Factor structure of the Fear of Cancer Recurrence Inventory (FCRI): Comparison of international FCRI factor structure data and factor analysis of the Dutch FCRI-NL using three predominantly breast cancer samples

Treating Fear of Cancer Recurrence with Eye Movement Desensitization Reprocessing: A Sequential, Randomized Single-Case Experimental Design

Fear of cancer recurrence (FCR) is defined as "fear, worry, or concern relating to the possibility that cancer will come back or progress". After cancer treatment, 20% of patients suffer from clinical fear of cancer recurrence (FCR), warranting specialized treatment. While intrusive catastrophic scenarios are clinical symptoms of FCR, they are rarely the key focus in current FCR treatments. Eye Movement Desensitization Reprocessing (EMDR) including the flash forward procedure explicitly addresses these intrusions. The present study explored whether EMDR is effective in treating clinical FCR. A sequentially replicated, randomized single-case experimental design was used among six cancer survivors with clinical levels of FCR. During an 84-day period, participants daily registered their FCR level. The Fear of Recurrence Inventory was administered at baseline, EMDR start, EMDR completion and study completion. The start of EMDR was randomized. All participants commented positively on the effect of EMDR during the semi-structured interviews: EMDR helped decrease intrusions and face death anxiety. Visual analysis of daily FCR were in line with these comments. Regression analysis showed a significant decrease of daily FCR in two participants, while the randomization test showed no effects. FCRI scores decreased below clinical levels in all participants, which was considered a reliable change in four participants. There was no drop-out. In light of these mixed findings, EMDR appears a promising treatment for FCR. Further research needs to establish its effectiveness and explore whether diminishing the emotional load of intrusions constitutes the working mechanism of EMDR in FCR.

Effects of CALM intervention on neutrophil-to-lymphocyte ratio (NLR), fear of cancer recurrence and quality of life in patients with lung cancer

PURPOSE

To evaluate the feasibility and practicability of Managing Cancer and Living Meaningfully (CALM) as a psychological intervention to reduce neutrophil to lymphocyte ratio (NLR), fear of cancer recurrence, general distress, and improve quality of life in lung cancer survivors.

METHODS

Eighty lung cancer patients with FCRI severity subscale (≥13 points) were recruited and randomly assigned to CALM or usual care (UC). NLR was recorded before and after treatment. The Fear of Cancer Recurrence Inventory (FCRI), Quality of Life Questionnaire Core 30 (QLQ-C30) and Depression-Anxiety-Stress Scale (DASS-21) were used to evaluate patients at baseline (T0), immediately after treatment (T1), and at 2 (T2) and 4 (T3) months.

RESULTS

Compared with UC, NLR was significantly different before and after CALM intervention (z=-5.498; P=0.000). There were significant differences in the scores of QLQ, FCR and general distress before and after the T1, T2 and T3 interventions (F=220.30, F=315.20, F=290.10, respectively; P<0.001). NLR was negatively correlated with QOL both before (r=-0.763; P<0.0001) and after the intervention (r=-0.810, P<0.0001). FCR and general distress were negatively correlated with QOL in CALM (T0: r=-0.726, r=-0.776, respectively; P<0.0001; T1: r=-0.664, r=-0.647, respectively; P<0.0001; T2: r=-0.678, r=-0.695, respectively; P<0.0001; T3: r=-0.511, P = 0.0008; r=-0.650, P<0.0001).

CONCLUSION

CALM intervention can effectively reduce the NLR, alleviate the recurrence fear and general distress and improve the quality of life in patients. This study suggests that CALM may be an effective psychological intervention for reducing symptoms associated with lung cancer survivors.

Factors associated with a high level of unmet needs and their prevalence in the breast cancer survivors 1-5 years after post local treatment and (neo)adjuvant chemotherapy during the COVID-19: A cross-sectional study

Objective

To assess the prevalence of unmet needs in post-treatment breast cancer survivors and identify sociodemographic, clinical, and psychosocial variables associated with reported unmet needs during the COVID-19 pandemic.

Materials and methods

In this cross-sectional study, 430 post-treatment breast cancer survivors, ranging between 1 and 5 years after the procedure, completed the Cancer Survivors' Unmet Needs (CaSUN) questionnaire from September 2021 and January 2022. The multivariate logistic analysis identified factors associated with at least one reported unmet need in the total CaSUN scale and specific domains.

Results

A total of 67% of survivors reported at least one unmet need. The most frequently reported unmet needs were the lack of accessible hospital parking (43%) and recurrence concerns (39.5%). The majority of reported unmet needs relate to comprehensive care (44%), followed by the psychological and emotional support domain (35.3%). Younger age (OR = 0.95, 95% CI = 0.92-0.99; p < 0.001), three or more comorbidities (OR = 0.27, 95% CI = 0.11-0.71, p < 0.01), a lower quality of life (OR = 0.06, 95% CI = 0.01-0.47, p < 0.01) and low resilience (OR = 0.95, 95% CI = 0.93-0.99) were associated with a high level of unmet needs in the multivariate regression model. Results are presented for factors associated with a high level of unmet needs for comprehensive cancer care and psychological and emotional support domain.

Conclusion

A high prevalence found in our study could be attributed to the COVID-19 pandemic, where patients may have missed adequate follow-up care, although comparing to studies done in non-pandemic time is difficult. Family physicians should be more attentive toward younger cancer survivors and those with more comorbidities as both characteristics can be easily recognized in the family practice.