Uncertainty and Quality of Life in Women With Breast Cancer: Moderating Role of Coping Styles

Coping strategies and psychological distress in postoperative recovery: A repeated-measures study in women undergoing breast-conserving surgery

Objective

Breast-conserving surgery (BCS) is the standard treatment for early-stage breast cancer, yet patients often experience significant psychological distress and physical symptoms during recovery. This study aimed to explore the relationships between antecedents, physical symptoms (pain and nausea), psychological distress, and coping strategies utilized by women recovering from BCS to improve management of postoperative challenges.

Methods

This repeated-measures descriptive study involved 75 women who underwent BCS with sentinel lymph node biopsy at a National Cancer Institute-designated center. Participants completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Ways of Coping Instrument on Postoperative Day 1 (POD1) and POD14. Bivariate analyses, multiple linear regression, and structural equation modeling were conducted to evaluate associations between antecedents, coping strategies, and distress. Open-ended responses were qualitatively analyzed for thematic content.

Results

Seeking social support (POD1 mean ​= ​1.25; POD14 mean ​= ​1.20) and planful problem-solving (POD1 mean ​= ​1.19; POD14 mean ​= ​1.04) were the most frequently used coping strategies, while accepting responsibility and confrontive coping were least utilized. Overall coping strategy use decreased between POD1 and POD14, likely reflecting recovery adaptation. Significant predictors of distress included escape-avoidance coping (β ​= ​0.415, P ​< ​0.001), social support (β ​= ​0.270, P ​= ​0.02), history of nausea (β ​= ​0.517, P ​< ​0.001), and age (β ​= ​0.293, P ​= ​0.007). Coping strategies did not mediate the relationship between antecedents and distress.

Conclusions

Adaptive coping strategies such as social support and planful problem-solving play a critical role in mitigating distress during BCS recovery. Interventions should emphasize fostering these strategies and addressing high-risk groups, such as younger patients and those with a history of nausea. Despite limitations, this study underscores the importance of supporting adaptive coping to improve postoperative outcomes and provides a basis for future research.

Relationship between uncertainty in illness and fear of progression among lung cancer patients: The chain mediation model

BACKGROUND

Uncertainty in illness (UI) and fear of progression (FoP) are significant psychological challenges for lung cancer patients. Coping styles and social support are critical mediators, influencing patients' ability to manage the emotional and psychological burden of UI and FoP. However, limited research has explored the chain mediation effect of these factors on the relationship between UI and FoP, particularly among Chinese lung cancer patients.

AIM

To investigate the association between UI and FoP among patients with lung cancer.

METHODS

Convenience sampling was used to recruit inpatients diagnosed with lung cancer at a tertiary hospital in Changde City between November and December 2023. A total of 320 participants completed the Mishel Uncertainty in Illness Scale, Simplified Coping Style Questionnaire, Mandarin Chinese Version of the Medical Outcomes Study Social Support Survey, and Fear of Progression Questionnaire-Short Form. The chain mediation analysis was performed using the PROCESS macro to examine the relationships between the variables.

RESULTS

The results revealed that UI had a significant direct effect on FoP (effect = 0.224, 95%CI: 0.136-0.408). Additionally, three indirect pathways were identified: (1) Social support (effect = 0.128, 95%CI: 0.045-0.153); (2) Coping style (effect = 0.115, 95%CI: 0.048-0.157); and (3) Chain mediators involving social support and coping style (effect = 0.072, 95%CI: 0.045-0.120). The total indirect effect of the three mediation paths is 31.5%. These results confirm that social support and coping style significantly mediate the relationship between UI and FoP.

CONCLUSION

Based on cross-sectional data and a chain mediation model, this study explored the mechanisms between UI, social support, coping style, and FOP. Patients with lung cancer have higher levels of FOP, and the results of this study revealed a correlation between these four factors. Social support and coping style partially mediated the effects of UI on FOP, and there was a chain-mediating effect between UI and FOP. Programs designed to strengthen social support networks should also incorporate training to develop adaptive coping strategies, ultimately reducing FOP and improving overall quality of life.

The Effects of Coping Strategies Between Uncertainty and Quality of Life of Korean Women With Gynecological Cancer: Evaluation of Uncertainty in Illness Theory and Stress and Coping Theory

The objective of this study was to explore the mediation effects of coping strategies on the relationship between uncertainty and quality of life in Korean women with gynecological cancer. Mishel's Uncertainty in Illness Theory and Lazarus and Folkman's Stress and Coping Theory were used to guide the study. Three coping strategies (problem-focused, active emotional, and avoidant emotional) partially mediated the relationship between uncertainty and quality of life. This work provides evidence that reducing uncertainty has significant effects on coping strategies and positively affects the quality of life in women with gynecological cancer.

Coping with breast cancer during medical and occupational rehabilitation: a qualitative study of strategies and contextual factors

PURPOSE

This study aimed to gain a deeper understanding of the coping processes of breast cancer survivors (BCSs) during medical and occupational rehabilitation after acute treatment.

METHODS

This study is part of the mixed-methods Breast Cancer Patients' Return to Work study conducted in Germany. Data were collected through semistructured interviews with 26 female BCSs 5-6 years after their diagnosis. A qualitative content analysis was conducted to investigate the coping strategies and contextual factors of coping of BCSs.

RESULTS

The participants used different strategies for coping with their breast cancer, namely, approach- versus avoidance-oriented coping and emotion- versus problem-focused coping. During the medical rehabilitation process, coping behavior was used mainly to address disease management and its consequences. During the occupational rehabilitation process, most coping strategies were used to overcome discrepancies between the patient's current work capacity and the job requirements. The contextual factors of coping were in the health, healthcare, work-related, and personal domains.

CONCLUSION

The study findings provide in-depth insights into the coping processes for BCSs during the rehabilitation phase and highlight the importance of survivorship care after acute cancer treatment.

IMPLICATIONS FOR CANCER SURVIVORS

The results indicate that BCSs employ approach- and avoidance-oriented strategies to cope with their cancer during rehabilitation. As both attempts are helpful in the short term to cope with physical and emotional consequences of the cancer, healthcare and psychosocial personnel should respect the coping strategies of BCSs while also being aware of the potential long-term negative impact of avoidance-oriented coping on the rehabilitation process.

The effect of multimodal care based on Peplau's interpersonal relationship theory on postoperative recovery in lung cancer surgery: a retrospective analysis

BACKGROUND

Lung cancer remains a major global health concern due to its high incidence and mortality rates. With advancements in medical treatments, an increasing number of early-stage lung cancer cases are being detected, making surgical treatment the primary option for such cases. However, this presents challenges to the physical and mental recovery of patients. Peplau known as the "mother of psychiatric associations" has formulated a theory of interpersonal relationships in nursing. Through effective communication between nurses and patients over four periods, she has established a good therapeutic nurse-patient relationship. Therefore, this study aimed to explore the effect of perioperative multimodal nursing based on Peplau's interpersonal relationship theory on the rehabilitation of patients with surgical lung cancer.

METHODS

We retrospectively analyzed 106 patients with non-small cell lung cancer who underwent thoracoscopic lobectomy at our department between June 2021 and April 2022. Patients were categorized into two groups according to the different nursing intervention techniques. The Peplau's group comprised 53 patients who received targeted nursing interventions, and the control group comprised 53 patients who received conventional nursing care. We observed the patients' illness uncertainty, quality of life, and clinical symptoms in both groups.

RESULTS

Patients in the Peplau's group had significantly lower illness uncertainty scores and a significantly higher quality of recovery than those in the control group. However, there were no significant differences in length of post-anesthesia care unit stay, complication rates, and visual analog scores between both groups.

CONCLUSION

The multimodal perioperative nursing based on Peplau's interpersonal relationship theory not only reduces the illness uncertainty of patients with lung cancer surgery and improves their QoR but also expands the application of this theory in clinical practice, guiding perioperative nursing of patients with lung cancer.

IMPLICATIONS

These findings provide practical information for standardized care in a hectic anesthetic care setting.

IMPACT

The assessed anesthesia nursing model helps reduce uncertainty and promote early recovery in patients with cancer at various stages of their disease, which expands the scope of therapeutic practice and existing theories. It also serves as a guide for care in the anesthesia recovery room.

REPORTING METHOD

We adhered to the relevant Equator guidelines and the checklist of items in the case-control study report.

PATIENT OR PUBLIC CONTRIBUTION

Patients cooperated with medical staff to complete relevant scales.

Managing Symptom Distress: Key Factors for Patients on Adjuvant Endocrine Therapy for Breast Cancer

CONTEXT

Patients with breast cancer taking adjuvant endocrine therapy (AET) experience significant symptoms impacting mood, quality of life (QOL), and AET adherence and satisfaction.

OBJECTIVES

The aim of this study was to examine the extent to which coping ability and self-efficacy for symptom management moderate the relationships between patients' symptom distress and their mood, QOL, and AET adherence and satisfaction.

METHODS

As part of a randomized controlled trial, participants completed baseline measures including: sociodemographics, symptom distress (breast cancer prevention trial symptom checklist), coping skills (measure of current status), self-efficacy (self-efficacy for managing symptoms), anxiety and depression (hospital anxiety and depression scale), QOL (functional assessment of cancer therapy - general), AET adherence (medication adherence report scale), and AET satisfaction (cancer therapy satisfaction questionnaire). We conducted moderated regression analyses to examine whether coping and self-efficacy moderated the associations of symptom distress with baseline measures.

RESULTS

Coping skills moderated the associations of symptom distress with depression and QOL. Among those with lower coping, higher symptom distress was associated with worse depression symptoms (p=.04) and worse QOL (p < 0.001). Self-efficacy moderated the associations of symptom distress with depression symptoms and AET adherence and satisfaction. Among those with higher self-efficacy, higher symptom distress was associated with worse depression symptoms (p < 0.001), worse AET adherence (p < 0.001), and less AET satisfaction (p = 0.01).

CONCLUSION

Coping skills may buffer the effect of AET symptom distress. Findings indicate the relationship between symptom distress and self-efficacy is more nuanced and requires further research to better understand.

Mediation Effects of Coping Styles on Fear of Progression and Reproductive Concerns in Breast Cancer Patients of Reproductive Age

PURPOSE

This study aimed to investigate reproductive concerns among breast cancer patients of reproductive age, analyze the influencing factors, explore the relationship between coping styles, fear of progression (FOP), and reproductive concerns, and identify the multiple effects of coping styles on the relationship between FOP and reproductive concerns among Chinese breast cancer patients.

METHODS

A cross-sectional, descriptive study was conducted among breast cancer patients in four tertiary grade A hospitals in Fujian, China, from January 2022 to September 2022. A total of 210 patients were recruited to complete paper-based questionnaires, which included the general data questionnaires, the Reproductive Concerns After Cancer Scale (RCACS), the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), and the Medical Coping Modes Questionnaire (MCMQ). Structural equation models were utilized to evaluate the multiple effects of coping styles on FOP and reproductive concerns.

RESULTS

Reproductive concerns in breast cancer patients had a mean score of 53.02 (SD, 10.69), out of a total score of 90, and coping styles for cancer (confrontation, avoidance) were closely associated with FOP and reproductive concerns. FOP showed a significant positive correlation with reproductive concerns (r = .52, p < .01). At the same time, confrontation was significantly negatively correlated with both FOP (r = -.28, p < .01) and reproductive concerns (r = -.39, p < .01). Avoidance was positively correlated to both FOP (r = .25, p < .01) and reproductive concerns (r = .34, p < .01). The impact of FOP on reproductive concerns is partially mediated by confrontation and avoidance, with effect sizes of .07 and .04, respectively. These mediating factors account for 22.0% of the total effect.

CONCLUSIONS

The FOP directly impacted reproductive concerns, while coping styles could partially mediate the association between FOP and reproductive concerns. This study illustrates the role of confrontation and avoidance in alleviating reproductive concerns, suggesting that it is necessary to focus on the changes in reproductive concerns among reproductive-age breast cancer patients. Healthcare professionals can improve disease awareness and reduce patients' FOP, thereby promoting positive psychological and coping behaviors and ultimately alleviating reproductive concerns.

Coping strategies as mediators of uncertainty and psychological distress in patients with advanced cancer

PURPOSE

Uncertainty in the context of advanced cancer diagnosis often incurs significant psychological distress. The aims were to evaluate the incidence of psychological distress upon diagnosis of advanced cancer and to analyze whether the relationship between illness uncertainty and psychological distress can be mediated by coping strategies.

METHODS

A multicenter, prospective, cross-sectional study was conducted in 15 medical oncology departments across Spain. Individuals with unresectable advanced cancer completed questionnaires on uncertainty (Michel Uncertainty of Illness Scale, coping strategies (Mental Adjustment to Cancer, M-MAC), and psychological distress (Brief Symptom Inventory, BSI-18) after the diagnostic and treatment appointment and before beginning systemic cancer treatment.

RESULTS

841 patients eligible for systemic treatment with palliative intent were included between February 2020 and April 2022. A total of 71.7% had clinically significant levels of psychological distress. Univariate analyses identified that the groups with less psychological distress were male (ηp2  = 0.016), married (ηp2  = 0.006), and had a better performance status (ηp2  = 0.007). The most widely used coping strategies were positive attitude and cognitive avoidance. A positive relationship was found between uncertainty, coping strategies, and psychological distress (p < 0.05). Participants who responded with anxious preoccupation suffered more helplessness and psychological distress, while those who responded with cognitive avoidance displayed greater positive attitude and lesser psychological distress.

CONCLUSION

Patients with newly diagnosed unresectable advanced cancer frequently experience psychological distress in the face of uncertainty, potentially influenced by coping strategies like cognitive avoidance.

Illness uncertainty and quality of life in patients with advanced cancer and their family caregivers: An actor-partner interdependence model analysis

OBJECTIVE

The relationship between illness uncertainty and quality of life (QOL) has been examined for either the patient or caregiver, but not among the patient-caregiver dyads. This study examined relationships between illness uncertainty and QOL among patients with advanced cancer and family caregivers.

METHODS

We conducted a secondary analysis of data from a randomized clinical trial that examined the effects of a dyadic-based intervention on psychological outcomes for patients with advanced cancer and family caregivers (N = 484 dyads). Illness uncertainty and QOL were measured using the shorten version of the Mishel Uncertainty in Illness Scale for Adult and the Functional Assessment of Cancer Therapy, respectively. The actor-partner interdependence model was used to examine whether an individual's uncertainty (either a patient's or caregiver's) was associated with their own QOL (i.e., an actor effect) and/or their partner's QOL (i.e., a partner effect).

RESULTS

Significant actor effects included a negative association between patients' uncertainty and their own QOL (b = -0.422; p < 0.001) and a negative association between caregivers' uncertainty and their own QOL (b = -0.408; p < 0.001). In terms of partner effects, patients' uncertainty was negatively associated with caregivers' QOL (b = -0.095; p < 0.01). No partner effect was found for caregivers, suggesting that caregivers' uncertainty was not related to patients' QOL.

CONCLUSIONS

Study findings support targeted interventions offered to both patients and their family caregivers to manage their illness uncertainty and improve their QOL.

Heterogeneity of posttraumatic stress, depression, and fear of cancer recurrence in breast cancer survivors: a latent class analysis

PURPOSE

Breast cancer survivors may demonstrate elevated psychological distress, which can also hinder adherence to survivorship care plans. Our goal was to study heterogeneity of behavioral health and functioning in breast cancer survivors, and identify both risk and protective factors to improve targets for wellness interventions.

METHODS

Breast cancer survivors (n = 187) consented to complete self-reported psychological measures and to access their medical records. Latent class analysis (LCA) was used to classify heterogeneous subpopulations based on levels of depression, post-traumatic stress, fear of cancer recurrence, cancer-related pain, and fatigue. Multinomial logistic regression and auxiliary analysis in a 3-step modeling conditional approach was used to identify characteristics of the group based on demographics, treatment history and characteristics, and current medication prescriptions.

RESULTS

Three subpopulations of breast cancer survivors were identified from the LCA: a modal Resilient group (48.2%, n = 90), a Moderate Symptoms group (34%, n = 65), and an Elevated Symptoms group (n = 17%, n = 32) with clinically-relevant impairment. Results from the logistic regression indicated that individuals in the Elevated Symptoms group were less likely to have a family history of breast cancer; they were more likely to be closer to time of diagnosis and younger, have received chemotherapy and psychotropic prescriptions, and have higher BMI. Survivors in the Elevated Symptoms group were also less likely to be prescribed estrogen inhibitors than the Moderate Symptoms group.

CONCLUSIONS

This study identified subgroups of breast cancer survivors based on behavioral, psychological, and treatment-related characteristics, with implications for targeted monitoring and survivorship care plans.

IMPLICATIONS FOR CANCER SURVIVORS

Results showed the majority of cancer survivors were resilient, with minimal psychological distress. Results also suggest the importance of paying special attention to younger patients getting chemotherapy, especially those without a family history of breast cancer.

Effect of receiving a customizable brochure on breast cancer patients' knowledge about their diagnosis and treatment: A randomized clinical trial

BACKGROUND

Patients' lack of knowledge about their own disease may function as a barrier to shared decision-making and well-being. This study aimed to evaluate the impact of written educational materials on breast cancer patients.

METHODS

This multicenter, parallel, unblinded, randomized trial included Latin American women aged ≥18 years with a recent breast cancer diagnosis yet to start systemic therapy. Participants underwent randomization in a 1:1 ratio to receive a customizable or standard educational brochure. The primary objective was accurate identification of molecular subtype. Secondary objectives included identification of clinical stage, treatment options, participation in decision-making, perceived quality of information received, and illness uncertainty. Follow-up occurred at 7-21 and 30-51 days post-randomization.

CLINICALTRIALS

gov identifier: NCT05798312.

RESULTS

One hundred sixty-five breast cancer patients with a median age of 53 years and 61 days from diagnosis were included (customizable: 82; standard: 83). At first available assessment, 52%, 48%, and 30% identified their molecular subtype, disease stage, and guideline-endorsed systemic treatment strategy, respectively. Accurate molecular subtype and stage identification were similar between groups. Per multivariate analysis, customizable brochure recipients were more likely to identify their guideline-recommended treatment modalities (OR: 4.20,p = 0.001). There were no differences between groups in the perceived quality of information received or illness uncertainty. Customizable brochure recipients reported increased participation in decision-making (p = 0.042).

CONCLUSIONS

Over one third of recently diagnosed breast cancer patients are incognizant of their disease characteristics and treatment options. This study demonstrates a need to improve patient education and shows that customizable educational materials increase patients' understanding of recommended systemic therapies according to individual breast cancer characteristics.

Factors related to preoperative uncertainty among patients with breast cancer in Wenzhou, China: A cross-sectional study

Background

One of the most prevalent psychological signs of breast cancer is uncertainty, which is more prevalent in Chinese patients during the preoperative period. Despite the numerous factors contributing to preoperative uncertainty, there is limited relevant research conducted in China.

Objective

This study aimed to describe the current state of preoperative uncertainty and to investigate the relationship between anxiety, illness perception, social support, and preoperative uncertainty in patients with breast cancer in Wenzhou, China.

Methods

This cross-sectional research used a simple random sampling technique to select 122 participants from a university hospital in Wenzhou, China, from July 2022 to December 2022, employing validated instruments. Descriptive statistics and Pearson's correlation coefficient were utilized to analyze the data.

Results

The average preoperative uncertainty scores of the patients fell within a moderate range (M = 61.92, SD = 7.51). Significant correlations were found between anxiety (r = 0.638, p <0.01), illness perception (r = 0.704, p <0.01), social support (r = -0.481, p <0.01), and preoperative uncertainty.

Conclusions

The results can assist healthcare professionals, especially nurses, in recognizing the factors contributing to uncertainty before surgery in patients with breast cancer. This knowledge enables them to promptly address and minimize this issue, leading to improved outcomes.

Health-related quality of life in breast cancer patients in low-and-middle-income countries in Asia: a systematic review

Introduction

Breast cancer remains one of the major cancers worldwide. In Asia, breast cancer is leading both incidence and mortality rates. Health-related quality of life (HRQoL) studies play an important role in clinical treatment. This systematic review aimed to summarize the evidence of HRQoL and associated factors among patients with breast cancer in low-and-middle-income countries (LMICs) in Asia.

Method

Performed according to PRISMA guidelines for systematic review, the studies were searched from three databases (PubMed, Cochrane, Scopus) up to November 2020. The studies which met the predefined eligibility criteria were selected, extracted, and assessed the quality according to the Newcastle-Ottawa Scale (NOS) tool.

Results and Discussion

A total of 2,620 studies were searched on the three databases, of which 28 met the selection criteria, then, were included in the systematic review. The Global Health Status (GHS) score of breast cancer patients based on the EORTC QLQ-C30 questionnaire ranged from 56.32 ± 25.42 to 72.48 ± 15.68. The overall HRQoL scores using the FACT-G and FACT-B instruments ranged from 60.78 ± 13.27 to 82.23 ± 12.55 and from 70.29 ± 13.33 to 108.48 ± 19.82, respectively. Factors affecting HRQoL of patients with breast cancer included age, education level, income, marital status, lifestyle, tumor stage, method, and treatment duration. Patient's income showed a consistent effect on HRQoL while the remaining factors reported inconsistent findings across the studies. In conclusion, the HRQoL of breast cancer patients in LMICs in Asia was low and affected by several sociodemographic factors which should be studied more in future research.

Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis

PURPOSE

Illness uncertainty is widely recognized as a psychosocial stressor for cancer survivors and their family caregivers. This systematic review and meta-analysis aimed to identify the sociodemographic, physical, and psychosocial correlates that are associated with illness uncertainty in adult cancer survivors and their family caregivers.

METHODS

Six scholarly databases were searched. Data synthesis was based on Mishel's Uncertainty in Illness Theory. Person's r was used as the effect size metric in the meta-analysis. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

Of 1116 articles, 21 articles met the inclusion criteria. Of 21 reviewed studies, 18 focused on cancer survivors, one focused on family caregivers, and 2 included survivors and family caregivers. Findings identified distinct correlates for illness uncertainty in cancer survivors, including sociodemographic factors (e.g., age, gender, race), stimuli frame (e.g., symptom, family history of cancer), structure providers (e.g., education), coping, and adaptation. Notable effect sizes were observed in the correlations between illness uncertainty and social support, quality of life, depression, and anxiety. Caregivers' illness uncertainty was associated with their race, general health, perception of influence, social support, quality of life, and survivors' prostate-specific antigen levels. Insufficient data precluded examining effect size of correlates of illness uncertainty among family caregivers.

CONCLUSION

This is the first systematic review and meta-analysis to summarize the literature on illness uncertainty among adult cancer survivors and family caregivers. Findings contribute to the growing literature on managing illness uncertainty among cancer survivors and family caregivers.

Contribution of coping style to the association between illness uncertainty and demoralisation in patients with breast cancer: a cross-sectional mediation analysis

OBJECTIVE

Demoralisation is a common psychological issue in patients with cancer and aggravates depression, reduces the quality of life and even causes suicidal ideation. There is a lack of knowledge about illness uncertainty, coping style and demoralisation in patients with breast cancer. The current study explored the relationship between illness uncertainty and demoralisation among those patients, as well as the potential mediating role of coping style.

DESIGN

A cross-sectional study.

SETTING

Participants were recruited from the Breast Tumor Center in a tertiary hospital in Shijiazhuang, Hebei province.

PARTICIPANTS

A total of 211 patients with breast cancer completed the survey.

OUTCOME MEASURES

A total of 211 patients with breast cancer completed the Mishel's Uncertainty in Illness Scale, Trait Coping Style Questionnaire and the Mandarin version of Demoralization Scale (DS-MV).

RESULTS

Of the patients, 47.40% exhibited symptoms of demoralisation (DS-MV>30), and the mean of demoralisation score was (29.55±13.21). The results demonstrated that illness uncertainty and negative coping styles were positively related to demoralisation (p<0.001), while active coping styles were negatively related to demoralisation (p<0.001). Importantly, coping styles could partially mediate the relationship between illness uncertainty and demoralisation (p<0.01).

CONCLUSION

Our study illustrated that illness uncertainty was associated with demoralisation in patients with breast cancer, and coping style acted as a mediator in this relationship. The findings highlighted the critical role of reducing negative coping styles to the early prevention and efficient treatment of demoralisation among those patients.

A new landscape in illness uncertainty: A systematic review and thematic synthesis of the experience of uncertainty in patients with advanced cancer receiving immunotherapy or targeted therapy

OBJECTIVE

Over the past 20 years, immunotherapy and targeted therapy (TT) have been extending the life expectancy and providing hope for a growing number of patients with advanced and metastatic cancer. However, the efficacy, side effects, and overall prognosis of these treatments are highly unpredictable. Recent research suggests that these patients may be experiencing significant uncertainty which impacts their functioning. This study reviewed the literature on the experiences of uncertainty for individuals with advanced or metastatic cancer patients who are receiving immunotherapy or TT.

METHOD

A systematic literature review was conducted. Data was extracted from studies by pairs of reviewers. Literature quality was appraised using the Critical Appraisal Skills Program checklist. Following data extraction, thematic synthesis was used to summarize findings across studies and generate overarching themes.

RESULTS

Fifteen qualitative studies were included. Findings highlighted impacts of various sources of uncertainty (financial, emotional, social), unmet needs related to uncertainty (practical, informational, communication), and recommendations for the management of uncertainty. Clinical implications and study limitations were indicated.

CONCLUSIONS

Findings were situated within Mishel's Uncertainty in Illness Theory and the literature on supportive care for advanced cancer populations. Recommendations related to improving healthcare provider communication and balancing hope and expectations for treatment outcomes were highlighted. Further research is needed to investigate experiences of uncertainty in this population. Tailored interventions for uncertainty may be warranted.

Exploring the moderated role of two psychological programs on sexual pleasure from physical symptoms, body image distortion and emotional problems of Hispanic women with breast cancer

Decreased sexual pleasure is a common problem in women with breast cancer. The aim of this study was to evaluate the effect of psychoeducation vs. acceptance and commitment therapy to improve sexual pleasure according to the predictive role of physical, cognitive and emotional factors. Results of 139 Hispanic women (Mexico and Spain) diagnosed with breast cancer reveal that only the emotional factor of depression predicts decreased sexual pleasure. Although women who participated in the psychoeducation program presented greater physical symptomatology, body image distortions and emotional distress, the results seem to indicate that psychoeducational guidelines are relevant to improve sexual pleasure in those women who manifest higher levels of previous depression. Future research is required to clarify these issues.

Status and influencing factors of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury: a quantitative and qualitative study

BACKGROUND

Disease uncertainty widely exists among family caregivers of patients with moderate and severe craniocerebral injury. This negative emotional reaction will reduce the ability of family caregivers to make decisions during the critical stage of the patient, causing serious effects on the rescue and prognosis of patients with moderate and severe craniocerebral injury. Therefore, this article aims to understand the state of the uncertainty of the disease of family caregivers of patients with moderate and severe craniocerebral injury in China, to analyze the influencing factors, and to explore the specific resource of the uncertainty of the disease combined with qualitative study. The outcomes will provide a theoretical basis for formulating an accurate clinical nursing intervention strategy.

METHODS

This study was conducted in the neurosurgery ward. A total of 214 family caregivers were evaluated using five previously validated scales: (i) Mishel Uncertainty in Illness Scale for family member, (ii) Simplified Coping Style Questionnaire, (iii) Social Support Rating Scale, and (iv) Self-Rating Anxiety Scale, (v) Zarit Caregiver Burden Interview. Kolmogorov-Smirnov was used to test the normality of the data distribution. The potential determinants of disease uncertainty were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of disease uncertainty in family caregivers of patients with moderate and severe craniocerebral injury. Objective sampling method was used to conduct semi-structured interviews with 17 family caregivers of patients with moderate and severe craniocerebral injury, and Colaizzi 7-step analysis method was used to analyze and summarize the interview data.

RESULTS

The evaluated participants exhibited critically high levels of perceived uncertainty. The results of multiple linear regression showed that the influencing factors of family caregivers' disease uncertainty were anxiety, number of other caregivers, GOS, negative coping style, and caregiver burden. The qualitative research focuses on two main topics: the sources of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury and experience to cope with the situation.

CONCLUSION

The main cause of disease uncertainty of family caregivers of patients with moderate and severe craniocerebral injury is that patients' disease progression and prognosis as well as caregivers' own pressure of responsibility and negative mental status. Furthermore, caregivers' own pressure of responsibility and negative mental status are not clear. Therefore, helping family caregivers adopt positive coping approaches, guiding them to actively seek support from family and society, improving their nursing skills, and understanding of disease progression and prognosis all play an important role in alleviating the uncertainty of the disease.

The lived experience during the peri-diagnostic period of breast cancer: A scoping review

OBJECTIVES

The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer.

METHODS

Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches.

RESULTS

A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period.

CONCLUSIONS

The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity.

PRACTICE IMPLICATIONS

Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.

Prognostic Value of Negative Emotions on the Incidence of Breast Cancer: A Systematic Review and Meta-Analysis of 129,621 Patients with Breast Cancer

Breast cancer (BC) is one of the common malignant tumors in women and affects 1.6 million new cases globally each year. Investigators have recently found that negative emotions (NEs) and their impacts have greatly influenced the incidence and risk of BC. The present study aims to provide an association between NEs and the incidence of BC with possible risk factors. A total of 9343 studies were screened; nine studies met all inclusion criteria that were considered for the meta-analysis. The qualitative studies were measured by the Newcastle-Ottawa Scale; the observational studies were included with relative risks (RR) and corresponding 95% confidence intervals (CI). Besides the NEs and BC, the possible risk factors were evaluated. We analyzed data from 129,621 women diagnosed with NEs of which 2080 women were diagnosed with BC and their follow-up year ranges were from 4–24 years. NEs were significantly (p < 0.0001) associated with a higher incidence of BC with RR = 1.59, 95% CI:1.15–2.19, with other high-risk factors including, geographical distribution, emotion types, standard diagnosis of NEs, and follow-up duration. This study suggests that NEs significantly increase the risk for the incidence of BC, which can be supportive of the prognosis of the disease.

Illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia: A cross-sectional study

AIMS AND OBJECTIVES

To investigate the relationship between illness uncertainty, self-perceived burden and quality of life and explore the mediating role of self-perceived burden between illness uncertainty and quality of life in patients with chronic myeloid leukaemia.

BACKGROUND

Patients with chronic myeloid leukaemia need long-term, potentially lifelong therapy to control the disease, which affects their quality of life. There is a need for exploring potentially changeable factors to develop interventions. Little is known about the effects of illness uncertainty and self-perceived burden on quality of life in this population.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 248 patients with chronic myeloid leukaemia was recruited from four university hospitals from February to August 2020. Participants were assessed with the Mishel Uncertainty in Illness Scale, Self-Perceived Burden Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The STROBE checklist was used to report the results.

RESULTS

Illness uncertainty and self-perceived burden were negatively associated with quality of life in patients with chronic myeloid leukaemia. Self-perceived burden partially mediated the relationship between illness uncertainty and quality of life. The indirect effect was -0.101, accounting for 22.9% of the total effect.

CONCLUSION

The findings revealed the relationship between illness uncertainty, self-perceived burden and quality of life in patients with chronic myeloid leukaemia. Self-perceived burden exerted a mediating role between illness uncertainty and quality of life in this population.

RELEVANCE TO CLINICAL PRACTICE

This study alerts healthcare providers to pay attention to patients' illness uncertainty and self-perceived burden, which can contribute to develop effective interventions to improve the quality of life among patients with chronic myeloid leukaemia in the clinical practice.

Uncertainty in illness and coping styles: Moderating and mediating effects of resilience in stroke patients

BACKGROUND

Stroke has a great influence on the patient's mental health, and reasonable psychological adjustment and disease perception can promote the recovery of mental health.

AIM

To explore the relationships among resilience, coping style, and uncertainty in illness of stroke patients.

METHODS

A retrospective study was used to investigate 154 stroke patients who were diagnosed and treated at eight medical institutes in Henan province, China from October to December 2019. We used the Mishel Uncertainty in Illness Scale, the Connor-Davidson Resilience Scale, and the Medical Coping Modes Questionnaire to test the uncertainty in illness, resilience, and coping style, respectively.

RESULTS

Resilience had a significant moderating role in the correlation between coping style and unpredictability and information deficiency for uncertainty in illness (P < 0.05). Further, the tenacity and strength dimensions of resilience mediated the correlation between the confrontation coping style and complexity, respectively (P < 0.05). The strength dimension of resilience mediated the correlation between an avoidance coping style and the unpredictability of uncertainty in illness (P < 0.05), as well as correlated with resignation, complexity, and unpredictability (P < 0.05).

CONCLUSION

Resilience has moderating and mediating roles in the associations between coping style and uncertainty in illness, indicating that it is vital to improve resilience and consider positive coping styles for stroke patients in the prevention and control of uncertainty in illness.

Turkish adaptation of the Mishel uncertainty in illness scale-community form

PURPOSE

The study aims to conduct the Turkish validity and reliability study of the Mishel uncertainty in illness scale-community form.

DESIGN AND METHODS

This is a study with a methodological design. It was carried out in a family health center in a province in the Black Sea Region between May and October 2019. The sample of the study consisted of 479 individuals with chronic diseases. The data were analyzed with exploratory and confirmatory factor analysis.

FINDINGS

The Cronbach's alpha was found to be 0.79. The fit indices of the 20-item scale with three-factor structure are at an acceptable level (root mean square error of approximation: 0.056; comparative fit index: 0.926; incremental fix index: 0.927; goodness of fit index: 0.918; Tucker-Lewis index: 0.915; adjusted goodness of fit index: 0.896; χ² /SD: 2.481, p < 0.001).

PRACTICE IMPLICATIONS

The level of uncertainty revealed by the scale gives information about the chronic disease management of individuals.

Uncertainty in illness and the coping styles of severe patients with COVID-19: Current status and correlation

This study aimed to investigate the characteristics of uncertainty in illness and the coping styles of patients with severe coronavirus 2019 (COVID-19) and to explore their relationship to provide effective guidance for clinical nursing. A cross-sectional survey was used to investigate 56 severe patients with COVID-19 in a designated hospital in Wuhan. A general information questionnaire, the Mishel Uncertainty in Illness Scale for Adults (MUIS-A) and the Medical Coping Modes Questionnaire (MCMQ) were used to collect the data. A statistical analysis was performed. The total score of the MUIS-A was a 66.29 ± 17.25 which was at a low level, while the total score of the MCMQ was 54.16 ± 6.39. The scores of facing and avoiding were significantly higher than those in the norm. The difference in the yielding dimension of patients with different family economic situations was statistically significant. The total score of MUIS-A correlated negatively with the coping style of facing and avoiding and positively correlated with the coping style of yielding. The coping style of patients was one of the factors influencing uncertainty in illness. Nursing staff need to pay close attention to the psychological state of their patients, understand their coping styles and actively correct negative coping styles to reduce the uncertainty in illness and promote physical as well as mental recovery.

The Importance of Alexithymia in Post-surgery. Differences on Body Image and Psychological Adjustment in Breast Cancer Patients

Breast cancer is a disease that is difficult to face and that often hinders body acceptance. Body changes due to surgery can be very emotionally challenging for those who experience them. The aim of this study is to explore the differences on body image and psychological adjustment on women with breast cancer with high and low alexithymia according to the type of surgery. In this cross-sectional study, 119 women diagnosed with breast cancer (stages I, II, and III) were evaluated with different self-report questionnaires. Afterward, patients were divided into two groups (high and low levels of alexithymia) to analyze dependent variables (body image and psychological adjustment) according to the type of surgery (radical mastectomy or breast conserving therapy). The results of the General Linear Model suggest that when patients show high alexithymia combined with having undergone a radical mastectomy, they show higher levels of Hopelessness. Furthermore, in patients with high alexithymia, higher scores of maladaptive coping styles and greater distortion of body image were found. Alexithymia seems to play an important role in the way in which women cope with their disease, especially in those with radical mastectomy.

A Feasibility Study of an Uncertainty Management Intervention for Patient-Partner Dyads Experiencing Breast Cancer

OBJECTIVES

To examine the feasibility, acceptability, and effects of a dyad-based uncertainty management intervention for breast cancer, including tailored information and coping skills training.

SAMPLE & SETTING

16 patient-partner dyads experiencing breast cancer were enrolled from a midwestern comprehensive cancer center.

METHODS & VARIABLES

A single-group pre-/post-test design was used, and descriptive statistics and Cohen's d were calculated. Measures were completed before the intervention and during each treatment cycle. Feasibility, acceptability, fidelity, uptake, and outcome variables (uncertainty, dyadic coping, family functioning) were included.

RESULTS

16 dyads were enrolled during a 13-month period; 15 dyads completed the training for the study, and 13 dyads completed all study activities. Overall, participants reported satisfaction with the intervention. Small to medium effect sizes were observed across the outcomes.

IMPLICATIONS FOR NURSING

This study highlights the need for nurses to help couples manage uncertainty related to new cancer treatment. Tailored interventions can allow nurses to use their time efficiently by focusing on individuals' actual needs.

Illness uncertainty, coping, and quality of life among patients with prostate cancer

OBJECTIVE

Illness uncertainty is a significant source of psychological distress that affects cancer patients' quality of life (QOL). Mishel's uncertainty in illness theory (UIT) proposes that illness uncertainty influences an individual's use of coping strategies, and directly and indirectly influences their QOL. This study tested the relationships depicted in the adapted UIT in cancer patients.

METHODS

This cross-sectional study is a secondary analysis of the baseline data from a randomized clinical trial (N = 263 prostate cancer patients). Patients were diagnosed with localized (64.6%), biochemical recurrent (12.6%), or advanced (22.8%) prostate cancer. Uncertainty, coping (avoidant and active coping strategies), and QOL (physical and mental well-being) were measured using the Mishel's uncertainty of illness scale, Brief COPE, and the Medical Outcomes Study 12-item short form (SF-12), respectively. We used path analysis to achieve the research aim.

RESULTS

Patients' illness uncertainty directly, negatively influenced their physical well-being (P < .001) and mental well-being (P < .05). Patients' illness uncertainty was positively related to their avoidant coping strategies (P < .001). Patients' active and avoidant coping strategies influenced their mental well-being (P < .001). Uncertainty also negatively influenced mental well-being through avoidant coping strategies. The model had excellent fit to the data.

CONCLUSIONS

Our findings have indicated the potential of improving QOL by decreasing illness uncertainty and reducing avoidant coping strategies. Future research is needed to better understand the complex relationships between illness uncertainty, coping strategies, and domains of QOL among patients with different types of cancer using longitudinal research.

Symptom Clusters and Quality of Life over 1 Year in Breast Cancer Patients Receiving Adjuvant Chemotherapy

Objective:

Evidence is scant regarding symptom clusters and quality of life (QOL) over 1 year in women who receive adjuvant breast cancer chemotherapy (CTX). Our purpose was to identify the prevalence and severity of individual symptoms, symptom clusters, and QOL in women receiving adjuvant breast cancer CTX from baseline over 1 year.

Methods:

Symptoms were identified in a sample (n = 219) at three times: baseline (prior to the first adjuvant CTX treatment), 1 month after the last CTX (approximately 6 months after baseline), and 1 year after baseline. The Hospital Anxiety and Depression Scale and Symptom Experience Scale measured symptoms. The Medical Outcomes Study, Short-Form Survey, measured QOL. Exploratory factor analysis identified symptom clusters at each time and core symptoms in clusters over time.

Results:

The prevalence and severity of 10 symptoms decreased over time (P < 0.05). Fatigue, sleep disturbance, and pain were most prevalent; all were of mild severity. Two symptom clusters were identified at baseline and one met internal consistency reliability criteria at the later times. Core symptoms were identified. Both the physical and mental component scores of QOL improved over time (P < 0.01), but physical was below the general population norms 1 year after baseline.

Conclusions:

The symptom experience was dynamic, and symptom clusters changed over 1 year. Despite mild severity, core symptoms and clusters persisted over 1 year, and physical health was below the general population norms. Breast cancer survivors with persistent single and co-occurring symptoms need to be taught to manage the patterns of symptoms over time because they may not resolve by 1 year.

Tolerating Uncertainty in the Dark: Insomnia Symptoms, Distress, and Well-Being Among Parents of Adolescents and Young Adults with Cancer

BACKGROUND

Given the need to better understand mechanisms linking poor sleep and psychological distress in the context of chronic illness, we explored a novel factor, intolerance of uncertainty (IU), in relation to insomnia among parents of adolescents and young adults (AYAs) with cancer. We hypothesized that parents with higher IU would report greater insomnia symptoms, which would be associated with higher anxiety and depressive symptoms. These greater levels of anxiety and depressive symptoms are hypothesized to mediate the relationship between insomnia symptoms and subjective well-being (SWB).

METHOD

Surveying 59 parents of AYAs with cancer, we computed a parallel-serial mediational analysis using bootstrapping techniques for ordinary least squares regression to test two pathways (adjusting for whether the AYA currently resided with the parent). The first serial pathway was IU→insomnia symptoms→anxiety symptoms→SWB. The second pathway was IU→insomnia symptoms→depressive symptoms→SWB.

RESULTS

Although the first pathway involving sleep and anxiety as serial mediators was nonsignificant, the second pathway with sleep and depressive symptoms was significant. The relationship between IU and SWB was mediated through insomnia and depressive symptoms. An alternative serial mediation analysis wherein depressive symptoms preceded sleep was not significant, lending support to study findings.

CONCLUSION

This study provides preliminary evidence that IU's detrimental influence on depression and SWB may operate through its influence on insomnia symptoms. Given implications for parents' well-being and, likely, their subsequent capacity to care for the AYA with cancer, interventions addressing IU and disturbed sleep among this underserved population deserve attention.

Quality of life and health status of Indonesian women with breast cancer symptoms before the definitive diagnosis: A comparison with Indonesian women in general

OBJECTIVES

Breast cancer (BC) is prevalent in low and middle-income countries (LMICs) where the majority of cases are diagnosed in late stages. The aims of this study were: (1) to assess quality of life (QOL) and health status of Indonesian women with BC symptoms before definitive diagnosis; (2) to compare QOL and health status between women with BC symptoms before definitive diagnosis and Indonesian women in general; (3) to evaluate the association between demographic variables (age, residence, social economic status and education level) and QOL within the Indonesian women with BC symptoms before definitive diagnosis.

METHODS

We used WHOQOL-BREF to measure QOL and EQ-5D-5L for health status. Multivariate analysis of covariance (MANCOVA) was used to compare QOL and health status between women with BC symptoms and women from the general Indonesian population in order to control for confounders. Regression analyses were used for testing the association between the demographic variables, QOL, and health status.

RESULTS

In comparison with the data from the women from the general population (n = 471), the women with BC symptoms (n = 132) reported lower QOL, especially in physical and psychological domains. They also reported more problems in all dimensions of health status. Higher education and monthly income were positively associated with QOL and health status among the women with BC symptoms.

CONCLUSION

Before receiving a definitive diagnosis, women who visit hospitals with symptoms of BC, report a lower QOL and health status than women in general. Our results suggest that healthcare providers should provide targeted strategies for women with BC symptoms to improve their QOL.