The relationship between breast cancer anxiety and mammography: experiential avoidance as a moderator

Anticipatory anxiety and participation in cancer screening. A systematic review

OBJECTIVES

To synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates.

METHODS

Searches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types.

RESULTS

A total of 74 articles (nparticipants  = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening.

CONCLUSION

Anticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests.

Effectiveness of cognitive-based interventions for improving body image of breast cancer patients: A systematic review and meta-analysis

Objective

Breast cancer patients often suffer from body image disturbance due to impairment of their body/appearance resulting from surgeries, other cancer treatments, and/or their complications. Cognitive-based interventions (CBIs) have recently been adopted for patients having breast cancer but their effects on improving body image are uncertain. This systematic review aimed to examine the effects of CBIs on body image in these patients, identify the optimal dose, characteristics, and/or component(s) of an effective intervention for these patients to inform future research and practice.

Methods

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, ten online databases and five search engines were used to search for eligible studies. Quality appraisal of included studies and meta-analysis results were conducted using Rob 2 and Grading of Recommendations Assessment, Development and Evaluation profiler Guideline Development Tool, respectively. RevMan and comprehensive meta-analysis software were used to perform data analysis and synthesis.

Results

Eleven eligible randomized controlled trials (RCTs) examining the effects of cognitive behavioral, acceptance and commitment, mindfulness, and self-compassion therapies were reviewed. Results of the meta-analysis showed that CBIs significantly reduced negative body image perception (Standardised Mean Difference, SMD ​= ​-0.49, 95% confidence interval [CI], [-0.87, -0.11], I ²  ​= ​81%, 6 RCTs, 758 participants), when compared to the control groups (mainly usual care) at immediately post-intervention; in which, CBT-based (SMD ​= ​-0.37, 95% CI (-0.60, -0.13), I ²  ​= ​0%) and group-based (SMD ​= ​-0.38, 95% CI (-0.62, -0.13), I ²  ​= ​0%) programs had more consistent and significant effects.

Conclusions

In view of the highly heterogeneous and limited RCTs identified, high-quality controlled trials of CBIs for improving the body image of patients having breast cancer are suggested.

Systematic review registration

PROSPERO, CRD42021259173.

Effect of music on anxiety and pain during ultrasound-guided core needle breast biopsy: a randomized controlled trial

PURPOSE

Although imaging-guided core needle breast biopsy is a minimally invasive diagnostic procedure, it is reported that patients may experience anxiety and pain. Interventions to reduce anxiety are important for high quality health services during imaging-guided core needle breast biopsy. The purpose of this study was to evaluate the effect of music intervention on anxiety and pain levels of patients undergoing ultrasound-guided core needle breast biopsy.

METHODS

In a prospective randomized controlled design, patients who were referred for ultrasound-guided core needle breast biopsy were invited to the study and randomized into the intervention group who received standard care with classical music intervention before and during the biopsy procedure, and the control group who received only standard care. Both groups received local anesthesia. The Spielberger State-Trait Anxiety Inventory and the Visual Analogue Scale (VAS) were used for measuring anxiety and pain levels after the procedure. One-way multivariate analysis of variance test was used to find the effect of music intervention on patient anxiety and pain.

RESULTS

There were 31 patients (48.4%) in the intervention group and 33 (51.6%) in the control group; the groups were similar in terms of sociodemographic characteristics and general (trait) anxiety levels. The patients in the music intervention group had significantly lower state anxiety score than the control group (p = 0.008) with a mean difference of 3.8 (95% CI, 1.0-6.6). The mean difference of VAS pain score was 6.0 (95% CI, 2.2-14.2), which not statistically significant between groups (p = 0.150). There was no significant correlation between the VAS and the state anxiety scale (r = 0.003, p = 0.980).

CONCLUSION

Music reduced anxiety, but not pain during ultrasound-guided core needle breast biopsy. These results have implications especially for low and middle-income countries where low-cost and easily implemented interventions are needed to address patient anxiety during breast biopsy procedures.

Emotion regulation and psychological distress in cancer survivors: A systematic review and meta-analysis

Emotion regulation may affect the levels of psychological distress of cancer survivors, but inconsistencies exist among studies regarding the direction of this effect. The systematic review and meta-analysis sought to estimate the associations between emotion regulation patterns (repression, suppression, experiential avoidance and cognitive reappraisal) and psychological distress among cancer survivors. Fifteen studies met inclusion criteria for systematic review, and seven studies focussing on suppression were included in the meta-analysis. The systematic review pointed to a marked variability in associations among the emotion regulation patterns and psychological distress. The three meta-regressions of the relationships between suppression and psychological distress found significant fixed- and random-effect sizes (except marginal significance of a random-effect model for partial correlation). Subgroup analysis showed no moderation effect of time since diagnosis or study quality, but a significant difference (fixed-effect model only, p = 0.005) was found between correlative studies and those controlling for confounders. The current study suggests that suppression is related to elevated levels of psychological distress among cancer survivors, although large inconsistencies exist among studies and publication bias could not be ruled out. Further studies with large samples and a consistent approach are thus required to evaluate the associations of emotion regulation patterns and psychological distress.

The role of emotions in cancer patients' decision-making

INTRODUCTION

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Psychoneuroendocrine evaluation of an acceptance and commitment based stress management training

BACKGROUND AND OBJECTIVES

Acceptance and Commitment Therapy (ACT), a behavioral therapy that targets psychological flexibility (PF), has been shown to be efficacious across a wide range of problems, including chronic work-related stress and perceived stress. ACT's effect on the multiple levels of the acute stress response (i.e., subjective and biological) is less well understood. The aim of the current study was to test whether ACT, by working toward PF, would reduce both the endocrine and subjective evaluations of participants' acute stress response.

METHODS

Participants (n = 35) were randomized to an ACT condition or waitlist (WL). Participants in the ACT condition received a two-day ACT workshop on how to flexibly deal with stress. All participants completed a standardized laboratory stress test.

RESULTS

The ACT and WL groups did not differ on main comparisons of the endocrine response (i.e., cortisol) or subjective evaluation. Baseline levels of PF moderated some outcomes. Avoidant participants had a stronger endocrine stress reaction if they received the ACT intervention.

LIMITATIONS

The control condition was a WL and not an active intervention comparison.

CONCLUSIONS

ACT is not useful in reducing the acute stress response and may even be iatrogenic, at least during tasks with little real-world impact for their personal values. Clinical or methodological significance of this article: This was one of the first studies to investigate the impact of an ACT intervention on biological parameters. The short-term intervention did not attenuate acute endocrine stress levels or subjective stress appraisals. Future studies should investigate which interventions and under which conditions attenuate acute and long-term stress responses.

Decision making for breast cancer prevention among women at elevated risk

Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.

What Do Patients Tweet About Their Mammography Experience?

RATIONALE AND OBJECTIVE

The purpose of this study was to evaluate themes related to patients' experience in undergoing mammography, as expressed on Twitter.

METHODS

A total of 464 tweets from July to December 2015 containing the hashtag #mammogram and relating to a patient's experience in undergoing mammography were reviewed.

RESULTS

Of the tweets, 45.5% occurred before the mammogram compared to 49.6% that occurred afterward (remainder of tweets indeterminate). However, in patients undergoing their first mammogram, 32.8% occurred before the examination, whereas in those undergoing follow-up mammogram, 53.0% occurred before the examination. Identified themes included breast compression (24.4%), advising other patients to undergo screening (23.9%), recognition of the health importance of the examination (18.8%), the act of waiting (10.1%), relief regarding results (9.7%), reflection that the examination was not that bad (9.1%), generalized apprehension regarding the examination (8.2%), interactions with staff (8.0%), the gown (5.0%), examination costs or access (3.4%), offering or reaching out for online support from other patients (3.2%), perception of screening as a sign of aging (2.4%), and the waiting room or waiting room amenities (1.3%). Of the tweets, 31.9% contained humor, of which 56.1% related to compression. Themes that were more common in patients undergoing their first, rather than follow-up, mammogram included breast compression (16.4% vs 9.1%, respectively) and that the test was not that bad (26.2% vs 7.6%, respectively).

CONCLUSION

Online social media provides a platform for women to share their experiences and reactions in undergoing mammography, including humor, positive reflections, and encouragement of others to undergo the examination. Social media thus warrants further evaluation as a potential tool to help foster greater adherence to screening guidelines.

The relevance of experiential avoidance in breast cancer distress: insights from a psychological group intervention

BACKGROUND

Research on the implication of experiential avoidance in the aetiology and maintenance of diverse forms of psychopathology has grown considerably over the last 10 years. However, the potential contribution of experiential avoidance to cancer-related distress has received limited attention. Accordingly, the objective of this study was to examine the association between experiential avoidance, symptoms of anxiety and depression, and quality of life (QoL) during the course of a psychological group intervention for women with breast cancer.

METHODS

Fifty-four women with breast cancer participated in a psychological group intervention designed to reduce distress and improve QoL. Participants completed measures of experiential avoidance, anxiety and depressive symptoms, and QoL upon the first and last sessions.

RESULTS

A path analysis revealed that, after controlling for baseline measures, smaller reductions in experiential avoidance during the course of the intervention predicted smaller reductions in anxiety and depressive symptoms. Also, experiential avoidance had a negative indirect effect on QoL via depressive symptoms.

CONCLUSIONS

Experiential avoidance may perpetuate the emotional problems commonly found in women with breast cancer and attenuate improvements associated with participation in psychological interventions. Implications for clinical practice in psycho-oncology are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

La relevancia de la flexibilidad psicológica en el contexto del cáncer: una revisión de la literatura

La flexibilidad psicológica ha sido relacionada con diversos indicadores positivos en individuos con problemas de salud mental y enfermedades crónicas, y ha sido identificada como un importante mecanismo de cambio psicoterapéutico. Sin embargo, la atención prestada a la flexibilidad psicológica en la psicooncología ha sido limitada, a pesar de su potencial relación con el distrés relacionado con el cáncer. El objetivo de la presente revisión descriptiva fue reunir los estudios que han examinado la asociación entre la flexibilidad psicológica y distintos indicadores de bienestar en pacientes con cáncer, o evaluado el impacto de intervenciones destinadas a incrementar el nivel de flexibilidad psicológica en pacientes con cáncer. A pesar del bajo número de estudios, los resultados demuestran de forma consistente que la flexibilidad psicológica está asociada a altos niveles de bienestar en pacientes con cáncer, incluso en presencia de deterioro físico. Para finalizar, se presentan algunas implicaciones para la práctica clínica en psico-oncología.