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Trajectories of fear of recurrence in women with breast cancer

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Abstract

Purpose

Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery.

Methods

Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months.

Results

From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time.

Conclusions

These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.

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References

  1. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, Ozakinci G (2013) Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv 7:300–322

    Article  PubMed  Google Scholar 

  2. Simard S, Savard J (2009) Fear of cancer recurrence inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer 17:241–251

    Article  PubMed  Google Scholar 

  3. Ness S, Kokal J, Fee-Schroeder K, Novotny P, Satele D, Barton D (2013) Concerns across the survivorship trajectory: results from a survey of cancer survivors. Oncol Nurs Forum 40:35–42

    Article  PubMed  Google Scholar 

  4. Brennan ME, Butow P, Spillane AJ, Boyle F (2014) Patient-reported quality of life, unmet needs and care coordination outcomes: Moving toward targeted breast cancer survivorship care planning. Asia Pac J Clin Oncol. doi:10.1111/ajco.12254

  5. Savard J, Ivers H (2013) The evolution of fear of cancer recurrence during the cancer care trajectory and its relationship with cancer characteristics. J Psychosom Res 74:354–360

    Article  PubMed  Google Scholar 

  6. Stanton AL, Danoff-Burg S, Huggins ME (2002) The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment. Psychooncology 11:93–102

    Article  PubMed  Google Scholar 

  7. Vickberg SM (2003) The Concerns About Recurrence Scale (CARS): a systematic measure of women’s fears about the possibility of breast cancer recurrence. Ann Behav Med 25:16–24

    Article  PubMed  Google Scholar 

  8. Lee-Jones C, Humphris G, Dixon R, Hatcher MB (1997) Fear of cancer recurrence—a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology 6:95–105

    Article  CAS  PubMed  Google Scholar 

  9. Tewari A, Chagpar AB (2014) Worry about breast cancer recurrence: a population-based analysis. Am Surg 80:640–645

    PubMed  Google Scholar 

  10. Koch L, Bertram H, Eberle A, Holleczek B, Schmid-Hopfner S, Waldmann A, Zeissig SR, Brenner H, Arndt V (2014) Fear of recurrence in long-term breast cancer survivors—still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the cancer survivorship—a multi-regional population-based study. Psychooncology 23:547–554

    Article  PubMed  Google Scholar 

  11. Simard S, Savard J, Ivers H (2010) Fear of cancer recurrence: specific profiles and nature of intrusive thoughts. J Cancer Surviv 4:361–371

    Article  PubMed  Google Scholar 

  12. Skaali T, Fossa SD, Bremnes R, Dahl O, Haaland CF, Hauge ER, Klepp O, Oldenburg J, Wist E, Dahl AA (2009) Fear of recurrence in long-term testicular cancer survivors. Psychooncology 18:580–588

    Article  PubMed  Google Scholar 

  13. Simard S, Savard J (2009) Screening and comorbidity of clinical fear of cancer recurrence. Psychooncology 18(Suppl 2):S171

    Google Scholar 

  14. Hirai K, Shiozaki M, Motooka H, Arai H, Koyama A, Inui H, Uchitomi Y (2008) Discrimination between worry and anxiety among cancer patients: development of a Brief Cancer-Related Worry Inventory. Psychooncology 17:1172–1179

    Article  PubMed  Google Scholar 

  15. Lebel S, Rosberger Z, Edgar L, Devins GM (2009) Emotional distress impacts fear of the future among breast cancer survivors not the reverse. J Cancer Surviv 3:117–127

    Article  PubMed  Google Scholar 

  16. Llewellyn CD, Weinman J, McGurk M, Humphris G (2008) Can we predict which head and neck cancer survivors develop fears of recurrence? J Psychosom Res 65:525–532

    Article  PubMed  Google Scholar 

  17. Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B (2006) Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psychooncology 15:306–320

    Article  PubMed  Google Scholar 

  18. van den Beuken-van Everdingen MH, Peters ML, de Rijke JM, Schouten HC, van Kleef M, Patijn J (2008) Concerns of former breast cancer patients about disease recurrence: a validation and prevalence study. Psychooncology 17:1137–1145

    Article  PubMed  Google Scholar 

  19. Dinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C (2014) Comorbidity of fear of progression and anxiety disorders in cancer patients. Gen Hosp Psychiatry. doi:10.1016/j.genhosppsych.2014.08.006

  20. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2009) Quality of life and non-pain symptoms in patients with cancer. J Pain Symptom Manag 38:216–233

    Article  Google Scholar 

  21. Butow P, Kelly S, Thewes B, Hruby G, Sharpe L, Beith J (2014) Attentional bias and metacognitions in cancer survivors with high fear of cancer recurrence. Psychooncology. doi:10.1002/pon.3659

  22. McGinty HL, Goldenberg JL, Jacobsen PB (2012) Relationship of threat appraisal with coping appraisal to fear of cancer recurrence in breast cancer survivors. Psychooncology 21:203–210

    Article  PubMed  Google Scholar 

  23. Mehnert A, Berg P, Henrich G, Herschbach P (2009) Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psychooncology 18:1273–1280

    Article  PubMed  Google Scholar 

  24. Liu Y, Perez M, Schootman M, Aft RL, Gillanders WE, Jeffe DB (2011) Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat 130:165–173

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Mehnert A, Koch U, Sundermann C, Dinkel A (2013) Predictors of fear of recurrence in patients one year after cancer rehabilitation: a prospective study. Acta Oncol 52:1102–1109

    Article  PubMed  Google Scholar 

  26. Thewes B, Butow P, Bell ML, Beith J, Stuart-Harris R, Grossi M, Capp A, Dalley D (2012) Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours. Support Care Cancer 20:2651–2659

    Article  CAS  PubMed  Google Scholar 

  27. Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, New York

    Book  Google Scholar 

  28. Dhruva A, Dodd M, Paul SM, Cooper BA, Lee K, West C, Aouizerat BE, Swift PS, Wara W, Miaskowski C (2010) Trajectories of fatigue in patients with breast cancer before, during, and after radiation therapy. Cancer Nurs 33:201–212

    Article  PubMed Central  PubMed  Google Scholar 

  29. Langford DJ, Tripathy D, Paul SM, West C, Dodd MJ, Schumacher K, Miaskowski C (2011) Trajectories of pain and analgesics in oncology outpatients with metastatic bone pain. J Pain 12:495–507

    Article  PubMed Central  PubMed  Google Scholar 

  30. Lindviksmoen G, Hofso K, Paul SM, Miaskowski C, Rustoen T (2013) Predictors of initial levels and trajectories of depressive symptoms in women with breast cancer undergoing radiation therapy. Cancer Nurs 36:E34–E43

    Article  PubMed  Google Scholar 

  31. Huang HP, Chen ML, Liang J, Miaskowski C (2014) Changes in and predictors of severity of fatigue in women with breast cancer: a longitudinal study. Int J Nurs Stud 51:582–592

    Article  PubMed  Google Scholar 

  32. Kyranou M, Puntillo K, Dunn LB, Aouizerat BE, Paul SM, Cooper BA, Neuhaus J, West C, Dodd M, Miaskowski C (2014) Predictors of initial levels and trajectories of anxiety in women before and for 6 months after breast cancer surgery. Cancer Nurs 37(6):406–417. doi:10.1097/NCC.0000000000000131

  33. Mellon S, Kershaw TS, Northouse LL, Freeman-Gibb L (2007) A family-based model to predict fear of recurrence for cancer survivors and their caregivers. Psychooncology 16:214–223

    Article  PubMed  Google Scholar 

  34. Miaskowski C, Cooper B, Paul SM, West C, Langford D, Levine JD, Abrams G, Hamolsky D, Dunn L, Dodd M, Neuhaus J, Baggott C, Dhruva A, Schmidt B, Cataldo J, Merriman J, Aouizerat BE (2012) Identification of patient subgroups and risk factors for persistent breast pain following breast cancer surgery. J Pain 13:1172–1187

    Article  PubMed Central  PubMed  Google Scholar 

  35. Van Onselen C, Paul SM, Lee K, Dunn L, Aouizerat BE, West C, Dodd M, Cooper B, Miaskowski C (2013) Trajectories of sleep disturbance and daytime sleepiness in women before and after surgery for breast cancer. J Pain Symptom Manag 45:244–260

    Article  Google Scholar 

  36. Kyranou M, Paul SM, Dunn LB, Puntillo K, Aouizerat BE, Abrams G, Hamolsky D, West C, Neuhaus J, Cooper B, Miaskowski C (2013) Differences in depression, anxiety, and quality of life between women with and without breast pain prior to breast cancer surgery. Eur J Oncol Nurs 17:190–195

    Article  PubMed Central  PubMed  Google Scholar 

  37. Dunn LB, Cooper BA, Neuhaus J, West C, Paul S, Aouizerat B, Abrams G, Edrington J, Hamolsky D, Miaskowski C (2011) Identification of distinct depressive symptom trajectories in women following surgery for breast cancer. Health Psychol 30:683–692

    Article  PubMed Central  PubMed  Google Scholar 

  38. Karnofsky D, Abelmann WH, Craver LV, Burchenal JH (1948) The use of nitrogen mustards in the palliative treatment of carcinoma. Cancer 1:634–656

    Article  Google Scholar 

  39. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN (2003) The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum 49:156–163

    Article  PubMed  Google Scholar 

  40. Brunner F, Bachmann LM, Weber U, Kessels AG, Perez RS, Marinus J, Kissling R (2008) Complex regional pain syndrome 1—the Swiss cohort study. BMC Musculoskelet Disord 9:92

    Article  PubMed Central  PubMed  Google Scholar 

  41. Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45:5–13

    Article  CAS  PubMed  Google Scholar 

  42. Sheehan TJ, Fifield J, Reisine S, Tennen H (1995) The measurement structure of the Center for Epidemiologic Studies Depression Scale. J Pers Assess 64:507–521

    Article  CAS  PubMed  Google Scholar 

  43. Fletcher BS, Paul SM, Dodd MJ, Schumacher K, West C, Cooper B, Lee K, Aouizerat B, Swift P, Wara W, Miaskowski CA (2008) Prevalence, severity, and impact of symptoms on female family caregivers of patients at the initiation of radiation therapy for prostate cancer. J Clin Oncol 26:599–605

    Article  PubMed  Google Scholar 

  44. Spielberger CG, Gorsuch RL, Suchene R, Vagg PR, Jacobs GA (1983) Manual for the state-anxiety (form Y): Self Evaluation Questionnaire. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  45. Bieling PJ, Antony MM, Swinson RP (1998) The state-trait anxiety inventory, trait version: structure and content re-examined. Behav Res Ther 36:777–788

    Article  CAS  PubMed  Google Scholar 

  46. Jensen MP (2003) The validity and reliability of pain measures in adults with cancer. J Pain 4:2–21

    Article  PubMed  Google Scholar 

  47. Ferrell BR, Wisdom C, Wenzl C (1989) Quality of life as an outcome variable in the management of cancer pain. Cancer 63:2321–2327

    Article  CAS  PubMed  Google Scholar 

  48. Padilla GV, Presant C, Grant MM, Metter G, Lipsett J, Heide F (1983) Quality of life index for patients with cancer. Res Nurs Health 6:117–126

    Article  CAS  PubMed  Google Scholar 

  49. Waldrop DP, O’Connor TL, Trabold N (2011) “Waiting for the other shoe to drop:” distress and coping during and after treatment for breast cancer. J Psychosoc Oncol 29:450–473

    PubMed  Google Scholar 

  50. Raudenbush SW, Bryk AS (2002) Hierarchical linear models: applications and data analysis methods. Sage Press, Thousand Oaks

    Google Scholar 

  51. Enders CK (2010) Applied missing data analysis. Guilford Press, New York

    Google Scholar 

  52. Lebel S, Beattie S, Ares I, Bielajew C (2013) Young and worried: age and fear of recurrence in breast cancer survivors. Health Psychol 32:695–705

    Article  PubMed  Google Scholar 

  53. Ziner KW, Sledge GW, Bell CJ, Johns S, Miller KD, Champion VL (2012) Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis. Oncol Nurs Forum 39:287–295

    Article  PubMed  Google Scholar 

  54. Thewes B, Bell ML, Butow P (2013) Fear of cancer recurrence in young early-stage breast cancer survivors: the role of metacognitive style and disease-related factors. Psychooncology 22:2059–2063

    Article  CAS  PubMed  Google Scholar 

  55. Heitzmann CA, Merluzzi TV, Jean-Pierre P, Roscoe JA, Kirsh KL, Passik SD (2011) Assessing self-efficacy for coping with cancer: development and psychometric analysis of the brief version of the Cancer Behavior Inventory (CBI-B). Psychooncology 20:302–312

    Article  PubMed  Google Scholar 

  56. Philip EJ, Merluzzi TV, Zhang Z, Heitzmann CA (2013) Depression and cancer survivorship: importance of coping self-efficacy in post-treatment survivors. Psychooncology 22:987–994

    Article  PubMed Central  PubMed  Google Scholar 

  57. Benight CC, Bandura A (2004) Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy. Behav Res Ther 42:1129–1148

    Article  PubMed  Google Scholar 

  58. Chesney MA, Neilands TB, Chambers DB, Taylor JM, Folkman S (2006) A validity and reliability study of the coping self-efficacy scale. Br J Health Psychol 11:421–437

    Article  PubMed Central  PubMed  Google Scholar 

  59. Lebel S, Maheu C, Lefebvre M, Secord S, Courbasson C, Singh M, Jolicoeur L, Benea A, Harris C, Fung MF, Rosberger Z, Catton P (2014) Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv 8:485–496

    Article  PubMed  Google Scholar 

  60. Herschbach P, Book K, Dinkel A, Berg P, Waadt S, Duran G, Engst-Hastreiter U, Henrich G (2010) Evaluation of two group therapies to reduce fear of progression in cancer patients. Support Care Cancer 18:471–479

    Article  PubMed  Google Scholar 

  61. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, Paterson C, Ramesar S, Budhrani P, Carranza I, Lucas J, Jacobsen PB, Goodman MJ, Kip KE (2012) Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med 37(2):185–195

  62. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, Widen RH, Fitzgerald SG, Shelton MM, Barta M, Goodman M, Cox CE, Kip KE (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology 18:1261–1272

    Article  PubMed  Google Scholar 

  63. Butow PN, Bell ML, Smith AB, Fardell JE, Thewes B, Turner J, Gilchrist J, Beith J, Girgis A, Sharpe L, Shih S, Mihalopoulos C (2013) Conquer fear: protocol of a randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. BMC Cancer 13:201

    Article  PubMed Central  PubMed  Google Scholar 

  64. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44:1–25

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by grants from the National Cancer Institute (NCI) (CA107091, CA118658) and was supported by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131. Dr. Miaskowski is supported by a grant from the NCI (K05 CA168960) and is an American Cancer Society Clinical Research Professor. Dr. Langford is supported by a Department of Defense Breast Cancer Research Program Postdoctoral Fellowship (W81XWH-11-1-0719). Dr. Merriman is supported by a training grant from the NINR (T32 NR011972). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Conflict of interest

The authors have no conflicts of interest to disclose. We have full control of all primary data and agree to allow the journal to review our data if requested.

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Authors and Affiliations

  1. School of Medicine, University of California, San Francisco, CA, USA

    Laura B. Dunn & John M. Neuhaus

  2. School of Nursing, University of California, San Francisco, CA, USA

    Dale J. Langford, Steven M. Paul, Kord Kober, Claudia West & Christine Miaskowski

  3. UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA

    Laura B. Dunn, Molly B. Berman & Dianne M. Shumay

  4. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    John D. Merriman

  5. Department of Psychiatry, University of California, San Francisco, 401 Parnassus, Box 0984-F, San Francisco, CA, 94143-0984, USA

    Laura B. Dunn

  6. The Wright Institute, Berkeley, CA, USA

    Molly B. Berman

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  1. Laura B. Dunn
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Correspondence to Laura B. Dunn.

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Dunn, L.B., Langford, D.J., Paul, S.M. et al. Trajectories of fear of recurrence in women with breast cancer. Support Care Cancer 23, 2033–2043 (2015). https://doi.org/10.1007/s00520-014-2513-8

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