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

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

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

Factors influencing fear of cancer recurrence among prostate cancer patients: a systematic review and meta-analysis

PURPOSE

To identify and quantify the influence factors of fear of cancer recurrence among prostate cancer patients through meta-analysis.

DESIGN

A systematic review and meta-analysis followed by the PRISMA2020 checklist.

METHODS

We searched PubMed, Web of Science, Cochrane Library, Embase, CNKI, CMAPH, VIP, and Wanfang databases, along with manual retrieval, to identify relevant studies published from 1981 to November 2023. Two independent reviewers screened the literature, extracted data, and assessed study quality. Meta-analysis was conducted using R 4.2.3 software.

RESULTS

A total of 5031 studies were identified through database searches and manual retrieval. After removing duplicates and screening titles, abstracts, and full texts, 19 studies met the inclusion criteria and were included in the final analysis. The meta-analysis revealed a significant association between fear of cancer recurrence among prostate cancer patients and age (odds ratio = 0.9084), partnership (1.0462), income (0.9076), employment status (1.0799), education (0.8146), treatment (2.0567), time since diagnosis (1.5252), stage of disease (1.6895), biochemical recurrence (3.2214), hormone function (0.8042), urinary function (1.1271), Gleason score (2.9419), quality of life (0.5704), self-rated health (0.6711), social support (1.2149), anxiety (2.1002), depression (2.8319), negative emotion (2.0835), and hope level (1.2363).

CONCLUSION

Our findings considerably enhance the understanding of the influencing factors of fear of cancer recurrence of patients with prostate cancer. The insights this study provides can enable health-care providers to apply quick and effective assessment tools to identify high-risk patients with fear of cancer recurrence early and thereby support the personalized interventions to reduce it, promoting overall health.

Fear of cancer recurrence among adolescent and young adult cancer survivors: a mixed-methods systematic review

PURPOSE

Fear of cancer recurrence (FCR) is common and burdensome in adolescent and young adult (AYA) cancer survivors. This systematic review examines FCR assessment, prevalence, severity, progression, related factors, consequences, and interventions in AYA cancer survivors.

METHODS

Electronic databases including PubMed, CINAHL, PsycINFO, Cochrane, and Embase were searched from their inception to October 2024. Two reviewers identified eligible peer-reviewed empirical studies, including both qualitative and quantitative ones on FCR in AYA survivors. The risk of bias was assessed using the Mixed-Methods Appraisal Tool. Quantitative studies were synthesized narratively, while qualitative studies underwent thematic synthesis.

RESULTS

Among the 5340 studies identified, 34 studies were included finally. 21.4 to 93.3% of AYA cancer survivors experienced FCR. About one-third of survivors with moderate or high FCR improved over time. Female survivors, those with advanced cancer stages, and individuals with negative illness perceptions or higher anxiety reported higher FCR. Persistent FCR was associated with increased psychological problems and lower quality of life. Two studies on behavioral interventions, particularly internet-based cognitive-behavioral therapy (CBT), were acceptable but had limited evidence of efficacy.

CONCLUSION

FCR is prevalent among AYA cancer survivors, particularly in female survivors, those with advanced cancer stages, and those with negative perceptions or higher anxiety. A significant proportion experience persistent, but variability in current evidence limits a comprehensive understanding of its severity, progression, and intervention efficacy. To enhance FCR management, the use of validated assessment tools is essential in both research and clinical contexts. Addressing the physical and psychological aspects of survivorship through comprehensive care is crucial for alleviating FCR and improving overall well-being.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying the key factors of FCR will stimulate the research and the development of targeted interventions for AYA cancer survivors.

The Relational Experience of Fear of Cancer Recurrence in Family Caregivers: A Reflexive Thematic Analysis Study

Fear of cancer recurrence (FCR) affects approximately 50% of family caregivers. While FCR in cancer patients has been well-documented, less is known about the experience of FCR in family caregivers. This study aimed to qualitatively explore the distinct characteristics of FCR in family caregivers. A focus group and semi-structured interviews were conducted via videoconferencing with family caregivers of cancer survivors (stages I-III, finished treatment, no recurrence). Participants were recruited through Canadian hospitals, community partners, and social media. The focus group and qualitative interviews explored family caregivers' experiences of FCR, including its content, frequency, impact, and management. A reflexive thematic analysis was used. In total, twenty family caregivers participated. Six participated in the focus group. Sixteen participated in the interviews. Two participated in both. Family caregivers described their experience of FCR as all-consuming, constant, and marked by a sense of helplessness. Qualitative analysis revealed a major theme of relational aspects of FCR in family caregivers, with the following four inter-related themes: patient-centric hypervigilance, self-silencing, FCR as isolating, and finding support. This qualitative study examined the experiences of family caregivers living with FCR. Our findings highlight that relational factors shape how family caregivers experience and manage their FCR. High-quality survivorship care should be redefined to include FCR interventions tailored to family caregivers.

Association between fear of cancer recurrence and emotional distress in breast cancer: a latent profile and moderation analysis

BACKGROUND

Breast cancer patients often experience significant psychological challenges, particularly fear of cancer recurrence (FCR), which is a prevalent and distressing concern following diagnosis. FCR can lead to heightened emotional distress, including anxiety and depression. Resilience, the ability to adapt positively to adversity, may play a crucial role in mitigating these negative emotional outcomes. This study aims to explore the heterogeneity of FCR among breast cancer patients and examine the moderating effect of resilience on the relationship between FCR and emotional distress.

MATERIALS AND METHODS

A cohort of 398 breast cancer patients participated in the Be Resilient to Breast Cancer (BRBC) program between May and December 2023. Surveys were administered to assess FCR, resilience, and emotional distress levels. Data were analyzed using two approaches: latent profile analysis (LPA) to identify distinct FCR profiles and moderation analysis to evaluate the role of resilience.

RESULTS

Three distinct FCR profiles were identified: low (27.5%), middle (53%), and high (19.5%). Resilience significantly moderated the association between FCR and anxiety (B = 0.115, SE = 0.046, P = 0.014), but no significant moderating effect was observed for depression.

DISCUSSION

The findings highlight significant heterogeneity in FCR among breast cancer patients, with a substantial proportion experiencing moderate to high levels of FCR. Resilience was found to buffer the impact of FCR on anxiety, suggesting that interventions aimed at enhancing resilience could alleviate anxiety related to FCR in this population. These results underscore the importance of incorporating resilience-focused strategies into psychological therapies for breast cancer patients.

A Dyadic Analysis of Optimism, Pessimism, and Fear of Cancer Recurrence in Couples Coping With Early-Stage Breast Cancer

PURPOSE

Fear of cancer recurrence (FCR) is a common yet unaddressed concern among breast cancer (BC) survivors and their intimate partners. Moderate-to-severe FCR has been associated with numerous negative health outcomes and diminished functioning among survivors and their intimate partners. Therefore, it is essential to understand what factors are associated with higher FCR for both patients and partners. Dispositional traits, such as optimism and pessimism, have been associated with FCR severity at the individual (intrapersonal) level. However, few studies have focused on this link in a dyadic, interpersonal context. To address this gap, the present study sought to investigate the association between optimism, pessimism, and FCR in BC survivors and their intimate partners.

METHODS

Optimism, pessimism, and FCR were assessed for 79 couples (n = 158 paired individuals) in which one partner was an early-stage BC survivor who had recently completed adjuvant treatment. The intrapersonal (actor) and interpersonal (partner) associations between optimism or pessimism and FCR were simultaneously investigated using actor-partner interdependence modeling.

RESULTS

A significant positive intrapersonal effect was observed between pessimism and FCR for both survivors and partners, but not between optimism and FCR. No significant interpersonal effects were observed between either optimism or pessimism and FCR.

CONCLUSIONS

Findings indicated that higher levels of pessimism (rather than optimism) are uniquely associated with higher FCR in early-stage BC survivors and their partners. Understanding the role of pessimism in FCR susceptibility will allow for more efficient and timely support of BC survivors and their intimate partners following a cancer diagnosis.

Fear of cancer recurrence is associated with higher primary care use after cancer treatment: a survey-administrative health data linkage study

PURPOSE

To examine the association between fear of cancer recurrence (FCR) and healthcare utilization after completing cancer treatment.

METHODS

A population-based survey to examine survivors' experiences and needs after completing cancer treatment was administered by the provincial cancer registry as part of a national study. Respondents included Nova Scotian survivors of breast, melanoma, colorectal, prostate, hematologic, and young adult cancers who were 1-3 years post-treatment. FCR was assessed using a single item that captured presence and severity. Survey responses were linked to cancer registry, physicians' claims, hospitalization, and ambulatory care data. The data linkage provided four years of healthcare utilization data for each cancer survivor, beginning 1 year after their cancer diagnosis. The final study cohort were cancer survivors who responded to the survey, had their data linked, completed the FCR survey items, and were alive and cancer-free during the 4-year follow-up period (n = 823). The data were analyzed descriptively and using regression models for count data analysis.

RESULTS

Thirty-eight percent of respondents reported FCR. Younger respondents reported higher levels of FCR compared to older respondents: for example, 66.1% of respondents age 18-54 years reported FCR whereas 24.4% of respondents age 75 years and older reported FCR. More females than males reported FCR. Upon adjusted analyses, FCR was associated with 22% higher primary care use after cancer treatment (incidence rate ratio = 1.22, 95% confidence interval = 1.19-1.25, p < 0.0001). No differences were found for specialist visits between those with FCR and those with no FCR (p = 0.366).

CONCLUSION

FCR is a highly prevalent ongoing effect for those who complete cancer treatment. Cancer survivors who reported FCR visited their primary care providers more during follow-up care than those without FCR.

Comparison of the sense of spousal support, anxiety, depression and their relationship to fear of cancer recurrence between lymphoma patients and their spouses: A cross-sectional study in China

PURPOSE

To investigate the level of fear of cancer recurrence (FCR) in spouses of patients with lymphoma and its relationship with patients' FCR, as well as the correlations between FCR, sense of spousal support (SSS), anxiety, and depression in the couples.

METHODS

A cross-sectional study of 233 couples where one partner had lymphoma was conducted from May 2021 to February 2022. Participants provided demographic information and completed the Spouse Support Inventory and Hospital Anxiety and Depression Scale. The Fear of Progression Questionnaire (for patients) and Fear of Progression Questionnaire for Partners (for spouses) were used to measure FCR. Descriptive analyses, t-tests, variance analysis, Spearman's correlation analysis, and multiple linear regression analysis was performed.

RESULTS

The prevalence of FCR, anxiety, and depression in patients was 37.7%, 68.7%, and 83.3%, respectively. The prevalence of FCR, anxiety, and depression in spouses was 56.2%, 78.1%, and 81.1%, respectively. Spouses' FCR scores were higher than those of patients, whereas patients' SSS and anxiety scores were higher than those of their spouses. Multiple linear regression analysis showed that patients' anxiety and SSS, as well as spouses' FCR were significantly associated with patients' FCR. Variables significantly associated with higher FCR among spouses were anxiety, per capita monthly household income, and patients' FCR.

CONCLUSIONS

Patients with lymphoma and their spouses have a certain degree of FCR, anxiety, and depression. FCR levels in spouses are higher than in patients.

IMPLICATIONS FOR CANCER SURVIVORS

Psychological support interventions for couples may be effective in reducing FCR and facilitating family adaptation to cancer.

Feasibility and Acceptability of the Fear-Less Screening and Stratified-Care Model for Fear of Cancer Recurrence Among People Affected by Early-Stage Cancer

OBJECTIVES

Fear of cancer recurrence (FCR) is a prevalent unmet need for people affected by cancer, in the context of limited healthcare resources. Stratified-care models have potential to meet this need, while reducing resource demands. This study aimed to evaluate the feasibility and acceptability of screening procedures and interventions within the Fear-Less stratified-care model among those impacted by early-stage cancer.

METHODS

People affected by breast, head and neck, or gynaecological cancer, who had completed curative treatment, were screened for FCR. Individuals experiencing moderate FCR (scored 13-21 on the Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF) were offered a purpose-developed clinician-guided self-management intervention, while those experiencing severe FCR (FCRI-SF score ≥ 22) were offered individual therapy (ConquerFear). Re-screening and evaluation measures were completed post-intervention.

RESULTS

Seventy-six (70%) of 109 eligible people completed screening, with 53/76 participating in the Fear-Less model evaluation. Thirty-nine of 53 participants reported FCR and were referred to an intervention; 30/39 (77%) accepted the referral. Fifteen (83%) of 18 participants completing the self-management intervention reported reading ≥ 75% of the resource at 5 weeks, with 10/18 (56%) reporting clinically meaningful (≥ 10%) reductions on the FCRI-SF post-intervention. Qualitative feedback indicated screening and the stratified-care received were acceptable.

CONCLUSIONS

Screening procedures and interventions forming the Fear-Less model appear feasible and acceptable for identifying and treating FCR among people affected by early-stage cancer. Although further research is required to evaluate its efficacy, this model has the potential to meet a major unmet need, where psychosocial services are limited amid increased demand.

TRIAL REGISTRATION

This study was retrospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622000818730) on 10/6/2022.

Factors Associated With Fear of Cancer Recurrence in Colorectal Cancer Patients: A Meta-analysis in Health Ecological Perspective

BACKGROUND

Fear of cancer recurrence is a major source of stress and unmet need for colorectal cancer patients.

OBJECTIVE

This review aimed to identify factors influencing fear of cancer recurrence in colorectal cancer patients.

METHODS

Multiple electronic databases were systematically searched for studies from inception to January 2024 using concepts "colorectal neoplasm," "fear," and "recurrence." Two authors independently screened, assessed the quality of eligible studies, and extracted relevant data. The synthesis of effect sizes was conducted using R software version 4.3.1.

RESULTS

A total of 20 studies were included, of which 11 were of moderate quality and 9 were of high quality. The studies reported on 22 potential influencing factors across 5 levels of the health ecological model, including innate personal traits, psychobehavioral factors, interpersonal network factors, living and working conditions, and policy environment factors. After synthesizing the data, it was found that all 22 factors were significantly associated with fear of cancer recurrence in colorectal cancer patients. Of these, 9 factors showed a moderate correlation with fear of cancer recurrence (0.3 < r ≤ 0.6), whereas 13 factors showed a lower level of correlation (r ≤ 0.3).

CONCLUSIONS

The factors associated with the fear of cancer recurrence in colorectal cancer patients are complex and partially modifiable.

IMPLICATIONS FOR PRACTICE

This study suggests that healthcare providers can use a health ecological perspective to provide interventions targeting these factors for colorectal cancer patients to effectively alleviate their fear of cancer recurrence and improve their quality of life.

Effectiveness of Massage Therapy for Cancer Pain, Quality of Life and Anxiety Levels: A Systematic Review and Meta-Analysis

AIM

To synthesise the effectiveness of massage therapy for cancer pain, quality of life and anxiety among patients with cancer.

DESIGN

Systematic review and meta-analysis.

METHODS

This review was reported according to the PRISMA guidelines. Studies evaluating the effects of massage therapy on cancer pain, quality of life or anxiety in patients with cancer pain were eligible. The Cochrane Risk of Bias tool and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality of studies. Outcomes were pooled using standardised mean differences and narratively synthesised when meta-analysis was not possible.

DATA SOURCES

Pubmed, EMBASE, Web of Science, CINAHL, CENTRAL, Google Scholar, ProQuest Theses and Dissertations were searched for English peer-reviewed studies and grey literature published from inception to 8 January 2024.

RESULTS

Thirty-six RCTs involving 3671 participants were included. Massage therapy significantly improved pain (pooled SMD = -0.51, 95% CI -0.68 to -0.33), quality of life (pooled SMD = 0.48, 95% CI 0.19-0.78 when higher scores indicate better quality of life; pooled SMD = -0.52, 95% CI -0.88 to -0.16 when higher scores indicate poorer quality of life) and anxiety (pooled SMD = -0.38, 95% CI: -0.57 to -0.18) post-intervention. All outcomes had very low certainty of evidence. Most studies had unclear or high risk of bias.

CONCLUSION

This review found that massage therapy is beneficial to patients with cancer in improving pain, quality of life and anxiety. Healthcare institutions and healthcare professionals should recognise the value of massage therapy to enhance the care of patients with cancer pain.

REPORTING METHOD

PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

REGISTRATION

PROSPERO CRD42023407311.

Cognitive-behavioural therapy effectiveness for fear of cancer recurrence: systematic review and meta-analysis

OBJECTIVE

Fear of cancer recurrence is one of the psychological distresses for patients with cancer and cancer survivors, which poses a physical and psychological threat. There is scant evidence on the effectiveness of cognitive-behavioural therapy in reducing fear of cancer recurrence. Therefore, we conducted a systematic review and meta-analysis to assess the effectiveness of cognitive-behavioural therapy for fear of cancer recurrence.

METHOD

The review was reported according to Preferred Reporting Items for Systematic Review and Meta-analyses statement. Seven databases were systematically searched from inception to 31 March 2023. Randomised controlled trials implementing cognitive-behavioural therapy interventions and studies reporting fear of cancer recurrence were included. The methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool 2.

RESULTS

A total of 32 randomised controlled trials involving 1515 cancer survivors and 1845 patients with cancer undergoing treatment were included. The meta-analysis indicated a significant effect of cognitive-behavioural therapy on fear of cancer recurrence in patients with cancer and cancer survivors compared with controls (g=-0.65; 95% CI=-0.86, -0.44; p<0.001). The results of the overall risk of bias indicated some concerns in 4 studies and a high risk in 28 studies.

CONCLUSION

The study indicated the effectiveness of cognitive-behavioural therapy intervention for fear of cancer recurrence in patients with cancer and cancer survivors, which should inform future clinical practice of interventions for the treatment of fear of cancer recurrence.

PROSPERO REGISTRATION NUMBER

CRD42023404948.

Three-year trajectories and associated factors of fear of cancer recurrence in newly diagnosed head and neck cancer patients: a longitudinal study

PURPOSE

Limited data exists on the long-term course of fear of cancer recurrence (FCR) in head and neck cancer (HNC) patients. One in five patients was found to experience persistent high FCR in the first months after diagnosis. This study assessed the 3-year trajectories and associated factors of FCR in newly diagnosed HNC patients.

METHODS

Six hundred twenty-one patients from the NETherlands Quality of life and Biomedical Cohort study (NET-QUBIC) completed the FCR assessment at baseline, 3-, 6-, 12-, 24-, and 36-months posttreatment. Trajectories of FCR were identified using latent class growth analysis. Multinominal logistic regression analysis was used to assess associations between FCR trajectories and baseline demographic and medical variables, personality, and coping.

RESULTS

Three FCR trajectories were identified: "consistently high" (n = 45, 7%), "elevated and declining" (n = 209, 34%), and "low and declining" (n = 367, 59%). Patients in the "elevated and declining" and "consistently high" trajectory were younger, had more comorbidities, higher negative adjustment, a higher level of neuroticism, more social support seeking, and more reliance on passive and palliative coping strategies.

CONCLUSION

Three years following diagnosis, the majority of HNC patients showed a resilient FCR trajectory whereas a small percentage of HNC patients (7%) showed persistent high FCR over time.

IMPLICATIONS FOR CANCER SURVIVORS

Younger patients and those with a higher level of neuroticism or maladaptive coping strategies were more vulnerable to have a consistent high level of FCR over time. It is important to identify these patients to provide optimal and tailored psychosocial support.

The Worries About Recurrence or Progression Scale in Cancer (WARPS-C): A Valid and Reliable Measure to Screen for Fear of Cancer Recurrence

OBJECTIVE

The Worries About Recurrence or Progression Scale (WARPS) was recently validated in four common chronic illnesses other than cancer, after a rigorous development process based on the COSMIN criteria. Available measures of fear of progression or fear of cancer recurrence (FCR) have been criticised for not meeting all COSMIN criteria. Therefore, this study aimed to explore the psychometric properties of the WARPS in a cancer sample to assess its applicability to measure FCR.

METHODS

We recruited 346 participants living with or beyond cancer for an online survey. The psychometric properties of the WARPS were examined using a confirmatory factor analysis. Convergent validity was assessed against the current gold standard questionnaires and constructs related to FCR. Some participants completed a follow-up survey 2 weeks later, to assess the test-retest reliability. Finally, a Receiver Operating Characteristics analysis was conducted to determine clinical cut-offs for the WARPS.

RESULTS

Confirmatory factor analysis confirmed that the WARPS has one underlying factor, fear of recurrence or progression (FRP), with adequate model fit. The WARPS demonstrated excellent internal consistency, test-retest reliability and showed convergent validity. ROC analysis revealed a cut-off of 54 for moderate, and 65 for severe FCR on the WARPS.

CONCLUSIONS

The WARPS demonstrated good psychometric properties in a cancer sample. It has the capacity to be used as a screening tool to identify clinical levels of FCR. The WARPS was developed consistent with the COSMIN criteria and overcomes some of the limitations of existing measures.

Anxiety, depression and fear of cancer recurrence in uveal melanoma survivors and ophthalmologist/oncologist communication during survivorship in France - protocol of a prospective observational mixed-method study

BACKGROUND

Quality of life (QoL) in patients undergoing surveillance for uveal melanoma (UM) can be affected by psychological sequelae. Fear of cancer recurrence (FCR) may be acute especially when prognostication indicates an increased risk of metastatic recurrence. Communication with an ophthalmologist or oncologist can then play a key role in impacting QoL.

METHODS

In this prospective study co-designed with patient's partners and using a mixed-method approach, 250 patients at high versus low risk of metastatic recurrence are recruited in a national UM reference centre in France. At T1, after the 6-months post-treatment surveillance visit, dyads of clinicians and eligible patients complete a questionnaire to assess their respective experience of the communication during that consultation. Patients also complete questionnaires assessing their health literacy, information preference, and satisfaction with the information received (EORTC QLQ-INFO25), genomic testing knowledge, genomic test result receipt, satisfaction with medical care (EORTC PATSAT-C33), perceived recurrence risk, anxiety and depression (HADS), fear of cancer recurrence (FCRI) and quality of life (EORTC QLQ-C30 and QLQ-OPT30). At 12-months post-treatment (T2), patients complete again the HADS, FCRI, EORTC QLQ-C30 and QLQ-OPT30. Multilevel analyses will assess the effect of satisfaction with the information received on FCR and QoL accounting for the clinicians' and patients' characteristics. In-depth interviews planned sequentially with ≈25 patients will deepen understanding of patients' care experience.

DISCUSSION

As information on prognosis based on medical parameters becomes widely integrated into oncology practice, this study will highlight UM survivors' information expectations and satisfaction with communication, and its effect on FCR and QoL. Culturally adapted recommendations for doctor-patient communication will be provided for contexts of oncology surveillance involving poor prognosis in cases of recurrence.

TRIAL REGISTRATION

NCT06073548 (October 4, 2023).

Model of Health-Related Quality of Life in Breast Cancer Patients Using Cross-Sectional Data: The Role of Resilience

Purpose

Resilience has been suggested as an important predictor of both physical and mental health-related quality of life in breast cancer patients. However, it is unclear why resilient women handle their diagnosis better, not only mentally, but also physically. The aim of this study was to investigate paths between resilience, physical activity, and mental, physical, and global health-related quality of life in breast cancer patients.

Patients and Methods

Structural equation modeling was conducted to evaluate the proposed structural paths using a sample of 638 women with newly diagnosed breast cancer patients from Sweden.

Results

Resilience was directly associated with physical activity and mental health-related quality of life. It was indirectly associated with physical functioning, through mental health-related quality of life and physical activity. Resilience was also indirectly associated with global quality of life, through mental health-related quality of life.

Conclusion

Mental health support and encouraging physical activity may be especially relevant to enhance all aspects of health-related quality of life early in the breast cancer process. Results should be replicated longitudinally.

Nature and Determinants of Fear of Cancer Recurrence After Endoscopic Submucosal Dissection for Early Gastric Cancer: A Cross-Sectional Study

Gastric cancer is one of the most prevalent tumors in China and other countries, with high morbidity and mortality. Fear of cancer recurrence is common among cancer survivors. Fear of cancer recurrence experiences and psychological interventions have been investigated in breast and other cancers. However, this phenomenon and associated factors have not been evaluated in early gastric cancer survivors in China. The objective of this study was to investigate the nature of fear of cancer recurrence and influencing factors in Chinese patients with early gastric cancer treated with endoscopic submucosal dissection. This cross-sectional study in two centers included 312 early gastric cancer patients who answered self-report questionnaires and were treated with endoscopic submucosal dissection between June 2022 and May 2023 to assess fear of cancer recurrence. Gender, family history of gastrointestinal tumor, tumor recurrence, Helicobacter pylori infection, disease perception, and self-perceived burden were significant factors influencing fear of cancer recurrence (p < .05). More than half of early gastric cancer patients have fear of cancer recurrence, and how to deal with it has become a key issue in the postoperative care of patients. Medical professionals should address these factors to reduce fear of cancer recurrence in at-risk patients.

Fear of cancer recurrence in breast cancer survivors carrying a BRCA1 or 2 genetic mutation : a cross-sectional study

BACKGROUND

Fear of cancer recurrence (FCR) affects virtually all patients who have been treated for cancer, to varying degrees. Breast cancer survivors who carry a BRCA1 or BRCA2 gene mutation are at high risk of cancer recurrence. No study has yet assessed FCR specifically in this population.

OBJECTIVES

This cross-sectional study, conducted in women who were treated for breast cancer and carrying a BRCA1/2 mutation, aimed to: (1) assess the mean level of FCR and estimate the proportion of patients with clinical levels of FCR; (2) examine the relationships between FCR and selected psychological variables (e.g., avoidance, intolerance to uncertainty) and quality of life; (3) explore whether FCR levels vary as a function of the past preventive treatment received; and (4) to assess the associations between FCR and the presence of decisional conflict or regret regarding the various preventive options.

METHOD

Participants were recruited through an e-mail sent to an oncogenetic network mailing list (Réseau ROSE). Participants were asked to complete a battery of questionnaires online assessing FCR and other psychological and quality of life variables.

RESULTS

A total of 89 women completed the survey. Most participants had undergone a preventive mastectomy (62.9%) and a preventive salpingo-oophorectomy (75.3%) at the time of the study. The mean Fear of Cancer Recurrence Inventory-severity score was 16.8, which exceeds the clinical cut-off score of 13, and 70.8% of the participants showed a clinical level of FCR. FCR was significantly associated with higher levels of anxiety and depression, and higher avoidance and intolerance of uncertainty, but not with quality of life. No significant difference was observed on the total FCR score between women who had received preventive surgery (mastectomy and/or salpingo-oophorectomy) and those considering it, and those not considering it. The association was significant between higher FRC scores and greater decisional conflicts and regrets about choosing to undergo preventive surgery.

CONCLUSION

These data suggest that FCR is a significant problem for breast cancer survivors carrying a BRCA1/2 genetic mutation, even after undergoing a prophylactic surgery. This highlights the importance of providing these women with specific psychological intervention focusing on FCR.

Fear of cancer recurrence experienced by pediatric survivors of childhood cancer: a scoping review

PURPOSE

In contrast to the extensive literature on fear of cancer recurrence (FCR) experienced by adults, literature evaluating pediatric FCR has just begun to emerge. Given the rapidly expanding body of work assessing FCR in childhood and adolescence, a scoping review was conducted to synthesize existing findings. We aimed to assess (1) the characteristics and methods of this literature, (2) how pediatric FCR has been measured, and (3) the extant knowledge of FCR experienced by pediatric survivors of cancer.

METHODS

Inclusion criteria were: (1) original reports, (2) participants diagnosed with cancer before age 18, (3) current mean age under 18, (4) FCR was explicitly measured (quantitatively) or captured (qualitatively) via survivor self-report, and (6) published in English. Exclusion criteria were: (1) case studies, and (2) grey literature. Three databases (Embase, MEDLINE, PsycINFO) and reference lists from included studies were searched. All studies were screened for inclusion by two authors and all data were extracted by a single author.

RESULTS

Of 3906 identified studies, 19 were included. Studies (published 1991 - 2023) encompassed diverse geographical locations, study designs, and measurement methods. Few assessed FCR as a primary aim (n = 6, 32%). FCR was experienced by 43 - 90% of pediatric survivors. FCR was often positively associated with somatic symptoms and negatively associated with quality of life and emotional functioning.

CONCLUSION

FCR is a prevalent issue for children and adolescents. Additional evidence is needed to explore and confirm preliminary findings. Future pediatric FCR studies should aim to align with published priority research areas.

Ecosystem Barriers and Facilitators Linked to the Fear of Cancer Recurrence: An Umbrella Review

The fear of cancer recurrence is an important topic in the healthcare field. In general, approximately 40% of survivors experience high levels of fear of recurrence. This study aims to fill this gap by synthesizing the findings of systematic reviews studies investigating ecosystems, correlates or predictors, and barriers and facilitators of fear of cancer recurrence among cancer survivors. An umbrella meta-synthesis was conducted using the following databases: MEDLINE, PsycINFO, PsycARTICLES, CINAHL, Business source premier, and SOCindex, ending in April 2024 with PRISMA methods. A total of 24 systematic reviews, representing 729 articles, were included in the study. In total, six ecosystems were identified, including family, work, friends, the healthcare system, caregivers, and religion. As part of this umbrella review, 55 specific ecosystemic factors were identified that may contribute to fear of cancer recurrence. Furthermore, the umbrella review identified 12 facilitators and 12 barriers related to fear of cancer recurrence. This umbrella meta-synthesis contributed significantly to our review's strength in synthesizing the main ecosystem and its influence on fears of cancer recurrence. Understanding the interdependence of ecosystems should enable future research on intervention effectiveness or the development of interventions that could reduce the fear of cancer recurrence.

Latent profile analysis and related factors for fear of cancer recurrence among Chinese breast cancer patients in rehabilitation

PURPOSE

Fear of cancer recurrence (FCR) is a psychological problem often faced by breast cancer patients in the rehabilitation period. The aim of this study was to identify FCR subgroups of Chinese breast cancer patients in rehabilitation and to analysis the factors affecting each subgroup. The effects of the subgroups on quality of life (QoL) were also explored.

METHODS

Cross-sectional data were collected from 300 breast cancer patients in a rehabilitation setting. The researchers invited the subjects to complete questionnaires on FCR, fatigue, anxiety depression, perception of illness and QoL. The researchers conducted a latent profile analysis. The factors influencing the subgroups of FCR were identified using ANOVA and multinomial logistic regression analyses. Linear regression analyses were used to explore the effect of subgroups on QoL.

RESULTS

There were three subgroups of FCR: profile 1 'Low FCR Group' (42.3%), profile 2 'Moderate FCR Group' (45.6%), and profile 3 'High FCR Group' (12.1%). Cancer stage II was a protective factor for FCR patients (OR = 0.107, P < 0.01) and was more likely to be categorized among the low FCR group. Anxiety depression was a risk factor for FCR patients and was more likely to be categorized in the medium FCR group (OR = 1.764, P < 0.001) and in the high FCR group (OR = 2.911, P < 0.001). In addition, patients subjected to a high perception of illness were more likely to be considered in the medium FCR group (OR = 1.041, P < 0.05), a risk factor affecting patients with FCR. Linear regression analysis showed that subgroups with higher FCR had a stronger negative predictive effect on their QoL (all P < 0.001).

CONCLUSIONS

The FCR was identified as three subgroups among breast cancer patients in rehabilitation, which suggests that healthcare professionals should give full consideration to the impact of cancer stage, anxiety and depression, and illness perceptions on the FCR subgroups in order to improve their QoL.

Quality of life following pelvic exenteration in neoplasms

BACKGROUND

Pelvic exenteration (PE) is an extensive surgical treatment reserved for advanced or recurrent pelvic neoplasms, with potential impacts on patients' quality of life (QoL) poorly referenced in the literature.

OBJECTIVES

This study aimed to evaluate QoL outcomes among three types of PE.

METHODS

A cross-sectional study assessed 106 patients divided into anterior PE (APE), posterior PE (PPE), or total PE (TPE) groups. QoL was measured using e short form 36 version 2 (SF-36) and the European Organization for Research and Treatment of Cancer QoL Quality of Life Questionnaire Core 30 (QLQ-C30) QoL questionnaires. Descriptive and inferential analyses compared questionnaire scores.

RESULTS

The findings unveiled a balance among the three groups concerning demographic variables and comorbidities, with the exception of a male predominance in the APE and TPE cohorts. Notably, the APE group exhibited elevated scores in overall health (assessed via SF-36) and social functioning and diarrhea domains (assessed via QLQ-C30). Moreover, in terms of the fatigue and nausea/vomiting domains (assessed via QLQ-C30), the APE group demonstrated superior QoL compared to the PPE group. Conversely, the PPE group manifested a notably lower QoL in the constipation domain (assessed via QLQ-C30) compared to the other two groups. Additionally, disease recurrence was significantly associated with diminished QoL across multiple domains.

CONCLUSION

APE patients exhibited better QoL than PPE and TPE groups, with disease recurrence adversely affecting QoL.

The impact of clinically relevant health conditions on psychosocial outcomes in survivors of childhood cancer: results of the DCCSS-LATER study

PURPOSE

Investigate the association between presence, number and type of clinically relevant health conditions and a range of psychosocial outcomes (emotional, social, cognitive, physical) in survivors of childhood cancer (CCS).

METHODS

CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed between 1963-2001, attained age ≥ 18, diagnosed < 18, ≥ 5 years since diagnosis) completed a questionnaire on health conditions (2013-2014), and questionnaires on psychosocial outcomes (2017-2020): Hospital Anxiety and Depression Scale, Short form 36, TNO-AZL Questionnaire for Adult Health-Related Quality of Life, and the Self-Rating Scale for Post-Traumatic Stress Disorder. Associations among health conditions and psychosocial outcomes were assessed with regression analysis, adjusting for attained age, sex, and time since diagnosis, and adjusting for multiple testing (p < 0.004).

RESULTS

A total of 1437 CCS, mean age 36.3 years, 51.1% female, ≥ 15 years since diagnosis, completed questionnaires on health and psychosocial outcomes. CCS with a clinically relevant health condition, and those with more conditions had worse emotional, social, and physical outcomes; regression coefficients were small to moderate. CCS with gastro-intestinal conditions, endocrine, nervous systems, eye, or ear conditions, and especially those with secondary malignant neoplasms, reported worse psychosocial functioning; regression coefficients were small/moderate to large.

CONCLUSION AND IMPLICATIONS

Health care professionals should be aware of the increased risk for psychosocial problems among CCS with health conditions, especially for survivors with secondary malignant neoplasms, gastro-intestinal, endocrine, nervous system, eye, and ear conditions. CCS may benefit from psychological interventions to develop coping strategies to manage health conditions and psychosocial consequences of the cancer trajectory.

Examining the role of resilience in the relationship between social support and fear of recurrence among patients with gastric cancer on chemotherapy: a cross-sectional study in Jiangsu, China

OBJECTIVES

The objective of this study is to investigate the relationships between fear of cancer recurrence (FCR), social support and resilience, and further determine whether resilience mediates social support and FCR among Chinese patients with gastric cancer undergoing chemotherapy.

DESIGN

Multicentre cross-sectional survey.

SETTING

Four hospitals in Jiangsu Province, China, with grade-A tertiary hospital settings.

PARTICIPANTS

755 patients with gastric cancer on chemotherapy across four hospitals in China were included from March 2021 to September 2022.

OUTCOME MEASURES

The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Connor-Davidson Resilience Scale (CD-RISC) and Social Support Rating Scale (SSRS) were used to test the model's constructs. Statistical analyses were conducted by using IBM SPSS V.26.0 software. PROCESS V.3.4 macro was used to analyse the mediating role of resilience in the relationship between social support and FCR.

RESULTS

The mean scores for SSRS, CD-RISC and FoP-Q-SF in patients with gastric cancer receiving chemotherapy were 41.55±7.79, 54.83±18.46 and 30.91±10.11, respectively. 43.3% (n=327) had psychological dysfunction, 56.8% (n=429) had low to medium resilience and 99.1% (n=748) had medium to robust social support. Significant differences exist among three variables, resilience positively correlated with social support, while FCR negatively correlated with resilience and social support (p<0.001). Resilience fully mediated the relationship between social support and FCR (a*b-path=-0.126, 95% CI -0.169 to -0.086).

CONCLUSIONS

Mediation analysis shows resilience mediates social support and FCR in patients with gastric cancer as the negative effect of social support on FCR was fully mediated by resilience. Interventions targeting these variables may reduce FCR in patients with gastric cancer undergoing chemotherapy.

Fear of cancer recurrence in adolescent patients with malignant bone tumors: a cross-section survey

BACKGROUND

Adolescent malignant-bone tumor patients' fear of cancer recurrence is a significant psychological issue, and exploring the influencing factors associated with fear of cancer recurrence in this population is important for developing effective interventions. This study is to investigate the current status and factors influencing fear of cancer recurrence (FCR) related to malignant bone-tumors in adolescent patients, providing evidence for future targeted mental health support and interventions.

DESIGN

A cross-sectional survey.

METHODS

In total, 269 adolescent malignant-bone tumor cases were treated at two hospitals in Zhejiang Province, China from January 2023 to December 2023. Patients completed a General Information Questionnaire, Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Family Hardiness Index (FHI), and a Simple Coping Style Questionnaire (SCSQ). Univariate and multivariable logistic regressions analysis were used to assess fear of cancer recurrence.

RESULTS

A total of 122 (45.4%) patients experienced FCR (FoP-Q-SF ≥ 34). Logistic regression analysis analyses showed that per capita-monthly family income, tumor stage, communication between the treating physician and the patient, patient's family relationships, family hardiness a positive coping score, and a negative coping score were the main factors influencing FCR in these patients (P < 0.05).

CONCLUSIONS

FCR in malignant-bone tumor adolescent patients is profound. Healthcare professionals should develop targeted interventional strategies based on the identified factors, which affect these patients; helping patients increase family hardiness, helping patients to positively adapt, and avoid negative coping styles.

The development and validation of the Worries About Recurrence or Progression Scale (WARPS)

OBJECTIVES

Worry about recurrence or progression is a common concern among people with chronic physical illnesses. Although there are options to measure the fear of cancer recurrence and other illness-specific measures, there is only one transdiagnostic measure of fear of progression, which does not assess the fear of recurrence or relapse.

DESIGN

A multi-phase study outlining the development and validation of a novel transdiagnostic measure of fear of recurrence or progression, the Worries About Recurrence and Progression Scale (WARPS).

METHOD

From a prior systematic review, we used quotes from people with lived experience to generate 55 items. Next, we piloted the items with 10 people with a range of chronic conditions, leading to a final total of 57 items. We then recruited four groups of people with cardiac disease, rheumatic disease, diabetes and respiratory disease (n = 804). An exploratory factor analysis in a randomly split sample resulted in an 18 item, single factor scale. We then performed confirmatory factor analysis on these 18 items in the remaining sample.

RESULTS

The 18-item WARPS demonstrated good construct validity, internal consistency and test-retest reliability. Specifically, the WARPS was strongly correlated with the Fear of Progression Questionnaire, and with illness-specific fears. Significant, moderate correlations were observed with depression, anxiety, stress, and death anxiety. The WARPS demonstrated the validity and reliability amongst people with four of the most common chronic conditions and the factor structure was invariant across genders.

CONCLUSION

The WARPS is a valid and reliable tool to measure transdiagnostic worries about recurrence and progression.

Emotional Distress, Cognitive Complaints, and Care Needs among Advanced Cancer Survivors Treated with Immune Checkpoint Blockade: A Mixed-Method Study

BACKGROUND

There is a need for a better understanding of survivorship-related issues in advanced cancer survivors treated with immune checkpoint blockade (ICB). The purpose of this study was to identify survivorship-related issues, with a focus on psychological distress, cognitive complaints, physical sequelae, impact on family dynamics, and care needs in unresectable, advanced cancer survivors treated with ICB.

METHODS

Semi-structured interviews and patient-reported outcome measures (PROMs) were conducted in survivors followed up at the University Hospital Brussels. We performed content analysis on the semi-structured interviews and analyzed the PROMs descriptively.

RESULTS

70 cancer survivors (71.4%) consented to participate between July 2022 and November 2023. Clinical fear of cancer recurrence (FCR) was present in 54.3% of the cancer survivors, and 18.6% had elevated cognitive complaints. We identified triggers related to clinically important psychological distress, such as immune-related adverse events, the progression/recurrence of disease, difficulties in adjusting to life after treatment, and co-existing life stressors, alongside persistent physical issues and unmet psychological and nutritional care needs.

CONCLUSION

Our results indicate the existence of persistent psychological, physical, and cognitive issues, and support the need for routine screening for FCR. The identified triggers related to severe psychological distress can aid clinicians in timely referring the patient, thereby enhancing survivorship care.

Effectiveness of Cognitive Behavioral Therapy on Fear of Cancer Recurrence in Breast Cancer: A Systematic Review and Meta-analysis

BACKGROUND

Fear of cancer recurrence is one of the psychological distresses that seriously affects the quality of life of breast cancer patients. However, the evidence for cognitive behavioral therapy on fear of cancer recurrence in breast cancer is limited.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in reducing breast cancer patients' fear of cancer recurrence.

METHODS

Seven databases were searched for randomized controlled studies on cognitive behavioral therapy for fear of cancer recurrence in cancer patients from the inception of the database to April 30, 2023, with no language restrictions. Meta-analysis was performed using Stata MP 17. The Cochrane Risk of Bias Tool version 2 was used to assess the quality of the included studies. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation method.

RESULTS

This review includes a total of 13 randomized controlled trials with 1447 breast cancer patients and survivors. When compared with controls, meta-analysis revealed that cognitive behavioral therapy significantly reduced the fear of cancer recurrence (g = -0.44; 95% confidence interval, -0.75 to -0.13; P < .001), whereas subgroup analysis revealed that only mindfulness-based cognitive therapy was significant. The overall risk of bias was high. The Grading of Recommendations, Assessment, Development and Evaluation assessment showed a low overall quality of evidence.

CONCLUSIONS

Cognitive behavioral therapy may be effective in reducing fear of cancer recurrence in breast cancer patients, and mindfulness-based cognitive therapy is particularly worthy of implementation.

IMPLICATIONS FOR PRACTICE

Mindfulness-based cognitive therapy may be used as an additional strategy to help manage breast cancer patients' fears of cancer recurrence.

Associations of illness perception and social support with fear of progression in young and middle-aged adults with digestive system cancer: A cross-sectional study

PURPOSE

While Fear of progression (FoP) is a natural reaction in cancer, elevated FoP can impact life quality and social function. Our study aims to explore how illness perception, social support, and posttraumatic growth influence patients' FoP.

METHODS

This study enrolled 243 young and middle-aged adults with digestive system cancer at a hospital in Guangzhou from November 2022 to November 2023. In this study, the measurement instruments utilized included The Fear of Progression Questionnaire-Short Form, The Brief Illness Perception Questionnaire, The 12-item Perceived Social Support Scale, and The 21-item Posttraumatic Growth Inventory. Data was analyzed employing polynomial regression and response surface analyses.

RESULTS

The mean score of FoP was 35.45 ± 10.05, and 59.3% of the cancers (scores≥34) had clinically dysfunctional levels of FoP. Regarding congruence, patients' FoP was higher when the levels of illness perception and social support were both low or high than when the levels were both intermediate. Regarding incongruence, patients' FoP was lower when the level of illness perception was low and social support was high compared with when the level of illness perception was high and social support was low. Additionally, posttraumatic growth moderated the (in)congruence effect of illness perception-social support on the FoP of patients.

CONCLUSIONS

Low or high illness perception-social support congruence was detrimental to the FoP of patients. Low illness perception-high social support incongruence was beneficial to patients' FoP. Posttraumatic growth can be a positive factor for enhancing the impact of low illness perception-high social support incongruence on patients' FoP.

Effects of meaning therapy on spirituality, psychological health, and quality of life in patients with cancer: A systematic review and meta-analysis of randomized controlled trials

Objective

This study aimed to systematically review studies of meaning therapy on patients with cancer and to evaluate its effectiveness on spiritual outcomes, psychological outcomes, and quality of life (QOL).

Methods

A comprehensive literature search were performed in five international databases (PubMed, Embase, Web of Science, The Cochrane Library, and CINAHL) and four Chinese databases (CNKI, Wanfang Data, VIP, and CBM) from the inception to August 2023. The methodological quality of each included studies was evaluated by using the revised Cochrane risk-of-bias tool for randomized trials. The random-effects model or fixed-effects model was utilized for effect size analysis, and the standardized mean difference (SMD) or mean difference (MD) along with its corresponding 95% confidence interval (CI) was computed. Meta-analysis was conducted by using the RevMan software 5.4.1.

Results

Eight randomized controlled trials with 1251 participants were included in this review. Meta-analyses revealed that meaning therapy can significantly improve the spiritual outcomes including meaning in life (SMD = -0.48; 95% CI = -0.89 to -0.07; P = 0.02), hopelessness (SMD = -0.30; 95% CI = -0.51 to -0.09; P = 0.005), self-esteem (MD = -2.74; 95% CI = -4.17 to -1.32; P = 0.0002) and spiritual well-being (MD = -3.32; 95% CI = -5.63 to -1.01; P = 0.005), psychological outcomes including anxiety (MD = -0.66; 95% CI = -1.30 to -0.01; P = 0.05), depression (SMD = -0.37; 95% CI = -0.55 to -0.20; P < 0.0001), psychological distress (SMD = -0.35; 95% CI = -0.70 to -0.01; P = 0.04) and desire for hastened death (MD = -0.76; 95% CI = -1.47 to -0.05; P = 0.04), and QOL (SMD = -0.29; 95% CI = -0.50 to -0.09; P = 0.006) in patients with cancer.

Conclusions

Meaning therapy has positive effects on improving spirituality, psychological health, and QOL of patients with cancer. More high-quality randomized controlled trials with larger sample sizes are warranted to confirm the results of our review and to clarify the long-term effects of meaning therapy in the future.

Systematic review registration

PROSPERO (No. CRD42021278286).

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.

"Dancing on the edge of the abyss": Posttraumatic growth in men cancer survivors

OBJECTIVE

Surviving cancer can lead to self-perceived beneficial changes and personal growth, commonly referred to as posttraumatic growth. However, the survivorship experience of men following cancer remains understudied. Thus, our objective was to obtain a comprehensive understanding of men's perceptions of the changes in their lives following cancer.

METHODS

Twenty-four Israeli men who completed cancer treatment participated in five focus group meetings. Data analysis was performed using the thematic analysis method.

RESULTS

Four themes were identified pertaining to both positive and negative changes in the men's lives following cancer: 1) negative manifestations of cancer survivorship; 2) changes in perceptions of life; 3) changes in perceptions of self; and 4) putting changes into action.

CONCLUSION

Whereas earlier research indicated a minimal impact of cancer on men survivors' lives, this study demonstrates multidimensional changes in the lives of such men. Findings revealed a dialectic post-cancer experience that consisted of negative manifestations of cancer survivorship co-existing with positive developments in different aspects of the men's lives. Additionally, prioritizing one's self was a novel finding of the current study.

Disruptions in Cancer Care Due to the COVID-19 Pandemic and Fear of Cancer Recurrence in Women with Breast Cancer: A Mixed-Methods Study

OBJECTIVE

This study investigated if fear of cancer recurrence (FCR) levels and the proportion of women having a clinical level of FCR differed by whether women had or had not experienced disruptions in their cancer tests and treatments due to the pandemic.

METHODS

We conducted a mixed-methods study between November 2020 and March 2021 among women diagnosed with breast cancer in the previous five years at the time of their entry in the study. Women completed a questionnaire online assessing disruptions in breast cancer tests and treatments due to the pandemic and the severity subscale of the Fear of Cancer Recurrence Inventory. Semi-structured interviews were also conducted with a subsample of 24 participants and were thematically analyzed.

RESULTS

The proportion of patients with a clinical level of FCR was significantly higher among those who experienced the postponement or cancellation of diagnostic and disease progression tests (e.g., blood tests, X-rays, or magnetic resonance imaging; adjusted PR = 1.27 95% CI = 1.13-1.43). Qualitative findings suggest that FCR was exacerbated by the pandemic context. In particular, perceived or actual barriers to care access due to the pandemic were identified as significant FCR-enhancing factors.

CONCLUSIONS

These results highlight the need to keep diagnostic and progression tests as timely as possible to prevent increases in FCR levels and offer counselling about FCR when postponing or cancellation are inevitable.

Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority

PURPOSE

This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors.

METHODS

Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score.

RESULTS

One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z =  - 15.939, P < 0.001) and EQ-VAS scores (Z =  - 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z =  - 1.610, P = 0.107), but the difference was not statistically significant.

CONCLUSION

Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.

Couples' skills training intervention in young breast cancer patients with fear of cancer recurrence: A randomized controlled trial

PURPOSE

This study adapted the Chinese version of the Couple Skills Training intervention program to couples of young breast cancer patients in China and investigated its effects on fear of cancer recurrence (FCR), cancer-related communication, and level of hope among the couples.

METHODS

Ninety young breast cancer patients and their spouses were recruited and randomly assigned to the intervention group (45 couples) and the control group (45 couples). Couples in the intervention group received skills training and were assessed at baseline, post-intervention, and 3 months post-intervention to measure outcomes. Differences in scores between the two groups were analyzed using two-sample t-tests and generalized estimating equations (GEE) controlling for demographic and health-related variables.

RESULTS

Couples' skills training intervention effectively reduced FCR and improved cancer-related communication in young breast cancer patients compared to the control group (both p < 0.001). Spouses' expectations significantly increased (p < 0.001). At 3 months post-intervention, couples in the intervention group showed significant improvements in FCR, cancer-related communication, and hope (all p < 0.001).

CONCLUSION

Couples' skills training interventions are beneficial for helping young breast cancer patients cope with FCR. Couples-based interventions play a crucial role in addressing FCR in these patients and their spouses. Future research should consider larger samples and longer follow-up periods to enhance intervention effectiveness.

CLINICAL TRIAL CENTER REGISTRATION NUMBER

This study has also been registered with the Chinese Clinical Trial Registry (No: ChiCTR2200063327).

Patient-initiated follow-up in women with early-stage endometrial cancer: A long-term follow-up of the OPAL trial

OBJECTIVE

A long-term follow-up of the OPAL trial to compare the effect of patient-initiated (PIFU) versus hospital-based (HBFU) follow-up on fear of cancer recurrence (FCR), quality of life (QoL) and healthcare use after 34 months of follow-up.

DESIGN

Pragmatic, multicentre randomised trial.

SETTING

Four Danish departments of gynaecology between May 2013 and May 2016.

POPULATION

212 women diagnosed with stage I low-intermediate risk endometrial carcinoma.

METHODS

The control group attended HBFU with regular outpatient visits (i.e., 8) for 3 years after primary treatment. The intervention group underwent PIFU with no prescheduled visits but with instructions about alarm symptoms and options of self-referral.

MAIN OUTCOME MEASURES

The endpoints were FCR as measured by the Fear of Cancer Recurrence Inventory (FCRI) and QoL as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire C-30 (EORTC QLQ C-30), and healthcare use as measured by questionnaires and chart reviews after 34 months of follow-up.

RESULTS

FCR decreased from baseline to 34 months in both groups and no difference was found between allocations (difference -6.31 [95% confidence interval -14.24 to 1.63]). QoL remained stable with no difference in any domains between the two arms at 34 months using a linear mixed model analysis. The use of healthcare was significantly lower in the PIFU group (P < 0.01).

CONCLUSION

Patient-initiated follow-up is a valid alternative to hospital-based follow-up for people who have been treated for endometrial cancer and have low risk of recurrence.

Personalized surveillance and aftercare for non-metastasized breast cancer: the NABOR study protocol of a multiple interrupted time series design

BACKGROUND

Follow-up of curatively treated primary breast cancer patients consists of surveillance and aftercare and is currently mostly the same for all patients. A more personalized approach, based on patients' individual risk of recurrence and personal needs and preferences, may reduce patient burden and reduce (healthcare) costs. The NABOR study will examine the (cost-)effectiveness of personalized surveillance (PSP) and personalized aftercare plans (PAP) on patient-reported cancer worry, self-rated and overall quality of life and (cost-)effectiveness.

METHODS

A prospective multicenter multiple interrupted time series (MITs) design is being used. In this design, 10 participating hospitals will be observed for a period of eighteen months, while they -stepwise- will transit from care as usual to PSPs and PAPs. The PSP contains decisions on the surveillance trajectory based on individual risks and needs, assessed with the 'Breast Cancer Surveillance Decision Aid' including the INFLUENCE prediction tool. The PAP contains decisions on the aftercare trajectory based on individual needs and preferences and available care resources, which decision-making is supported by a patient decision aid. Patients are non-metastasized female primary breast cancer patients (N = 1040) who are curatively treated and start follow-up care. Patient reported outcomes will be measured at five points in time during two years of follow-up care (starting about one year after treatment and every six months thereafter). In addition, data on diagnostics and hospital visits from patients' Electronical Health Records (EHR) will be gathered. Primary outcomes are patient-reported cancer worry (Cancer Worry Scale) and overall quality of life (as assessed with EQ-VAS score). Secondary outcomes include health care costs and resource use, health-related quality of life (as measured with EQ5D-5L/SF-12/EORTC-QLQ-C30), risk perception, shared decision-making, patient satisfaction, societal participation, and cost-effectiveness. Next, the uptake and appreciation of personalized plans and patients' experiences of their decision-making process will be evaluated.

DISCUSSION

This study will contribute to insight in the (cost-)effectiveness of personalized follow-up care and contributes to development of uniform evidence-based guidelines, stimulating sustainable implementation of personalized surveillance and aftercare plans.

TRIAL REGISTRATION

Study sponsor: ZonMw. Retrospectively registered at ClinicalTrials.gov (2023), ID: NCT05975437.

Effects of Social Support, Family Resilience, and Individual Resilience on Fear of Cancer Recurrence Among Persons With Breast Cancer: A Cross-Sectional Study

BACKGROUND

There is limited research exploring the psychological and social predictors of fear of cancer recurrence (FCR).

OBJECTIVE

This study tested the effects of social support, family resilience, and individual resilience on FCR among persons with breast cancer.

METHODS

A convenience sampling method was used to select 214 participants from March to August 2021 in 1 tertiary hospital in Jinan, China. Data were collected using self-administered questionnaires. Path analysis was adopted to explore the effects of social support, family resilience, and individual resilience on FCR.

RESULTS

Findings showed that 94.6% of the participants reached a clinical level of FCR. Social support (β = -.75, p < .01) and individual resilience (β = -.32, p < .01) negatively and directly impacted FCR. Family resilience indirectly impacted FCR through individual resilience (β = -.22, 95% confidence interval (CI): -.34 to -.08). Social support indirectly impacted FCR through family resilience and individual resilience (β = -.15, 95% CI: -.23 to -.06).

CONCLUSIONS

Persons with breast cancer experienced a high level of FCR. Individual resilience was a mediator between family resilience and FCR. Resilience (individual resilience and family resilience) partially mediated the effects of social support on FCR. The findings indicate that measures focused on improving individual resilience, family resilience, and social support should be considered by nurses, which are helpful for easing FCR.

Trajectories of fear of progression in nasopharyngeal carcinoma patients receiving proton and heavy ion therapy

OBJECTIVE

The study examined the growth trajectory of fear of progression(FOP) in nasopharyngeal carcinoma (NPC) patients. In addition, sociodemographic and clinical variables of each trajectory class were analyzed.

METHOD

Two hundred sixteen NPC patients undergoing proton and heavy ion therapy were measured beginning (T0) and end of a 4-week proton and heavy ion therapy (T1), 3 months (T2) and 6 months (T3) after discharge. And data from the final 197 NPC patients were analyzed. NPC patients' FOP was investigated by the Fear of Progression Questionnaire-Short Form (FOP-Q-SF) form T0 to T3. SPSS and Mplus were used for statistical analysis. The LGMM was used to analyze the trajectory of FOP followed up over 6 months after proton and heavy ion therapy. The logistic regression was utilized to compare the differences in sociodemographic and clinical characteristics of patients in different trajectory groups of FOP.

RESULTS

One hundred ninety-seven NPC patients were analyzed. LGMM analysis showed that three-group trajectory solution was the best fitting (low-fear decline FOP (14.21%), the moderate-fear stable FOP(43.15%), and high-fear rising FOP (42.64%). Significant positive associations were found between age < 30 years (β = 3.399, p = 0.023), with or without children (β = 3.1, p = 0.002), primary/recurrence (β = -6.196, p < 0.001), diagnosis < 3 months (β = 4.435, p = 0.031), high school education (β = 2.98, p = 0.048), and high fear rising FOP. Patients who had moderate financial stress (β = 2.51, p = 0.041), with or without children (β = 1.564, p = 0.003), primary/recurrence (β = -2.578, p = 0.005), less than 30 radiotherapy times (β = 0.979, p = 0.046) tended to report significant moderate-fear stable FOP over time.

CONCLUSION

42.64% of the NPC patients showed high-fear rising FOP over the 6 months after treatment. Age 18-30 years, with or without children, relapsed, diagnosis < 3 months, and high school education and reporting being a pessimist predicts higher FOP scores. Early identification of age 18-30 years, with or without children, relapsed, diagnosis < 3 months, and high school education might help to identify populations experiencing long-term FOP. Clinical teams responsible to develop the target interventions for management of FCR in clinical practice.

Impact of fear of recurrence in patients with cancer on caregivers' psychological health: A meta-analysis

Objective

This study aims to quantitatively investigate the relationship between fear of cancer recurrence in patients with cancer and their caregivers' psychological health, examining the extent of the impact of this fear on caregivers.

Methods

We conducted a comprehensive search in PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO databases from inception until May 2023 for relevant English publications. Pearson correlation coefficients (r) were utilized as effect sizes to assess the overall relationship between fear of recurrence and psychological outcomes among caregivers of patients with cancer.

Results

A total of 19 eligible studies were included in the analysis. The findings revealed a moderate positive correlation between fear of recurrence in patients with cancer and caregivers' fear of recurrence and depression. A relatively weaker correlation was observed between patients' fear of recurrence and caregivers' anxiety. Due to considerable heterogeneity (I2 ​= ​91.99%, Q ​= ​212.23), the primary outcome of fear of recurrence in patients with cancer influencing caregivers' fear of recurrence was examined through subgroup analyses.

Conclusions

Our meta-analysis established a significant positive correlation between fear of recurrence in patients with cancer and negative psychological consequences among caregivers, including recurrence fear, depression, and anxiety. Future research should explore the evolution of adverse psychological outcomes in both patients with cancer and their caregivers over time and delve into the bivariate psychological impact within the patient-caregiver dyads.

Systematic review registration

PROSPERO, CRD42022383866.

Fear of cancer recurrence and mental health: A comprehensive meta-analysis

OBJECTIVE

This study aimed to examine the relationship between fear of cancer recurrence (FCR) and symptoms of anxiety, depression, and emotional distress in cancer survivors. Additionally, potential effect modifiers of this link were investigated.

METHODS

A systematic search was conducted in PsychInfo, PubMed/Medline, Web of Science, and the Cochrane Central Register of Controlled Trials until June 2022. Studies reporting the association between FCR and mental health indices in adolescent and young adult survivors (15-39 years) and adult survivors (>18 years) were included. Study quality was assessed using the Joanna Briggs Institute checklist for cross-sectional studies.

RESULTS

A total of 72 primary studies with 31,740 participants were identified, with the majority having a low risk of bias. The results revealed a significant association between FCR and depression, anxiety, and emotional distress. This association was observed whether FCR was examined in relation to each factor individually or collectively. The effect sizes fell within the medium range. Notably, the relationship between FCR and mental health strengthened over the years of publication. Additionally, lengthier FCR assessment instruments yielded larger effect sizes compared to shorter and single-item instruments, underscoring the significance of instrument selection.

CONCLUSIONS

This meta-analysis provides further evidence that FCR is linked to a range of common mental health problems. The medium effect sizes observed indicate the need to consider FCR when evaluating the mental health of cancer survivors, and vice versa. Further research is required to elucidate the underlying mechanisms of the FCR-mental health link.

Protective Factors against Fear of Cancer Recurrence in Breast Cancer Patients: A Latent Growth Model

The current study aimed to examine the fear of cancer recurrence (FCR) trajectory and protective predictors in women coping with breast cancer (BC). The study's model investigated whether a higher coping self-efficacy and positive cognitive-emotion regulation at the time of the BC diagnosis would lead to reduced levels of FCR at six months and in later stages (12 and 18 months) post-diagnosis. The sample included 494 women with stages I to III BC from Finland, Italy, Portugal, and Israel. They completed self-report questionnaires, including the Fear of Cancer Recurrence Inventory (FCRI-SF), the Cancer Behavior Inventory-Brief Version (CBI-B), the Cognitive-Emotion Regulation Questionnaire (CERQ short), and medical-social-demographic data. Findings revealed that a higher coping self-efficacy at diagnosis predicted lower FCR levels after six months but did not impact the FCR trajectory over time. Surprisingly, positive cognitive-emotion regulation did not predict FCR levels or changes over 18 months. FCR levels remained stable from six to 18 months post-diagnosis. This study emphasizes the importance of developing specific cancer coping skills, such as coping self-efficacy. Enhancing coping self-efficacy in the first six months after BC diagnosis may lead to lower FCR levels later, as FCR tends to persist in the following year.

The relationship between symptom perception and fear of progression in patients with chronic heart failure: a multiple mediation analysis

AIMS

Studies have shown that symptom perception is associated with fear of progression (FOP) in many diseases and regulated by psychological factors. Whether the association also occurs in patients with chronic heart failure (HF) remains unclear, as do the specific mechanisms involved. This study aimed to explore the multiple mediation effects of self-care confidence and mental resilience on the relationship between symptom perception and FOP in Chinese patients with chronic HF.

METHODS AND RESULTS

A cross-sectional study was conducted on 247 patients with chronic HF recruited from two hospitals in Yangzhou, China. The sociodemographic and clinical data and self-reported questionnaires including heart failure somatic perception, fear of progression, self-care confidence, and mental resilience were collected. Data analysis relating to correlations and mediating effects was carried out by SPSS 26.0 and PROCESS v3.3 macro. Fear of progression was positively correlated with symptom perception (r = 0.599, P < 0.01), but negatively correlated with self-care confidence (r = -0.663, P < 0.01), mental resilience-strength (r = -0.521, P < 0.01), and mental resilience-toughness (r = -0.596, P < 0.01). The relationship between symptom perception and FOP was mediated by self-care confidence [effect = 0.095, 95% confidence interval (CI) (0.054-0.142)] and mental resilience-toughness [effect = 0.033, 95% CI (0.006-0.074)], respectively, and together in serial [effect = 0.028, 95% CI (0.011-0.050)]. The proportion of the mediating effect accounting for the total effect was 31.0%.

CONCLUSION

Self-care confidence and mental resilience-toughness were multiple mediators of the association between symptom perception and FOP in patients with chronic HF. Interventions targeted at strengthening self-care confidence and mental resilience may be beneficial for the reduction of FOP, especially with regard to toughness.

The Mediating Role of Self-Perceived Burden Between Social Support and Fear of Progression in Renal Transplant Recipients: A Multicenter Cross-Sectional Study

Purpose

To explore the mechanism of social support and fear of progression (FoP) in renal transplant recipients (RTRs) and the self-perceived burden that acts as a mediator between social support and FoP.

Patients and Methods

Sociodemographic and clinical characteristics, the Social Support Rating Scale (SSRS), the Self-Perceived Burden Scale (SPBS), and the Fear of Progression-Questionnaire-Short Form (FoP-Q-SF) were used. Structural equation modeling (SEM) was used to examine the mediating role of self-perceived burden.

Results

Our results showed that social support was negatively related to the self-perceived burden (r = -0.28, p < 0.001) and FoP (r = -0.37, p < 0.001). Moreover, we determined that self-perceived burden was positively related to FoP (r = 0.58, p < 0.001) and that the indirect effect of social support on FoP via self-perceived burden was significant (β = -0.172, 95% CI: -0.253, -0.097), and with a mediating effect value of 36.9%.

Conclusion

The FoP in RTRs is a concern. Higher social support and lower self-perceived burden can reduce the risk of FoP. Healthcare professionals (HCPs) should assist RTRs in correctly evaluating an individual's social support system, helping them optimize social support to reduce the self-perceived burden and the development of FoP.

ConquerFear-Group: A randomized controlled trial of an online-delivered group-based psychological intervention for fear of cancer recurrence in breast cancer survivors

OBJECTIVE

Fear of cancer recurrence (FCR) is a distressing concern among cancer survivors. Interventions to address FCR need to be effective but also accessible and low cost. This randomized controlled trial evaluated the efficacy of an online group-based psychological intervention for FCR (ConquerFear-Group).

METHODS

Eligible breast cancer (BC) survivors had completed primary treatment 3 months-5 years previously, were ≥18 years, and scored ≥22 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Participants were randomized to online ConquerFear-Group (focusing on metacognitive strategies, values-clarification, and education about follow-up behavior) or online group-based relaxation training (active control). Questionnaires were completed at baseline (T1), 1 week post-intervention (T2), three (T3) and six (T4) months later. The primary outcome was FCR (FCRI total). A number of secondary and process outcomes were also collected. Treatment effects were evaluated with mixed linear models.

RESULTS

Of 866 eligible BC survivors, 475 (55%) completed the FCR screening, and 85 (18%) were randomized to ConquerFear-Group or relaxation training (2 × 6 groups). Compared with control participants, ConquerFear-Group participants experienced larger reductions in FCR (Cohen's d = 0.47, p = 0.001) and FCR severity (d = 0.57, p < 0.001), as well as mindfulness and decentering from baseline through follow-up, and improvements in emotion regulation (T2), worry (T2, T3) and rumination (T2) at some time points.

CONCLUSIONS

The results demonstrated statistically significant and stable effects of ConquerFear-Group on FCR that were maintained over a 6-month period. It is suggested to investigate the program in a real-life setting, where a pragmatic trial can further demonstrate feasibility and effectiveness.

Latent Profiles of Fear of Cancer Recurrence and Associations with Physical and Mental Health Outcomes

BACKGROUND

Fear of cancer recurrence (FCR) is a multidimensional construct; however, few studies have meaningfully integrated FCR severity (i.e., level of fear) with FCR-related concepts (e.g., triggers).

PURPOSE

The present study determined (a) latent profiles of FCR; (b) socio-demographic variations between identified profiles; (c) interactions between identified profiles and resilience and rumination on chronic physical disorders, depressive/anxiety symptoms, and quality of life.

METHODS

The present study is a secondary data analysis of which 404 cancer survivors were included in this study. All participants completed the Fear of Cancer Recurrence Inventory and measures of resilience, rumination, depressive/anxiety symptoms, and quality of life.

RESULTS

Latent profile analysis identified three distinct profiles based on varying levels of FCR and FCR-related concepts; Profile 1 "Low FCR" (n = 108; 26.4%), Profile 2 "Moderate FCR, High coping" (n = 197; 49.4%), and Profile 3 "High FCR, distress and impairment" (n = 99; 24.3%). Profile 3 was associated with younger age and history of radiotherapy. Latent profiles of FCR significantly interacted with resilience and rumination on depressive/anxiety symptoms.

CONCLUSIONS

Latent profile analysis integrates FCR severity and FCR-related concepts to support a nuanced understanding of FCR. Our results suggest specific points of intervention, which extend beyond addressing FCR severity.

"Cancer Never Goes Out of Your Mind Even for a Single Second". Cancer-Related Ruminations From the Perspectives of Cancer Survivors

OBJECTIVE

This study aimed to explore a deeper understanding of how cancer survivors experience and manage ruminative thoughts.

DATA SOURCES

A descriptive qualitative design. The study was conducted with cancer survivors (n = 21). A semistructured interview guide was used for data collection, and content analysis method was implemented to gain a better understanding from the collected data. The study procedure and reporting adhere to the guideline for reporting qualitative research COnsolidated criteria for REporting Qualitative research (COREQ) checklist.

CONCLUSION

Three main themes were developed: "Struggling within cognitions", "Coping", and "Required needs". The results highlight that cancer survivors have intrusive ruminative thoughts about cancer and need support to cope with these thoughts. It was also found that over time, they experienced changes in their perspectives, gained meaning, and were able to use deliberate ruminations.

IMPLICATIONS FOR NURSING PRACTICE

Nurses have an effective role in providing care and determining the needs of individuals. Nurses can easily recognize intrusive ruminations, help cancer survivors raise awareness about the effects of ruminative thoughts on them, and support them in coping with intrusive ruminations using effective interventions.

Association between self-esteem and fear of cancer recurrence in cancer survivors: A cross-sectional study

PURPOSE

There may be a correlation between self-esteem as an important psychological resource for individuals and Fear of cancer recurrence (FCR), but the relationship between the two is unclear. The aim of our investigation was to evaluate the association of FCR and self-esteem in cancer survivors.

METHODS

Cross-sectional sampling was used to select cancer survivors. The study instruments used included: General information questionnaire, Rosenberg Self-Esteem Scale, Perceived Social Support Scale, Fear of Cancer Recurrence Inventory- Shorter Form. We used logistic regression, where models were adjusted considering confounding variables to determine odds ratios (ORs) with 95% confidence intervals (CIs) for the association of FCR with self-esteem.

RESULTS

Between February 2022 to July 2022, we screened 380 participants for eligibility, of whom 348 were included in the study. The percentage of cancer survivors who experienced clinical level of FCR was 73.9% and the self-esteem score was 27.73 ± 3.67 at a moderate level. The Pearson' s correlation coefficient indicated a significant inverse relationship between FCR and self-esteem (p < 0.001; r = -0.375). In a multivariable logistic regression model, FCR still has a negative correlation with self-esteem (OR, 0.812; 95%CI, 0.734-0.898). Subgroup analysis indicated that the correlation between FCR and self-esteem in cancer survivors was nearly the same in various strata, demonstrating its soundness and stability.

CONCLUSIONS

This study confirms that elevated self-esteem in individuals surviving cancer may be a protective factor for FCR. Improving the level of self-esteem in cancer survivors can be one of the important directions of clinical interventions for FCR.

Triggers and Coping Strategies for Fear of Cancer Recurrence in Cancer Survivors: A Qualitative Study

BACKGROUND

Fear of cancer recurrence (FCR) has been demonstrated to be one of the most frequently reported unmet psychological needs among cancer survivors. The aim of this study was to explore and describe the potential triggers and coping strategies for FCR in Chinese cancer survivors.

METHODS

The study process was conducted using an interpretive phenomenological research method, and Chinese cancer survivors were interviewed face-to-face in a semi-structured interview, using purposive sampling combined with a maximum variance sampling strategy, and the interviews were transcribed, organized, and analyzed by applying Giorgi analysis with the help of NVivo11 software.

RESULTS

A total of 10 participants, 4 males and 6 females, were interviewed. Three themes emerged in terms of potential triggers for FCR: (1) intrusive thoughts; (2) disease symptoms; and (3) awaiting medical examination. Two themes regarding positive coping and avoidance coping emerged with regard to coping strategies adopted by cancer survivors when experiencing FCR. Under these 2 themes were 5 sub-themes: (1) seeking medical support; (2) self-health management; (3) spiritual coping; (4) unaccompanied toleration; and (5) attention shifting.

CONCLUSION

FCR as the most common psychological problem for cancer survivors, and it should be given more attention. Early identification and precise intervention for potential triggers of FCR may prevent the emergence and development of FCR. The guidance toward and cultivation of positive coping strategies when cancer survivors experience FCR could be an important direction in future nursing education.