A correlation study of fear of cancer recurrence, illness representation, self-regulation, and quality of life among gynecologic cancer survivors in Taiwan

Latent profile analysis of fear of progression in Chinese hematologic malignancy survivors

Fear of disease progression (FoP) is a multidimensional concept that refers to the fear or worry about disease progress. Little is known about the distinct FoP profiles and their determinants in culturally specific contexts, especially among hematologic malignancies (HM) patients in China. This study aimed to identify heterogeneous profiles of FoP and their associated predictors among Chinese patients with HM. A convenience sample of patients suffering from HM were enrolled from March 2023 to February 2024. To gather multidimensional data from the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Brief Illness Perception Questionnaire (BIPQ), the Hospital Anxiety and Depression Scale (HADS), the Family Hardiness Index (FHI), and the EuroQol-Visual Analogue Scale (EQ-VAS), we performed a questionnaire-based cross-sectional study on 455 survivors with HM. The statistical method included latent profile analysis (LPA) and multivariate logistic regression. Three latent profiles of FoP were found: the low-risk fear group (20.88%), the moderate-risk fear group (54.73%), and the high-risk fear group (24.49%). Patients with higher levels of illness perception, anxiety, and depression were more likely to report higher levels of FoP. The study revealed that female gender (OR 2.295-2.577), age > 65 years (OR 4.140-9.363), lower education (OR 0.270-0.365), and lymphoma diagnosis (OR 2.95) significantly predicted higher FoP risk (all P < 0.05), while higher income (OR 0.390-0.477, P < 0.05) and greater family resilience showed protective effects. The findings underscore the need for risk-stratified interventions targeting psychosocial vulnerabilities, particularly in elderly and female adults with HM. This study provides empirical evidence supporting the application of precision psycho-oncology approaches in HM survivorship management. It also contributes to the broader comprehension of FoP and highlights the importance of family-centered interventions .

Mediation Effects of Self-care Self-efficacy and Health-promoting Behaviors on Fear of Cancer Recurrence and Posttraumatic Growth in Postoperative Patients With Cervical Cancer: A Cross-sectional Study

PURPOSE

High recurrence risks significantly contribute to poor health outcomes among postoperative cervical cancer patients. This study aimed to determine the impact of fear of cancer recurrence (FCR) on the posttraumatic growth (PTG) in postoperative cervical cancer patients and to investigate the mediating effects of self-care self-efficacy and health-promoting behaviors within this relationship.

METHODS

A total of 334 cervical cancer patients who had undergone surgery in three tertiary hospitals in Liaoning Province, China, were recruited using a convenience sampling method. Data were collected using the general information questionnaire, the Fear of Progression Questionnaire (FCR), the Post-traumatic Growth Inventory (PTG), the Strategies Used by People to Promote Health (self-care self-efficacy), and the Health-Promoting Lifestyle Profile (health-promoting behaviors). Data analysis was performed using descriptive analysis, Pearson's correlations, and multiple linear regression analysis. A structural equation model was conducted using Amos 24.0 software.

RESULTS

PTG of cervical cancer patients after surgery was significantly and negatively associated with FCR (r = -.54, p < .001), while positively correlated with self-care self-efficacy (r = .51, p < .001) and health-promoting behaviors (r = .59, p < .001). The mediation model revealed that self-care self-efficacy (Boots 95% CI 0.39 ∼ 0.15) and health-promoting behaviors (Boots 95% CI 0.51 ∼ 0.24) independently served as mediating factors, respectively. Self-care self-efficacy and health-promoting behaviors played a significant chain mediating effect between FCR and PTG (Boots 95% CI 0.19 ∼ 0.07), with an indirect effect of 11.6%.

CONCLUSION

This study demonstrated that self-care self-efficacy and health-promoting behaviors partially mediated the relationship between FCR and PTG in cervical cancer survivors after surgery. Implementing tailored interventions that focus on enhancing self-care self-efficacy and health-promoting behaviors among cervical cancer survivors may help alleviate concerns about cervical cancer recurrence and enhance PTG following surgery.

Impact of psychological resilience and social support on psycho-social adjustment in postoperative patients with primary hepatocellular carcinoma: mediating effects of fear of progression

Background

Postoperative patients with primary hepatocellular carcinoma (HCC) confront not only physiological challenges but also psychological and social adaptation issues. It is imperative to enhance psycho-social adjustment (PSA) levels and further improve the quality of life among this population. However, research on PSA levels in postoperative HCC patients is lacking, and investigations into its associations with psychological resilience, social support, and fear of progression (FoP) remain unexplored currently.

Objectives

This study aims to: (1) investigate the current status of PSA and analyze its influencing factors among postoperative HCC patients; (2) explore the interrelationships among psychological resilience, social support, FoP and PSA based on the Chronic Illness Adaptation Model employing a structural equation model.

Methods

Convenience sampling methods were employed to recruit participants from the Department of Hepatobiliary Surgery at a tertiary hospital in Xi'an, Shaanxi, China, and a total of 399 patients completed the surveys. The survey instruments included a general information questionnaire, Connor-Davidson Resilience Scale (CD-RISC), Social Support Rating Scale (SSRS), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and Psychosocial Adjustment to Illness Scale Self-report (PAIS-SR). Data entry was conducted using Epidata 3.1 with dual verification, followed by statistical analyses performed using SPSS 27.0 and Amos 28.0.

Results

The structural equation model revealed two paths. In Path 1 (psychological resilience → FoP → PSA), the direct effect was -0.383 (95% CI [-0.589, -0.112]), with an indirect effect of -0.075 (95% CI [-0.170, -0.018]). In Path 2 (social support → FoP → PSA), the direct effect was -0.297 (95% CI [-0.587, -0.063]), with an indirect effect of -0.069 (95% CI [-0.156, -0.019]).

Conclusion

Postoperative patients with primary HCC exhibit lower levels of PSA. Higher levels of psychological resilience and social support correspond to elevated PSA levels. Conversely, advanced age, greater financial burden, and increased FoP are associated with lower PSA levels. FoP serves as a partial mediator between psychological resilience and PSA, as well as between social support and PSA. Future research would benefit from longitudinal designs to elucidate the developmental trajectories and causal links among these variables.

Fear of recurrence in postoperative lung cancer patients: Trajectories, influencing factors and impacts on quality of life

AIMS

To investigate the trajectory, influencing factors and dynamic relationships between fear of cancer recurrence (FCR) and quality of life (QOL) in lung cancer patients.

DESIGN

Prospective longitudinal study.

METHODS

Longitudinal data from 310 lung cancer patients across three hospitals in China were assessed at 1, 3, 6 and 12 months postoperatively (T1 -T4 ). Descriptive statistics characterised patient demographics, clinical characteristics, levels of FCR and QOL. A linear mixed-effects model was employed to analyse FCR trajectories, identify influencing factors on these trajectories, and predict the impact of FCR on QOL.

RESULTS

FCR changed significantly over time, with a slight decrease during T1 -T2 , an increase at T3 and gradual decline at T4 . Higher fear levels were associated with female sex, suburban or rural residency, being a family breadwinner, presence of comorbidities and negative coping behaviours, and low family resilience. QOL negatively correlated with FCR, and FCR predicted lower QOL.

CONCLUSIONS

At 3 and 6 months postoperatively, lung cancer patients, especially women, suburban or rural residents, family breadwinners, those with comorbidities, negative coping behaviours and low family resilience, reported high levels of FCR. Healthcare providers should pay special attention to lung cancer patients especially during the period of 3-6 months post-surgery and offer tailored interventions to improve their QOL.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Understanding the FCR trajectories, its influencing factors and its negative impacts on QOL can guide the development of targeted interventions to reduce fear and enhance well-being in patients with cancer.

IMPACT

Identifying the trajectories and influencing factors of fear of lung cancer recurrence in patients at different time points informs future research on targeted interventions to improve QOL.

REPORTING METHOD

The study adhered to the guidelines outlined in the Statement on Reporting Observational Longitudinal Research.

Prediction of high-level fear of cancer recurrence in breast cancer survivors: An integrative approach utilizing random forest algorithm and visual nomogram

PURPOSE

This study is the first attempt to use a combination of regression analysis and random forest algorithm to predict the risk factors for high-level fear of cancer recurrence and develop a predictive nomogram to guide clinicians and nurses in identifying high-risk populations for high-level fear of cancer recurrence.

METHODS

After receiving various recruitment strategies, a total of 781 survivors who had undergone breast cancer resection within 5 years in four Grade-A hospitals in China were included. Besides demographic and clinical characteristics, variables were also selected from the perspectives of somatic, cognitive, psychological, social and economic factors, all of which were measured using a scale with high reliability and validity. This study established univariate regression analysis and random forest model to screen for risk factors for high-level fear of cancer recurrence. Based on the results of the multi-variable regression model, a nomogram was constructed to visualize risk prediction.

RESULTS

Fatigue, social constraints, maladaptive cognitive emotion regulation strategies, meta-cognition and age were identified as risk factors. Based on the predictive model, a nomogram was constructed, and the area under the curve was 0.949, indicating strong discrimination and calibration.

CONCLUSIONS

The integration of two models enhances the credibility of the prediction outcomes. The nomogram effectively transformed intricate regression equations into a visual representation, enhancing the readability and accessibility of the prediction model's results. It aids clinicians and nurses in swiftly and precisely identifying high-risk individuals for high-level fear of cancer recurrence, enabling the development of timely, predictable, and personalized intervention programs for high-risk patients.

The effects of physical symptoms, self-efficacy and social constraints on fear of cancer recurrence in breast cancer survivors: Examining the mediating role of illness representations

OBJECTIVE

Fear of cancer recurrence (FCR) is common in breast cancer survivors (BCS). This study examined the mediating role of illness representations in the relationships between FCR and physical symptoms, social constraint and self-care self-efficacy.

METHODS

In this cross-sectional study, 385 women with breast cancer completed a series of questionnaires including the FCR Inventory, Social Constraints Scale-15, Cancer Survivors Self-Efficacy Scale, Illness Perception Questionnaire-Revised and European Organization for Research and Treatment Quality of Life Questionnaire-Breast Cancer. Structural equation modelling method was conduct by using a bootstrapping method.

RESULTS

Physical symptoms (β = 0.272, p < 0.01), social constraints (β = 0.130, p < 0.01), self-efficacy (β = -0.233, p < 0.01) and illness representation (β = 0.261, p < 0.01) have direct effects on FCR. The indirect effects of physical symptoms (β = 0.10, p < 0.01), social constraints (β = 0.076, p < 0.01) and self-efficacy (β = -0.025, p < 0.05) on FCR were partially mediated by illness representations.

CONCLUSIONS

In this study, the effects of physical symptoms, social constraints and self-efficacy on FCR were found to be mediated by illness representation. Reducing the impact of negative illness representations on FCR by reducing physical symptoms, increasing self-efficacy, and promoting open disclosure of cancer-related concerns may be effective in reducing FCR in BCS.

Supportive care needs of breast cancer survivors with different levels of fear of cancer recurrence: A cross-sectional survey study

PURPOSE

To examine the supportive care needs of breast cancer survivors with nonclinical, subclinical, or clinical fear of cancer recurrence.

METHODS

In this cross-sectional study, 385 breast cancer survivors consented and completed a set of online questionnaires. Supportive care needs were assessed by using the 34-item Supportive Care Needs Survey. Fear of cancer recurrence was assessed by using the Fear of Cancer Recurrence Inventory.

RESULTS

One hundred eighty-four (47.8%) participants reported nonclinical fear of cancer recurrence, 147 (38.2%) reported subclinical fear of cancer recurrence, and 54 (14.0%) reported clinical fear of cancer recurrence. Higher levels of fear of cancer recurrence were associated with higher levels of supportive care needs in five domains (β = 0.30-0.60, P < 0.001) after adjusting for places of residence, education, motherhood, and time since diagnosis. Among participants with nonclinical fears of cancer recurrence, the most common needs were in the 'Health care system/Information' domain (50.5%). Among participants with subclinical or clinical fear of cancer recurrence, the most common needs were in the 'Psychological' domain (85.7% and 96.3%, respectively).

CONCLUSION

Fear of cancer recurrence was associated with supportive care needs. The most common needs among participants with subclinical or clinical fears of cancer recurrence were psychological needs.

Investigation on psychological status of patients with cervical precancerous lesions and cancer among Han and Ethnic minority in Yunnan Province of China

Objective

The aim of this study was to explore the correlation and difference of influencing factors by analyzing the psychological status of patients with cervical precancerous lesions and cancer in Han and Ethnic minorities. So as to provide evidence for more targeted psychological intervention for categories types of patients.

Methods

The Chinese version of Kessler 10 scale was used to investigate 200 Han Chinese patients with cervical lesions and 100 ethnic minority patients with cervical lesions in Yunnan Cancer Center. Statistical analysis was performed using t-test, analysis of variance, and multivariable linear regression.

Results

There was no significant difference in the distribution of demographic characteristics between the two groups (P > 0.05).The results of univariate analysis showed that the impression of K10 score was statistically significant among the following factors: educational level, awareness of HPV vaccine, disease screening status, employee medical insurance, economic burden of disease, cancerous or not, pathological type, treatment modalities, marital status, and family genetic history of tumor (P < 0.05). After multivariate analysis and considering the influence of the number of independent variables, it indicates that the economic burden of the disease, occupation, and family genetic history of tumor had a greater impact on the total score of Han patients among many factors, accounting for a total of 8.1%(Adj R² = 0.081).Treatment modalities had the greatest effect on the scores of ethnic minority patients, accounting for 8.4%(Adj R² = 0.084).

Conclusion

The factors affecting the psychological status of patients between the two groups have similarities and differences. Multifactorial analysis showed that the main factors affecting the psychology of Han patients were: economic burden caused by the disease, occupation, and family genetic history of tumor; while the main factors affecting the psychology of minority patients were: treatment modalities. Therefore, targeted recommendations and policy measures can be proposed respectively.

"Illness perceptions and factors of distress as mediators between trait emotional intelligence and quality of life in endometriosis"

Past findings highlighted the presence of distress symptoms and poor quality of life in people with endometriosis. Several studies showed that trait Emotional Intelligence (trait EI) is a key component of one's wellbeing, whilst Illness Perceptions may play an important role in psychological distress and perceived quality of life. The current study sought to test the hypothesis that an association between trait EI and Quality of Life in individuals with endometriosis would be mediated by Illness Perceptions, examining also the relations with General Distress (depression, anxiety, and stress). 364 women with endometriosis aged between 18 and 58 years old (M = 33.87; SD = 8.64) filled a protocol to assess Trait EI, Illness Perceptions, General Distress, and Quality of Life. Structural Equation Modelling was used to assess the relationship between the observed variables. Illness Perception was a mediator in the relationship between Trait EI, General Distress, and Quality of Life. Moreover, General Distress was a mediator between Trait EI and Quality of Life, and between Illness Perceptions and Quality of Life. Results showed that both Trait EI and Illness perceptions are key components for levels of distress and quality of life in women with endometriosis.

Relationship between social support and fear of cancer recurrence among Chinese cancer patients: A systematic review and meta-analysis

Background

To quantitatively analyze the association between social support (SS) and fear of cancer recurrence (FCR) by reviewing current evidence from observational studies.

Methods

A comprehensive literature search was performed in nine databases from inception to May 2022. Observational studies that used both SS and FCR as study variables were included. Regression coefficient (β') and correlation coefficient (r) were calculated with R software. Subgroup analysis was utilized to investigate the degree of the relationship between SS and FCR as well as the impact of various forms of SS on FCR in cancer patients.

Results

Thirty-seven studies involving 8,190 participants were identified. SS significantly reduced FCR risk [pooled β' = -0.27, 95% confidence interval (CI) = -0.364 to -0.172], with moderate negative correlations (summary r = -0.52, 95% CI = -0.592 to -0.438). Meta-regression and subgroup analysis showed that types of cancer and study type were the source of heterogeneity. However, types of SS [actual SS, perceived social support (PSS), and others], source of actual SS, and source of PSS were not significant moderators.

Conclusion

To the best of our knowledge, this is the first systematic review and meta-analysis to quantitatively investigate the association between SS and FCR in Chinese cancer patients using β' and r coefficients. The results re-emphasized that social workers should enhance the use of SS by cancer patients and establish a sound SS system by either implementing more relevant research or developing targeted policies. Based on meta-regression and subgroup analyses, moderators of the association between SS and FCR should also be studied closely as they may help identify patients in need. In addition, longitudinal research, as well as mixed research, should be conducted to more comprehensively explore the relationship between SS and FCR.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42022332718.

The fear of cancer recurrence and progression in patients with pancreatic cancer

PURPOSE

It is plausible that patients with pancreatic cancer experience fear of tumor recurrence or progression (FOP). The aim of this study was to compare FOP in patients with pancreatic cancer treated with surgical resection, palliative systemic treatment, or best supportive care (BSC) and analyze the association between quality of life (QoL) and FOP and the effect of FOP on overall survival (OS).

METHODS

This study included patients diagnosed with pancreatic cancer between 2015 and 2018, who participated in the Dutch Pancreatic Cancer Project (PACAP). The association between QoL and WOPS was assessed with logistic regression analyses. OS was evaluated using Kaplan-Meier curves with the log-rank tests and multivariable Cox proportional hazard analyses adjusted for clinical covariates and QoL.

RESULTS

Of 315 included patients, 111 patients underwent surgical resection, 138 received palliative systemic treatment, and 66 received BSC. Patients who underwent surgical resection had significantly lower WOPS scores (i.e., less FOP) at initial diagnosis compared to patients who received palliative systemic treatment or BSC only (P < 0.001). Better QoL was independently associated with the probability of having a low FOP in the BSC (OR 0.95, 95% CI 0.91-0.98) but not in the surgical resection (OR 0.97, 95% CI 0.94-1.01) and palliative systemic treatment groups (OR 0.97, 95% CI 0.94-1.00). The baseline WOPS score was not independently associated with OS in any of the subgroups.

CONCLUSION

Given the distress that FOP evokes, FOP should be explicitly addressed by health care providers when guiding pancreatic cancer patients through their treatment trajectory, especially those receiving palliative treatment or BSC.

The intrapersonal and interpersonal processes of fear of recurrence among cervical cancer survivors: a qualitative study

OBJECTIVE

Cervical cancer's emotional and mental toll often extends beyond the disease's duration. Fear of cancer recurrence has been identified as prominent in patients and survivors, yet there is a paucity of studies regarding this population. The present study sought to explore and expand the understanding of the meaning of fear of cancer recurrence among cervical cancer survivors.

METHODS

In this qualitative study, semi-structured interviews were conducted with 15 cervical cancer survivors. The interviewees' mean age was 41.33 years (range 34-47 years), and the mean time since diagnosis was 3.1 years (ranged from 0.5 to 7 years).

RESULTS

Three central themes emerged that represent intrapersonal and interpersonal processes: The first, "No longer resilient" refers to feelings of uncertainty in the face of the illness experienced on the intrapersonal level, where the interviewee mostly engaged with efforts to return to the "normal" state that existed before the cancer diagnosis. The second, "To be afraid in a dyad," relates to the interpersonal level that included mutual fears shared by the interviewee and her partner. The third "And what if the disease comes back and I die?" represents a combination of intrapersonal and interpersonal processes manifested by the greatest fear - death - expressed by both the interviewee and her partner.

CONCLUSIONS

The present findings revealed that the fear of cancer recurrence represents intrapersonal and interpersonal processes encompassing three factors - uncertainty, social-cognitive processing, and death anxiety. Accordingly, potential psycho-social treatment options could be tailored to specifically address the prominence of these factors for cervical cancer survivors.

Adjunctive Chinese Herbal Medicine Treatment is Associated With an Improved Survival Rate in Patients With Cervical Cancer in Taiwan: A Matched Cohort Study

Background

Cervical cancer is one of the most common cancers in Taiwan. Some patients take Chinese herbal medicine (CHM). However, very few current studies have ascertained the usage and efficacy of CHM in patients with cervical cancer. The aim of this study was to investigate the benefits of complementary CHM among patients with cervical cancer in Taiwan.

Methods

We included the newly diagnosed cervical cancer patients who were registered in the Taiwanese Registry for Catastrophic Illness Patients Database between 2000 and 2010. The end of follow-up period was December 31, 2011. Patients who were less than 20 years old, had missing information for age, withdrew from the National Health Insurance (NHI) program during the follow-up period, or only received other TCM interventions such as acupuncture or tuina massage were excluded from our study. After performing 1:1 frequency matching by age and index date, we enrolled 7521 patients in both CHM and non-CHM user groups. A Cox regression model was used to compare the hazard ratios (HRs) of the risk of mortality. The Kaplan-Meier curve was used to compare the difference in survival time.

Results

According to the Cox hazard ratio model mutually adjusted for CHM use, age, comorbidity, treatment, and chemotherapeutic agents used, we found that CHM users had a lower hazard ratio of mortality risk (adjusted HR = 0.29, 95%CI = 0.27-0.31). The survival probability was higher for patients in the CHM group. Bai-Hua-She-She-Cao (Herba Oldenlandiae, synonym Herba Hedyotis diffusae) and Jia-Wei-Xiao-Yao-San were the most commonly prescribed single herb and Chinese herbal formula, respectively.

Conclusions

Adjunctive CHM may have positive effects of reducing mortality rate and improving the survival probability for cervical cancer patients. Further evidence-based pharmacological investigations and clinical trials are warranted to confirm the findings in our study.

The Effect of Treatment on Quality of Life, Symptoms, and Social Life in Gynecologic Cancer Patients

This study was carried out to determine the effect of treatment on quality of life, symptoms, and social life in patients with gynecologic cancer. Data were collected through face-to-face interviews to evaluate the individual and disease characteristics of the patients. The Edmonton Symptom Assessment Scale was used to determine the severity of the side effects. Functional Assessment of Cancer Therapy-General 4 was used to evaluate the quality of life. The total post-treatment quality of life scores of the patients were lower than their total pre-treatment scores. Patients who received chemotherapy and chemoradiotherapy had a lower quality of life than those who received radiotherapy, and they were less involved in social activities. Half of the individuals participated in social activities in the pre-treatment period, but this rate decreased to 16.4% after the treatment started. In this study, the quality-of-life scores of the patients who received gynecologic cancer treatment decreased after treatment and the patients experienced many symptoms at an increasingly severe level.

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.

Relationship between illness perception, fear of progression and quality of life in interstitial lung disease patients: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to investigate whether fear of progression mediates the association between illness perception and quality of life among interstitial lung disease patients.

BACKGROUND

So far, the physiological treatment of interstitial lung disease is limited. In addition to immunosuppressants such as glucocorticoids, two anti-fibrosis drugs (pirfenidone and nintedanib) have shown moderately beneficial effects on slowing the progression of interstitial lung disease fibrosis. However, none of these drugs has shown reliable or strong beneficial effects on improving quality of life. Psychological care and mental health support strategies focusing on improving patients' quality of life are particularly important.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of patients suffering from interstitial lung disease were enrolled from August to December 2019. Data including sociodemographic and clinical characteristics, illness perception, fear of progression and quality of life were collected. The descriptive analysis and Pearson correlations were analysed by SPSS 26.0 (IBM Corp.). PROCESS v3.4 (by Andrew F. Hayes) macro was applied to analyse the mediating effects. We used the STROBE checklist to report the results.

RESULTS

Both illness perception and fear of progression were correlated with quality of life. Fear of progression mediated the association between illness perception and quality of life. The indirect effect was 0.121, and the proportion of intermediary effect in the main effect was 26.36%.

CONCLUSION

Interstitial lung disease patients experience relatively poor quality of life and fear of progression exerts a mediating role between illness perception and quality of life.

RELEVANCE TO CLINICAL PRACTICE

This study alerts medical staff to pay attention to negative illness perception and excessive fear, which is helpful to formulate effective interventions to manage interstitial lung disease patients' quality of life.

Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research

Objective: Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice. Inclusion Criteria: We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs. Methods and Analysis: The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings. Findings: After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty. Conclusion: While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted.

Symptom Clusters and Quality of Life in Cervical Cancer Patients Receiving Concurrent Chemoradiotherapy: The Mediating Role of Illness Perceptions

OBJECTIVES

Although studies shows that symptom clusters and illness perceptions are negatively associated with quality of life (QoL), it is unclear how these variables of cervical cancer patients who receive concurrent chemoradiotherapy (CCRT) relate to each other. This study aimed to identify the symptom clusters in cervical cancer patients who receive CCRT and evaluate the mediating effect of illness perceptions on the relationship between symptom clusters and QoL.

METHODS

A cross-sectional survey was conducted on 286 cervical cancer patients receiving CCRT from October 2019 to October 2020. M.D. Anderson Symptom Inventory, Brief Illness Perception Questionnaire, and Functional Assessment Cancer Therapy-Cervix were applied to investigate the symptom clusters, illness perceptions and QoL of the participants, respectively. Exploratory factor analysis was conducted to identify symptom clusters. The relationships among symptom clusters, illness perceptions, and QoL were analyzed with the structural equation modeling.

RESULTS

A total of four symptom clusters were identified, including psychological status symptom cluster, therapy side-effect symptom cluster, sickness symptom cluster, and gastrointestinal symptom cluster (χ² = 1,552.282, Df = 78, P < 0.001). Symptom clusters, illness perceptions, and QoL were significantly correlated. Symptom clusters had significant direct (β = -0.38, P < 0.001) and indirect effects (β = -0.21, P < 0.001) on QoL.

CONCLUSION

Illness perceptions played a significant mediating role between symptom clusters and QoL in cervical cancer patients receiving CCRT. Strategies like prompting effective symptom management for the purposes of alleviating illness perceptions may contribute to improving their QoL.

Life experiences and disease trajectories in women coexisting with ovarian cancer

OBJECTIVE

This study investigated the lived experiences of ovarian cancer survivors amid the disease trajectory and psychosocial adaptation.

MATERIALS AND METHODS

Twenty-one women, all of whom were ovarian cancer survivors, were recruited from medical centers in Taiwan. In-depth, face-to-face, semi-structured interviews were conducted and transcribed verbatim from audio recordings. The sample size was determined by information saturation during data collection. The steps of data process and analysis were performed using Giorgi's phenomenology.

RESULTS

Three themes and 12 subthemes were extracted: (1) a depressed state, as if facing a fierce enemy: being sentenced to a death penalty like facing an insurmountable challenge; contradictory information and helplessness; turnaround for treatment decision; and facing stigmatization from society; (2) shadow of cancer recurrence: side-effects of cancer treatment; falling into desperation and frustration; worrying about cancer recurrence; and continuing to fight cancer; (3) a change of mindset to move forward: experiencing changes in outlook on life; activating the self-healing process; coexisting with cancer and treating it as a chronic disease; and experiencing physical and mental purification and enhancement.

CONCLUSION

The conventional models caring for patients with ovarian cancer are based on disease and unable to meet their needs because the lengthy rehabilitation journey. Therefore, medical personnel should emphasize patients' medical autonomy and combine professional care and social resources to help patients developing adjustment strategies and establishing support systems in timely manner for body, mind, and soul of these patients.

The Effect of Art Therapy in Women with Gynecologic Cancer: A Systematic Review

OBJECTIVES

The purpose of this study was to evaluate the evidence of art therapy on the psychological outcome, quality of life (QOL), and cancer-related symptoms in women with gynecological cancer.

METHODS

A systematic literature search was conducted. The randomized controlled trials, quasiexperimental studies, case reports, and qualitative studies were all included.

RESULT

1,587 articles were retrieved. A total of 9 articles met the inclusion criteria. The existing studies provided initial evidence to suggest that art therapy may benefit gynecological cancer patients with respect to improving psychological outcome and QOL, reducing fatigue related to cancer, and improving subjective overall health condition. However, the quality of the current evidence limits the efficacy of these findings.

CONCLUSION

Research on art therapy of gynecologic cancer patients is insufficient. We cannot draw the conclusion that art therapy benefits gynecological cancer patients in the psychological outcome, QOL, and cancer-related symptoms. More rigorous research is needed.

Translation and validation of Taiwan Chinese version of the self-regulation questionnaire for gynecologic cancer survivors

OBJECTIVE

To culturally adapt the self-regulation questionnaire to the Taiwan Chinese version (TC-SRQ) and to evaluate its psychometric properties for gynecologic cancer survivors.

MATERIALS AND METHODS

A cross-sectional study was employed with a purposive sample of 287 gynecologic cancer survivors. The TC-SRQ was adapted from a Germany version through back-translation to ensure its quality. For construct validity, confirmatory factor analysis (CFA) was used to assess the TC-SRQ measurement model with fit indexes including the χ² test, the root mean square error of approximation (RMSEA), and the normed fit index (NFI), the comparative fit index (CFI), and non-normed fit indices (NNFI). For concurrent validity, the Taiwanese version of the European Organization for Research and Treatment of Cancer's 30-item core quality of life (EORTC QLQ-C30) questionnaire was used as a criterion measure for quality of life (QOL). Reliability was evaluated by internal consistency and test-retest reliability.

RESULTS

For a modified measurement model of TC-SRQ, the model fit (χ² = 311.23, P = .0; RMSEA = .088; NFI = .97, CFI = .98, NNFI = .97) was acceptable. The evidence of construct validity of TC-SRQ scale was confirmed by the model estimates. TC-SRQ correlated positively with the global QOL, physical, cognitive, emotional, and social functioning domains, and negatively with fatigue and pain domains of EORTC QLQ-C30. For known groups validity, TC-SRQ was correlated with groups attributed by age, family support, health status, and sleep quality. A Cronbach's α of .91 indicated good internal consistency; the test-retest reliability was .82.

CONCLUSIONS

TC-SRQ is a valid and reliable instrument for assessing self-regulation in gynecologic cancer survivors.