Social-cognitive processes associated with fear of recurrence among women newly diagnosed with gynecological cancers

Total Pain and Fear of Recurrence in Post-Treatment Cancer Patients: Serial Mediation of Psychological Flexibility and Mentalization and Gender Moderation

Background: The research indicates that painful experiences can significantly affect the fear of cancer recurrence among cancer survivors, which is a distressing concern that influences both physiological and psychological recovery. This cross-sectional study aims to advance our comprehension of the associations between total pain and the fear of recurrence in post-treatment cancer patients by examining two potential mediators: psychological flexibility and mentalization. Methods: Three hundred and thirty-five participants (aged 22 to 88, 49.1% female) who had finished their cancer treatment completed self-report assessments of total pain, their fear of recurrence, psychological flexibility, and mentalization. Results: The serial mediation analysis showed that all dimensions of total pain were positively and indirectly related to the fear of recurrence through psychological flexibility and mentalization in serial. Additionally, gender was found to moderate these serial mediational effects. Conclusions: In line with the psychological flexibility model, personal capacities to face difficult internal/external problems and interpret one's behavior in motivational terms can counterbalance a patient's negative emotions and feelings related to the illness. Gender factors also determine the way in which post-treatment cancer patients manage potential future anxiety and fears.

Cancer Fear, Emotion Regulation, and Emotional Distress in Patients With Newly Diagnosed Lung Cancer

BACKGROUND

Research related to newly diagnosed lung cancer patients' emotional regulation strategies and how these strategies influence their emotional distress is scarce.

OBJECTIVE

The aim of this study was to investigate the relationship between cancer fear, emotion regulation, and emotional distress in patients with newly diagnosed lung cancer.

METHOD

A cross-sectional, correlation research design was conducted, using self-report questionnaires: the Cancer Fear Scale, the Emotion Regulation Questionnaire, and the Hospital Anxiety and Depression Scale. A total of 117 newly diagnosed lung cancer patients were sampled.

RESULTS

Nearly 70% of newly diagnosed lung cancer patients had a high level of cancer fear; 56.4%, depression; and 45.3%, anxiety. Depression was positively associated with cancer fear ( r = 0.239, P < .01) and expressive suppression ( r = 0.185, P < .05), but negatively associated with cognitive reappraisal ( r = -0.323, P < .01). Anxiety was positively associated with cancer fear ( r = 0.488, P < .01) but negatively associated with cognitive reappraisal ( r = -0.214, P < .05). Cancer fear and cognitive reappraisal were significant explanatory factors and explained 25.2% of variance in anxiety. Cancer fear, expressive suppression, and cognitive reappraisal were significant explanatory factors and explained 16.7% of variance in depression.

CONCLUSIONS

Newly diagnosed lung cancer patients with cancer fear and who used fewer cognitive reappraisal strategies or more expressive suppression had more emotional distress.

IMPLICATIONS FOR PRACTICE

Clinicians should be attentive to patients' cancer fears and emotion regulation strategies as early as possible to prevent their emotional distress.

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.

Cancer-Related Dysfunctional Beliefs About Sleep Mediate the Influence of Sleep Disturbance on Fear of Progression Among Patients With Surgically Resected Lung Cancer

BACKGROUND

Lung cancer is associated with significant psychological distress, including fear of progression (FoP). Because insomnia and depression are highly prevalent and associated with FoP, we examined the association between FoP, insomnia, and depression in cancer patients. Furthermore, we tested the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS) on this association.

METHODS

We analyzed data collected from patients with surgically resected non-small cell lung cancer from a single-center randomized controlled study investigating digital healthcare applications. Baseline demographic and clinical variables were collected. In addition, self-reported questionnaires including the Fear of Progression Questionnaire-Short Form, Patients Health Questionnaire-9 items (PHQ-9), Insomnia Severity Index, and C-DBS were administered.

RESULTS

Among the 320 enrolled patients with lung cancer, a regression model showed that FoP was predicted by age (β = -0.13, P = 0.007), PHQ-9 (β = 0.35, P < 0.001), and C-DBS (β = 0.28, P < 0.001). Insomnia did not directly influence FoP, but C-DBS mediated the association. Depression directly influenced FoP, but C-DBS did not mediate this association.

CONCLUSION

Among patients with surgically resected lung cancer, C-DBS mediated the effects of severity of insomnia on FoP. Depression directly influenced FoP, but C-DBS did not influence this association. To reduce FoP among patients with lung cancer, C-DBS should be addressed in the cognitive behavioral therapy module.

Sense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study

BACKGROUND

Depression and anxiety symptoms are two common psychological disturbances in cervical cancer patients. We tested whether sense of coherence (SOC) mediates the association of perceived social support (PSS) with depression and anxiety symptoms among cervical cancer patients in China.

METHODS

We conducted a survey involving 294 cervical cancer patients aged ≥ 18 years from July to December 2020 at three hospitals in Liaoning Province, China; 269 patients completed the survey. We included a demographic questionnaire, the Multidimensional Scale of Perceived Social Support (MSPSS), Antonovsky's Sense of Coherence Scale, the Hamilton Depression Rating Scale, and the Zung Self-Rating Anxiety Scale (SAS) in this study. We used hierarchical regression analysis to examine the relationship among PSS, SOC, and symptoms of depression and anxiety. We used asymptotic and resampling strategies to explore the mediating effect of SOC.

RESULTS

PSS was negatively associated with depressive symptoms (r = - 0.439, P < 0.01) and anxiety symptoms (r = - 0.325, P < 0.01). SOC was negatively related to depressive symptoms (r = - 0.627, P < 0.01) and anxiety symptoms (r = - 0.411, P < 0.01). SOC partially mediated the association between PSS and depressive symptoms (a*b = - 0.23, BCa95% CI: [- 0.31, - 0.14]) and anxiety symptoms (a*b = - 0.15, BCa95% CI: [- 0.23, - 0.08]). The proportions of the mediating effect accounting for SOC were 49.78% and 41.73% for depressive symptoms and anxiety symptoms, respectively.

CONCLUSION

The study showed that SOC could mediate the association between PSS and symptoms of depression and anxiety. This suggests that SOC might serve as a potential target for intervention in symptoms of depression and anxiety that accompany cervical cancer.

Psychosocial predictors of fear of cancer recurrence in a cohort of gynecologic cancer survivors

OBJECTIVE

To describe fear of cancer recurrence in a cohort of women with gynecologic cancers and to identify psychosocial predictors of elevated fear of recurrence.

METHODS

Survey data from an ongoing cohort study of gynecologic cancer survivors were used (n = 154). Relationships between fear of cancer recurrence measured by the 6-item Cancer Worry Scale in the most recent survey and psychosocial factors (cancer-related distress, depression, anxiety, hopelessness, and posttraumatic growth) assessed 6-18 months prior were examined using univariate and multivariate linear regression models, adjusting for age, cancer stage, cancer type, and time since diagnosis.

RESULTS

Most participants were ≥60 years old, diagnosed with early-stage cancer, and 2-5 years post-diagnosis. The mean score on the Cancer Worry Scale was 10.31 (SD = 3.01), and 46 individuals (30.0%) scored ≥12, indicating high fear of recurrence. In univariate analyses, greater distress (p = 0.007), anxiety (p = 0.006), hopelessness (p = 0.007), and posttraumatic growth (p = 0.0006) were significantly associated with higher scores on the Cancer Worry Scale. The associations of hopelessness and posttraumatic growth with higher Cancer Worry Scale scores remained significant after adjustment for covariates.

CONCLUSIONS

Fear of recurrence is frequent among gynecologic cancer survivors. Women who reported more distress, hopelessness, anxiety and, surprisingly, more post-traumatic growth reported more fear. These results contribute to our understanding of which cancer survivors are most at risk of elevated fear of recurrence and highlight the importance of continued focus on psychosocial well-being among cancer survivors.

Fear of recurrence in elderly patients with coronary heart disease: the current situation and influencing factors according to a questionnaire analysis

Objective

Fear of recurrence is a common psychosocial sequela among patients with heart disease. Analyses of coronary heart disease, particularly in elderly patients, are relatively rare. This study aimed to investigate the current situation in this context, as well as the influencing fear factors concerning recurrence in elderly patients with coronary heart disease.

Methods

A total of 200 elderly outpatients with coronary heart disease were recruited to participate in this survey from a tertiary hospital in Baoding (China). The questionnaires included items from the Disease Progression Simplified Scale, the Simplified Coping Style Questionnaire, and the Social Support Rating Scale (SSRS). Univariate and multivariate regression analyses were adopted to investigate the influencing factors on the fear of recurrence.

Results

The fear of recurrence score in elderly patients with coronary heart disease was (38.46 ± 8.13), among which 119 cases (59.5%) scored higher than 34 points. The SSRS total average score was (34.89 ± 9.83) points. Positive coping style and social support were negatively correlated with the total score of recurrence fear (r =  − 0.621, − 0.413, both P < 0.001). There was a positive correlation between negative coping style and the total score of recurrence fear (r = 0.232, P < 0.001). Multiple linear regression analysis showed that the course of the disease, the number of disease recurrence cases, active coping, and social support were relevant factors in fear of recurrence (all P < 0.05).

Conclusion

The detection rate of fear of recurrence in elderly patients with coronary heart disease was relatively high but could be reduced by active interventions and enhancing social support.

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.

Social constraints and fear of recurrence among Chinese American breast cancer survivors: An exploration of psychosocial mediators

OBJECTIVE

Fear of cancer recurrence (FCR) is commonly experienced among Caucasian and Chinese American breast cancer survivors (BCS). Emerging studies have suggested that Caucasian BCS' communication with family members contributes to their FCR. However, whether such findings apply to Chinese American BCS has yet to be explored. This study examined the association between social constraints (i.e., perceived barriers from significant others inhibiting cancer-related disclosure) and FCR among 136 Chinese American BCS, plus proposed that self-stigma (i.e., internalized feelings of shame about having cancer), bodily pain, and ambivalence over emotional expression (AEE; conflict between the desire to express emotions and the fear of its consequences) would mediate the association.

METHODS

Participants recruited through cancer associations in the USA were invited to complete a cross-sectional survey measuring their socio-demographic/cancer-related variables and the above-mentioned psychological variables.

RESULTS

Higher levels of social constraints, AEE, self-stigma, and bodily pain were associated with higher FCR (rs ranged from 0.27 to 0.40, ps < 0.01). After controlling for covariates, path analysis results supported the proposed mediation model with satisfactory fit indices (χ² (7) = 2.08, Comparative Fit index = 1.00, Tucker Lewis Index = 1.08, Root Mean Square Error of Approximation = 0.00). Specifically, social constraints were associated with higher FCR through increased self-stigma (β = 0.10, 95% confidence interval [CI] = 0.02, 0.17), AEE (β = 0.14, 95% CI = 0.01, 0.27), and bodily pain (β = 0.09, 95% CI = 0.02, 0.17), indicating significant mediation effects. After considering the mediators, the direct effect from social constraints to FCR was no longer significant.

CONCLUSIONS

The association between social constraints and higher FCR could be mediated by increased self-stigma, AEE, and bodily pain among Chinese American BCS. Interventions targeting to address those variables may reduce FCR among those BCS.

OVPSYCH2: A randomized controlled trial of psychological support versus standard of care following chemotherapy for ovarian cancer

BACKGROUND

Fear of disease progression (FOP) is a rational concern for women with Ovarian Cancer (OC) and depression is also common. To date there have been no randomized trials assessing the impact of psychological intervention on depression and FOP in this patient group.

PATIENTS AND METHODS

Patients with primary or recurrent OC who had recently completed chemotherapy were eligible if they scored between 5 and 19 on the PHQ-9 depression and were randomized 1:1 to Intervention (3 standardized CBT-based sessions in the 6-12 weeks post-chemotherapy) or Control (standard of care). PHQ-9, FOP-Q-SF, EORTC QLQ C30 and OV28 questionnaires were then completed every 3 months for up to 2 years. The primary endpoint was change in PHQ-9 at 3 months. Secondary endpoints were change in other scores at 3 months and all scores at later timepoints.

RESULTS

182 patients registered; 107 were randomized; 54 to Intervention and 53 to Control; mean age 59 years; 75 (70%) had completed chemotherapy for primary and 32 (30%) for relapsed OC and 67 patients completed both baseline and 3-month questionnaires. Improvement in PHQ-9 was observed for patients in both study arms at three months compared to baseline but there was no significant difference in change between Intervention and Control. A significant improvement on FOP-Q-SF scores was seen in the Intervention arm, whereas for those in the Control arm FOP-Q-SF scores deteriorated at 3 months (intervention effect = -4.4 (-7.57, -1.22), p-value = 0.008).

CONCLUSIONS

CBT-based psychological support provided after chemotherapy did not significantly alter the spontaneously improving trajectory of depression scores at three months but caused a significant improvement in FOP. Our findings call for the routine implementation of FOP support for ovarian cancer patients.

Is patient participation in multidisciplinary tumor conferences associated with their fear of progression?

PURPOSE

Previous studies found that some breast cancer patients in Germany are invited to participate in a multidisciplinary tumor conference (MTC) during the discussion of their own case. MTCs are regular meetings of a treatment team in which the diagnosis and treatment plan of cancer patients are discussed. Psychological consequences concerning the patients' participation in an MTC have not been examined yet. This study examines the association between patients' participation in MTC and patients' fear of progression (FoP).

METHODS

This analysis is part of a larger project named "Patient participation in multidisciplinary tumor conferences in Breast Cancer Care" (PINTU) which is a multicenter observational mixed-methods study. The study was conducted in six breast and gynecological cancer centers in North Rhine-Westphalia, Germany. Data were collected from 2018 to 2020 by patient survey at three time points. Patients with (n = 81) and without (n = 120) MTC participation were compared. FoP was measured with a 12-item short form of the FoP Questionnaire (FoP-Q-SF) at all three measurement time points. Data analysis included descriptive statistics, a one-way repeated variance analysis (ANOVA), and a one-way repeated ANCOVA using the propensity score as a covariate.

RESULTS

Data of n = 201 patients were included in the analysis. In general, FoP scores decreased in both groups from T0 to T2 (F = 36.539, p < 0.001, η²  = 0.155). Non-participating patients did not differ with regard to their FoP from patients who participated in an MTC before and after participation. The results of AN(C)OVA revealed no significant effects concerning the influence of patient participation in an MTC on FoP (F = 0.014, p = 0.907, η² = <0.001 and (F = 0.013, p = 0.909, η² = <0.001).

CONCLUSION

Since the FoP is not influenced by participation, the findings do not support recommendations for or against patient participation in an MTC. Further research should focus on the question of which patient groups might benefit from participation in an MTC with regard to which outcome variables.

Clusters of Psychological Symptoms in Breast Cancer: Is There a Common Psychological Mechanism?

BACKGROUND

Breast cancer patients tend to experience numerous concurrent psychological symptoms that form clusters. It has been proposed that a common psychological mechanism may underlie the membership of symptoms in a given cluster, but this hypothesis has never been investigated. Maladaptive emotion regulation (ER) is one possible common mechanism.

OBJECTIVE

This study examined cross-sectional and prospective relationships between subjective (experiential avoidance, expressive suppression, and cognitive reappraisal) and objective (high-frequency heart rate variability) measures of ER and clusters of psychological symptoms among women receiving radiation therapy for breast cancer.

METHOD

A total of 81 women completed a battery of self-report scales before (T1) and after (T2) radiotherapy, including measures of anxiety, depression, fear of cancer recurrence, insomnia, fatigue, pain, and cognitive impairments. Resting high-frequency heart rate variability was measured at T1.

RESULTS

Latent profile analyses identified between 2 and 3 clusters of patients with similar levels of symptoms at T1 and T2 and with a similar profile of symptom changes between T1 and T2. Discriminant analyses showed that higher levels of avoidance and suppression predicted membership in symptom clusters that included more severe symptoms cross-sectionally at T1 and at T2 (both P values < .0001). However, ER at T1 did not significantly predict membership in clusters of symptom changes between T1 and T2 (P = .15).

CONCLUSION

Maladaptive ER strategies, more particularly suppression and avoidance, are a possible psychological mechanism underlying clusters of cancer-related psychological symptoms.

IMPLICATIONS FOR PRACTICE

Psychological interventions targeting maladaptive ER strategies have the potential to treat several psychological symptoms simultaneously.

Worse patient-physician relationship is associated with more fear of cancer recurrence (Deimos Study): A study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

OBJECTIVE

Fear of cancer recurrence (FCR) is an important psychological trauma associated with reduction in the quality of life, disruptions in the level of adjustment, emotional distress and anxiety. The purpose of the study was to evaluate the impact of patient-physician relationship on FCR.

METHODS

The study was designed as a multicentre survey study. The cancer survivors, who were under remission, were evaluated with structured questionnaires. Patient-physician relationship (PPR) scale in which higher scores indicate better relationship and FCR inventory was used.

RESULTS

Between January and April 2019, 1,580 patients were evaluated. The median age was 57.0 (19-88), and 66% were female. There was high level of FCR scores in 51% of participants. There was a negative correlation between PPR and FCR scores (r = -.134, p < .001). In multivariate analysis, young age, female gender, history of metastasectomy and worse PPR were associated with high levels of FCR.

CONCLUSION

It is the first data showing the adverse impact of worse PPR on FCR. The strategies to improve the PPR should be practised. In addition, the cancer survivors, who are under the risk of FCR, should be evaluated and managed.

The course and predictors of perceived unsupportive responses by family and friends among women newly diagnosed with gynecological cancers

Perceived unsupportive responses from close others play an important role in psychological adaptation of patients with cancer. Little is known about whether these negative responses change after someone experiences a serious life event, and even less is known about the individual characteristics and related factors that might contribute to both the levels of and changes in perceived unsupportive responses over the course of adaptation to an experience. This longitudinal study aimed to evaluate changes in perceived unsupportive behavior from family and friends among women newly with gynecologic cancer as well as initial demographic, disease, and psychological factors that predict the course of perceived unsupportive behavior over time. Women (N = 125) assigned to the usual care arm of a randomized clinical trial comparing a coping and communication intervention with a supportive counseling intervention to usual care completed six surveys over an 18 month period. Growth models using multilevel modeling were used to predict unsupportive responses over time. Average levels of perceived unsupportive responses from family and friends were low. Unsupportive responses varied from patient to patient, but patients did not report a systematic change in perceived unsupportive responses over time. Cultivating meaning and peace and coping efficacy were associated with fewer perceived unsupportive responses as well as reductions in perceived unsupportive responses over time. Emotional distress, cancer concerns, functional impairment, holding back sharing concerns, and cognitive and behavioral avoidance predicted higher perceived unsupportive responses over time. The findings are discussed in terms of the self-presentation theory and social network responses to persons undergoing difficult life events.

Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates

BACKGROUND

Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses.

METHODS

We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained.

RESULTS

There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features.

CONCLUSIONS

The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.

An examination of the relationship of patient modifiable and non-modifiable characteristics with fear of cancer recurrence among colorectal cancer survivors

PURPOSE

Fear of cancer recurrence (FCR) is one of the most common and distressing issues affecting cancer survivors. This study examined (1) the association between modifiable cognitive, behavioral, and social characteristics and FCR, (2) the association between non-modifiable characteristics and FCR, and (3) the relative contributions of modifiable and non-modifiable characteristics to FCR.

METHODS

Participants (n = 120) had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months. Participants completed self-report measures of modifiable cognitive (e.g., beliefs about worry), behavioral (e.g., health-related reassurance seeking), and social (e.g., social constraints) characteristics. Non-modifiable characteristics (e.g., age, disease severity) were assessed via self-report and medical record review.

FINDINGS

Modifiable (i.e., perceived risk, self-efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking, social constraints) and non-modifiable (i.e., age, gender, disease severity, neuroticism, conscientiousness) characteristics were associated with FCR (p's < .05). Hierarchical linear regression analyses demonstrated that modifiable characteristics accounted for an additional 15% of the variance (p < .001) beyond that accounted for by non-modifiable characteristics (R² = .45, p < .001), with perceived risk (B = .35) and health-related reassurance seeking (B = .22) emerging as significant predictors of FCR (p's < .05).

IMPLICATIONS

Results identify non-modifiable characteristics that may serve as risk factors for greater FCR and identify specific modifiable characteristics (i.e., perceived risk, health-related reassurance seeking) to be targeted by interventions to reduce FCR among cancer survivors.

A qualitative approach in determining the patient-centered information and supportive care needs of cancer patients in Singapore

OBJECTIVES

To qualitatively interpret the information and supportive care needs perceived by cancer patients undergoing treatment in order to get a deeper appreciation of patients' needs and concerns. The intended outcome is to provide baseline knowledge for improving patient-centred strategies to better meet the information and supportive needs of patients.

DESIGN

A qualitative research approach, based on conventional content analysis, was used throughout the research process. The three open-ended questions obtained from a previous quantitative study guided the researchers to explore the information and supportive care needs of patients. Data from patients' responses were analysed and coded in themes.

PARTICIPANTS AND SETTING

Patients attending the Ambulatory Treatment Unit of the National Cancer Centre Singapore were invited to participate in the study. We determined from these subjects the type of information that cancer patients need, and to measure the extent to which these information needs are met by measuring patients' level of satisfaction. Included in the quantitative study were three open-ended questions designed to gain a deeper understanding of their needs and concerns. All subjects were aged 21 years and above and able to understand and communicate in English/Mandarin. They were also aware of their diagnosis, they were not cognitively impaired and were not at the end-of-life situation.

RESULTS

A variety of information and supportive care needs were identified, and three specific areas of concerns were identified: (1) psychosocial and supportive care needs, (2) information needs and (3) information delivery by professionals.

CONCLUSION

The information and supportive care needs expressed were consistent with issues of cancer patients undergoing treatment. The strategies to improve patients' coping abilities through patient-centred care are discussed. Further studies assessing the barriers of information provision by healthcare professionals should provide more detailed knowledge about unmet information needs.

A Study on the Psychological Factors Affecting the Quality of Life Among Ovarian Cancer Patients in China

PURPOSE

We aim to test whether resilience mediates the association of fear of progression (FoP) with quality of life (QoL) among ovarian cancer patients in China.

METHODS

We collected 230 questionnaires from the First Affiliated Hospital of China Medical University in Liaoning Province, and 209 completed the questionnaire survey. The survey instrument consisted of four questionnaires: a sociodemographic and clinical characteristics questionnaire, the Functional Assessment of Cancer Therapy general instrument, the Fear of Progression Questionnaire-Short Form and the Connor-Davidson Resilience Scale. Hierarchical regression analysis was used to examine the relationship among FoP, resilience, and QoL, including physical well-being, social well-being, emotional well-being, and functional well-being. We used asymptotic and resampling strategies to examine the indirect effect of resilience.

RESULTS

FoP was negatively associated with resilience (r=-0.543, P<0.01) and QoL (physical well-being: r=-0.537, P<0.01; social well-being: r=-0.426, P<0.01; emotional well-being: r=-0.487, P<0.01; functional well-being: r=-0.529, P<0.01). Resilience was positively related with QoL (physical well-being: r=0.449, P<0.01; social well-being: r=0.548, P<0.01; emotional well-being: r=0.430, P<0.01; functional well-being: r=0.655, P<0.01). Resilience partly mediated the association between FoP and physical well-being (a×b=-0.05, BCa 95% CI: -0.09, -0.02), social well-being (a×b=-0.21, BCa 95% CI: -0.29, -0.14), emotional well-being (a×b=-0.05, BCa 95% CI: -0.08, -0.02), and functional well-being (a×b=-0.24, BCa 95% CI: -0.32, -0.17). The proportion of the mediating effect accounted for by resilience were 22.57%, 57.22%, 26.02%, 53.42% for physical well-being, social well-being, emotional well-being and functional well-being, respectively.

CONCLUSION

The study showed that resilience could mediate the association between fear of progression and quality of life. It suggests that resilience might provide a potential target for intervention in quality of life with ovarian cancer.

Screening for fear of cancer recurrence: Instrument validation and current status in early stage lung cancer patients

BACKGROUND

Fear of cancer recurrence (FCR) is one of the most distressing concerns for cancer patients. A psychometrically validated brief scale is urgently needed for use in busy clinical oncology settings. This study aimed to (1) develop and validate the 7-item fear of cancer recurrence scale Chinese version (FCR7-C), and (2) explore the severity of FCR in post-operative early-stage lung cancer patients in Taiwan.

METHODS

Early-stage lung cancer patients were recruited from a medical center in Taiwan. The FCR7-C was evaluated for content and construct validity and internal consistency reliability. Construct validity of FCR7-C was determined by the empirically supported correlation and confirmatory factor analysis (CFA).

RESULTS

A total of 160 subjects were recruited. The FCR7-C was shown to have satisfactory content validity and internal consistency reliability (Cronbach's α = 0.9). The uni-dimensional structure was confirmed by CFA that showed a good fit for the model. The FCR7-C score correlates positively with the degree of most of the physical symptoms, anxiety, and depression, but correlates negatively with patient age, performance status, and quality of life. We found that 81.9% of patients reported at least some FCR, with a mean FCR severity of 15.18 (SD = 7.78).

CONCLUSION

FCR7-C is a brief screening tool with good psychometrics. Patients with early-stage lung cancer still revealed mild to moderate level of FCR. Applying the FCR7-C for to screen cancer patients' distress and further develop personalized psychological interventions would be strongly suggested.

The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD

Anxiety is a highly prevalent psychological comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has detrimental effects on pulmonary rehabilitation (PR) outcomes. It has been suggested that disease-specific fears could play an even more important role in COPD patients' disease progression. However, little is known about how different disease-specific fears impact COPD. This study examined how different disease-specific fears relate to different PR outcome measures in COPD patients and how these relationships evolve over the course of PR. Before and after a 3-week inpatient PR program, COPD patients (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Disease-specific fears (fear of physical activity, fear of dyspnea, fear of disease progression, fear of social exclusion) were assessed with the COPD-Anxiety-Questionnaire-Revised. Health-related quality of life (HQoL), COPD health status, dyspnea in daily life, depression, and anxiety were measured using validated questionnaires. Multiple regression showed that greater disease-specific fears at the start of PR were associated with worse functional exercise capacity, HQoL, health status, and depression at the start and end of PR (controlling for age, sex, lung function, smoking status, and general anxiety). Patients who showed a stronger decrease in disease-specific fears improved more in PR outcome measures over the course of PR. Furthermore, different disease-specific fears were related to different PR outcome measures. The results show that disease-specific fears are associated with treatment outcome measures, both cross-sectionally and prospectively. Therefore, disease-specific fears should be addressed in COPD patients as they might play a significant role in disease progression.

Is emotion regulation associated with cancer-related psychological symptoms?

OBJECTIVES

This study examined the cross-sectional and prospective relationships between subjective (cognitive reappraisal, expressive suppression and experiential avoidance) and objective (high-frequency heart rate variability [HF-HRV]) measures of emotion regulation (ER) and a set of psychological symptoms (anxiety, depression, fear of cancer recurrence [FCR], insomnia, fatigue, pain, and cognitive impairments) among women receiving radiation therapy for non-metastatic breast cancer.

DESIGN

Eighty-one participants completed a battery of self-report scales within 10 days before the start of radiotherapy (T1) and within 10 days after its end (T2; approximately 6 weeks after T1). HF-HRV at rest was measured at T1.

RESULTS

Canonical correlation analyses revealed that higher levels of experiential avoidance and expressive suppression were cross-sectionally associated with higher levels of all symptoms, except pain, at T1 and at T2 (both p's < 0.0001). Higher levels of suppression and reappraisal at T1 were marginally associated with reduced FCR and with increased depression and fatigue between T1 and T2 (p = 0.07). HF-HRV was not associated with symptoms cross-sectionally or prospectively.

CONCLUSIONS

Although preliminary, these results are consistent with the hypothesis that maladaptive ER strategies, assessed subjectively, may cross-sectionally act as a transdiagnostic mechanism underlying several cancer-related psychological symptoms.

Quality of Life and PTSD Symptoms, and Temperament and Coping With Stress

Due to advances in medicine, a malignant neoplasm is a chronic disease that can be treated for a lot of patients for many years. It may lead to profound changes in everyday life and may induce fear of life. The ability to adjust to a new situation may depend on temperamental traits and stress coping strategies. The research presented in this paper explores the relationships between quality of life, PTSD symptoms, temperamental traits, and stress coping in a sample of patients diagnosed with cancer. One hundred and twenty nine participants aged 24-81 years, 69 females diagnosed with breast cancer and 60 males diagnosed with lung cancer completed Formal Characteristics of Behavior - Temperament Inventory, Coping Inventory for Stressful Situations, PTSD Inventory, and Quality of life SF-36 questionnaire. Higher level of emotional reactivity and higher level of perseveration was associated with lower emotional quality of life. Higher level of emotion oriented-coping and higher level of avoidant-distracted coping was associated with higher level of PTSD symptoms. Emotion-oriented coping and avoidant-distracted coping are ineffective in dealing with stress in the case of patients diagnosed with cancer, because they are associated with a higher level of PTSD symptoms. The significance of temperamental traits for quality of life in the situation of the patients is marginal. Control of specific factors concerned with current health and treatment status is needed the future research.

Quality of life in cancer as a function of temperament, coping and posttraumatic stress disorder

The research presented in this paper explores the relationship between three blocks of explaining variables, ie. temperamental traits, stress coping PTSD and the explained variable which is quality of life in a sample of patients diagnosed with cancer. One hundred and twenty nine participants aged 24–81 years, 69 females diagnosed with breast cancer and 60 males diagnosed with lung cancer completed Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI), Coping Inventory for Stressful Situations (CISS), PTSD Inventory (PTSD-C) and Quality of life SF-36 questionnaire. Higher level of emotional reactivity was associated with lower emotional quality of life. Higher level of emotion oriented-coping and higher level of avoidant-distracted coping was associated with higher level of intrusion/arousal and avoidance/numbing, ie. dimensions of PTSD symptoms. There were no statistically significant associations between temperamental traits and stress coping strategies nor between PTSD symptoms level and quality of life. Emotion-oriented coping and avoidant-distracted coping are ineffective in dealing with stress in the situation of patients diagnosed with cancer, because it leads to higher level of PTSD symptoms. The significance of temperamental traits for quality of life in the situation of the patients is marginal. Control of specific factors concerned with current health and treatment status is needed the future research.

Acceptance, social support, benefit-finding, and depression in women with gynecological cancer

PURPOSE

Although studies have demonstrated a protective role for benefit finding in psychological distress, little is known about how benefit finding leads to lower psychological distress. This study's goal was to use a multiple mediator model to evaluate whether the effect of benefit-finding on depression was mediated by acceptance of cancer, acceptance of emotions, and received social support.

METHODS

One hundred seventy-four women recently diagnosed with gynecological cancer completed measures of perceived benefits from the cancer experience, acceptance-based strategies, social support, and depression. Using a cross-sectional approach, we analyzed a multiple mediator model with benefit-finding as the independent variable, depressive symptom severity as the outcome, and acceptance-based strategies and social support as mediators.

RESULTS

Acceptance-based strategies and social support significantly mediated the relationship between benefit-finding and depression. Emotional acceptance had the strongest mediational effect, controlling for the other two mediators.

CONCLUSIONS

Helping women diagnosed with gynecological cancers identify benefits from their cancer experience may reduce depression by paving the way for them to accept their emotional reactions, accept life changes associated with cancer, and facilitate supportive reactions from family and friends. Future longitudinal research is needed to confirm whether gynecological cancer patients who perceive more benefits will feel less depressed later.

Fear of Progression in Cancer Patients and Survivors

Fear of progression (or fear of recurrence) is an appropriate, adequate response to the real threat of cancer. However, elevated levels of fear of progression can become dysfunctional, affecting well-being, quality of life, and social functioning. Research has shown that fear of progression is one of the most frequent distress symptoms of patients with cancer. As a clear consensus concerning clinically relevant states of fear of progression is still lacking, it is difficult to provide a valid estimate of the rate of cancer patients who clearly suffer from fear of progression. Current evidence suggests that probably 50% of cancer survivors experience moderate to severe fear of progression. Furthermore, many patients express unmet needs in dealing with the fear of cancer spreading. These results underscore the need to provide effective psychological treatments for clinical states of fear of progression. Some psychosocial interventions for treating fear of progression have been developed. Our own, targeted intervention study showed that clinical fear of progression can be effectively treated with brief group therapy.

Relationship Between Depressive Symptoms and Social Cognitive Processing in Partners of Long-Term Breast Cancer Survivors

PURPOSE/OBJECTIVES

To determine (a) if depressive symptoms in partners of long-term breast cancer survivors (BCSs) could be predicted by social cognitive processing theory and (b) if partners of younger and older BCSs were differentially affected by the cancer experience.
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DESIGN

A cross-sectional, descriptive study using self-report questionnaires.
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SETTING

Indiana University in Bloomington and 97 ECOG-ACRIN Cancer Research Group sites in the United States.
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SAMPLE

508 partners of BCSs diagnosed three to eight years prior to the study. 
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METHODS

Secondary data mediation analyses were conducted to determine if cognitive processing mediated the relationship between social constraints and depressive symptoms. Age-related differences on all scales were tested.
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MAIN RESEARCH VARIABLES

Depressive symptoms; secondary variables included social constraints, cognitive processing (avoidance and intrusive thoughts), and potentially confounding variables.
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FINDINGS

Cognitive processing mediated the relationship between social constraints and depressive symptoms for partners. Partners of younger BCSs reported worse outcomes on all measures than partners of older BCSs.
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CONCLUSIONS

As predicted by the social cognitive processing theory, cognitive processing mediated the relationship between social constraints and depressive symptoms. In addition, partners of younger BCSs fared worse on social constraints, intrusive thoughts, and depressive symptoms than partners of older BCSs. 
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IMPLICATIONS FOR NURSING

Results provide support for using the social cognitive processing theory in an intervention design with partners of long-term BCSs to decrease depressive symptoms.

The relationship between holding back from communicating about breast concerns and anxiety in the year following breast biopsy

PURPOSE

Evidence suggests open communication about breast cancer concerns promotes psychological adjustment, while holding back can lead to negative outcomes. Little is known about the relationship between communication and distress following breast biopsy. Design/ Sample: Women (N = 128) were assessed at the time of breast biopsy and again one week and three, six, and 12 months post-result.

METHODS

Linear mixed modeling examined relationships between holding back and anxiety for women with benign results (n = 94) or DCIS/invasive disease (n = 34) following breast biopsy.

FINDINGS

Anxiety increased among women with a benign result engaging in high but not low or average levels of holding back. Holding back was positively associated with anxiety post-result in breast cancer survivors, with anxiety decreasing over time. Conclusions/ Implications: Interventions to enhance communication are warranted, and knowledge of the differences among women with benign results and/or DCIS/invasive disease may allow for the development of tailored interventions.

Fear of cancer recurrence and its predictors among cervical cancer survivors

Objective

To identify the characteristics of fear of cancer recurrence (FCR) in cervical cancer survivors (CCSs) and investigate the relationship of FCR with demographic and medical characteristics, level of quality of life (QOL), and psychological distress. We also aimed to determine the predictors of FCR.

Methods

The short version of the Fear of Progression Questionnaire (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-Cervical (FACT-Cx) questionnaire were administered to 699 CCSs who had complete treatment at Songklanagarind Hospital between 2006 and 2016. Analysis was performed to determine potential predictors associated with FCR.

Results

Among the 12 items of the FoP-Q-SF, the 3 greatest fears were 1) worrying about what would happen to their family; 2) being afraid of pain; and 3) fear of disease progression. The prevalences of anxiety and depression disorder were 20.46% and 9.44%, respectively. CCSs who had FCR at the 5th quintile were more likely to have medical co-morbidities, low FACT-Cx scores in all domains and a high HADS scores (anxiety and depression disorder). Multivariate analysis showed that only anxiety disorder (odds ratio [OR]=4.99; p<0.001) and low FACT-Cx score (total) (OR=6.14; p<0.001) were identified as independent predictors for FCR at the 5th quintile.

Conclusion

FCR is an important problem in cervical cancer which should be addressed during post-treatment care. Only anxiety disorder and low QOL were independently associated with high FCR.

Traumatic exposure and posttraumatic stress disorder among flood victims: Testing a multiple mediating model

A total of 187 flood victims from Wuhu, a Chinese city affected most severely by a flood during July 2016, were selected to complete self-report measures of traumatic exposure, feelings of safety, fear, posttraumatic negative cognition, and posttraumatic stress disorder. The results found that traumatic exposure could directly predict posttraumatic stress disorder. Besides, traumatic exposure had indirect prediction on posttraumatic stress disorder through three ways, including a one-step path of negative self-cognition, a two-step path from feelings of safety to fear, and a three-step path from feelings of safety to negative self-cognition via fear. Implications and future directions are correspondingly discussed.

New insights into frequency and contents of fear of cancer progression/recurrence (FOP/FCR) in outpatients with colorectal carcinoma (CRC) receiving oral capecitabine: a pilot study at a comprehensive cancer center

BACKGROUND

Fear of cancer progression/recurrence (FOP/FCR) is considered one of the most prevalent sources of distress in cancer survivors and associated with lower quality of life and functional impairment. Detailed measures of FOP/FCR are needed because little is known about the knowledge of FOP/FCR, its associations with the patient-doctor relationship, and the rate of adequate therapy. Colorectal cancer (CRC) is one of the most prevalent cancer entities, and oral capecitabine is widely prescribed as treatment. Therefore, we initiated a pilot study to expand the literature on FOP/FCR in CRC outpatients receiving capecitabine and to generate hypotheses for future investigations.

METHODS

This study included 58 patients treated at a comprehensive cancer center. FOP/FCR was assessed with the Fear of Progression Questionnaire (FOP-Q-SF). Satisfaction with the relationships with doctors was assessed with the Patient-Doctor Relationship Questionnaire-9 (PRDQ-9). Levels of side effects were rated by the patients on a visual analog scale. Clinical data were extracted from the charts.

RESULTS

A total of 19 out of 58 patients (36%) suffered from FOP/FCR according to our assessment. Levels of FOP/FCR seemed to be mostly moderate to high. Only four out of the 19 distressed patients (21%) were treated accordingly. Typical side effects of oncological treatment were associated with higher FOP/FCR. Satisfaction with doctor-patient relationships was not associated with FOP/FCR. Regarding single items of FOP/FCR, three out of the five most prevalent fears were associated with close relatives.

DISCUSSION

FOP/FCR occurred frequently in more than one in three patients, but was mostly untreated in this sample of consecutive outpatients with CRC receiving oral capecitabine. In detail, most fears were related to family and friends. In addition to an unmet need of patients, our data indicate sources of distress not considered thus far. If replicated in larger studies, results may help to inform intervention development and improve patient care.

Resilience, Positive Coping, and Quality of Life Among Women Newly Diagnosed With Gynecological Cancers

BACKGROUND

Resilience has been linked to psychological adaptation to many challenging life events.

OBJECTIVE

The goal was to examine 3 coping strategies--expressing positive emotions, positive reframing of the cancer experience, and cultivating a sense of peace and meaning in life--as potential mechanisms by which resilience translates to quality of life among women recently diagnosed with gynecological cancer.

METHODS

This cross-sectional study utilized baseline data from women diagnosed with gynecological cancer participating in an ongoing randomized clinical trial (n = 281; mean age, 55 years; 80% were white). Participants completed measures of resilience, positive emotional expression, positive reappraisal, cultivating a sense of peace and meaning, and quality of life. Univariate and multiple mediation analyses were conducted.

RESULTS

Greater resilience was related to higher quality of life (P < .001). Multiple mediation analyses indicated that the coping strategies, as a set, accounted for 62.6% of the relationship between resilience and quality of life. When considered as a set, cultivating a sense of peace and meaning had the strongest indirect effect (b = 0.281, SE = 0.073, P < .05).

CONCLUSION

The findings suggested that resilient women may report higher quality of life during gynecological cancer diagnosis because they are more likely to express positive emotions, reframe the experience positively, and cultivate a sense of peace and meaning in their lives.

IMPLICATIONS FOR PRACTICE

Interventions promoting a sense of purpose in one's life and facilitating expression of positive emotions may prove beneficial, particularly for women reporting higher levels of resilience.

Therapy processes, progress, and outcomes for 2 therapies for gynecological cancer patients

OBJECTIVE

Although a number of effective psychotherapies have been identified for cancer patients, little is known about therapy processes, as they unfold the course of treatment and the role of therapy processes in treatment outcome. We used growth curve modeling to evaluate the associations between therapy processes and outcomes among gynecological cancer patients participating in 2 types of therapy.

METHODS

Two hundred twenty five women newly diagnosed with gynecological cancer were randomly assigned to receive 8 sessions of a coping and communication intervention or a client-centered supportive therapy. Participants completed measures of preintervention and postintervention depression, working alliance after Session 2, and postsession progress and depressive symptoms after each session. Therapists completed measures of perceived patient progress.

RESULTS

Both patients and therapists reported a steady increase in session progress and patients reported a steady decrease in depressive symptoms over the course of both the coping and communication intervention and client-centered supportive sessions. Perceived progress in one session predicted progress in the subsequent session. Early working alliance predicted improved session progress and reductions in postsession depressive symptoms over sessions. Working alliance did not predict prepost treatment changes in depression. Patient-rated session progress predicted greater reductions in pretreatment to posttreatment depression, but therapist-rated progress did not.

CONCLUSIONS

For 2 types of treatment delivered to women diagnosed with gynecological cancer, patient-rated session progress and depressive symptoms rated over therapy sessions may serve as a yardstick that can be useful to therapists to gauge patient's response to treatment.

Quality of life trajectories after diagnosis of gynecologic cancer: a theoretically based approach

PURPOSE

The course of quality of life after diagnosis of gynecologic cancer is not well understood. We aimed to identify subgroups of gynecologic cancer patients with distinct trajectories of quality of life outcomes in the 18-month period after diagnosis. We also aimed to determine whether these subgroups could be distinguished by predictors derived from Social-Cognitive Processing Theory.

METHODS

Gynecologic cancer patients randomized to usual care as part of a psychological intervention trial (NCT01951807) reported on depressed mood, quality of life, and physical impairment soon after diagnosis and at five additional assessments ending 18 months after baseline. Clinical, demographic, and psychosocial predictors were assessed at baseline, and additional clinical factors were assessed between 6 and 18 months after baseline.

RESULTS

A two-group growth mixture model provided the best and most interpretable fit to the data for all three outcomes. One class revealed subclinical and improving scores for mood, quality of life, and physical function across 18 months. A second class represented approximately 12 % of patients with persisting depression, diminished quality of life, and greater physical disability. Membership of this high-risk subgroup was associated with holding back concerns, more intrusive thoughts, and use of pain medications at the baseline assessment (ps < .05).

CONCLUSIONS

Trajectories of quality of life outcomes were identified in the 18-month period after diagnosis of gynecologic cancer. Potentially modifiable psychosocial risk factors were identified that can have implications for preventing quality of life disruptions and treating impaired quality of life in future research.

Group-based trajectory modeling of fear of disease recurrence among women recently diagnosed with gynecological cancers

OBJECTIVE

Fear of cancer recurrence is an important clinical phenomenon and is associated with decrements in life domains. The study goals were to characterize patterns of global fear of recurrence (FOR) and 4 domains of fear (health, role, womanhood, and death worry) over time in women who were diagnosed with gynecological cancer and to identify demographic, medical, and psychological predictors of FOR.

METHOD

One hundred eighteen women participating in the usual care arm of a randomized trial completed the Concerns about Recurrence scale as well as measures of depressive symptoms, cancer-specific distress, coping, coping efficacy, and social network responses at 4 time points. The majority of the sample was diagnosed with stage 3 ovarian cancer.

RESULTS

Group-based trajectory modeling identified subgroups of women with high-stable (49.1%), high-decreasing (25.3%), and low-stable (25.5%) trajectories for global FOR. For role worries, 3 similar group trajectories were identified. For health worries, modeling identified subgroups with high-decreasing (19.1%) and low-increasing (80.9%) trajectories. For womanhood worries, modeling identified subgroups with high-increasing (15.7%) and low-decreasing (84.2%) trajectories. Young age, metastatic cancer, depression, cancer distress, holding back, and lower coping efficacy were associated with the high-stable global FOR and at least 1 domain of FOR.

CONCLUSION

Almost half of the women recently diagnosed with gynecological cancer evidence persistently elevated FOR over the 6-month period postdiagnosis. Psychological interventions to reduce FOR may be more effective if they focus on teaching patients coping skills, as well as greater comfort expressing cancer-specific concerns to others.

Avoidant coping and self-efficacy mediate relationships between perceived social constraints and symptoms among long-term breast cancer survivors

OBJECTIVE

Many breast cancer survivors feel constrained in discussing their cancer experience with others. Limited evidence suggests that social constraints (e.g., avoidance and criticism) from loved ones may negatively impact breast cancer survivors' global health, but research has yet to examine relationships between social constraints and common physical symptoms. Informed by social cognitive processing theory, this study examined whether perceived social constraints from partners and healthcare providers (HCPs) were associated with fatigue, sleep disturbance, and attentional functioning among long-term breast cancer survivors (N = 1052). In addition, avoidant coping and self-efficacy for symptom management were examined as potential mediators of these relationships.

METHODS

Long-term breast cancer survivors (mean years since diagnosis = 6) completed questionnaires assessing social constraints from partners and HCPs, avoidant coping, self-efficacy for symptom management, and symptoms (i.e., fatigue, sleep disturbance, and attentional functioning). Structural equation modeling was used to evaluate the hypothesized relationships among variables in two models: one focused on social constraints from partners and one focused on social constraints from HCPs.

RESULTS

Both models demonstrated good fit. Consistent with theory and prior research, greater social constraints from both partners and HCPs were associated with greater symptom burden (i.e., greater fatigue and sleep disturbance, poorer attentional functioning). In addition, all relationships were mediated by avoidant coping and self-efficacy for symptom management.

CONCLUSIONS

Findings are consistent with social cognitive processing theory and suggest that symptom management interventions may be enhanced by addressing the impact of social constraints from survivors' partners and HCPs on their coping and self-efficacy. Copyright © 2016 John Wiley & Sons, Ltd.

Factors associated with depressive symptoms in young long-term breast cancer survivors

PURPOSE

Long-term breast cancer survivors frequently report distress (i.e., depressive symptoms) that impacts their quality of life. Previous studies have found that negative social interactions ("social constraints") from partners contribute to long-term, unresolved cycling of intrusive thoughts and cognitive avoidance, resulting in psychological distress. However, these relationships have not been tested in long-term breast cancer survivors. Furthermore, the effect of partners' depressive symptoms on the survivors' depressive symptoms has not been tested within the context of these relationships. Therefore, the purpose of this study was to test relationships between breast cancer survivors' depressive symptoms and (1) social constraints, cognitive avoidance, and intrusive thoughts, and (2) partners' depressive symptoms.

METHODS

Data were from a cross-sectional descriptive study of breast cancer survivors (N = 222) 3-8 years post-diagnosis and their partners, who completed surveys assessing demographic characteristics, social constraints, intrusive thoughts, cognitive avoidance, and depressive symptoms. Structural equation modeling confirmatory path analyses were conducted to determine significant relationships between survivors' depressive symptoms and all other variables.

RESULTS

Our model fits the data well. Breast cancer survivors' depressive symptoms were predicted by social constraints and intrusive thoughts. The relationship between survivors' depressive symptoms and partners' depressive symptoms was close but not significant.

CONCLUSIONS

As hypothesized, depressive symptoms were predicted by social constraints and intrusive thoughts. Further research is needed to understand the possible relationship between survivors' long-term depressive symptoms and cognitive avoidance and partners' depressive symptoms. Our findings highlight the negative impact of social constraints from partners on psychological outcomes in long-term breast cancer survivors.

The impact of events scale: a comparison of frequency versus severity approaches to measuring cancer-specific distress

OBJECTIVE

The Impact of Events Scale (IES) is one of the most widely used measures of event-specific distress. The IES assesses the frequency with which respondents experience intrusive thoughts and avoidant behaviors over the past week. Our aim is to demonstrate the benefit of a severity-based measurement approach of the IES compared with a frequency-based measurement approach.

METHODS

A mixed group of post-treatment cancer survivors (N = 325; M = 31.8 years old) completed measures assessing quality of life (Functional Assessment of Cancer Therapy-General), psychological adjustment (Mental Health Inventory), and cancer-related distress (IES). The IES was keyed to the cancer experience and administered with standard (frequency) and modified (severity) response options.

RESULTS

Classical reliability analyses and bifactor modeling were conducted on both versions of the IES. Reliability estimates suggest that the IES severity items were more highly intercorrelated than the IES frequency items. Both versions of the IES were highly correlated (r = 0.82), showing the presence of a dominant general factor. Bifactor modeling suggested that the severity items generally provided higher levels of discrimination than the frequency items. Validity correlations with the Functional Assessment of Cancer Therapy-General and Mental Health Inventory demonstrated that the IES severity performed as good as or better than the IES frequency.

CONCLUSIONS

Given the high correlations and similarity in content, the IES severity items largely assess the same construct as the IES frequency items. However, IES severity items generally showed improved psychometric properties and similar or higher correlations with quality of life and psychological adjustment. The IES severity approach appears to be a more informative method for assessing cancer-specific distress.

Existential challenges experienced by lymphoma survivors: Results from the 2010 LIVESTRONG Survey

We sought to examine the existential challenges that cancer survivors may experience as they strive to make meaning, regain their self-identity, cope with fear of recurrence, and experience feelings of grief and guilt. Lymphoma survivors (n = 429) completed the 2010 LIVE STRONG: survey and provided responses about meaning, cancer worry, security, identity, grief, guilt, and perceived functional impairment due to these concerns. Most survivors (73%-86%) endorsed existential concerns, with 30-39 percent reporting related perceived functional impairment. Concerns were associated with being female, younger, unmarried, and having undergone stem cell transplantation. Lymphoma survivors experience existential challenges that impact their life even years after diagnosis.

Shyness and openness--common ground for dialogue between health personnel and women about sexual and intimate issues after gynecological cancer

In this article we explore shyness and openness related to sexuality and intimacy in long-term female survivors of gynecological cancer, and how these women experienced dialogue with health personnel on these issues. Further analysis on two core themes, based on empirical data presented elsewhere, inspired continued theoretical and philosophical thinking drawing on Løgstrup's expressions of life and unified opposites. The findings show that gynecological cancer survivors and health personnel share common ground as human beings because shyness and openness are basic human phenomena. Health personnel's own movement between these phenomena may represent a resource because it can help women to handle sexual and intimacy challenges following gynecological cancer.

Emotion episodes during psychotherapy sessions among women newly diagnosed with gynecological cancers

OBJECTIVE

The aim of this study was to describe emotion episodes during early and late psychotherapy sessions among women newly diagnosed with gynecological cancer and to examine whether the total number of emotion episodes during early and later sessions was associated with baseline psychological distress, dispositional emotion expressivity, and patient-rated therapeutic progress.

METHODS

The study utilized data from an ongoing study examining the efficacy of two psychotherapy interventions, a coping and communication intervention and a supportive counseling intervention, for women diagnosed with gynecological cancer. Emotion episode coding was completed for the first and sixth psychotherapy sessions for each patient randomized to receive psychotherapy (N = 173). Patients completed baseline survey measures of psychological distress and dispositional emotional expressivity and post-session ratings of therapeutic progress.

RESULTS

The average number of emotion episodes was 7.4 in the first session and 5.2 episodes in the sixth session. In both sessions, the majority of emotion episodes contained only negative emotions and focused on a cancer-related topic. A higher number of emotion episodes in the first session was associated with higher psychological distress reported in the baseline survey (p = 0.02). A higher number of emotion episodes in the sixth session was associated with a higher number of emotion episodes in the first session (p < 0.001) and higher patient-rated progress as rated in the sixth session (p = 0.016).

CONCLUSION

The findings highlight the importance of expressed emotions, particularly negative emotions about cancer-related topics, in therapeutic progress during psychotherapy among women diagnosed with gynecological cancer.

A meta-analysis of the relationship between social constraints and distress in cancer patients

Social constraints on cancer-related disclosure have been associated with increased distress among cancer patients. The goals of this meta-analysis were: (1) to quantify the average strength of the relationships between social constraints and general and cancer-specific distress in cancer patients; and (2) to examine potential moderators of these relationships. A literature search was conducted using electronic databases, and 30 studies met inclusion criteria. Moderate, significant relationships were found between social constraints and both general distress (r = 0.37, 95 % CI 0.31-0.43) and cancer-specific distress (r = 0.37, 95 % CI 0.31-0.44). The relationship between social constraints and cancer-specific distress was stronger for studies of patients who, on average, had been diagnosed more recently. Relationships between social constraints and both general and cancer-specific distress did not vary by age or gender. Findings suggest that social constraints may be important to target in interventions to reduce distress in cancer patients, especially those who have been recently diagnosed.

The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPD-related fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

Outcome of supportive talks in a hospital setting: insights from cancer patients and their relatives

BACKGROUND

In psychosocial cancer rehabilitation, relatives are often central to patients' experiences and management of their cancer disease, and they need to be actively involved in rehabilitation. To address this need we developed a psychosocial rehabilitation intervention. As part of the intervention, lung or gynecological cancer patients and a relative as a pair were offered three supportive talks initiated on the date of admission and completed within 2 months.

OBJECTIVE

The objective of this study was to qualitatively assess the outcome of supportive talks from the pairs' perspectives and to provide a nuanced understanding of psychosocial support offered to pairs in a hospital setting in Denmark.

METHODS

Using a qualitative approach, we conducted semi-structured interviews with pairs receiving supportive talks and pairs receiving usual care. The interviews focused on the pairs' experiences of psychosocial supportive talks in a hospital setting. A constant comparative analysis was applied to identify themes related to the ways the pairs experienced the talks.

RESULTS

The analysis revealed two main themes: 'appreciation of the supportive talks' and 'the influence of the hospital setting'. The majority of pairs valued the focus on relationship and interpersonal communication, although they appreciated various aspects of the talks. The hospital setting provided valuable resources (trained nurses and medical expertise), but existing clinical routines challenged the implementation of the supportive talks.

CONCLUSIONS

The supportive talks were appreciated as psychosocial support in line with the objective, or as information on cancer treatment and routine care. The implementation of a new rehabilitation practice was challenged by the influence of the hospital setting.

The role of social and cognitive processes in the relationship between fear network and psychological distress among parents of children undergoing hematopoietic stem cell transplantation

The current study examined whether cognitive and social processing variables mediated the relationship between fear network and depression among parents of children undergoing hematopoietic stem cell transplant (HSCT). Parents whose children were initiating HSCT (N = 179) completed survey measures including fear network, Beck Depression Inventory, cognitive processing variables (positive reappraisal and self-blame) and social processing variables (emotional support and holding back from sharing concerns). Fear network was positively correlated with depression (p < .001). Self-blame and holding back emerged as individual partial mediators in the relationship between fear network and depression. Together they accounted for 34.3% of the variance in the relationship between fear network and depression. Positive reappraisal and emotional support did not have significant mediating effects. Social and cognitive processes, specifically self-blame and holding back from sharing concerns, play a negative role in parents' psychological adaptation to fears surrounding a child's HSCT.

Fear of progression

Fear of progression (or fear of recurrence) is an appropriate, rational response to the real threat of cancer and cancer treatments. However, elevated levels of fear of progression can become dysfunctional, affecting well-being, quality of life, and social functioning. Research has shown that fear of progression is one of the most frequent distress symptoms of patients with cancer and with other chronic diseases. As a clear consensus concerning clinically relevant states of fear of progression is currently lacking, it is difficult to provide a valid estimate of the rate of cancer patients who clearly suffer from fear of progression. However, recent systematic reviews suggest that probably 50 % of cancer patients experience moderate to severe fear of progression. Furthermore, many patients express unmet needs in dealing with the fear of cancer spreading. These results underline the necessity to provide effective psychological treatments for clinical levels of fear of progression. A few psychosocial interventions for treating fear of progression have been developed so far. Our own, targeted intervention study showed that dysfunctional fear of progression can be effectively treated with a brief group therapy.

Feasibility of a psychosocial rehabilitation intervention to enhance the involvement of relatives in cancer rehabilitation: pilot study for a randomized controlled trial

BACKGROUND

Cancer often affects the quality of life and well-being of patients as well as their relatives. Previous studies have suggested that relatives should be involved in psychosocial rehabilitation to address the needs for an interpersonal relationship with others in the disease trajectory. We developed an innovative rehabilitation program to be offered to the patient and a relative as a pair.

OBJECTIVE

The aim of the present pilot study was to examine the feasibility of the intervention in a randomized controlled trial (RCT) and to evaluate the impact on quality of life.

METHODS

The study was designed as an RCT comparing the new multimodal psychosocial rehabilitation with the usual services. The intervention comprised three 'supportive talks' and a residential rehabilitation course. From March 2010 to March 2011, participation was offered at the time of diagnosis to patients with lung or gynecological cancer from two departments at Odense University Hospital in Denmark. Questionnaires were used to estimate changes in quality of life (EORTC-QLQ-C30 on global health status) and well-being (WHO-Five Well-Being Index) at baseline and after 2 and 12 months. Information on the participants' views about the rehabilitation intervention was obtained from assessment charts and qualitative interviews.

RESULTS

A total of 209 patients were assessed for eligibility, but only 42 pairs were randomized to the study. The 2-month follow-up was completed by 34 patients and 32 relatives, and 19 patients and 21 relatives completed the 12-month follow-up. A higher dropout rate at the 12-month follow-up was reported in the intervention group compared with controls. Quality of life and well-being increased for patients and relatives in both the intervention and the control group, and no clinically significant difference was observed between the intervention and the control group. Pairs reported that the time of inclusion was inconvenient and that rehabilitation ought to meet their changing needs.

CONCLUSIONS

The pilot study showed that it may be difficult to conduct an RCT of a psychosocial rehabilitation intervention for pairs, and difficulties with inclusion and drop out have to be addressed. Interventions need to be carefully developed and tested before evaluating an effect in a large-scale study.