Emotions and Emotion Regulation in Breast Cancer Survivorship

Fear of cancer recurrence: A qualitative systematic review and meta-synthesis of patients' experiences

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.

Emotional functioning to screen for psychological distress in breast and colorectal cancer patients prior to adjuvant treatment initiation

INTRODUCTION

The objective was to analyze the usefulness of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) EF subscale to detect emotional problems in patients with breast (BC) and colorectal cancer (CRC).

METHODS

A prospective, observational, cross-sectional study was conducted. Participants completed the Brief Symptom Inventory (BSI) and EORTC-QLQ-C30. The following psychometric properties were calculated: accuracy, sensitivity, positive predictive value, specificity and negative predictive value.

RESULTS

The sample analyzed included 445 patients: 202 with BC and 243 with CRC. In total, 129 BC patients (64%) and 104 CRC patients (43%) suffered psychological distress according to the BSI. The accuracy of EORTC-QLQ-C30 EF in detecting psychological distress was 77% and 82% in BC and CRC respectively. Specificity rates for BC and CRC were 81% and 82%, and sensitivity was 75% and 82% respectively. Positive predictive value was 87% and 77%, and negative predictive value was 65% and 86% in BC and CRC respectively. The mean AUC for BC was 0.83 and 0.88 for CRC.

CONCLUSIONS

The EORTC-QLQ-C30 EF is useful for rapid screening. The systematic application of this scale would allow patients with cancer and emotional problems to be easily identified in clinical practice.

Neural correlates of chemotherapy-induced emotion regulation impairment in breast cancer patients

To investigate the chemotherapy-induced emotion regulation impairment and its neural correlates in breast cancer (BC) patients by event-related potentials (ERP), seventeen BC patients were investigated on emotion regulation paradigms while undergoing the recording of an event-related potential (ERP) both before and after chemotherapy. The performance of behavioral and ERP was compared for the data collected before and after chemotherapy (BCB and BCA, respectively). The correlation of the difference between the peak and the latency of each component before and after chemotherapy were compared with the difference in behavior (RT and AR). BC patients showed a lower accuracy rate in both explicit and implicit emotion identification in BCA compared to that in BCB. Further, both the N1 and P2 components were significantly delayed. The peak values of the N1 and P2 in BCA were significantly higher than those in BCB, whereas the peak value of the N2 in BCA was significantly lower than that in BCB. There was a positive correlation between the difference in latency at the CZ (r=0.88), F3 (r=0.97) and FZ (r=0.85) points in the N1 component and the RT. The difference in latency at the FCZ point in the N2 (r=0.88) component is positively correlated with the AR. The difference in peak value at the CPZ (r=0.89) point in the N1 component is positively correlated with the RT. Both the implicit and explicit emotional processing was compromised in BC patients following chemotherapy. These emotional processing deficits may be related to the changes of the N1, N2 and P2 of the ERP.

Emotional "Patient-Oriented" Support in Young Patients With I-II Stage Breast Cancer: Pilot Study

Objective: The recent increased survival rate after breast cancer (BC) diagnosis and treatment is mostly related to early screening in younger age. Evidence gained from newly detected assessed psychological needs as well as certain emotional regulatory patterns in younger survivors has been related in the literature to an extremely low rate of adherence to the psychological therapies offered. Tailored psychological support is necessary. The aim of the present study was to verify the preliminary efficacy of supportive psychological intervention with an innovative orientation: the Early BC Psychological Intervention (EBC-Psy).

Methods: A controlled study design was used to investigate the efficacy of EBC-Psy intervention. Preliminary data involved twenty-four patients in the age range of 35–50 years, diagnosed with cancer at the early stage (I–II), who were exposed to the EBC-Psy intervention. To address the effect of intervention, emotional variables were tested before the treatment (Time 1) and then again after 6 months of the treatment (Time 2); evaluated emotional dimensions were anxiety, anger, depression, and psychological distress.

Results: EBC-Psy intervention appears to be effective on both depression (p = 0.02) and psychological distress (p = 0.01), even in a short time, highlighting the strength of a reinforced positive psychological conceptual approach to deal with the “disease condition” in younger patients; on the contrary, the control group evidenced an increase in the same emotional variables in timing.

Conclusion: Our findings, even if limited by this small-scale protocol, seemed to confirm the role of positive psychotherapy after BC diagnosis and treatment through the impact of cognitive processes, coping strategies, and psychological resilience. Future theoretical framework could boost the intervention to design an innovative survivorship model.

Is expressive suppression harmful for Chinese American breast cancer survivors?

Emotion regulation strategies are important for cancer survivors' adjustment. Expressive suppression, defined as the active effort of inhibiting the expressive component of an emotional response, has been found to be a maladaptive emotion regulation strategy. These studies, however, have been limited to cross-sectional designs and primarily European American samples. Chinese culture encourages emotion suppression to preserve interpersonal harmony and therefore it may be important to test these emotion regulation processes with this population. This study aimed to examine the longitudinal effects of expressive suppression, ambivalence over emotional expression (i.e., inner conflict over emotional expression), and cognitive reappraisal on quality of life among Chinese American breast cancer survivors. 103 participants completed a questionnaire assessing expressive suppression, ambivalence over emotional expression, cognitive reappraisal, and quality of life at baseline and a questionnaire assessing quality of life eight weeks later. Consistent with our hypotheses, baseline ambivalence over emotional expression was associated with lower follow-up quality of life above and beyond the effect of expressive suppression. Furthermore, cognitive reappraisal moderated the relations between expressive suppression and follow-up quality of life, such that expressive suppression may be less detrimental for Chinese American breast cancer survivors who are able to regulate their emotions using cognitive reappraisal. Implications for informing interventions for Chinese American breast cancer survivors are discussed.

Effect of Community-Based Occupational Therapy on Health-Related Quality of Life and Engagement in Meaningful Activities of Women with Breast Cancer

We aimed to evaluate the short-term effects of community-based occupational therapy on health-related quality of life and engagement in meaningful activities among women with breast cancer. An open label randomized controlled trial study design was applied. The participants were members of various societies of women with cancer. In total, 22 women have participated in the study. Participants of the experimental group (n = 11) participated in a 6-week community-based occupational therapy program and the usual activities of various societies, whereas the control group (n = 11) women participated in the usual activities of the societies only. 1 of the participants withdrew during the course; therefore 21 completed the study successfully. Participants of both groups were assessed for health-related quality of life and the participants of the experimental group were assessed for engagement in meaningful activities. The evaluation was carried out during the nonacute period of the disease-at the beginning of the study and after 6 weeks. Women of the experimental group demonstrated statistically significantly better scores in the global quality of life, role functions, physical, emotional, cognitive, and social functions, fatigue, insomnia, financial impact, systemic therapy side effects, and breast symptoms scales compared to the control group participants (p < 0.05) after the 6 weeks, as measured by the EORTC QLQ-C30 questionnaire and its breast cancer module QLQ-BR23. Furthermore, women of the experimental group demonstrated significant greater engagement in meaningful activities when applying community-based occupational therapy (p < 0.05), as measured by using the Engagement in Meaningful Activities Survey (EMAS). The evaluation of the associations between the women's engagement in meaningful activities and changes in health-related quality of life showed that greater engagement in meaningful activities was associated with better emotional functions and a lower level of insomnia (p < 0.05). Based on the results of our study, we recommend applying occupational therapy in the field of community healthcare in order to maintain or improve breast cancer patients' health-related quality of life and suggest involving women into meaningful activities during community-based occupational therapy after clarifying which activities are important to them.

The Affect Regulation in Cancer framework: Understanding affective responding across the cancer trajectory

Affective dimensions of cancer have long been a central concern in the field of psycho-oncology. Recent developments in the field of affective science suggest the value of incorporating insights from the burgeoning literature on affect regulation. Accordingly, the objective of this article is to build on prior work in this area by applying a process-oriented affect regulation framework to the various phases of the cancer trajectory. The Affect Regulation in Cancer framework is adapted from Gross' process model of emotion regulation, and its aim is to integrate recent advances in affective science with work in the field of psycho-oncology. The basic elements of the affect generative and affect regulatory processes are outlined across the various phases of the cancer trajectory. Our proposed model provides a useful heuristic framework in advancing research on the ways people manage their affective responses throughout the cancer trajectory.