Fear of cancer recurrence and psychological well-being in women with breast cancer: The role of causal cancer attributions and optimism

What do cancer survivors believe caused their cancer? A secondary analysis of cross-sectional survey data

PURPOSE

Given that risk reduction and healthy lifestyles can prevent 4 in 10 cancers, it is important to understand what survivors believe caused their cancer to inform educational initiatives.

METHODS

In this secondary analysis, we analyzed cancer survivor responses on the Causes Subscale of the Revised Illness Perception Questionnaire, which lists 18 possible causes of illness and a free text question. We used descriptive statistics to determine cancer survivors' agreement with the listed causes and conducted separate partial proportional odds models for the top three causes to examine their associations with sociodemographic and clinical characteristics. Content analysis was used to examine free text responses.

RESULTS

Of the 1,001 participants, most identified as Caucasian (n = 764, 77%), female (n = 845, 85%), and were diagnosed with breast cancer (n = 656, 66%). The most commonly believed causes of cancer were: stress or worry (n = 498, 51%), pollution in the environment (n = 471, 48%), and chance or bad luck (n = 412, 42%). The associations of sociodemographic and clinical variables varied across the models. Free text responses indicated that hereditary and genetic causes (n = 223, 22.3%) followed by trauma and stress (n = 218, 21.8%) and bad luck or chance (n = 79, 7.9%) were the most important causes of cancer.

CONCLUSIONS

Study results illuminate cancer survivors' beliefs about varying causes of their cancer diagnosis and identify characteristics of survivors who are more likely to believe certain factors caused their cancer. Results can be used to plan cancer education and risk-reduction campaigns and highlight for whom such initiatives would be most suitable.

Familial aspects of fear of cancer recurrence: current insights and knowledge gaps

Fear of cancer recurrence is fear or worry about cancer recurrence or progress. Fear of recurrence can impact patients' quality of life and wellbeing. Cancer survivors' families support them practically and emotionally, making them a vital supplement for official healthcare. Given the well-established important role of the family in dealing with cancer, we compiled the studies that examined the relationship between family-related factors and fear of cancer recurrence (FCR) among cancer survivors (CSs). One of the foremost studies in this field is the FCR model presented by Mellon and colleagues, which included concurrent family stressors and family-caregiver FCR as factors linked to survivor FCR. Our goal was to prepare the ground for a family-based model of FCR that is more comprehensive than the one proposed by Mellon et al. sixteen years ago. The studies included those with samples of adult cancer survivors from different regions of the world. Most of the studies we reviewed are cross-sectional studies. We categorized family-related factors associated with survivor FCR into partner-related factors, including subgroups of disclosure to partner, cognitions of partner, and partner's sources of support; parenthood-related factors, including having children and parenting stress; family-related factors, including living situation, family history of cancer, family's perception of the illness, and family characteristics; and social interactions including social support, disclosure, social constraints, and attitudes of others. This review sheds light on how significant others of cancer survivors can affect and be affected by cancer-related concerns of survivors and emphasizes the necessity of further investigation of family-related factors associated with FCR.

Fear of cancer recurrence as a pathway from fatigue to psychological distress in mothers who are breast cancer survivors

Fatigue is prevalent and pervasive among breast cancer survivors. Mothers are particularly susceptible to fatigue due to the ongoing demands of their caring role. While fatigue has been associated with psychological distress in prior research, the pathway by which fatigue translates into psychological distress is unclear. Given the theoretical and empirical links between fatigue, fear of cancer recurrence (FCR) and psychological distress, the role of FCR in mediating the relationship between fatigue and psychological distress in mothers who are breast cancer survivors was investigated. Ninety-two mothers who were breast cancer survivors completed the Depression, Anxiety and Stress Scale, PROMIS-Cancer Fatigue Short Form and Concerns About Cancer Recurrence scale in an online survey. Mediation analysis via PROCESS was used to examine whether fatigue predicted depression, anxiety or stress through FCR. Fear of cancer recurrence mediated the relationships between fatigue and anxiety and fatigue and stress, while fatigue directly predicted depression. This study highlights FCR as a potential pathway to anxiety and stress in response to ongoing fatigue, and as a mechanism of action to reduce psychological distress among mothers who are breast cancer survivors. Future research examining this pathway from fatigue to psychological distress should also explore the nature of mothers' fears about their cancer recurring.

Fear of cancer recurrence and coping attitudes of breast cancer survivors

OBJECTIVE

This study aimed to determine the fear of cancer recurrence levels and coping orientation of breast cancer survivors.

METHODS

This descriptive exploratory study was conducted using a web-based online survey. This article is written using the STROBE checklist. The study was completed with 204 women participants. Data were collected using the 'Demographic and Clinical Information Form', 'Fear of Cancer Recurrence Inventory (FCRI)' and 'Coping Orientation to Problems Experienced Inventory-Revised (COPE-R)'.

RESULTS

FCRI total score average within the scope of the study was calculated as 42.00 ± 18.88. Women's COPE-R total score average is 80.62 ± 13.20. There was a positive correlation between FCRI total score and COPE-R (r = 0.183, p = 0.009). According to the results of multiple linear regression analysis, age, education level, CAM usage, getting psychological support and COPE-R subscales (accommodation, avoidance, self-punishment) were associated with FCRI total score.

CONCLUSIONS

The fear of cancer recurrence experienced by breast cancer survivors was associated with their coping orientation. Determining the fear of cancer recurrence level and coping orientation of breast cancer survivors by healthcare professionals will guide the reduction of women's fear of cancer recurrence and further the development of adaptive coping orientation.

Group-based trajectory and predictors of anxiety and depression among Chinese breast cancer patients

Background

The aim of the current study is to investigate the change in anxiety and depression amongst Chinese breast cancer patients and to identify causal associations between baseline variables and the trajectory of anxiety and depression within this identified group.

Methods

This is a longitudinal prospective study. Three hundred women with breast cancer were recruited. Patient's depression and anxiety were repeatedly measured by PHQ-9 and GAD-7 at baseline, 6, 12, and 18 months after discharge. The SAS 9.4 PROC Traj procedure was used to examine the group-based trajectory of these recruited patients. Linear mixed models (LMM) were utilized to examine anxiety/depression changes over time, accounting for relevant baseline demographic and clinical factors.

Results

About 26.3% of the participants reported none or very mild anxiety over time, 60.7% reported stable low-level anxiety, and the remaining 13.0% showed significantly decreasing trend in GAD total scores. Meanwhile, 10.7% of the participants reported none or very mild depressive symptoms over time, 66.0% reported stable PHQ total scores throughout the research period, and 23.3% were classified as the "high level-decreasing group". Patients reported significantly higher anxiety and depression scores in the first three assessments. Participants with no or mild life stress along with a positive personality tended to report lower anxiety and depression scores over time.

Conclusion

Most of the breast cancer patients reported stable low-level anxiety and depression 18 months after discharge. Early assessment of optimism and stress levels among cancer patients might help identify people at risk of experiencing long-term anxiety and depression.

What Causes Cancer in Women with a gBRCA Pathogenic Variant? Counselees' Causal Attributions and Associations with Perceived Control

Laypersons have a strong need to explain critical life events, such as the development of an illness. Expert explanations do not always match the beliefs of patients. We therefore assessed causal attributions made by women with a pathogenic germline variant in BRCA1/2 (gBRCA1/2-PV), both with and without a cancer diagnosis. We assumed that attributions would be associated with the control experience. We conducted a cross-sectional study of N = 101 women with a gBRCA1/2-PV (mean age 43.3 ± 10.9). Women answered self-report questionnaires on perceived causes and control. Most women (97%) named genes as a causal factor for the development of cancer. Surprisingly, the majority of women also named stress and health behavior (both 81%), environment (80%), and personality (61%). Women with a cancer diagnosis tended to endorse more causes. The attributions to personality (ρ = 0.39, p < 0.01) health behavior (ρ = 0.44, p < 0.01), and environment (ρ = 0.22, p < 0.05) were significantly associated with personal control, whereas attribution to genes showed a small, albeit significant association with treatment control (ρ = 0.20, p < 0.05). Discussing causal beliefs in clinical counseling may provide a “window of opportunity” in which risk factors and health behaviors could be better addressed and individually targeted.

The Impact of VR-CALM Intervention Based on VR on Psychological Distress and Symptom Management in Breast Cancer Survivors

Objective

To evaluate the effectiveness and feasibility of Managing Cancer and Living Meaningfully based on VR (VR-CALM), which is used to manage expected symptoms of cancer itself, relieve psychological distress, and improve quality of life (QOL) in the Chinese breast cancer survivors (BCs).

Methods

Ninety-eight patients with breast cancer were recruited in this study. These patients were randomly assigned to the VR-CALM group or the care as usual (CAU) group. All patients were evaluated by the Functional Assessment of Cancer Therapy-Breast cancer patient (FACT-B), Distress Thermometer (DT), Concerns About Recurrence Scale (CARS), Piper Fatigue Scale (PFS), Pittsburgh Sleep Quality Index (PSQI), The Self-Rating Anxiety Scale (SAS), and The Self-Rating Depression Scale (SDS) before and after VR-CALM or CAU application to BCs. We compared the differences in all these scores between the VR-CALM group and the control group.

Results

Patients in the VR-CALM group showed a significant decrease in levels of distress, anxiety, depression, sleep disorders, and fatigue (t = −6.829, t = −5.819, t = −2.094, t = −3.031, t = −10.082, P ≤ 0.001, 0.001, 0.05, 0.01, 0.001, respectively) and had higher level of quality of life (t = 8.216, P ≤ 0.001) compared with the CAU group after intervention. And postintervention patients in VR-CALM group compared with preintervention showed lower level of distress and remarkable improvement of QOL (t = 11.521, t = −10.379, P ≤ 0.001, 0.001). The preintervention questionnaire revealed no significant between-group differences regarding distress, anxiety, depression, sleep disorders, fatigue, and quality of life.

Conclusion

VR-CALM is a psychotherapy tailored to the needs of patients with breast cancer. This research innovatively used VR-based CALM intervention to improve psychological and chronic symptoms in BCs. The results of the present study indicate that VR-CALM has salutary effects on the improvement of QOL and relieves psychological distress, anxiety, depression, sleep disorders, and fatigue in BCs.

Patient perspectives on the causes of breast cancer: a qualitative study on the relationship between stress, trauma, and breast cancer development

Purpose: We qualitatively evaluated breast cancer survivors’ perception of the relation between breast cancer development and both childhood trauma and stressful life events in adulthood.

Methods: Women (N = 50) who have or had a positive breast cancer diagnosis completed a close-ended survey, a timeline of significant life events, and an in-depth interview. All interviews were transcribed and inductively coded using thematic analysis with an emphasis on patient perspectives of illness.

Results: Participants reported a perceived connection between breast cancer development and stressful life events, and four themes were identified: 1) experiencing major interpersonal stress in both childhood and adulthood, 2) ideas about the relationship between emotional stress and physical disease, 3) ideas about how different types of stress contribute to developing breast cancer, 4) post-treatment post-traumatic growth and meaning-making.

Conclusions: Our findings suggest that of the participants who felt something could be causally attributed to their developing breast cancer, most of them made causal attributions between social, personal, and physical stress and trauma across the lifetime to the aetiology of their breast cancer. We suggest that breast cancer patients and survivors may benefit from additional psycho-social, stress-reducing, and/or somatic-based trauma-informed therapies to address stress and trauma.

Factors Correlated With Fear of Cancer Recurrence in Cancer Survivors: A Meta-analysis

BACKGROUND

Fear of cancer recurrence (FCR) is one of the most common and aversive psychological phenomena among cancer survivors. Understanding the independent and potentially modifiable risk factors that contribute toward FCR seen in cancer survivors would inform future interventional trials aimed at reducing this risk.

OBJECTIVE

The aim of this study was to provide an evidence synthesis of factors correlated with FCR to inform the development of preventive interventions.

METHODS

A literature search was performed of the PsycINFO, EMBASE, and MEDLINE (PubMed) databases. Reports published from inception to 2020 focusing on the correlates of FCR with physical, psychological, and social factors were identified. Authors assessed the studies' risk of bias in accordance with the Standard Quality Assessment Criteria for Quantitative Studies (QualSyst criteria) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After extracting data and assessing the quality of the included studies, meta-analysis was conducted using RevMan 5.3 software.

RESULTS

Thirty-four articles were included in this study with a total sample of more than 13 000 cancer patients. Fear of cancer recurrence was positively correlated with anxiety, depression, avoidance, chemotherapy, distress, intrusive thoughts, fatigue, rumination, and neuroticism. It was negatively correlated with optimism, age, social support, quality of life, time since diagnosis, well-being, and self-efficacy.

CONCLUSIONS

We identified 16 factors that are correlated with FCR, 9 positively correlated with FCR and 7 negatively correlated with FCR.

IMPLICATIONS FOR PRACTICE

The findings of this study provide direction for the development of precise interventions for FCR in cancer survivors and lay the foundation for the further construction of an FCR-related nursing theoretical framework.

Unpacking the Mental Health of Nurses during COVID-19: Evidence from Pakistan

The prime objective of the present study is to test the effect of COVID-19 fear on the mental condition of nurses in the public health sector of Pakistan. This study seeks to measure the psychological distress, anxiety, and psychological well-being of nurses due to fear of COVID-19 and exposure to COVID-19. This research further reveals the moderating role of “social support” in the link between COVID-19 fear, exposure and mental health. Through a convenient sampling technique, 250 sample contributors were chosen from 12 public hospitals. The results were obtained by applying multiple regression and moderation analysis by SPSS and the Hayes process. The outcomes indicated that fear of exposure to COVID-19 affects the mental health of nurses. The findings also discovered that social support is not very constructive in the pandemic. However, we suggested that social support is the best weapon to encourage nurses to relieve their fear and minimize negative emotions.

How are women supported in making decisions regarding fertility preservation after a breast cancer diagnosis?

Although there has been an increase in fertility preservation treatment options in recent years, existing evidence would suggest that many young women who have breast cancer do not feel well supported in making decisions in this area. A breast cancer diagnosis and the possibility of becoming infertile are known to cause psychological issues for young women and many find it difficult to make decisions at this time, causing them a great deal of stress and anxiety. Given the need for patient-centred care, this literature review looked at the decision-making support given to women with a diagnosis of breast cancer as part of fertility preservation treatment. The review found that women lacked support and struggled to make decisions at this critical point in their lives. The findings of the review suggest that women would benefit from a wide range of decision support interventions prior to and following diagnosis.

Causal Attributions in Breast Cancer Patients Planning to Undergo Adjuvant Endocrine Therapy

The aim of this study was to explore causal attributions among Korean breast cancer patients who were planning to undergo adjuvant endocrine therapy (AET) as well as the relationships between patient demographic and clinical characteristics and their causal attributions. Causal attributions were assessed with an open-ended response item, which asked patients to list what they thought were the three most important causal factors of their illness. The relationships between patient characteristics and causal attributions were determined through univariate analysis, and the relationships between causal attributions were obtained using social network analysis. A total of 299 participants provided 707 responses. Stress, diet, and exercise were believed to be the three most likely causes of breast cancer. There were no significant differences between causal attributions and the age, education level, marital status, or cancer stage of patients. However, there were differences in the associations between personality, genetics, and reproductive history and patient-identified causal attributions according to the patients' family history of cancer. Patients with a family history of cancer were more likely to believe that personality and genetics/family history were causes of breast cancer compared to patients without such a history. Therefore, it is necessary to educate patients to perceive stress and lifestyle-related factors as modifiable causal factors in order to have a positive effect on their adherence to AET.

Examining the Mediating Effects of Stress on Fear of COVID-19 and Well-being Using Structural Equation Modeling

This study focuses on the effects of fear factor due to COVID-19 on stress and well-being of college students in India. The authors conducted a cross-sectional survey among 625 Indian students across various Indian universities and structural equation modeling (SEM) has been performed for analyzing the data. The findings of the study show a positive effect of fear of COVID-19 on stress with β = .27, p < 0.05, and a negative effect on well-being (β = -.13, p < 0.05). The results also depicted the mediating role of stress between fear of COVID-19 and well-being. Therefore, it is suggested that measures must be taken by individuals, society, and policy makers to include mental health maintenance in the pandemic response activities. Further longitudinal studies in different geographical regions and demographics can provide a more generalized understanding of the relationship between the pandemic and mental health. The limitations, policy implications, and suggestions are discussed.

Mental health-related quality of life is associated with diet quality among survivors of breast cancer

OBJECTIVE

This study sought to understand the association of mental health-related quality of life (MHRQoL) and nutritional status (food security status and malnutrition risk), with diet quality among female survivors of breast cancer.

METHOD

This pilot cross-sectional study utilized self-report survey data from the RAND-36, the USDA 2-item food insecurity screen, the Malnutrition Screening Tool (MST), and the Diet History Questionnaire II (DHQII)/Health Eating Index 2015 (HEI). Participants self-selected participation after being identified through an academic medical center cancer registry and contact through mailed recruitment letters and flyers posted in oncology clinics. Emotional well-being and social functioning composite scores of the RAND-36 were used to characterize MHRQoL. Correlational and regression analyses were performed to assess the association of diet quality, nutritional status, and MHRQoL.

RESULTS

The majority of participants (n = 90) were non-Hispanic white (90%), average age of 71.3 ± 8.1 years, and an average body mass index (BMI) of 28.2 ± 6.6. Four of the 90 participants (4.4%) scored at risk for food insecurity. Linear regression indicated that social functioning composite scores were positively associated with HEI scores (β = 0.11, SE = 0.53, p = 0.03). Controlling for demographic characteristics, education level (β = 5.25, SE = 2.25, p = 0.02) was positively associated with HEI scores.

CONCLUSION

Diet quality and MHRQoL were associated among breast cancer survivors, with education level also being associated with diet quality. These results can be used to aid targeted nutrition counseling and mental health interventions to address the nutritional vulnerabilities among female breast cancer survivors, particularly among older cancer survivors.

Patients Older 65 Years With Early Breast Cancer Prefer Intraoperative Radiation as a Locoregional Treatment Choice

BACKGROUND

Patients 65 years old or older with early endocrine-responsive breast cancer have many treatment options, including no radiation. This study aimed to evaluate treatment preference when intraoperative radiation therapy (IORT) is offered in this population.

METHODS

The study reviewed patients 65 years old or older with a diagnosis of early-stage endocrine-responsive breast cancer in 2016-2019 at a single hospital in a large integrated health care system. Electronic medical records of multidisciplinary breast tumor board discussion, treatment options documented by the treatment team, and final treatment offered were reviewed. Variables including age at biopsy, language, endocrine treatment, and comorbidities were collected. Regression analysis was used to evaluate for variables associated with patients' choice regarding radiation treatment.

RESULTS

The institutional IORT guidelines were met by 63 patients in the described age group who had a documented offer of all radiation treatment options. The median age of the patients was 70 years (interquartile range 63-77 years). Overall, 74.6% of the patients chose IORT, and 14.3% opted for whole-breast irradiation. Only 4.8% chose to omit radiation after breast-conserving surgery, and 6.3% chose mastectomy. The patients who chose IORT were more likely to receive endocrine treatment (odds ratio 3.70; p = 0.03). Age, race, language, and comorbidities were not associated with preference for IORT (p < 0.05).

CONCLUSIONS

Patients 65 years old or older with early-stage endocrine-responsive breast cancer preferred to have IORT despite counsel about the lack of survival benefit. This study suggests that local cancer control with the convenient radiation delivery method is important to the described patient population.

Effect of Coronavirus-19 on Mental Condition of International Students in China

Despite its importance, no study investigates the effects of COVID-19 on the mental condition of international students in China. By using data from international students in China, this study finds the positive and affirmative connection between fear of COVID-19 and generalized anxiety disorder among foreign students. Furthermore, this study reveals a negative association between fear of COVID-19 and the psychological well-being of foreign students in China. We also find that emotional intelligence has a positive and optimistic moderating influence on the relationship between fear of COVID-19 and generalized anxiety disorder but it has not moderating effect on the relationship between fear of COVID-19 and psychological well-being. Our study contributes to the body and knowledge and offers new insights concerning the effects of COVID-19 on the mental condition of international students.

The impact of fear of cancer recurrence on healthcare utilization among long-term breast cancer survivors recruited through ECOG-ACRIN trials

OBJECTIVE

To examine the relationship between fear of cancer recurrence (FCR) and healthcare utilization among long-term breast cancer survivors (BCS).

METHODS

In a cross-sectional survey study, 505 younger survivors (YS: ≤45 years) and 622 older survivors (OS: 55-70 years) 3-8 years from diagnosis completed a questionnaire assessing demographics, medical history, FCR, and healthcare utilization. Healthcare utilization consisted of breast cancer (BC) and non-BC-related routine and nonroutine utilization.

RESULTS

YS had significantly higher FCR than OS (p < 0.01). Independent of age, FCR was significantly associated with all three types of BC-related utilization (p < 0.05). In the multivariate models, we found a significant, positive interaction effect between FCR and increased comorbidities on nonroutine BC appointments (p = 0.01) and BC-related emergency room visits (p = 0.03). Additionally, comorbidities were associated with non-BC-related utilization (p < 0.01), and nonwhites were more likely to utilize nonroutine resources, both BC and non-BC-related (p < 0.01).

CONCLUSIONS

Increased FCR has been associated with hypervigilance among survivors and may lead to increased healthcare utilization. YS are at higher risk for increased FCR and psychosocial concerns, which may lead to overutilization. Providers should be aware that higher FCR may be related to increased use of healthcare resources and that these patients might be better served with supportive resources to increase quality of life and decrease inappropriate utilization. While this study provides increased evidence of the relationship between FCR and healthcare utilization, interventions are needed for survivors at risk to address unmet needs, especially as life expectancy increases among BCS.

The relationship between fears of cancer recurrence and patient age: A systematic review and meta-analysis

BACKGROUND

Fears of cancer recurrence (FCR) is one of the most prevalent concerns and a common unmet need reported by cancer patients. Patient age is a demographic variable that has been linked to FCR, among others. Although it is recognised by researchers that age and FCR may be negatively correlated, the strength of this correlation has yet to be established.

AIM

The aims of this study were to (a) conduct a meta-analysis to investigate the overall association of patient age in years with FCR across studies from 2009 to February 2019 and (b) scrutinise for patterns of these effect sizes across studies.

METHODS AND RESULTS

Peer-reviewed papers were gathered from the literature via online databases (PubMed, EMBASE, MEDLINE, and PsycINFO). Systematic review guidelines including a quality assessment were applied to the 31 selected studies (pooled participant N size = 19 777). The meta-analysis demonstrated a significant negative association between age and FCR (ES = -0.12; 95% CI, -0.17, -0.07). Meta-regression revealed the association of patient age and FCR significantly reduced over the last decade. A significant effect (β = -0.17, P = 0.005) of breast cancer versus other cancers on this age by FCR association was also identified.

CONCLUSION

The reliable and readily accessible personal information of age of patient can be utilised as a weak indicator of FCR level especially in the breast cancer field, where the majority of studies were drawn. The suggestion that age and FCR association may be attenuated in recent years requires confirmation.

Factors influencing fear of cancer recurrence in patients with breast cancer: Evidence from a survey in Yancheng, China

AIM

To identify the characteristics of fear of cancer recurrence (FCR) in breast cancer patients after surgery and investigate the relationship of FCR with demographic and medical characteristics, quality of life (QOL) and social support.

METHODS

The short version of the Fear of Progression Questionnaire (FoP-Q-SF), the functional assessment of cancer therapy for breast cancer (FACT-B) and the Social Support Rating Scale were administered to the 342 breast cancer patients who had undergone surgical treatment. The analysis was performed to determine potential predictors associated with FCR.

RESULTS

Of the 465 patients, 342 (73.5%) agreed to take part in the study. The mean age of participants was 51.46 ± 10.50 years (range, 30-81). Of the 342 participants, 92 (26.9%) cases were at Stage I, 131 (38.3%) cases at Stage II, 34 (9.9%) patients at Stage III and 85 (24.9%) patients at Stage IV. Among the 12 items of the FoP-Q-SF, the three greatest fears were: Item 10 'Worrying that medications could damage the body', Item 1 'Being afraid of disease progression' and Item 2 'Being nervous prior to doctors' appointments or periodic examinations'. About 68.4% of patients reported the dysfunctional level of fear of progression. Multiple linear regression analysis showed that religious belief, family income, disease stages, social support, QOL were identified as independent predictors for FCR.

CONCLUSION

We found that FCR is prevalent in postoperative breast cancer patients, and is influenced by many factors. It is necessary to implement positive intervention measures to alleviate the FCR and improve the QOL of patients.

Fear of cancer recurrence, anxiety and depressive symptoms in adolescent and young adult cancer patients

Background: Previous studies have indicated that younger age is consistently associated with high levels of fear of cancer recurrence (FCR), anxiety and depression. However, the associations among these variables in adolescent and young adult (AYA) cancer patients are not clear. This study explores the prevalence and correlates of FCR, anxiety and depressive symptoms in Chinese AYA cancer population. Methods: This is a cross-sectional study that includes 249 patients aged between 15 and 39 yrs at the time of cancer diagnosis. Patient's sociodemographic, clinical as well as psychological characteristics were collected by an information sheet, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-9). Descriptive statistics and multivariate analyses were conducted. Results: Eighty-nine (35.74%) patients experienced dysfunctional level of FCR, eighty-two (32.93%) patients experienced anxiety symptoms and ninety-six (38.55%) reported depressive symptoms. In multivariate analyses, being single, pessimistic, having more concurrent stressful life events and physical comorbidity were independently associated with higher FCR, anxiety and depressive symptoms. Patients who were not engaging in radiotherapy were more likely to report higher anxiety level. Conclusion: FCR, anxiety and depressive symptoms are frequently reported problems among AYA cancer patients. Age-appropriate and flexible psychological interventions are needed for this high-risk population.

Causal explanations for lack of pregnancy applying the common sense model of illness representation to the fertility context

OBJECTIVES

The current study explored causal explanations for lack of pregnancy and association with help-seeking behaviour. Differences based on gender and country Human Development Index were examined.

DESIGN

A mixed method design was used.

MAIN OUTCOME MEASURES

Data were drawn from the International Fertility Decision-Making Study, a cross-sectional study of 10,045 individuals (1690 men; 8355 women) from 79 countries. Respondents rated to what extent they believed their lack of pregnancy was due to something they or their partner had done/not done or other factors and described their reasons for making this rating.

RESULTS

Respondents were aged 18-50 (M = 31.83) years, partnered and had been trying to achieve a pregnancy/father a child for over six months (M = 2.8 years). Men and women primarily believed their lack of pregnancy was due to medical problems or chance/bad luck. Thematic analysis of textual responses from 29.7% of the sample found that respondents focused on their personal experience or a salient life event when describing the cause of their lack of pregnancy. Women expressed more regret and helplessness about causes than men. Significant country differences were observed.

CONCLUSIONS

Individuals may develop inaccurate causal explanations based on their personal experiences. Access to accurate information is necessary to facilitate timely help-seeking.

Predictors and interdependence of family support in a random sample of long-term young breast cancer survivors and their biological relatives

OBJECTIVE

Women diagnosed with breast cancer younger than 45 years (young breast cancer survivors-YBCS) and their biological relatives face significant stressors. Although family support is an important coping resource, little is known about YBCS' and relatives' support and whether it is interdependent. The study described family support in YBCS and their biological relatives; identified demographic, clinical, and psychosocial predictors of support; and determined the interdependence of support in YBCS-relatives family units.

METHODS

Data were collected from a random sample of YBCS and their first- or second-degree female relatives. Actor-partner interdependence models (APIM) explored predictors and interdependence of YBCS' and relatives' family support in dyads (YBCS and relative) and triads (YBCS and two relatives).

RESULTS

Among n = 310 YBCS and n = 431 first- or second-degree relatives, family support was higher in triads compared to dyads. APIMs identified actor effects in dyads, and actor and partner effects in triads. Across all family units, YBCS' higher self-efficacy was associated with higher YBCS support (actor effect) and relative support (partner effect); YBCS' prior diagnosis of depression was associated with lower YBCS and relative support (actor and partner effect); cost-related lack of access to care was associated with lower support among YBCS (actor effect) and relatives (actor and partner effect).

CONCLUSIONS

Family support was interdependent and was affected by self-efficacy, depression, and access to care. Interventions should include YBCS and relatives, enhance self-efficacy and access to care.

The relationship between cancer patient's fear of recurrence and chemotherapy: A systematic review and meta-analysis

OBJECTIVE

The study aim was to provide an overview of the current evidence available on the link between chemotherapy (CTX) and fear of cancer recurrence (FoR).

METHODS

PubMED, Medline, Embase, PsycINFO and Web of Science databases were searched to identify relevant studies. Two authors independently selected and assessed the studies regarding eligibility criteria. Meta-analysis of suitable studies was conducted, and quality rated.

RESULTS

Forty eligible studies were included in the systematic review and twenty-nine of them were included in further meta-analysis. Meta-analysis of the available data confirmed a weak relationship between CTX and FoR (29 studies, 30,176 patients, overall r=0.093, 95% CI: 0.062, 0.123, P˂0.001).

CONCLUSIONS

The meta-analysis demonstrates a weak but significant relationship between cancer patient's FoR and the receipt of chemotherapy. However, these results should be interpreted with caution. Further investigation is warranted to explore possible mechanisms of FoR increase in patients who receive chemotherapy. Longitudinal studies assessing the trajectory of FoR during chemotherapy are also warranted.