and their intimate partners face several adverse consequences from the cancer experience, including sleep disturbance, which is a common side effect of BC and its treatment. Sleep has been conceptualized and examined as an individual phenomenon despite most adults sharing a bed/room with a partner. Limited research has examined the associations between daily relationship processes and sleep in couples coping with cancer. Using an intensive longitudinal design, the present study examined the daily, within-person links between attempted and perceived partner responsiveness and subjective sleep. METHODS Immediately following adjuvant treatment, 72 early-stage BC survivors and their intimate partners (144 paired individuals) reported on daily attempted and perceived partner responsiveness each evening and subjective sleep each morning for 21 consecutive days. RESULTS Survivor and partner reports of partner responsiveness were associated with their own subjective sleep, such that greater attempted and perceived partner responsiveness were associated with improvements in one's own subjective sleep. Effects of one participant's partner responsiveness on their partner's sleep were not observed. CONCLUSIONS Findings suggest that among couples coping with early-stage BC, increased partner responsiveness is associated with subsequent improvements in subjective sleep. IMPLICATIONS FOR CANCER SURVIVORS Sleep disturbance is a serious concern for BC survivors and their intimate partners. Future research should assess intimacy processes as a potential method to improve BC survivor and partner sleep.
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Affiliation(s)
- Alyssa L Fenech
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716-2577, USA.
| | - Christine Perndorfer
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716-2577, USA
| | - Emily C Soriano
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716-2577, USA
| | - Amy K Otto
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Hannah A Brownlee
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716-2577, USA
| | - Michael Morreale
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716-2577, USA
| | - Scott D Siegel
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Jean-Philippe Laurenceau
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716-2577, USA.
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA.
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15
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Perndorfer C, Soriano EC, Siegel SD, Spencer RMC, Otto AK, Laurenceau JP. Fear of Cancer Recurrence and Sleep in Couples Coping With Early-Stage Breast Cancer. Ann Behav Med 2022; 56:1131-1143. [PMID: 35551585 PMCID: PMC9635995 DOI: 10.1093/abm/kaac018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) and sleep disturbance are common in cancer survivors. Yet, little research has examined their relationship, and even less is known about what links may exist between these variables among the intimate partners of cancer survivors. PURPOSE This study examines the relationship between FCR and sleep disturbance in breast cancer survivors and their partners. Using daily sleep data collected at two distinct periods early in survivorship-the completion of adjuvant treatment and the first post-treatment mammogram-higher survivor and partner FCR was hypothesized to predict greater sleep disturbance. METHODS Breast cancer survivors and intimate partners (N = 76 couples; 152 individuals) each reported sleep duration, sleep quality, sleep onset latency, and wake after sleep onset each morning of two 21-day sleep diary bursts during the first year post-diagnosis. Three validated measures formed latent FCR factors for survivors and partners, which were used to predict average daily sleep. RESULTS Across both sleep diary bursts, survivor FCR was associated with their own reduced sleep duration, reduced sleep quality, and greater sleep onset latency. Survivor FCR was also associated with their partners' reduced sleep quality and greater sleep onset latency. Partner FCR was associated with their own reduced sleep duration, reduced sleep quality, and greater sleep onset latency. Partner FCR was also associated with survivors' reduced sleep quality. CONCLUSIONS Findings revealed intrapersonal and interpersonal associations between FCR and sleep disturbance, addressing gaps in knowledge on FCR and an outcome with known short- and long-term implications for health and mortality.
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Affiliation(s)
- Christine Perndorfer
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Emily C Soriano
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Scott D Siegel
- Value Institute, Helen F. Graham Cancer Center and Research Institute, Newark, DE 19713, USA
| | - Rebecca M C Spencer
- Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Amy K Otto
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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16
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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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17
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The intrapersonal and interpersonal processes of fear of recurrence among cervical cancer survivors: a qualitative study. Support Care Cancer 2022; 30:2671-2678. [PMID: 34817691 PMCID: PMC8611176 DOI: 10.1007/s00520-021-06695-8] [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: 08/03/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Cervical cancer's emotional and mental toll often extends beyond the disease's duration. Fear of cancer recurrence has been identified as prominent in patients and survivors, yet there is a paucity of studies regarding this population. The present study sought to explore and expand the understanding of the meaning of fear of cancer recurrence among cervical cancer survivors. METHODS In this qualitative study, semi-structured interviews were conducted with 15 cervical cancer survivors. The interviewees' mean age was 41.33 years (range 34-47 years), and the mean time since diagnosis was 3.1 years (ranged from 0.5 to 7 years). RESULTS Three central themes emerged that represent intrapersonal and interpersonal processes: The first, "No longer resilient" refers to feelings of uncertainty in the face of the illness experienced on the intrapersonal level, where the interviewee mostly engaged with efforts to return to the "normal" state that existed before the cancer diagnosis. The second, "To be afraid in a dyad," relates to the interpersonal level that included mutual fears shared by the interviewee and her partner. The third "And what if the disease comes back and I die?" represents a combination of intrapersonal and interpersonal processes manifested by the greatest fear - death - expressed by both the interviewee and her partner. CONCLUSIONS The present findings revealed that the fear of cancer recurrence represents intrapersonal and interpersonal processes encompassing three factors - uncertainty, social-cognitive processing, and death anxiety. Accordingly, potential psycho-social treatment options could be tailored to specifically address the prominence of these factors for cervical cancer survivors.
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18
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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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19
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Yeung NCY, Lu Q. Social constraints and fear of recurrence among Chinese American breast cancer survivors: An exploration of psychosocial mediators. Psychooncology 2021; 31:98-106. [PMID: 34374165 DOI: 10.1002/pon.5784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is commonly experienced among Caucasian and Chinese American breast cancer survivors (BCS). Emerging studies have suggested that Caucasian BCS' communication with family members contributes to their FCR. However, whether such findings apply to Chinese American BCS has yet to be explored. This study examined the association between social constraints (i.e., perceived barriers from significant others inhibiting cancer-related disclosure) and FCR among 136 Chinese American BCS, plus proposed that self-stigma (i.e., internalized feelings of shame about having cancer), bodily pain, and ambivalence over emotional expression (AEE; conflict between the desire to express emotions and the fear of its consequences) would mediate the association. METHODS Participants recruited through cancer associations in the USA were invited to complete a cross-sectional survey measuring their socio-demographic/cancer-related variables and the above-mentioned psychological variables. RESULTS Higher levels of social constraints, AEE, self-stigma, and bodily pain were associated with higher FCR (rs ranged from 0.27 to 0.40, ps < 0.01). After controlling for covariates, path analysis results supported the proposed mediation model with satisfactory fit indices (χ2 (7) = 2.08, Comparative Fit index = 1.00, Tucker Lewis Index = 1.08, Root Mean Square Error of Approximation = 0.00). Specifically, social constraints were associated with higher FCR through increased self-stigma (β = 0.10, 95% confidence interval [CI] = 0.02, 0.17), AEE (β = 0.14, 95% CI = 0.01, 0.27), and bodily pain (β = 0.09, 95% CI = 0.02, 0.17), indicating significant mediation effects. After considering the mediators, the direct effect from social constraints to FCR was no longer significant. CONCLUSIONS The association between social constraints and higher FCR could be mediated by increased self-stigma, AEE, and bodily pain among Chinese American BCS. Interventions targeting to address those variables may reduce FCR among those BCS.
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Affiliation(s)
- Nelson C Y Yeung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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20
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O'Rourke L, Fisher PL, Campbell S, Wright A, Cherry MG. Factors Associated With Fear of Cancer Recurrence in Family Caregivers of Cancer Survivors: A Systematic Review. Front Psychol 2021; 12:625654. [PMID: 34335354 PMCID: PMC8323753 DOI: 10.3389/fpsyg.2021.625654] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/08/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: Fear of cancer recurrence (FCR) is a significant concern for family caregivers of cancer survivors and is associated with many adverse outcomes, including increased emotional distress and poorer quality of life. Although several theoretical models have been proposed to account for FCR in cancer survivors, their applicability to caregivers is unknown. The aim of this review was to identify clinical, demographic and psychological factors that are associated with, and predict, FCR in caregivers of cancer survivors. Method: AMED, CINAHL, Medline, PsycINFO, and Scopus were systematically searched for relevant studies reporting quantitative data on factors associated with FCR or similar constructs (e.g., worry or anxiety about cancer recurrence) in family caregivers of adult cancer survivors. Included studies were assessed for methodological quality using a standardized checklist adapted from the Agency for Healthcare Research and Quality. Results: Sixteen studies, half of which were cross-sectional, were included and summarized narratively. Non-modifiable factors, including age (n = 6) and treatment modality (n = 4), were found to be associated with increased FCR. Significant positive associations were also reported between illness perceptions and FCR (n = 3). However, there was heterogeneity across included studies with regards to factors examined and most were conducted in the USA. There were also several methodological limitations to the included studies. Conclusions: Research examining FCR in caregivers of cancer survivors has predominantly focused on demographic and clinical factors. Given the paucity of research exploring the psychological mechanisms underpinning FCR, future research should investigate theoretical underpinnings of FCR in caregivers of cancer survivors to support the development of psychological interventions for this population. Systematic Review Registration: PROSPERO, identifier [CRD42019119729].
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Affiliation(s)
- Louise O'Rourke
- Department of Primary Care and Mental Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool, United Kingdom
| | - Peter L Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool, United Kingdom.,Clinical Health Psychology Service, Linda McCartney Centre, Liverpool University National Heath Service Foundation Trust, Liverpool, United Kingdom
| | - Sophie Campbell
- Clinical Health Psychology Service, Linda McCartney Centre, Liverpool University National Heath Service Foundation Trust, Liverpool, United Kingdom
| | - Amelia Wright
- Department of Primary Care and Mental Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool, United Kingdom
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool, United Kingdom.,Clinical Health Psychology Service, Linda McCartney Centre, Liverpool University National Heath Service Foundation Trust, Liverpool, United Kingdom
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21
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Anderson K, Smith A'B, Diaz A, Shaw J, Butow P, Sharpe L, Girgis A, Lebel S, Dhillon H, Burhansstipanov L, Tighe B, Garvey G. A Systematic Review of Fear of Cancer Recurrence Among Indigenous and Minority Peoples. Front Psychol 2021; 12:621850. [PMID: 34012412 PMCID: PMC8126623 DOI: 10.3389/fpsyg.2021.621850] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
While cancer survivors commonly experience fear and anxiety, a substantial minority experience an enduring and debilitating fear that their cancer will return; a condition commonly referred to as fear of cancer recurrence (FCR). Despite recent advances in this area, little is known about FCR among people from Indigenous or other ethnic and racial minority populations. Given the high prevalence and poor outcomes of cancer among people from these populations, a robust understanding of FCR among people from these groups is critical. The current review identified and aggregated existing literature on FCR amongst adult cancer survivors from Indigenous and minority populations. The protocol of this review was registered with PROSPERO in July 2020 (Registration number: CRD42020161655). A systematic search of bibliographic databases was conducted for relevant articles published from 1997 to November 2019. Data from eligible articles were extracted and appraised for quality by two independent reviewers. Nineteen articles from four countries (United States of America, Canada, Australia and the United Kingdom) met the inclusion criteria, including 14 quantitative, 4 qualitative and 1 mixed-methods study. Only one article reported on an Indigenous population. Few studies reported on FCR prevalence (n = 3) or severity (n = 9). While the variation in tools used to measure FCR hindered a robust estimate of severity, results suggested some differences in FCR severity between minority and dominant populations, although these may have been due to study metholodological differences. Few factors were reported as being associated with FCR in minorities across multiple studies. The qualitative synthesis found five themes associated with the lived experience of FCR: (i) variations in the lived experience of FCR; (ii) spirituality and worldview impacting on FCR; (iii) the importance of staying positive; (iv) complexities around support; and (v) increasing cancer knowledge. The findings of this review highlight differences in FCR across cultures and contexts, which reinforces the need for culturally-specific approaches to this condition. The dearth of research in this area is of concern given the significant burden of cancer in these populations. A deeper understanding of this condition among Indigenous and minority populations is critical to developing and delivering appropriate and effective psychosocial care for cancer survivors from these groups. Systematic Review Registration: identifier [CRD42020161655].
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Affiliation(s)
- Kate Anderson
- Menzies School of Health Research, Brisbane, QLD, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Allan 'Ben' Smith
- Centre for Oncology Education & Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Abbey Diaz
- Menzies School of Health Research, Brisbane, QLD, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Afaf Girgis
- Centre for Oncology Education & Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Haryana Dhillon
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | | | - Boden Tighe
- Menzies School of Health Research, Brisbane, QLD, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, QLD, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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22
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Soriano EC, Otto AK, LoSavio ST, Perndorfer C, Siegel SD, Laurenceau JP. Fear of Cancer Recurrence and Inhibited Disclosure: Testing the Social-Cognitive Processing Model in Couples Coping With Breast Cancer. Ann Behav Med 2021; 55:192-202. [PMID: 32608472 PMCID: PMC7980765 DOI: 10.1093/abm/kaaa043] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Withholding cancer-related concerns from one's partner (protective buffering) and feeling that one's partner is inaccessible or unresponsive to such disclosure (social constraints) are two interpersonal interaction patterns that separately have been linked to poorer adjustment to cancer. PURPOSE Guided by the Social-Cognitive Processing Model, we examined the joint effects of social constraints and protective buffering on fear of cancer recurrence (FCR) in survivors and spouses. Social constraints and protective buffering were hypothesized to emerge as independent predictors of higher FCR. METHODS Early-stage breast cancer survivors and spouses (N = 79 couples; 158 paired individuals) completed up to five repeated measures of FCR, social constraints, protective buffering, and relationship quality during the year postdiagnosis. A second-order growth curve model was estimated and extended to test the time-varying, within-person effects of social constraints and protective buffering on a latent FCR variable, controlling for relationship quality. RESULTS As hypothesized, greater social constraints and protective buffering significantly (p < .05) predicted higher concurrent FCR at the within-person level, controlling for global relationship quality and change in FCR over time. The fixed effects were found to be similar for both survivors and spouses. CONCLUSIONS Findings suggest that interaction patterns resulting in inhibited disclosure are associated with greater FCR for both survivors and spouses, consistent with the Social-Cognitive Processing Model. This work adds to the growing body of research highlighting the social context of FCR.
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Affiliation(s)
- Emily C Soriano
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | - Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Stefanie T LoSavio
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Christine Perndorfer
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | - Scott D Siegel
- Value Institute, Christiana Care Health System, Newark, DE, USA
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23
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Tan JH, Sharpe L, Russell H. The impact of ovarian cancer on individuals and their caregivers: A qualitative analysis. Psychooncology 2021; 30:212-220. [PMID: 32940943 DOI: 10.1002/pon.5551] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Ovarian cancer remains an understudied cancer with poor prognosis, few effective treatments and little understanding of the how individuals and their families face the challenges and uncertainty following diagnosis. This study synthesized the subjective experiences of individuals and their caregivers in the face of the uncertainty produced by the disease. METHODS Qualitative data were obtained from the Ovarian Cancer Australia 2017 Consumer Survey. An inductive thematic analysis was conducted on responses from 219 individuals with ovarian cancer and 78 caregivers. RESULTS Nine themes were identified from the individual's responses and seven themes from the caregivers. For both groups, the uncertainty created at diagnosis led to a cascade of complex responses. For the individuals, uncertainty gave rise to fears for the future, which were exacerbated by unmet healthcare needs or treatment-related difficulties. For some individuals, these fears led to disruption to their lives, isolation and emotional distress. For others, helpful coping styles and social support protected them from these negative consequences. For caregivers, the processes were similar, but uncertainty predominantly led to feelings of hopelessness and "survivor guilt." CONCLUSIONS Our results identified processes that may guide future interventions and research targeting unmet needs and protective factors for individuals with ovarian cancer and their caregivers. Findings also suggest the potential to facilitate effective support between individuals and their caregivers.
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Affiliation(s)
- Jit Hui Tan
- Clinical Psychology Unit, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- Clinical Psychology Unit, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Russell
- Ovarian Cancer Australia, Melbourne, Victoria, Australia
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24
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Rivera-Rivera JN, Badour CL, Burris JL. The association between psychological functioning and social support and social constraint after cancer diagnosis: a 30-day daily diary study. J Behav Med 2021; 44:355-367. [PMID: 33506286 DOI: 10.1007/s10865-021-00200-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/06/2021] [Indexed: 01/16/2023]
Abstract
This study evaluated one positive and one negative aspect of social functioning (social support and social constraint, respectively) to increase understanding of its relation to psychological functioning (distress and wellbeing) after cancer diagnosis. Participants in this longitudinal study were recently diagnosed, predominately late stage, first primary cancer survivors (n = 48). Data collection involved a 30-day period of daily assessment. Data were analyzed using multilevel linear models. As in prior studies, none of the variables changed significantly over time (ps = .07 to .99). Based on the intraclass correlation coefficient, 51 to 75% of the variance in the daily assessment data are attributable to between-person differences. There was a positive relationship between social constraint and both general and cancer-specific distress (ps < .05) and between social support and cancer-specific wellbeing (ps < .001). In prospective models, higher than average general distress predicted higher social support the next day (p = .004) and higher than average cancer-specific wellbeing predicted more social constraint the next day (p = .01). The findings lend some support to the interdependence of social functioning and psychological functioning after cancer diagnosis.
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Affiliation(s)
- Jessica N Rivera-Rivera
- Department of Psychology, University of Kentucky, Kastle Hall, Lexington, KY, 40506-0044, USA
| | - Christal L Badour
- Department of Psychology, University of Kentucky, Kastle Hall, Lexington, KY, 40506-0044, USA
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Kastle Hall, Lexington, KY, 40506-0044, USA.
- Markey Cancer Center, University of Kentucky, Combs Cancer Research Building, Lexington, KY, 40536, USA.
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25
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Thana K, Lehto R, Sikorskii A, Wyatt G. Informal caregiver burden for solid tumour cancer patients: a review and future directions. Psychol Health 2021; 36:1514-1535. [PMID: 33393827 DOI: 10.1080/08870446.2020.1867136] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Recent shifts in healthcare delivery and treatment for solid tumour cancer patients have modified the responsibilities of informal caregivers. The objective of this study was to: review informal caregiver burden factors and determine areas where future research is needed. METHODS The Arksey and O'Malley's framework and a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this review. Research literature was systematically searched using five-electronic databases, including PubMed, PsycINFO, Cochrane, CINAHL, and SCOPUS, and reference lists from included studies to identify publications since 2010. Inclusion criterion was caregivers providing home-based care to a cancer patient. RESULTS The search yielded 43 eligible papers of 2119 reviewed, including articles from over 17 countries. Caregiver physical and psychological health, financial strain, and social isolation, as well as limited family and social support continued to be important factors contributing to high levels of caregiver burden. Less recognised factors affecting higher burden included caregivers' self-esteem, male gender, and the dynamic nature of cancer treatment. CONCLUSIONS This review updates the state of the science on informal caregiver burden when caring for patients with solid tumour cancers and informs future interventions on how to reduce this burden.
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Affiliation(s)
- Kanjana Thana
- Faculty of Nursing, Chiangmai University, Chiangmai, Thailand
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, MI, USA
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26
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Murphy LK, Heathcote LC, Prussien KV, Rodriguez EM, Hewitt JA, Schwartz LE, Ferrante AC, Gerhardt CA, Vannatta K, Compas BE. Mother-child communication about possible cancer recurrence during childhood cancer survivorship. Psychooncology 2020; 30:536-545. [PMID: 33227159 DOI: 10.1002/pon.5600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Providing opportunities to communicate about possible cancer recurrence may be adaptive for youth in remission, yet parents may experience difficulty guiding discussions related to fears of cancer recurrence (FCR). This study aimed to characterize mother-child discussions about potential cancer recurrence during post-treatment survivorship and to determine predictors of maternal communication. METHODS Families (N = 67) were recruited after the child's initial cancer diagnosis (age 5-17 years) and mothers self-reported their distress (post-traumatic stress symptoms; PTSS). During survivorship 3-5 years later, mothers were video-recorded discussing cancer with their children. Presence and length of discussion about potential cancer recurrence, triggers for FCR, expressed affect, and conversational reciprocity were examined. Hierarchical regressions were used to assess maternal PTSS near the time of cancer diagnosis and child age as predictors of maternal communication. RESULTS Three-quarters of dyads spontaneously discussed risk for or fears about cancer recurrence; mothers initiated the topic more frequently than their children. Dyads discussed internal (bodily symptoms) and external (medical, social) triggers of FCR. Higher maternal PTSS at diagnosis predicted significantly lower levels of maternal positive affect (β = -0.36, p = 0.02) and higher levels of maternal negative affect (β = 0.30, p = 0.04) during discussion of recurrence 3-5 years later. Older child age significantly predicted higher levels of maternal negative affect (β = 0.35, p = 0.02). Higher maternal PTSS at diagnosis predicted shorter discussions about recurrence for younger children (β = 0.27, p = 0.02). CONCLUSIONS Understanding predictors and characteristics of mother-child discussions about recurrence can guide family-based FCR interventions, particularly those promoting communication as a supportive tool. Both maternal PTSS and child age are important to consider when developing these interventions.
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Affiliation(s)
- Lexa K Murphy
- Department of Psychology & Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kemar V Prussien
- Department of Psychology & Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Erin M Rodriguez
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Jackson A Hewitt
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura E Schwartz
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Amanda C Ferrante
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University, Nashville, Tennessee, USA
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27
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An examination of the relationship of patient modifiable and non-modifiable characteristics with fear of cancer recurrence among colorectal cancer survivors. Support Care Cancer 2020; 29:869-876. [PMID: 32524283 DOI: 10.1007/s00520-020-05552-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/25/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is one of the most common and distressing issues affecting cancer survivors. This study examined (1) the association between modifiable cognitive, behavioral, and social characteristics and FCR, (2) the association between non-modifiable characteristics and FCR, and (3) the relative contributions of modifiable and non-modifiable characteristics to FCR. METHODS Participants (n = 120) had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months. Participants completed self-report measures of modifiable cognitive (e.g., beliefs about worry), behavioral (e.g., health-related reassurance seeking), and social (e.g., social constraints) characteristics. Non-modifiable characteristics (e.g., age, disease severity) were assessed via self-report and medical record review. FINDINGS Modifiable (i.e., perceived risk, self-efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking, social constraints) and non-modifiable (i.e., age, gender, disease severity, neuroticism, conscientiousness) characteristics were associated with FCR (p's < .05). Hierarchical linear regression analyses demonstrated that modifiable characteristics accounted for an additional 15% of the variance (p < .001) beyond that accounted for by non-modifiable characteristics (R2 = .45, p < .001), with perceived risk (B = .35) and health-related reassurance seeking (B = .22) emerging as significant predictors of FCR (p's < .05). IMPLICATIONS Results identify non-modifiable characteristics that may serve as risk factors for greater FCR and identify specific modifiable characteristics (i.e., perceived risk, health-related reassurance seeking) to be targeted by interventions to reduce FCR among cancer survivors.
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McHale CT, Cruickshank S, Torrens C, Armes J, Fenlon D, Banks E, Kelsey T, Humphris GM. A controlled pilot trial of a nurse-led intervention (Mini-AFTERc) to manage fear of cancer recurrence in patients affected by breast cancer. Pilot Feasibility Stud 2020; 6:60. [PMID: 32399254 PMCID: PMC7204012 DOI: 10.1186/s40814-020-00610-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is common in people affected by breast cancer. FCR is associated with increased health service and medication use, anxiety, depression and reduced quality of life. Existing interventions for FCR are time and resource intensive, making implementation in a National Health Service (NHS) setting challenging. To effectively manage FCR in current clinical practice, less intensive FCR interventions are required. Mini-AFTERc is a structured 30-min counselling intervention delivered over the telephone and is designed to normalise moderate FCR levels by targeting unhelpful behaviours and misconceptions about cancer recurrence.This multi-centre non-randomised controlled pilot trial will investigate the feasibility of delivering the Mini-AFTERc intervention, its acceptability and usefulness, in relation to specialist breast cancer nurses (SBCNs) and patients. This protocol describes the rationale, methods and analysis plan for this pilot trial of the Mini-AFTERc intervention in everyday practice. METHODS This study will run in four breast cancer centres in NHS Scotland, two intervention and two control centres. SBCNs at intervention centres will be trained to deliver the Mini-AFTERc intervention. Female patients who have completed primary breast cancer treatment in the previous 6 months will be screened for moderate FCR (FCR4 score: 10‑14). Participants at intervention centres will receive the Mini-AFTERc intervention within 2 weeks of recruitment. SBCNs will audio record the intervention telephone discussions with participants. Fidelity of intervention implementation will be assessed from audio recordings. All participants will complete three separate follow-up questionnaires assessing changes in FCR, anxiety, depression and quality of life over 3 months. Normalisation process theory (NPT) will form the framework for semi-structured interviews with 20% of patients and all SBCNs. Interviews will explore participants' experience of the study, acceptability and usefulness of the intervention and factors influencing implementation within clinical practice. The ADePT process will be adopted to systematically problem solve and refine the trial design. DISCUSSION Findings will provide evidence for the potential effectiveness, fidelity, acceptability and practicality of the Mini-AFTERc intervention, and will inform the design and development of a large randomised controlled trial (RCT). TRIAL REGISTRATION ClinicalTrials.gov: NCT0376382. Registered 4th December 2018, https://clinicaltrials.gov/ct2/show/NCT03763825.
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Affiliation(s)
- Calum T. McHale
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
| | | | - Claire Torrens
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, Surrey UK
| | - Deborah Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Tom Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Gerald M. Humphris
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
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29
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Lim E, Humphris G. The relationship between fears of cancer recurrence and patient age: A systematic review and meta-analysis. Cancer Rep (Hoboken) 2020; 3:e1235. [PMID: 32671982 DOI: 10.1002/cnr2.1235] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Fears of cancer recurrence (FCR) is one of the most prevalent concerns and a common unmet need reported by cancer patients. Patient age is a demographic variable that has been linked to FCR, among others. Although it is recognised by researchers that age and FCR may be negatively correlated, the strength of this correlation has yet to be established. AIM The aims of this study were to (a) conduct a meta-analysis to investigate the overall association of patient age in years with FCR across studies from 2009 to February 2019 and (b) scrutinise for patterns of these effect sizes across studies. METHODS AND RESULTS Peer-reviewed papers were gathered from the literature via online databases (PubMed, EMBASE, MEDLINE, and PsycINFO). Systematic review guidelines including a quality assessment were applied to the 31 selected studies (pooled participant N size = 19 777). The meta-analysis demonstrated a significant negative association between age and FCR (ES = -0.12; 95% CI, -0.17, -0.07). Meta-regression revealed the association of patient age and FCR significantly reduced over the last decade. A significant effect (β = -0.17, P = 0.005) of breast cancer versus other cancers on this age by FCR association was also identified. CONCLUSION The reliable and readily accessible personal information of age of patient can be utilised as a weak indicator of FCR level especially in the breast cancer field, where the majority of studies were drawn. The suggestion that age and FCR association may be attenuated in recent years requires confirmation.
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Affiliation(s)
- Edward Lim
- Medical School, University of St Andrews, St Andrews, UK
| | - Gerald Humphris
- Medical School, University of St Andrews, St Andrews, UK.,Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
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30
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Chin JH, Mansori S. Theory of Planned Behaviour and Health Belief Model: females’ intention on breast cancer screening. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1647927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jing Huey Chin
- Malaysia University of Science and Technology, 12, Jalan PJU 5/5, Kota Damansara, Petaling Jaya, Selangor 47810, Malaysia
| | - Shaheen Mansori
- Malaysia University of Science and Technology, 12, Jalan PJU 5/5, Kota Damansara, Petaling Jaya, Selangor 47810, Malaysia
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31
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Xu W, Wang J, Schoebi D. The role of daily couple communication in the relationship between illness representation and fear of cancer recurrence in breast cancer survivors and their spouses. Psychooncology 2019; 28:1301-1307. [PMID: 30946501 DOI: 10.1002/pon.5082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Previous studies have shown the significance of illness representation in maintaining of fear of cancer recurrence (FCR). The current study explored the association of illness representation and fear of cancer recurrence in daily life among breast cancer survivors and their spouses, considering the role of daily couple communication. METHODS A total of 54 couples in which the wives were breast cancer survivors were recruited to complete Brief Illness Perception Questionnaire and to report their communication information and fear of cancer recurrence in daily life. RESULTS At the between-person level, individuals with severer illness representation were likely to express more negative and less positive information in daily life, irrespective of whether they were patients or spouses. At the within-person level, perceptions of positive information acted as a mediator between disclosures of positive/negative information and changes in FCR. CONCLUSIONS There were interactions of the relationship of illness representation to FCR between breast cancer survivors and their spouses. Daily couple communication played critical roles in the association between illness representation and FCR.
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Affiliation(s)
- Wei Xu
- Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China.,School of Psychology, Nanjing Normal University, Nanjing, China
| | - Jianping Wang
- Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Dominik Schoebi
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
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32
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Perndorfer C, Soriano EC, Siegel SD, Laurenceau JP. Everyday protective buffering predicts intimacy and fear of cancer recurrence in couples coping with early-stage breast cancer. Psychooncology 2018; 28:317-323. [PMID: 30426612 DOI: 10.1002/pon.4942] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/29/2018] [Accepted: 11/07/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patient and spouse/partner mutual self-disclosure is central for maintaining intimacy and cognitive processing when transitioning to life after cancer. Protective buffering inhibits self-disclosure and is defined as efforts to protect one's partner from upset and burden by hiding or denying cancer-related concerns. Intimacy and fear of cancer recurrence (FCR) are important determinants of individual and couple adaptation following cancer. Links between protective buffering and intimacy have not been examined in the context of daily life, and links with FCR have not been studied. We hypothesized that protective buffering is associated with decreased intimacy and increased FCR at a daily, within-person level. METHODS Sixty-nine early-stage breast cancer (BC) survivors and their spouses completed electronic diaries for 21 consecutive days at the end of adjuvant treatment. Patients and spouses reported on daily protective buffering, intimacy, and FCR. Dyadic multilevel path modeling was used to estimate within-person effects. Patient and spouse protective buffering on one's own as well as one's partner's same-day intimacy and FCR were examined, controlling for previous levels of intimacy and FCR. RESULTS Protective buffering was associated with decreased intimacy and increased FCR for the individual reporting buffering that same day. Patient and spouse protective buffering was also linked to decreased intimacy for her/his partner that same day. Moreover, patient protective buffering predicted increased spouse FCR that same day. CONCLUSIONS Findings supported a daily, within-person link between buffering, intimacy, and FCR, suggesting open disclosure of cancer-related concerns may be a relevant target for interventions for adaptation to BC.
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Affiliation(s)
- Christine Perndorfer
- Department of Psychological & Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Emily C Soriano
- Department of Psychological & Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Scott D Siegel
- Psychosocial Oncology, Helen F. Graham Cancer Center & Research Institute, Newark, Delaware, USA
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