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Arch JJ, Slivjak ET, Finkelstein LB. A Novel Intervention to Reduce Fear of Progression and Trauma Symptoms in Advanced Cancer Using Written Exposure to Worst-Case Scenarios. J Palliat Med 2024; 27:1009-1017. [PMID: 38579139 DOI: 10.1089/jpm.2023.0658] [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] [Indexed: 04/07/2024] Open
Abstract
Background: Adults with advanced cancer experience profound future uncertainty, reflected in elevated fear of cancer progression (FoP) and cancer-related trauma symptoms. These symptoms are associated with physical symptom burden and poorer quality of life, and few interventions exist to manage them. Objective: To develop and pilot a written exposure-based coping intervention (EASE) focused on worst-case scenarios among adults with advanced cancer reporting elevated cancer-related trauma symptoms or FoP. Design: A single-arm intervention development and pilot trial. Participants: The trial enrolled 29 U.S. adults with stage III or stage IV solid tumor cancer (n = 24) or incurable or higher-risk blood cancer (n = 5) reporting elevated cancer-related trauma symptoms or FoP. Among those screened, 74% were eligible, with an eligible-to-enrolled rate of 85%. Design/Measurements: EASE was delivered over five 1:1 videoconferencing sessions. Feasibility and acceptability were evaluated via attendance, surveys, and exit interviews. Outcomes were assessed at five time points through 3-month (FU1, main assessment of interest) and 4.5-month (FU2) follow-up. Results: Participant and interventionist feedback was used to iteratively refine EASE. Among participants, 86% (25/29) completed all five sessions and FU1; surveys and exit interviews indicated high acceptability. Primary outcomes of cancer-related trauma symptoms and FoP improved significantly from pre to both follow-ups by predominantly large effect sizes. Secondary outcomes of anxiety, depression, hopelessness, fear of death/dying, and fatigue, and most process measures improved significantly by FU1 or FU2. Conclusions: EASE, a novel adaptation of written exposure therapy, is a promising approach to reducing FoP and cancer-related trauma symptoms among adults with advanced cancer that warrants further study.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth T Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Lauren B Finkelstein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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2
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Lopez-Veneros D, Cumella R, Kronish IM, Lazarov A, Birk JL. Home-based cognitive bias modification training for reducing maladaptive fear in patients with suspected acute coronary syndrome: a pilot randomized clinical trial. Pilot Feasibility Stud 2024; 10:7. [PMID: 38212853 PMCID: PMC10782680 DOI: 10.1186/s40814-024-01442-2] [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: 02/07/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Patients evaluated in an emergency department for suspected acute coronary syndromes (ACS; e.g., myocardial infarction) often experience a lingering fear of recurrence, which may adversely affect their mental health and adherence to recommended health behaviors. Cognitive bias modification training (CBMT) is an acceptable, easy-to-use intervention that reduces fear of recurrence in cancer patients, and reduces fear and anxiety in other populations, providing an alternative to psychotherapy or counseling-based approaches. Feasibility testing is needed to assess whether a cardiac-related version of CBMT is acceptable to patients with elevated threat perceptions related to their suspected ACS. METHODS We developed a tablet-based CBMT intervention tailored to reduce cardiac-related fear of recurrence. In this double-blinded feasibility trial, patients with elevated threat perceptions related to a recent suspected ACS were randomized either to a 4-week, 8-session, tablet-delivered intervention (CBMT) group or to a sham attention control group. Feasibility outcomes included the proportion of eligible patients who enrolled, drop-out rate, intervention compliance rate, acceptability/pleasantness and usability ratings, and task engagement (i.e., accuracy, response time). RESULTS Of 49 eligible patients with suspected ACS and elevated threat perceptions recruited from NewYork-Presbyterian Hospital, over half (53.1%) enrolled after receiving a description of study procedures. Of the 26 randomized patients (mean age 59.15 years, 50% women), 2 patients (7.7%) dropped out. Additionally, 4 (15.4%) enrolled patients were not able to complete the tablet tasks, either due to difficulties with the technology or an inability to process the visually presented linguistic information at a sufficient speed. Still, among patients who returned the tablets (19 returned/20 received; 95%), most completed all assigned tablet tasks (intervention or control; 10/19; 52.6%), reporting that the tablets were easy to use and that the tasks were pleasant to complete. CONCLUSION Current findings suggest that cardiac-related CBMT is a promising and generally acceptable intervention for suspected ACS patients with cardiac-related threat perceptions which are akin to fear of recurrence. Nevertheless, challenges related to tablet usage indicate that the intervention user-experience should be further refined to optimize usability. TRIAL REGISTRATION Registered at ClinicalTrials.gov on 2/25/2019; NCT03853213. Registered with the Open Science Framework on 11/20/2017; https://osf.io/k7g8c/ .
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Affiliation(s)
- David Lopez-Veneros
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Robin Cumella
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jeffrey L Birk
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
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3
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Heathcote LC, Webster SN, Loecher N, Spunt SL, Simon P, Pradhan P, Coutts-Bain D, Sharpe L, Tutelman PR, Simons LE. The bodily threat monitoring scale: Development and preliminary validation in adult and childhood cancer survivors. Psychooncology 2023; 32:1885-1894. [PMID: 37916988 PMCID: PMC11311963 DOI: 10.1002/pon.6236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Bodily threat monitoring is a core clinical feature of Fear of cancer recurrence (FCR) and is targeted in psycho-oncology treatments, yet no comprehensive self-report measure exists. The aim of this study was the theory-informed development and initial validation of the Bodily Threat Monitoring Scale (BTMS). METHODS Adult survivors of breast and gynaecological cancers (Study 1: N = 306, age = 37-81 years) and childhood cancer survivors (Study 2: N = 126, age = 10-25 years) completed the BTMS, designed to assess how individuals monitor for and interpret uncertain symptoms as indicating that something is wrong with their body. Participants completed measures to assess construct and criterion validity of the BTMS, and childhood cancer survivors (Study 2) completed the BTMS again 2 weeks later to assess test-retest reliability. RESULTS The 19-item BTMS demonstrated excellent internal consistency across adult and childhood cancer samples (α = 0.90-0.96). Factor analyses indicated two subscales capturing 1. Monitoring of bodily sensations and 2. Threatening interpretations of bodily sensations. Two-week stability estimates were acceptable. For construct validity, the BTMS correlated with body vigilance and anxiety sensitivity. The BTMS also demonstrated criterion validity, yielding significant associations with FCR, intolerance of uncertainty, help-seeking behaviours, and quality of life. The BTMS was associated with FCR while controlling for body vigilance and anxiety sensitivity, indicating a unique contribution of this theory-informed measure. CONCLUSIONS The BTMS shows evidence of sound psychometric properties and could be used to elucidate the role of bodily threat monitoring in the maintenance and management of FCR.
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Affiliation(s)
- Lauren C. Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King’s College London, United Kingdom
| | - Sarah N. Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, United States
| | - Nele Loecher
- Department of Psychology and Behavioral Sciences, St Jude’s Children’s Research Hospital, USA
| | - Sheri L. Spunt
- Department of Pediatric Oncology, Stanford University School of Medicine, United States
| | - Pamela Simon
- Department of Pediatric Oncology, Stanford University School of Medicine, United States
| | - Poorva Pradhan
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Daelin Coutts-Bain
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, United States
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4
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Wang X, Liu X, Gu Z, Li X, Shu Y. Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis. Support Care Cancer 2023; 31:633. [PMID: 37843658 PMCID: PMC10579144 DOI: 10.1007/s00520-023-08100-y] [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: 07/19/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Nutritional management of patients with esophageal cancer is a significant issue. This systematic review aimed to comprehensively synthesize qualitative research evidence on the experiences and requirements in nutritional management from the perspective of patients with esophageal cancer. METHODS A systematic review and meta-synthesis of qualitative studies were conducted. Studies written in Chinese or English were retrieved from nine databases, namely, PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, WanFang, VIP, and SinoMed, from inception to December 23, 2022. After screening the titles, abstracts, and full texts, 19 articles were finally included for quality assessment and meta-synthesis. RESULTS Three comprehensive themes were derived. These were dietary experiences (perception of symptoms and dietary behaviors), emotional experiences (negative and positive emotions), and social support (inappropriate social support and inadequate nutritional management). CONCLUSIONS The experiences and requirements of esophageal cancer patients in terms of nutritional management during treatment and rehabilitation were reviewed and factors influencing nutritional management were discussed. The findings suggested that medical institutions should expedite the development of comprehensive nutritional management systems, create conducive nutritional environmental facilities, and establish interdisciplinary teams to implement personalized comprehensive interventional models for the management of patient nutrition. These steps would maximize the effectiveness of nutritional therapy, promote early patient recovery, and bridge the gap between healthcare professionals and patients in the understanding of nutritional management.
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Affiliation(s)
- Xinwei Wang
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Xingyu Liu
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Zhie Gu
- Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
| | - Xiaojie Li
- School of Nursing and Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Yusheng Shu
- Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China.
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5
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Bruin J, van Rood YR, Peeters KCMJ, de Roos C, Tanious R, Portielje JEA, Gelderblom H, Hinnen SCH. Efficacy of eye movement desensitization and reprocessing therapy for fear of cancer recurrence among cancer survivors: a randomized single-case experimental design. Eur J Psychotraumatol 2023; 14:2203427. [PMID: 37144665 PMCID: PMC10165926 DOI: 10.1080/20008066.2023.2203427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Background: Fear of cancer recurrence (FCR) is one of the greatest problems with which cancer survivors have to deal. High levels of FCR are characterized by intrusive thoughts about cancer-related events and re-experiencing these events, avoidance of reminders of cancer, and hypervigilance, similar to post-traumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) therapy focuses on these images and memories. It is effective in reducing PTSD and may be effective in reducing high levels of FCR.Objective: The aim of the present study is to investigate the effectiveness of EMDR for severe FCR in breast and colorectal cancer survivors.Method: A multiple-baseline single-case experimental design (n = 8) was used. Daily repeated measurements for FCR were taken during the baseline phase and treatment phase, post-treatment, and at the 3 month follow-up. Participants answered the Cancer Worry Scale (CWS) and the Fear of Cancer Recurrence Inventory, Dutch version (FCRI-NL) five times, i.e. at the start and at the end of each phase (baseline, treatment, post-treatment, and follow-up). The study was prospectively registered at clinicaltrials.gov (NL8223).Results: Visual analysis and effect size calculation by Tau-U were executed for the daily questionnaire on FCR. The weighted average Tau-U score was .63 (p < .01) for baseline versus post-treatment, indicating large change, and .53 (p < .01) between baseline and follow-up, indicating moderate change. The scores on the CWS and FCRI-NL-SF decreased significantly from baseline to follow-up.Conclusion: The results seem promising for EMDR therapy as a potentially effective treatment for FCR. Further research is recommended.
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Affiliation(s)
- J Bruin
- Department of Psycho Oncology, Leiden University Medical Center (LUMC), RC Leiden, the Netherlands
| | - Y R van Rood
- Department of Psychiatry, Leiden University Medical Center (LUMC), ZA Leiden, the Netherlands
| | - K C M J Peeters
- Department of Surgery, Leiden University Medical Center (LUMC), ZA Leiden, the Netherlands
| | - C de Roos
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - R Tanious
- Methodology of Educational Sciences, Leuven, Belgium
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - S C H Hinnen
- Department of Psycho Oncology, Leiden University Medical Center (LUMC), RC Leiden, the Netherlands
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Risk factors for psychological morbidity and the protective role of coping self-efficacy in young women with breast cancer early in diagnosis: a national multicentre cohort study. Breast Cancer Res Treat 2022; 194:91-102. [DOI: 10.1007/s10549-022-06576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/17/2022] [Indexed: 11/02/2022]
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7
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Oerlemans S, Efficace F, Kieffer JM, Kyriakou C, Xochelli A, Levedahl K, Petranovic D, Borges FC, Bredart A, Shamieh O, Gziskevicius L, Lehmann J, Scholz CW, Caocci G, Molica S, Stamatopoulos K, Panteliadou AK, Papaioannou M, Alrjoob W, Baliakas P, Rosenquist R, Malak S, Miranda A, Cocks K, van de Poll-Franse L. International validation of the EORTC QLQ-CLL17 questionnaire for assessment of health-related quality of life for patients with chronic lymphocytic leukaemia. Br J Haematol 2022; 197:431-441. [PMID: 35255152 DOI: 10.1111/bjh.18072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
Abstract
Selecting the most appropriate chronic lymphocytic leukaemia (CLL) treatment is challenging. Patient-reported health-related quality of life (HRQoL) is therefore a critical aspect to consider. This international study by the European Organization for Research and Treatment of Cancer (EORTC) tested the psychometric properties of a newly developed measure for CLL patients: the EORTC QLQ-CLL17 to supplement the core questionnaire (EORTC QLQ-C30). Patients with CLL (n = 341) from 12 countries completed the QLQ-C30, QLQ-CLL17 and a debriefing questionnaire. Sociodemographic and clinical data were recorded from medical records. A high percentage (30%-66%) reported symptoms and/or worries (e.g. aches/pains in muscles, lack of energy and worry/fears about health). Confirmatory factor analysis showed an acceptable to good fit of the 17 items on the three scales (i.e. symptom burden, physical condition/fatigue and worries/fears about health and functioning). Completion took on average 8 min. Test-retest and convergent validity was demonstrated. The QLQ-CLL17 differentiated between patients with an Eastern Cooperative Oncology group (ECOG) performance of 0 versus 1-3 (p's < 0.01 and clinically relevant). The newly developed EORTC QLQ-CLL17 will increase sensitivity of HRQoL assessment in patients with CLL. Implementation of this questionnaire both in clinical research and practice will help to generate unique clinically relevant data to better inform CLL treatment decision-making.
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Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Centre, Rome, Italy
| | - Jacobien M Kieffer
- Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Kerstin Levedahl
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Duska Petranovic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Fabio Cardoso Borges
- Department of Epidemiology and National Cancer Registry (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Lisbon, Portugal
| | - Anne Bredart
- Institut Curie - Psycho-Oncology Unit, Paris University, Paris, France.,Psychopathology and Health Process Laboratory (LPPS) (UR 4057), PSL University, Paris, France
| | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Giovanni Caocci
- Hematology, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Waleed Alrjoob
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie - Hématologie, Saint-Cloud, France
| | - Ana Miranda
- Department of Epidemiology and National Cancer Registry (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Lisbon, Portugal
| | - Kim Cocks
- York Trials Unit, University of York, York & Adelphi Values, Cheshire, UK
| | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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8
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Sharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J. Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct. Health Psychol Rev 2022; 17:301-320. [PMID: 35132937 DOI: 10.1080/17437199.2022.2039744] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - M Michalowski
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - B Richmond
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - R E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - J Shaw
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006.,Psycho-Oncology Co-operative Group (POCOG), The University of Sydney, NSW 2006
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9
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Cincidda C, Pizzoli SFM, Pravettoni G. Remote Psychological Interventions for Fear of Cancer Recurrence: Scoping Review. JMIR Cancer 2022; 8:e29745. [PMID: 35014956 PMCID: PMC8790693 DOI: 10.2196/29745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with cancer and survivors may experience the fear of cancer recurrence (FCR), a preoccupation with the progression or recurrence of cancer. During the spread of COVID-19 in 2019, patients and survivors experienced increased levels of FCR. Hence, there is a greater need to identify effective evidence-based treatments to help people cope with FCR. Remotely delivered interventions might provide a valuable means to address FCR in patients with cancer. OBJECTIVE The aim of this study is to first discuss the available psychological interventions for FCR based on traditional cognitive behavioral therapies (CBTs) or contemporary CBTs, in particular, mindfulness and acceptance and commitment therapy, and then propose a possible approach based on the retrieved literature. METHODS We searched key electronic databases to identify studies that evaluated the effect of psychological interventions such as CBT on FCR among patients with cancer and survivors. RESULTS Current evidence suggests that face-to-face psychological interventions for FCR are feasible, acceptable, and efficacious for managing FCR. However, there are no specific data on the interventions that are most effective when delivered remotely. CONCLUSIONS CBT interventions can be efficacious in managing FCR, especially at posttreatment, regardless of whether it is delivered face to face, on the web, or using a blended approach. To date, no study has simultaneously compared the effectiveness of face-to-face, web-based, and blended interventions. On the basis of the retrieved evidence, we propose the hypothetical program of an intervention for FCR based on both traditional CBT and contemporary CBT, named Change Of Recurrence, which aims to improve the management of FCR in patients with cancer and survivors.
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Affiliation(s)
- Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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10
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Wei L, Yang X, Sun S, Yu Y, Xie J, Zhao J, Wang X, Zhu L, Yao J. Fear-focused Self-compassion Therapy for young breast cancer patients' fear of cancer recurrence: Study protocol of a randomized controlled trial. Front Psychiatry 2022; 13:941459. [PMID: 36213912 PMCID: PMC9537371 DOI: 10.3389/fpsyt.2022.941459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In China, there are a growing number of young women being diagnosed with breast cancer. Fear of Cancer Recurrence (FCR) has become one of the major psychological concerns reported by young breast cancer patients. Yet, there is a lack of psychological intervention tailored for reducing FCR for Chinese young breast cancer patients. In the current study, the Fear-focused Self-compassion Therapy is developed to help Chinese young breast cancer patients to manage FCR. The therapy was developed based on FCR development theories and self-compassion related therapy. The primary objective is to evaluate the short-term and long-term effectiveness of Fear-focused Self-compassion Therapy. The secondary objective is to examine the underlying mechanisms of therapy in reducing FCR in young breast cancer patients. METHODS The Fear-focused Self-compassion Therapy consists of 8-week face to face group sessions. This study will be a randomized controlled trial with 160 Chinese young female breast cancer patients with severe FCR. Participants will be randomized to the therapy group or a usual care control group (1:1). Measurements will be completed at baseline, immediately completing intervention, 3, 6, and 12 months later. Primary outcomes are FCR severity, and secondary outcomes include symptoms of depression and anxiety, satisfaction with therapy, and cost-effectiveness of the therapy. DISCUSSION If successful, this study will provide an effective psychological intervention to treat FCR for young breast cancer patients in China, and illuminate the underlying mechanisms of the Fear-focused Self-compassion Therapy in reducing FCR. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT04965428. Registered 23rd July 2021, https://clinicaltrials.gov/ct2/show/NCT04965428?cond=fear+of+cancer+recurrence&draw=2&rank=1.
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Affiliation(s)
- Liuyu Wei
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Xiaomin Yang
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Shasha Sun
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Yunlei Yu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Juan Xie
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Jiang Zhao
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Xiao Wang
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Lei Zhu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Juntao Yao
- Shaanxi Provincial Cancer Hospital, Xi'an, China
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11
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Sekse RJT, Nordgreen T, Flobak E, Lystrup M, Braathen E, Werner HMJ. Development of a Framework and the Content for a Psychoeducational Internet-Delivered Intervention for Women after Treatment for Gynecological Cancer. NURSING REPORTS 2021; 11:640-651. [PMID: 34968339 PMCID: PMC8608053 DOI: 10.3390/nursrep11030061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
The number of women treated for gynecological cancer is increasing. At the same time, the duration of in-patient hospitalization has decreased, and follow-up with its primary focus on early recognition of recurrence does not meet all patients' needs. One method of follow-up may be digital intervention. This study describes the development of a psychoeducational Internet-delivered intervention targeting women's psychosocial needs during the follow-up period after treatment for gynecological cancer. The project consisted of three phases following the UK Medical Research Council Framework guidelines for the development of complex interventions. Phase one identified the evidence in the field, phase two identified the relevant theoretical framework, and phase three included a two-year work process including focus group interviews and think aloud interviews with users. Through the steps of literature review, theoretical framework, and an iterative development process with users and other stakeholders, a six-week program was developed. The program included psychoeducational information, multimedia, exercises, and weekly telephone follow-up with a dedicated nurse. This Internet-delivered intervention can be a novel method for addressing the gap in the provision of follow-up for women after treatment for gynecological cancer.
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Affiliation(s)
- Ragnhild Johanne Tveit Sekse
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway
- Department of Clinical Science, University of Bergen, 5009 Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, 5009 Bergen, Norway
- Faculty of Health Studies, VID Specialized University, 5009 Bergen, Norway; (M.L.); (E.B.)
- Correspondence:
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, 5009 Bergen, Norway;
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, 5018 Bergen, Norway
| | - Eivind Flobak
- Department of Information Science and Media Studies, University of Bergen, 5007 Bergen, Norway;
| | - Morten Lystrup
- Faculty of Health Studies, VID Specialized University, 5009 Bergen, Norway; (M.L.); (E.B.)
| | - Espen Braathen
- Faculty of Health Studies, VID Specialized University, 5009 Bergen, Norway; (M.L.); (E.B.)
| | - Henrica M. J. Werner
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands;
- GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
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12
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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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13
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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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14
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Shaw J, Kamphuis H, Sharpe L, Lebel S, Smith AB, Hulbert-Williams N, Dhillon HM, Butow P. Setting an International Research Agenda for Fear of Cancer Recurrence: An Online Delphi Consensus Study. Front Psychol 2021; 12:596682. [PMID: 33692719 PMCID: PMC7938308 DOI: 10.3389/fpsyg.2021.596682] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritize research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research. Methods Members of the International Psycho-oncology Society (IPOS) Fear of Cancer Recurrence Special Interest Group (FORwards) were invited to participate in an online Delphi study. Research domains identified in Round 1 were presented and discussed at a focus group (Round 2) to consolidate the domains and items prior to presentation in further survey rounds (Round 3) aimed at gaining consensus on research priorities of international significance. Results Thirty four research items were identified in Round 1 and 33 of the items were consolidated into six overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2, and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further four research items were identified by panelists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panelists. Given the high levels of consensus and stability between rounds, no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panelists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions was the third highest priority identified. Conclusion The findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment are based on a flexible approach based on symptom severity and can be delivered within routine clinical care were identified as research areas to prioritize. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need.
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Affiliation(s)
- Joanne Shaw
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Helen Kamphuis
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- Faculty of Science, School of Psychology, The University of Sydney, NSW, Australia
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Hulbert-Williams
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, United Kingdom
| | - Haryana Mary Dhillon
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, The University of Sydney, NSW, Australia.,Faculty of Science, Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group, Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
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15
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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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16
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Reb AM, Borneman T, Economou D, Cangin MA, Cope DG, Ma H, Ruel N, Sharpe L, Patel SK, Cristea M, Koczywas M, Ferrell B. A nurse-led intervention for fear of cancer progression in advanced cancer: A pilot feasibility study. Eur J Oncol Nurs 2020; 49:101855. [PMID: 33120211 PMCID: PMC8493814 DOI: 10.1016/j.ejon.2020.101855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the feasibility, acceptability, and preliminary effects of a nurse-led intervention for managing fear of cancer progression in advanced cancer patients. METHODS A single group mixed methods study was conducted in patients with stage III or IV gynecologic or lung cancer (n = 31) with dysfunctional levels of fear of progression or distress. The intervention consisted of seven videoconferencing sessions with skills practice. Feasibility measures included enrollment rate, attendance, attrition, and home practice adherence. Acceptability was based on exit interview responses. Content analysis was used to analyze the qualitative data. Participants completed quantitative questionnaires assessing fear of progression and secondary outcomes at baseline, eight, and 12 weeks. Linear mixed model analysis was used to assess changes in outcome measures. RESULTS The average enrollment rate was seven participants/month over 4.5 months. Participants attended a mean of 5.3 of seven sessions. Attrition rate was 30%. The analysis showed improvements over time in fear of progression and exploratory outcomes. Participants reported feeling calmer and more focused. The skills practice helped to manage anxiety and fears. Themes included: Struggling with fears, Refocusing the fears, and Realizing/reaffirming what is important in life. The most beneficial components included the values clarification exercise, detached mindfulness and worry postponement practices. CONCLUSION The intervention was acceptable; most feasibility criteria were met. Preliminary data suggest that the intervention reduced fear of progression and improved secondary outcomes. The intervention required a significant time commitment by participants, which may have contributed to increased attrition. To decrease burden, we will shorten the intervention.
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Affiliation(s)
- Anne M Reb
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA.
| | - Tami Borneman
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
| | - Denice Economou
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
| | - Marissa A Cangin
- City of Hope, Department of Supportive Care Medicine, Duarte, CA, USA
| | - Diane G Cope
- Florida Cancer Specialists & Research Institute, Fort Myers, FL, USA
| | - Huiyan Ma
- City of Hope, Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, Duarte, CA, USA
| | - Nora Ruel
- City of Hope, Department of Computational and Quantitative Medicine, Duarte, CA, USA
| | - Louise Sharpe
- University of Sydney, School of Psychology, Sydney, Australia
| | - Sunita K Patel
- City of Hope, Divisions of Outcomes and Psychology, Departments of Population Sciences and Supportive Medicine, Duarte, CA, USA
| | - Mihaela Cristea
- City of Hope National Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA
| | - Marianna Koczywas
- City of Hope National Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA
| | - Betty Ferrell
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
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17
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Heathcote LC, Loecher N, Simon P, Spunt SL, Jordan A, Tutelman PR, Cunningham S, Schapira L, Simons LE. Symptom appraisal in uncertainty: a theory-driven thematic analysis with survivors of childhood cancer. Psychol Health 2020; 36:1182-1199. [DOI: 10.1080/08870446.2020.1836180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nele Loecher
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela Simon
- Department of Pediatric Hematology-Oncology, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA
| | - Sheri L. Spunt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
| | - Perri R. Tutelman
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lidia Schapira
- Department of Medical Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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18
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Bergerot CD, Battle D, Philip EJ, Bergerot PG, Msaouel P, Smith A'B, Bamgboje AE, Shuch B, Derweesh IH, Jonasch E, Stern AP, Pal SK, Staehler M. Fear of Cancer Recurrence in Patients With Localized Renal Cell Carcinoma. JCO Oncol Pract 2020; 16:e1264-e1271. [PMID: 32955409 DOI: 10.1200/op.20.00105] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer commonly report distress and fear of cancer recurrence (FCR) impacting quality of life and clinical outcomes. This study aims to test the association between emotional well-being and clinical characteristics of survivors with localized renal cell carcinoma (RCC). MATERIALS AND METHODS Survivors with localized RCC were invited to participate in this study through social media by the Kidney Cancer Research Alliance. Participants self-reported clinical characteristics, distress (Distress Thermometer), and FCR (Fear of Cancer Recurrence-7). Ordinal regression was used to test the association between emotional well-being and patient characteristics. RESULTS A total of 412 survivors were included in this analysis. Participants were mostly female (79.4%) and well educated (58.3%), with a median age of 54 years (range, 30-80 years) and median time since diagnosis of 17.5 months. More than one half were diagnosed with stage I disease (56.1%). Most patients (62.3%) had a clear understanding of their diagnosis. A high prevalence of moderate to severe distress (67.0%) and FCR (54.9%) was reported across all survivors of RCC. Higher FCR was associated with female gender, younger age, and lack of understanding of their diagnosis (P = .001), whereas more recent diagnosis was associated with higher distress levels (P = .01). CONCLUSION Our findings suggest that FCR is a common problem that is persistent after therapy and that certain individuals, including female and younger patients, may be at particular risk of experiencing clinically relevant FCR.
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Affiliation(s)
- Cristiane Decat Bergerot
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Dena Battle
- Kidney Cancer Research Alliance, Alexandria, VA
| | - Errol J Philip
- University of California, San Francisco, San Francisco, CA
| | - Paulo Gustavo Bergerot
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Pavlos Msaouel
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Adeola Esther Bamgboje
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Brian Shuch
- Ronald Reagan UCLA Medical Center, University of California Los Angeles Medical Center, Los Angeles, CA
| | | | - Eric Jonasch
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sumanta K Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
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19
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Reb AM, Borneman T, Economou D, Cangin MA, Patel SK, Sharpe L. Fear of Cancer Progression: Findings From Case Studies and a Nurse-Led Intervention. Clin J Oncol Nurs 2020; 24:400-408. [PMID: 32678373 PMCID: PMC8366305 DOI: 10.1188/20.cjon.400-408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fear of cancer recurrence or progression (FOP) is a significant concern for cancer survivors. With the advent of new targeted therapies and immunotherapy, many patients with advanced cancer are living longer while dealing with uncertainty and fears related to cancer progression. Although some level of FOP is normal and adaptive, high levels adversely affect quality of life and healthcare costs. OBJECTIVES This article describes a nurse-led intervention for managing FOP in two patients with advanced gynecologic cancer. The intervention teaches skills for managing worry, challenging unhelpful beliefs, and modifying unhelpful coping behaviors. METHODS Preliminary findings from the two case studies are presented, including a comparison of post-treatment FOP scores to baseline scores. FINDINGS The participants reported feeling more focused, less overwhelmed, and more in control of their worries. Both participants achieved statistically reliable improvements in FOP scores.
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20
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Soriano EC, Valera R, Pasipanodya EC, Otto AK, Siegel SD, Laurenceau JP. Checking Behavior, Fear of Recurrence, and Daily Triggers in Breast Cancer Survivors. Ann Behav Med 2020; 53:244-254. [PMID: 29771272 DOI: 10.1093/abm/kay033] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a top ongoing concern of breast cancer (BC) survivors and thus the focus of recent intervention development. The Self-Regulation Model of FCR (Lee-Jones C, Humphris G, Dixon R, Hatcher MB. Fear of cancer recurrence-a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology. 1997;6:95-105.) states that everyday cancer-related events trigger FCR, which, in turn, leads to specific behavioral responses, including checking the body for signs or symptoms of cancer. Links between triggering events, FCR, and checking behavior have not yet been studied in the context of daily life or at the within-person level. PURPOSE The goal of this study was to examine whether FCR has a within-person link with daily checking behavior and whether FCR mediates the link between triggering events and checking behavior. METHODS Seventy-two early-stage BC survivors completed daily diaries over a 21-day period approximately 5 months after BC surgery. FCR, checking behavior, and triggering events were assessed each evening. RESULTS Multilevel modeling results indicated that FCR predicted greater odds of same-day, but not next-day, checking behavior. We found that daily FCR significantly mediated the same-day effect of triggering events on checking behavior. These average within-person effects varied substantially between patients and were not explained by momentary negative affect. CONCLUSIONS Findings support the within-person relationship between triggering events, FCR, and checking behavior posited by guiding theory, and can inform FCR intervention development.
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Affiliation(s)
- Emily C Soriano
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Rosmeiry Valera
- Department of Psychology, Bloomfield College, Bloomfield, NJ, USA
| | | | - Amy K Otto
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Scott D Siegel
- Helen F. Graham Cancer Center & Research Institute, Newark, DE, USA
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21
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Rudy L, Maheu C, Körner A, Lebel S, Gélinas C. The FCR‐1: Initial validation of a single‐item measure of fear of cancer recurrence. Psychooncology 2020; 29:788-795. [DOI: 10.1002/pon.5350] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Lauren Rudy
- Department of Educational and Counselling PsychologyMcGill University Montreal Quebec Canada
| | - Christine Maheu
- Ingram School of NursingMcGill University Montreal Quebec Canada
| | - Annett Körner
- Department of Educational and Counselling PsychologyMcGill University Montreal Quebec Canada
| | - Sophie Lebel
- School of PsychologyUniversity of Ottawa Ottawa Ontario
| | - Céline Gélinas
- Ingram School of NursingMcGill University Montreal Quebec Canada
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22
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Luigjes-Huizer YL, van der Lee ML, de Wit NJ, Helsper CW. Study protocol of the BLANKET trial: a cluster randomised controlled trial on the (cost-) effectiveness of a primary care intervention for fear of cancer recurrence in cancer survivors. BMJ Open 2019; 9:e032616. [PMID: 31796488 PMCID: PMC7003381 DOI: 10.1136/bmjopen-2019-032616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Many successfully treated patients with cancer suffer from fear of cancer recurrence (FCR), affecting their quality of life and their physical, emotional, cognitive and social functioning. Effective psychological interventions for FCR exist but are not widely available, as they are typically offered by specialised psycho-oncology professionals and institutes. Concurrently, the role of primary care in cancer and survivorship care is increasing. Therefore, there could be a role for general practitioners (GPs) and mental health workers (MHWs) working in primary care in supporting patients with FCR. In the current study, the effectiveness of a primary care delivered FCR intervention will be evaluated. METHODS AND ANALYSIS A two-armed cluster randomised trial will be conducted. The primary outcome will be FCR severity; secondary outcomes will be FCR-related distress, healthcare uptake and healthcare costs. Primary care practices in the Netherlands will be invited to participate in the study. Participating practices will be stratified by size and socioeconomic status and randomised. In the control arm, practices will provide care as usual. In the intervention arm, practices will offer the cognitive-behavioural FCR intervention that is being studied, which consists of an intake with the GP and five sessions with the MHW. Patients who have finished successful curative treatment for cancer between 3 months and 10 years ago will be invited to participate in the study by invitation letter from their GPs. Participating patients will fill out questionnaires at baseline, after 3 months and after 12 months. Data on healthcare use will be collected from their electronic health records. Qualitative interviews are held at T1 with patients and practitioners in the intervention group. ETHICS AND DISSEMINATION The Medical Research Ethics Committee (METC) Utrecht has reviewed the study in accordance with the Dutch Medical Research Involving Human Subjects Act (WMO) and other applicable Dutch and European regulations. Based on the requirements of the WMO, the METC Utrecht has issued an approval of the above-mentioned study. Any protocol amendments will be communicated to all relevant parties. Written consent is obtained from study participants. Results will be dispersed through peer-reviewed publications and scientific presentations. TRIAL REGISTRATION NUMBER NL7573 in the Netherlands Trial Register on 25-02-2019.
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Affiliation(s)
- Yvonne L Luigjes-Huizer
- Scientific Research, Helen Dowling Institute, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Mutsaers B, Butow P, Dinkel A, Humphris G, Maheu C, Ozakinci G, Prins J, Sharpe L, Smith AB, Thewes B, Lebel S. Identifying the key characteristics of clinical fear of cancer recurrence: An international Delphi study. Psychooncology 2019; 29:430-436. [PMID: 31713279 DOI: 10.1002/pon.5283] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 11/03/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Without an agreed-upon set of characteristics that differentiate clinical from nonclinical levels of fear of cancer recurrence (FCR), it is difficult to ensure that FCR severity is appropriately measured, and that those in need of intervention are identified. The objective of this study was to establish expert consensus on the defining features of clinical FCR. METHOD A three-round Delphi was used to reach consensus on the defining features of clinical FCR. Sixty-five experts in FCR (researchers, psychologists, physicians, nurses, and allied health professionals) were recruited to suggest and rate potential features of clinical FCR. Participants who indicated they could communicate diagnoses within their clinical role were also asked to consider the application of established DSM-5 and proposed ICD-11 diagnostic criteria (Health Anxiety, Illness Anxiety Disorder, Somatic Symptom Disorder) to clinical FCR. RESULTS Participants' ratings suggested that the following four features are key characteristics of clinical FCR: (a) high levels of preoccupation; (b) high levels of worry; (c) that are persistent; and (d) hypervigilance to bodily symptoms. Of participants whose professional role allowed them to diagnose mental disorders, 84% indicated it would be helpful to diagnose clinical FCR, but the use of established diagnostic criteria related to health anxiety or somatic-related disorders to clinical FCR was not supported. This suggests that participants consider clinical FCR as a presentation that is specific to cancer survivors. CONCLUSION Clinical FCR was conceptualized as a multidimensional construct. Further research is needed to empirically validate the proposed defining features.
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Affiliation(s)
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gerald Humphris
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Belinda Thewes
- School of Psychology, The University of Sydney, Sydney, Australia
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24
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van Helmondt SJ, van der Lee ML, van Woezik RAM, Lodder P, de Vries J. No effect of CBT-based online self-help training to reduce fear of cancer recurrence: First results of the CAREST multicenter randomized controlled trial. Psychooncology 2019; 29:86-97. [PMID: 31595627 DOI: 10.1002/pon.5233] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common consequence of surviving cancer; therefore, easily accessible self-help training could help many cancer survivors deal with FCR at low costs. The CAncer REcurrence Self-help Training (CAREST) trial evaluates the effectiveness of an online-tailored self-help training on the basis of evidence-based cognitive behavioral therapy principles in breast cancer survivors. Also, possible predictors for benefitting from the online self-help training were examined. METHODS This multicenter randomized controlled trial included 262 female breast cancer survivors, randomly assigned to either online self-help training (n = 130) or care as usual (CAU; n = 132). Participants completed questionnaires at baseline (T0), 3 months (T1; after intervention), and 9 months (T2). The primary outcome was FCR (Fear of Cancer Recurrence Inventory Severity subscale). Both effectiveness and predictors were analyzed with latent growth curve modeling (LGCM) according to the intention-to-treat principle. RESULTS LGCM showed no differences between the average latent slope in both groups (χ2 1 = .23, P = .63), suggesting that the treatments did not differ in their change in FCR over time. Moreover, no differences were found in the effects of the predictors on the latent slope in both groups (χ2 1 = .12, P = .73), suggesting that no significant predictors were found for the effect of the intervention on FCR. CONCLUSION There was no effect of the CBT-based online self-help training "Less fear after cancer" in the current study. Therefore, we recommend adding professional support to online interventions for FCR.
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Affiliation(s)
| | | | | | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, ETZ (Elisabeth TweeSteden Hospital), Tilburg, The Netherlands
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25
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Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, Maheu C, Ozakinci G, Prins J, Sharpe L, Smith AB, Thewes B, Simard S, Zachariae R. Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis. J Clin Oncol 2019; 37:2899-2915. [PMID: 31532725 PMCID: PMC6823887 DOI: 10.1200/jco.19.00572] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention (g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up (g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs (g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.
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Affiliation(s)
- Nina M Tauber
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada
| | | | - Andreas Dinkel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Technical University of Munich, Munich, Germany
| | - Jacqueline Galica
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Gerry Humphris
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Sophie Lebel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Maheu
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,McGill University, Montréal, Québec, Canada
| | - Gozde Ozakinci
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Judith Prins
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Louise Sharpe
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Allan Ben Smith
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, NSW, Australia
| | - Belinda Thewes
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Sébastien Simard
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Robert Zachariae
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Aarhus University Hospital, Aarhus, Denmark
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26
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Ng DWL, Kwong A, Suen D, Chan M, Or A, Ng SS, Foo CC, Fielding BF, Lam WW. Fear of cancer recurrence among Chinese cancer survivors: Prevalence and associations with metacognition and neuroticism. Psychooncology 2019; 28:1243-1251. [DOI: 10.1002/pon.5073] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Danielle Wing Lam Ng
- Centre for Psycho‐Oncological Research and Training, Division of Behavioural Sciences, School of Public HealthThe University of Hong Kong Hong Kong
| | - Ava Kwong
- Department of SurgeryThe University of Hong Kong Hong Kong
| | - Dacita Suen
- Department of SurgeryThe University of Hong Kong Hong Kong
| | - Miranda Chan
- Department of SurgeryKwong Wah Hospital, Hong Kong Hospital Authority Hong Kong
| | - Amy Or
- Department of SurgeryKwong Wah Hospital, Hong Kong Hospital Authority Hong Kong
| | - Siuman Simon Ng
- Department of SurgeryThe Chinese University of Hong Kong Hong Kong
| | - Chi Chung Foo
- Department of SurgeryThe University of Hong Kong Hong Kong
| | | | - Wendy W.T. Lam
- Centre for Psycho‐Oncological Research and Training, Division of Behavioural Sciences, School of Public HealthThe University of Hong Kong Hong Kong
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27
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The fear of cancer recurrence literature continues to move forward: a review article. Curr Opin Support Palliat Care 2019; 12:40-45. [PMID: 29251693 DOI: 10.1097/spc.0000000000000323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The volume of literature addressing fear of cancer recurrence (FCR) is rapidly increasing. A summary of key developments in the research and treatment of FCR was published by Sharpe et al. in 2017, and the current review focuses on works published thereafter. RECENT FINDINGS A comprehensive literature review was conducted to provide an up-to-date summary of peer-reviewed publications focusing on FCR. The search consisted of the most recent FCR reports published between 2016 and 2017, which can be broadly categorized as: methods of assessment; associations with FCR; FCR and caregivers; and FCR interventions. SUMMARY FCR assessments continue to undergo revisions, which may have positive implications for clinicians and researchers seeking shorter measures to assess the FCR of their patients and study participants. However, research is needed to determine if a shorter FCR measure could be created using items that measure the construct alone, yet still retaining optimal sensitivity and specificity, or also with its determinants and consequences. Doing so would result in either unidimensional or multidimensional measure of FCR. Notwithstanding these matters in FCR assessment, the state of the literature continues to advance our understanding about characteristics of survivors with highest FCR, which is useful to identify patients in need of FCR interventions. These empirical results are useful to further investigate the theoretical distinctions of FCR.
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28
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Almeida SN, Elliott R, Silva ER, Sales CMD. Fear of cancer recurrence: A qualitative systematic review and meta-synthesis of patients' experiences. Clin Psychol Rev 2018; 68:13-24. [PMID: 30617013 DOI: 10.1016/j.cpr.2018.12.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
Abstract
Fear of cancer recurrence (FCR) is a significant issue for most cancer survivors, with nearly half of cancer survivors reporting it at moderate to high levels of intensity. We aimed to further explore the experience of having FCR from the point of view of patients by systematically reviewing qualitative studies. Following PRISMA guidelines, 87 qualitative studies were selected. All participants' quotes about FRC were extracted, then analysed using a conceptual framework based on the emotion-focused therapy theory of emotion schemes, which consist of experienced/implicit emotions, along with perceptual-situational, bodily-expressive, symbolic-conceptual and motivational-behavioral elements. According to participant descriptions, FCR was found to be an intense, difficult, multi-dimensional experience. Considering the diversity of experiences identified, it is useful to look at FCR as an emotional experience that extends along a continuum of adaptive and maladaptive responses. For some participants, FCR was described in trauma-like terms, including forms of re-experiencing, avoidance, negative thoughts and feelings, and arousal or reactivity related to cancer-related triggers or memories. Vivid metaphors expressing vulnerability and conflict also reflect the strong impact of FCR in patients' lives and can help therapists empathize with their clients.
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Affiliation(s)
- Susana N Almeida
- Portuguese Institute of Oncology of Porto FG, EPE, ISMAI - University Institute of Maia, Maia, Portugal.
| | - Robert Elliott
- Counselling Unit, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Eunice R Silva
- Portuguese Institute of Oncology of Porto FG, EPE, Porto, Portugal
| | - Célia M D Sales
- Centre for Psychology at the University of Porto, Porto, Portugal
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29
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Sharpe L, Curran L, Butow P, Thewes B. Fear of cancer recurrence and death anxiety. Psychooncology 2018; 27:2559-2565. [PMID: 29843188 DOI: 10.1002/pon.4783] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/05/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022]
Abstract
In 2013, 3 systematic reviews of fear of cancer recurrence (FCR) and its predictors were published. All 3 concurred that FCR is a highly prevalent problem and amongst the largest unmet needs of cancer survivors, even 5 or more years after treatment. However, between them they identified only 1 study that had investigated the relationship between death anxiety and FCR. This is surprising because it is well acknowledged that a diagnosis of cancer, a potentially life-threatening illness, is associated with a number of existential issues that give rise to psychological sequelae such as intrusive thoughts about death and other post-traumatic symptoms. Outside the cancer literature, there has recently been a call to identify death anxiety as a transdiagnostic construct that underlies many anxiety disorders even in healthy people. And yet, the relevance of death anxiety to FCR has not been studied. We explore the barriers to the study of death anxiety and FCR and the reasons that a potential link between the 2 might have important theoretical and clinical implications. We conclude that establishing the relationship between death anxiety, FCR and other existential issues is essential in order to fully understand FCR, particularly in the context of advanced disease. We further conclude that whether death anxiety underlies FCR has important clinical implications which would potentially allow us to optimise currently available evidence-based treatments.
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Affiliation(s)
- L Sharpe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - L Curran
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,The Kinghorn Cancer Centre, St Vincent's Health Care Network, Sydney, New South Wales, Australia
| | - P Butow
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,PoCoG and CeMPED, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,SoURCe, Institute of Surgery, Sydney, New South Wales, Australia
| | - B Thewes
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Radboud Institute of Health Science, Department Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
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30
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Custers JAE, Kwakkenbos L, van de Wal M, Prins JB, Thewes B. Re-validation and screening capacity of the 6-item version of the Cancer Worry Scale. Psychooncology 2018; 27:2609-2615. [PMID: 29843189 DOI: 10.1002/pon.4782] [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: 01/29/2018] [Revised: 04/27/2018] [Accepted: 05/22/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is one of the major existential unmet needs of cancer survivors. Due to growing availability of evidenced-based interventions for high FCR, valid and reliable brief measures of FCR are needed. This study aimed to validate the 6-item Cancer Worry Scale (CWS) and to establish a cut-off score for high FCR. METHODS Participants in this study were 1033 cancer survivors and patients recruited as part of 5 existing studies on FCR involving patients and survivors with gastro-intestinal stromal tumors, colorectal, breast, and prostate cancer. De-identified data of the CWS, Fear of Cancer Recurrence Inventory (FCRI), Impact of Event Scale, Hospital Anxiety and Depression Scale, and EORTC-QLQ-C30 were amalgamated for the analyses. Confirmatory factor analysis of the CWS was performed. Sensitivity and specificity were tested with the FCRI as gold standard. RESULTS Results confirmed that the 6-item version of the CWS maintained good construct validity, convergent and divergent validity, and high internal consistency (α 0.90). The optimal cut-off for the 6-item CWS was 9 versus 10 using the 12 vs 13 FCRI-SF score (sensitivity 82%, specificity 83%) and the 15 vs 16 FCRI-SF score (sensitivity 88%, specificity 73%). Using the highest FCRI-SF cut-off (21 vs 22), the optimal CWS cut-off was 11 vs 12 (sensitivity 88%, specificity 81%). CONCLUSIONS The present results provide researchers and clinicians with a brief valid and reliable measure of FCR which is suitable for measuring FCR in cancer patients and survivors.
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Affiliation(s)
- José A E Custers
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, The Netherlands.,Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Marieke van de Wal
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Belinda Thewes
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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31
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Smith A'B, Sharpe L, Thewes B, Turner J, Gilchrist J, Fardell JE, Girgis A, Tesson S, Descallar J, Bell ML, Beith J, Butow P. Medical, demographic and psychological correlates of fear of cancer recurrence (FCR) morbidity in breast, colorectal and melanoma cancer survivors with probable clinically significant FCR seeking psychological treatment through the ConquerFear study. Support Care Cancer 2018; 26:4207-4216. [PMID: 29882025 DOI: 10.1007/s00520-018-4294-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Despite the prevalence of fear of cancer recurrence (FCR), understanding of factors underlying clinically significant FCR is limited. This study examined factors associated with greater FCR morbidity, according to a cognitive processing model, in cancer survivors who screened positively for clinically significant FCR seeking psychological treatment through the ConquerFear trial. METHODS Participants had completed treatment for breast, colorectal or melanoma cancer 2 months to 5 years previously and scored ≥ 13/36 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Hierarchical regression analyses examined associations between demographic, medical and psychological variables, namely metacognitions (MCQ-30), post-traumatic stress symptoms (IES-R) and FCR (FCRI total score). RESULTS Two hundred and ten (95%) of the 222 cancer survivors who consented to the ConquerFear trial completed the baseline questionnaire. Participants were predominantly (89%) breast cancer survivors. The final regression model accounted for 68% of the variance in FCR (demographic and medical variables 13%, metacognitions 26%, post-traumatic stress symptoms 28%). Negative metacognitive beliefs about worry and intrusive post-traumatic stress symptoms were significant individual correlates of FCR, but negative beliefs about worry did not significantly moderate the impact of intrusions on FCR morbidity. CONCLUSIONS Results provide partial support for the cognitive processing model of FCR. Psychological factors were found to play an important role in FCR morbidity after controlling for demographic/medical factors. More intrusive thoughts and negative beliefs about worry were strong independent predictors of FCR morbidity. Cancer survivors with clinically significant FCR may benefit from assessment for intrusive thoughts and metacognitions and delivery of trauma- and/or metacognitive-based interventions accordingly.
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Affiliation(s)
- Allan 'Ben' Smith
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia. .,Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | - Belinda Thewes
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jane Turner
- Mental Health Centre, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jemma Gilchrist
- Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Joanna E Fardell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Stephanie Tesson
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Melanie L Bell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia.,Epidemiology & Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Jane Beith
- Department of Medical Oncology, Chris O'Brien Lifehouse, Missenden Rd, Camperdown, NSW, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
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32
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Krok-Schoen JL, Naughton MJ, Bernardo BM, Young GS, Paskett ED. Fear of recurrence among older breast, ovarian, endometrial, and colorectal cancer survivors: Findings from the WHI LILAC study. Psychooncology 2018; 27:1810-1815. [PMID: 29644766 DOI: 10.1002/pon.4731] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine the prevalence of and factors associated with fear of recurrence (FCR) following treatment for breast, ovarian, endometrial, and colorectal cancer among older women. METHODS Participants were enrolled in the Women's Health Initiative Life and Longevity After Cancer study. Descriptive statistics and multivariate logistic regression models were used to assess the association of demographic, clinical, and quality of life variables with survivors' FCR, dichotomized as <14 (low) or ≥14 (high) using the Cancer Worry Scale. RESULTS Out of the 4259 participants, 3124 (73.3%) were diagnosed with breast cancer, 559 (13.1%) with colorectal cancer, 493 (11.6%) with endometrial cancer, and 83 (2%) with ovarian cancer. There were no significant differences in FCR by cancer type (P = .75), with a mean scale score of 10.8 ± 2.87 for all participants combined. Approximately 16% (n = 679) were in the high FCR group. Multivariable analyses indicated that being younger at diagnosis, reporting a symptom score of ≥8, receipt of chemotherapy, and lower self-rated health were significantly associated with high FCR. Women who were widowed or never married were less likely to report high FCR. CONCLUSIONS Fear of recurrence was experienced by a small but important proportion of older, long-term cancer survivors and is associated with multiple demographic and clinical variables. These results will better inform researchers and clinicians regarding the individuals who are at risk of FCR.
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Affiliation(s)
- Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Michelle J Naughton
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Gregory S Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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