scholarly journals Cause or Effect? The Role of Prognostic Uncertainty in the Fear of Cancer Recurrence

2021 ◽  
Vol 11 ◽  
Author(s):  
Paul K. J. Han ◽  
Caitlin Gutheil ◽  
Rebecca N. Hutchinson ◽  
Jason A. LaChance
Keyword(s):  
Ovarian Cancer ◽  
Theoretical Model ◽  
Cancer Recurrence ◽  
Fear Of Cancer Recurrence ◽  
Prognostic Information ◽  
Convenience Sample ◽  
Causal Pathways ◽  
Fear Of Cancer ◽  
The Relationship ◽  
Prognostic Uncertainty

BackgroundFear of cancer recurrence (FCR) is an important cause of suffering for cancer survivors, and both empirical evidence and theoretical models suggest that prognostic uncertainty plays a causal role in its development. However, the relationship between prognostic uncertainty and FCR is incompletely understood.ObjectiveTo explore the relationship between prognostic uncertainty and FCR among patients with ovarian cancer (OC).DesignA qualitative study was conducted utilizing individual in-depth interviews with a convenience sample of patients with epithelial ovarian cancer who had completed first-line treatment with surgery and/or chemotherapy. Semi-structured interviews explored participants’ (1) understanding of their prognosis; (2) experiences, preferences, and attitudes regarding prognostic information; and (3) strategies for coping with prognostic uncertainty. Inductive qualitative analysis and line-by-line software-assisted coding of interview transcripts was conducted to identify key themes and generate theoretical insights on the relationship between prognostic uncertainty and FCR.ResultsThe study sample consisted of 21 participants, nearly all of whom reported experiencing significant FCR, which they traced to an awareness of the possibility of a bad outcome. Some participants valued and pursued prognostic information as a means of coping with this awareness, suggesting that prognostic uncertainty causes FCR. However, most participants acknowledged fundamental limits to both the certainty and value of prognostic information, and engaged in various strategies aimed not at reducing but constructing and maintaining prognostic uncertainty as a means of sustaining hope in the possibility of a good outcome. Participants’ comments suggested that prognostic uncertainty, fear, and hope are connected by complex, bi-directional causal pathways mediated by processes that allow patients to cope with, construct, and maintain their uncertainty. A provisional dual-process theoretical model was developed to capture these pathways.ConclusionAmong patients with OC, prognostic uncertainty is both a cause and an effect of FCR—a fear-inducing stimulus and a hope-sustaining response constructed and maintained through various strategies. More work is needed to elucidate the relationships between prognostic uncertainty, fear, and hope, to validate and refine our theoretical model, and to develop interventions to help patients with OC and other serious illnesses to achieve an optimal balance between these states.

scholarly journals Interpretation Bias in Breast Cancer Survivors Experiencing Fear of Cancer Recurrence

2021 ◽  
Vol 12 ◽  
Author(s):  
Malwina Tuman ◽  
Kailey E. Roberts ◽  
Geoffrey Corner ◽  
Courtney Beard ◽  
Carol Fadalla ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Cancer Recurrence ◽  
Somatic Symptoms ◽  
Interpretation Bias ◽  
Fear Of Cancer Recurrence ◽  
Background Information ◽  
Fear Of Cancer ◽  
The Relationship

Introduction: Fear of cancer recurrence (FCR) is a prevalent and persistent challenge that many cancer survivors endure. While the role of interpretation bias, a tendency to perceive ambiguous situations as threatening, has been established in the onset and maintenance of FCR, few studies have examined cancer-related interpretation bias specifically. Grounded in the cognitive formulation of FCR, the current study aimed to fill this gap by investigating the relationship between cancer-related interpretation bias, FCR, and somatic symptoms, and examining whether bias mediates the relationship between somatic symptoms and FCR.Materials and Methods: This study used baseline data from a randomized controlled trial of a cognitive bias modification intervention. Breast cancer survivors (n = 110) provided demographic and medical background information as well as self-report measures of FCR and severity of somatic symptoms. A computer-based assessment of interpretation bias was used to measure cancer-related interpretation bias on several bias indices: percentage of cancer-related threat endorsement, and percentage of benign endorsement; mean reaction time (RT) for threat, and mean RT for benign endorsement.Results: Higher threat endorsement was linked to higher Overall Fear and emerged as a mediator of the relationship between overall somatic symptoms and Overall Fear. We also found that older age was related to longer benign endorsement RT.Conclusion: This study contributes understanding of factors related to cancer-related interpretation bias and provides evidence that bias may influence the relationship between somatic symptoms and FCR in cancer survivors.

scholarly journals Is a Brief Online Booklet Sufficient to Reduce Fear of Cancer Recurrence or Progression in Women With Ovarian Cancer?

2021 ◽  
Vol 12 ◽  
Author(s):  
Poorva Pradhan ◽  
Louise Sharpe ◽  
Phyllis N. Butow ◽  
Allan Ben Smith ◽  
Hayley Russell
Keyword(s):  
Ovarian Cancer ◽  
Medical History ◽  
Short Form ◽  
Cancer Recurrence ◽  
Demographic Characteristics ◽  
Fear Of Cancer Recurrence ◽  
Self Help ◽  
Fear Of Progression ◽  
Psychosocial Need ◽  
Fear Of Cancer

Background: Fear of cancer recurrence or progression (FCR/P) is a common challenge experienced by people living with and beyond cancer and is frequently endorsed as the highest unmet psychosocial need amongst survivors. This has prompted many cancer organizations to develop self-help resources for survivors to better manage these fears through psychoeducation, but little is known about whether they help reduce FCR/P.Method: We recruited 62 women with ovarian cancer. Women reported on their medical history and demographic characteristics and completed the Fear of Progression Questionnaire-Short Form (FoP-Q-SF). They then read a booklet on FCR specifically created for Ovarian Cancer Australia by two of the authors (ABS and PB). One week after reading the booklet, 50/62 women (81%) completed the FoP-Q-SF and answered questions about their satisfaction with the booklet.Results: More than half of the women (35/62; 56.5%) scored in the clinical range for FCR/P at baseline. Of the completers, 93% said that they would recommend the booklet to other women. Satisfaction with the booklet was relatively high (75.3/100) and more than two-thirds of women rated it as moderately helpful or better. However, FCR/P did not change significantly over the week following reading the booklet [t(49) = 1.71, p = 0.09]. There was also no difference in change in FCR/P between women in the clinical vs. non-clinical range on the FoP-Q. Women high in FCR/P rated the booklet as less helpful in managing FCR/P (r = −0.316, p = 0.03), but overall satisfaction with the booklet was not associated with degree of FCR/P (r = −0.24, p = 0.10).Conclusions: These results suggest that a simple online FCR booklet is acceptable to women with ovarian cancer and they are satisfied with the booklet, but, it was insufficient to change in FCR/P levels. These results suggest that such resources are valued by women with ovarian cancer, but more potent interventions are necessary to reduce FCR in this population.

scholarly journals Fear of cancer recurrence: A study of the experience of survivors of ovarian cancer

2017 ◽  
Vol 27 (3) ◽  
pp. 236-242 ◽  
Author(s):  
Jamie Kyriacou ◽  
Alexandra Black ◽  
Nancy Drummond ◽  
Joanne Power ◽  
Christine Maheu
Keyword(s):  
Ovarian Cancer ◽  
Cancer Recurrence ◽  
Fear Of Cancer Recurrence ◽  
Fear Of Cancer

scholarly journals Fear of cancer recurrence: testing a cognitive formulation across time in women with ovarian cancer

2021 ◽  
Author(s):  
Lindsey Torbit
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Predictive Validity ◽  
Emotional Experience ◽  
Cognitive Model ◽  
Cancer Recurrence ◽  
Model Fit ◽  
Data Driven ◽  
Fear Of Cancer Recurrence ◽  
Fear Of Cancer

Background: Lee-Jones and colleagues (1997) have proposed a comprehensive cognitive model of fear of cancer recurrence (FCR), however little research has utilized or fully tested this conceptual model. Additionally, the cross-sectional nature of most studies limits our understanding of the trajectory of FCR over time, and longitudinal research is greatly needed. Method: Patients completed assessment measures at baseline (Time 1) and three months post-baseline (Time 2). The three aims of this study were to (1) test the cognitive model of FCR within an ovarian cancer population; (2) examine model stability; and (3) test the predictive validity of the model. Results: An exploratory factor analysis (EFA) suggested a more parsimonious four-factor model relative to Lee-Jones et al.’s suggested model. Using the results of the EFA, structural equation modeling (SEM) was used to analyze the data-driven model, with findings revealing excellent model fit at Time 1,  2 (60, N=283) = 130.48, p< .001,  2 /df = 1.84, CFI = 0.95, RMSEA = .06, SRMR = .06. This same model was examined at Time 2, with findings revealing acceptable model fit;  2 (60, N=201) = 121.15, p < .001,  2 /df = 2.02, CFI =0.93, RMSEA = .07, SRMR = .07, thus confirming that configural invariance was met. Tests of predictive validity indicated that using the components of FCR at Time 1 to predict consequences at Time 2 resulted in adequate model fit, 2 (84, N=283) = 167.17, p < .001, CFI =0.94, RMSEA = .06, SRMR = .07,  2 /df = 1.99; however, the regression paths from the emotional experience and cognitive appraisals were not significant predictors of behavioural responses at Time 2. Discussion: Findings demonstrated that the emotional experience of FCR may be far more complex for ovarian cancer patients than previously suggested which has important treatment implications. The current study is the first to evaluate the relative stability of the components of a data-driven model of FCR, with results revealing that the majority of ovarian cancer patients experience FCR, which is stable across a three-month period. Findings suggest that screening for FCR would be beneficial across the cancer experience.

scholarly journals The Relationship Between Fears of Cancer Recurrence and Patient Gender: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Chuan Pang ◽  
Gerry Humphris
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cancer Recurrence ◽  
Fear Of Cancer Recurrence ◽  
Cancer Type ◽  
Publication Type ◽  
Cancer Types ◽  
Meta Regression ◽  
Fear Of Cancer ◽  
The Relationship

Background: A significant concern for patients treated for cancer is fear of cancer recurrence (FCR). Although a common experience, some patients report high levels of FCR that are difficult to manage and result in over vigilant checking and high use of health services. There has been speculation about the relationship of FCR with gender with mixed reports from several systematic reviews.Aims: To determine the association of FCR with gender in previous reported studies and investigate the strength of this relationship with various moderators including year of publication, type of cancer and measurement attributes of self-reported FCR instruments.Methods: A systematic review was conducted with searches of the literature from the MEDLINE, PubMed, Embase, and PsycINFO databases following PRISMA guidelines. All the included papers were divided into two groups, namely: “pure” that comprise only of patients with cancer types that both men and women can contract and “mixed” that report on patients with a variety of cancer types. The association between gender and FCR level was assessed by meta-analysis. A meta-regression was performed to investigate the moderating effects of factors including: the year of publication, cancer type, mean age of the sample and the length of the FCR scale measurement. This review was registered with PROSPERO, ID: CRD42020184812.Results: Finally, 29 studies were included. The N size of pooled participants was 33,339. The meta-analysis showed females to have an overall higher level of FCR than males (ES = 0.30; 95% CI, 0.23, 0.36). The meta-regression of moderating or control variables found little, if any, systematic variation in effect-sizes.Conclusion: This systematic review has clarified a potentially confused pattern of previous results in understanding the relationship between gender and FCR. Women report higher levels of FCR than men and this feature is one that clinicians and researchers can factor into their practice and future studies. The effect size is moderate, hence there is ample variation in FCR level, independent of gender, that requires further investigation.

Towards the validation of a new, blended theoretical model of fear of cancer recurrence

2018 ◽  
Vol 27 (11) ◽  
pp. 2594-2601 ◽  
Author(s):  
Sophie Lebel ◽  
Christine Maheu ◽  
Christina Tomei ◽  
Lori J. Bernstein ◽  
Christine Courbasson ◽  
...  
Keyword(s):  
Theoretical Model ◽  
Cancer Recurrence ◽  
Fear Of Cancer Recurrence ◽  
Fear Of Cancer
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