Fear Of Cancer Recurrence Inventory Research Articles

Pilot Randomized Controlled Trial of IN FOCUS: A Mind-Body Resiliency Intervention for Fear of Cancer Recurrence.

Fear of cancer recurrence (FCR) is prevalent and distressing among survivors of cancer. Evidence-based mind-body and cognitive-behavioral skills lack integration and testing in scalable formats. This pilot randomized controlled trial (NCT04876599) tested a synchronous, virtual mind-body group resiliency intervention for FCR (IN FOCUS). Adults with elevated FCR (FCR Inventory severity ≥ 16; 16-21=elevated, 22-36=clinically elevated) after completing primary treatment for non-metastatic cancer were randomly assigned (1:1) to eight weekly sessions of IN FOCUS or usual care (UC; synchronous, virtual community group support referral). Feasibility metrics included ≥ 70% retention per arm (primary outcome), ≥ 75% attendance in ≥ 6 sessions, ≥ 75% adherence to relaxation skills practice ≥ 3days per week and by delivery fidelity (% content covered in video-recorded sessions). Acceptability was assessed quantitatively via ratings of enjoyableness, convenience, helpfulness, odds of future use, and satisfaction (benchmark ≥ 80% of ratings ≥ 4 on 1-5 Likert scale) and qualitatively via individual exit interviews. Linear mixed models explicated slopes in FCR (secondary) and resiliency (exploratory; Current Experiences Scale) from baseline to 2months (primary endpoint) and 5months using intention-to-treat. From July 2021 to March 2022, 64 survivors enrolled (25-73years old, M=7years since diagnosis). IN FOCUS was feasible and acceptable (91% retention; attendance median=7 sessions, 97% relaxation practice adherence, 95% content fully covered; 82% of acceptability ratings ≥ 4). Interviews (n=59) revealed benefits in both arms. By 2months, compared to UC, IN FOCUS reduced FCR to a medium-to-large effect (Mdiff=-2.4; 95% CI=-4.2, -0.7; d=0.66). By 5months, FCR effects had attenuated (Mdiff=-0.16, 95% CI -1.97, 1.65; d=-0.04), although levels of resiliency had increased with a medium-to-large effect (Mdiff=10.0; 95% CI=4.9, 15.1; d=0.78). For survivors of non-metastatic cancer, a synchronous, virtual mind-body resiliency program for FCR is feasible, acceptable, and seemingly beneficial compared to a community group referral.

Mediating effects of rumination on insomnia in cancer survivors: Influences of cancer‐related fatigue, fear of recurrence, and psychological distress

AbstractBackgroundWhile advancements in cancer treatments have improved survival rates, they also lead to adverse effects such as insomnia, which significantly impacts survivors' sleep quality.ObjectiveThis study explores the influence of cancer‐related fatigue (CRF), Fear of Cancer Recurrence (FCR), and psychological distress, with rumination serving as a mediating factor, on the insomnia experienced by cancer survivors.MethodsThe study involved 220 cancer survivors attending Shohada‐e‐Tajrish Hospital's oncology center in Tehran, Iran. Participants were selected through convenience sampling and completed several questionnaires: the Insomnia Severity Index, Fear of Cancer Recurrence Inventory, Cancer Fatigue Scale, Kessler Psychological Distress Scale, and Rumination Response Scale.ResultsThe results showed that the tested model had a good fit, and the correlation matrix demonstrated significant positive correlations between CRF (0.46), FCR (0.15), psychological distress (0.55), and rumination (0.42) with insomnia in cancer survivors (p < 0.05). Notably, CRF (B = 0.356, p < 0.001) and psychological distress (B = 0.339, p < 0.001) affect insomnia both directly and indirectly through mediation by rumination, while the impact of FCR on insomnia was indirectly significant (B = 0.73, p < 0.05).ConclusionThe findings suggest that interventions focused on managing rumination could be potential targets to alleviate insomnia and improve the sleep quality of cancer survivors.

Fear of cancer recurrence inventory (FCRI) in Spanish: validation in Mexican women with breast cancer

Fear of cancer recurrence inventory (FCRI) in Spanish: validation in Mexican women with breast cancer

Fear of cancer recurrence and change in hair cortisol concentrations in partners of breast cancer survivors.

Partners of breast cancer (BC) survivors report high rates of psychological distress including fear of cancer recurrence (FCR). Research suggests that partners may have poorer physical health outcomes than the general population, but little research has examined the physiological biomarkers by which distress may impact partner health outcomes. The current study examined the associations between FCR and changes in hair cortisol among BC partners. Male partners (N = 73) of early-stage BC survivors provided hair samples during two visits, one after completion of survivors' adjuvant treatment (T1) and again 6 months later (T2). Two subscales from the Fear of Cancer Recurrence Inventory and one subscale from the Concerns about Recurrence Scale comprised a latent FCR factor at T1. A latent change score model was used to examine change in cortisol as a function of FCR. Partners were on average 59.65 years of age (SD = 10.53) and non-Hispanic White (83%). Latent FCR at T1 was positively associated (b = 0.08, SE = 0.03, p = .004, standardized β = .45) with change in latent hair cortisol from T1 to T2. Results indicated that greater FCR was associated with increases in hair cortisol in the months following adjuvant treatment. This is one of the first studies to examine the physiological correlates of FCR that may impact health outcomes in BC partners. Findings highlight the need for further research into the relationship between FCR and its physiological consequences. Interventions to address partner FCR are needed and may aid in improving downstream physical health outcomes.

Reproductive concerns and its correlation with fear of recurrence and level of family support in patients of childbearing age with gynecologic malignancies

BackgroundTo discuss the current status of reproductive concerns and its correlation with fear of recurrence and level of family support in patients of childbearing age with gynecologic malignancies.MethodsA convenient sampling method was used to enroll 188 patients with gynecologic malignancies in Nanjing Maternity and Child Health Care Hospital, Nanjing Drum Tower Hospital, General Hospital of Ningxia Medical University, and Haian Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from September 2022 to April 2023. Patients were assessed using general information questionnaire, Reproductive Concerns After Cancer Scale (RCAC), Fear of Cancer Recurrence Inventory (FCRI) questionnaire, and Perceived Social Support-Family (PSS-FA) Scale.ResultsAmong patients of childbearing age with gynecologic malignancies, the total RCAC score was (54.35 ± 7.52), indicating a moderate level of reproductive concerns. Patients scored (20.98 ± 4.51) on FCRI, implying a moderate level of fear of recurrence. The PSS-FA score was (9.57 ± 2.76), denoting a moderate level of family support. The total score and each dimensional score of RCAC were positively correlated with FCRI total score (P < 0.05), and negatively correlated with PSS-FA total score (P < 0.05). Fear of recurrence, family support level, number of children, educational background, treatment modality, and fertility intention were influencing factors for reproductive concerns in patients of childbearing age with gynecologic malignancies (all P < 0.05).ConclusionThe reproductive concerns, fear of recurrence and family support are all at moderate levels in patients of childbearing age with gynecologic malignancies, and reproductive concerns are positively correlated with fear of recurrence and negatively correlated with family support.

The relationship between fear of cancer recurrence and death anxiety among Chinese cancer patients: the serial mediation model

AimsThis study aims to investigate the association between fear of cancer recurrence (FCR) and death anxiety (DA) among Chinese cancer patients, while considering the mediating effects of experiential avoidance (EA) and meaning in life (MIL).MethodsFrom February to June 2023, convenience sampling was used to select newly diagnosed cancer patients in a tertiary Cancer Hospital in Chinese Hunan Province as the survey objects. A total of 436 cancer patients completed the Fear of Cancer Recurrence Inventory, the Meaning in Life Questionnaire, the Acceptance and Action Questionnaire-II, and the Templer’s death anxiety scale. Descriptive analysis and Pearson correlation analysis were conducted using SPSS 28.0 software. Serial mediation analysis was performed by Hayes’ PROCESS macro.ResultsGender, age, educational level, marital status, residence, occupation, per capita monthly household income, tumor type, and cancer stage were controlled in the model. The results revealed that fear of cancer recurrence had a significant direct effect on death anxiety (Effect = 0.075, 95% CI: 0.064 to 0.087). Additionally, three indirect pathways were identified: (1) through experiential avoidance (Effect = 0.037, 95% CI: 0.026 to 0.049), (2) through meaning in life (Effect = 0.022, 95% CI: 0.014 to 0.031), and (3) through the serial mediators involving meaning in life and experiential avoidance (Effect = 0.016, 95% CI: 0.010 to 0.023). The total indirect effect of the three mediation paths was 63.56%.ConclusionFear of cancer recurrence is a significant psychological distress experienced by cancer patients, which not only directly contributes to death anxiety but also may triggers changes, such as experiential avoidance and meaning in life. Ultimately, this comprehensive psychological distress leads to death anxiety.

Relationship Between Fear of Cancer Recurrence and Quality of Life in Patients Undergoing Active Cancer Treatment: The Mediating Role of Social Support.

Socio-psychological factors such as fear of recurrence and presence of social support may affect quality of life (QOL) of cancer patients. Identifying mediating factors that impact QOL are crucial for targeting vulnerability in patients undergoing cancer treatments. The study purpose was therefore to determine relationships between presence of fear of cancer recurrence and QOL of patients, with the mediating role of social support. A predictive correlational design was used to conduct the study with 300 patients with cancer who were undergoing chemotherapy, radiotherapy, or surgery at two medical centers in Tehran. Measures included a demographic information form, the Fear of Cancer Recurrence Inventory (FCRI), the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30), and the Multidimensional Scale of Perceived Social Support (MSPSS). Data analyses included descriptives, and path analysis analyses. Higher fear of cancer recurrence predicted lower QOL (β = -0.60, p < 0.001). Moreover, individuals with lower fear of cancer recurrence also perceived higher social support (β = 0.32, p < 0.001). Additionally, individuals with higher perceived social support also reported better QOL (β = 0.30, p < 0.001). Perceived social support plays a significant mediating role in the relationship between the fear of cancer recurrence and QOL in patients undergoing active cancer treatment. Enhancing social support among cancer patients may contribute to enhanced QOL, and as does reducing fears associated with disease recurrence.

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

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. 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. 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. 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.

Fear of cancer recurrence in ovarian cancer caregivers: Aqualitative study.

Although there is growing research exploring survivor fear of cancer recurrence (FCR), little is known about caregiver FCR. To date, examination of caregiver FCR has largely been conducted through the lens of survivor conceptualisations, limiting the development of caregiver-specific models, measures, and interventions. This study aimed to explore experiences of FCR among caregivers of people with ovarian cancer. Semi-structured telephone interviews were conducted with caregivers of people with ovarian cancer. Participants, recruited through Ovarian Cancer Australia, also completed an online survey collecting participant and patient demographic characteristics, information about the survivor's disease and caregiver levels of FCR using the Fear of Cancer Recurrence Inventory (Caregiver) (FCRI-c). Qualitative interviews explored caregiver fears, how fears and concerns were experienced and the frequency and timing of FCR. Thematic analysis using a Framework Approach was used to analyse the results. Twenty-four caregivers (54% male) participated in an interview. Most caregivers were providing care for their partner (n=14). Thematic analysis identified four inter-related themes and associated sub-themes: (1) Fear and uncertainty; (2) Liminality; (3) Hopelessness and (4) Caregiver's protection of the person and self (caregiver's role as protector). Underpinning these themes was an overarching fear of one's family member dying. Caregivers supporting people with ovarian cancer experience worries and concerns related to cancer recurrence or progression. These experiences are conceptually different to survivor experiences. Fear of one's family member dying, and the dual nature of caregiver protection/self-protection mean it is imperative that interventions are tailored specifically to caregiver needs. Future research facilitating the development of appropriate measures and interventions is essential to reduce caregiver FCR.

The effects of physical symptoms, self-efficacy and social constraints on fear of cancer recurrence in breast cancer survivors: Examining the mediating role of illness representations.

Fear of cancer recurrence (FCR) is common in breast cancer survivors (BCS). This study examined the mediating role of illness representations in the relationships between FCR and physical symptoms, social constraint and self-care self-efficacy. In this cross-sectional study, 385 women with breast cancer completed a series of questionnaires including the FCR Inventory, Social Constraints Scale-15, Cancer Survivors Self-Efficacy Scale, Illness Perception Questionnaire-Revised and European Organization for Research and Treatment Quality of Life Questionnaire-Breast Cancer. Structural equation modelling method was conduct by using a bootstrapping method. Physical symptoms (β=0.272, p<0.01), social constraints (β=0.130, p<0.01), self-efficacy (β=-0.233, p<0.01) and illness representation (β=0.261, p<0.01) have direct effects on FCR. The indirect effects of physical symptoms (β=0.10, p<0.01), social constraints (β=0.076, p<0.01) and self-efficacy (β=-0.025, p<0.05) on FCR were partially mediated by illness representations. In this study, the effects of physical symptoms, social constraints and self-efficacy on FCR were found to be mediated by illness representation. Reducing the impact of negative illness representations on FCR by reducing physical symptoms, increasing self-efficacy, and promoting open disclosure of cancer-related concerns may be effective in reducing FCR in BCS.

A pilot randomized controlled trial of a mind-body resiliency program for fear of cancer recurrence: Qualitative findings.

503 Background: Up to 70% of cancer survivors have elevated fear of cancer recurrence (FCR). Behavioral approaches are promising for managing FCR but lack testing in a scalable, synchronous, remotely-delivered, group format. This NCCIH-funded pilot RCT tested an adapted mind-body resiliency program (IN FOCUS) in comparison to a usual care control (UC; referral to virtual, cancer support groups). Methods: Adult survivors of any non-metastatic cancer (N=64) were recruited from two Boston-area academic medical centers (July 2021-March 2022). Inclusion criteria included primary treatment, elevated FCR (FCR Inventory severity≥16), English fluency, no undertreated serious mental illness, and access to Zoom. Survivors were randomized (1:1) to either 8 sessions of IN FOCUS or UC. Individual exit interviews were conducted virtually with high rates of completion (91% IN FOCUS, 94% UC). Open-ended questions probed survivors on study enjoyableness, convenience, helpfulness, odds of future skill use, satisfaction, and FCR. Interviews were recorded, transcribed, and analyzed using hybrid deductive/inductive coding by three coders (MM, ET, DH) with a senior coder (GY) for resolving discrepancies. Themes were iteratively collapsed and expanded through consensus. Results: Survivors randomized to IN FOCUS found group delivery (i.e., hearing insights from others, sharing similar cancer experiences) and learning a variety of new skills (i.e., positive psychology such as appreciations and humor, relaxation/breathing, CBT and health behaviors) as the most enjoyable and helpful aspects. Some survivors voiced challenges with scheduling, limited time for group discussion, and length of sessions. Homework was helpful yet challenging for survivors to implement independently. Virtual delivery and electronic materials were identified as most convenient, but some wished the manual was less dense and printed as a hard copy. Survivors valued the group facilitator’s rapport, empathy, and group diversity in terms of cancer diagnosis, but desired more diversity in age, race, and gender. IN FOCUS survivors described reductions in FCR, primarily attributed to cognitive (i.e., self-efficacy, changed perspective) and health behavior changes. However, several IN FOCUS survivors reported having no change in FCR, due to needing more time to incorporate skills or recent health events. UC survivors described benefits from reading study surveys, which prompted survivors to reflect on their psychosocial functioning, and coping skills. Conclusions: The IN FOCUS intervention and study materials were well-received and participants appreciated the integration of a variety of skills, in particular positive psychology followed by relaxation, CBT, and health behavior skills. Findings will guide future optimization and efficacy testing with heterogenous cancer survivors with FCR. Clinical trial information: NCT04876599 .

Effectiveness of a guided online primary care intervention for fear of cancer recurrence: A randomised controlled trial.

Fear of Cancer Recurrence (FCR) is highly prevalent among cancer survivors and leads to decreased quality of life and increased healthcare costs. We assessed the effectiveness of a guided online primary care intervention for FCR, compared to waiting list. In this RCT, participants were recruited online and randomised 1:1. All adults who finished successful curative cancer treatment between 3months and 10 years ago, wanted support for FCR, and had sufficient Dutch skills were eligible. The intervention consisted of a 10-week online programme and three to five video calling sessions with a trained mental health worker. After 6months, the control group received the same intervention. The primary outcome was the difference between the groups in the change in FCR severity from baseline (T0) to 6months (T2), measured online with the short form of the Fear of Cancer Recurrence Inventory. One hundred and seventy-three participants were enroled and randomised to the intervention (n=86) or control group (n=87). FCR severity dropped 2.1 points more in the intervention group than in the control group (2.7 points (SD=3.9) versus 0.6 points (SD=3.6), t(154)=3.4, p=0.0007). General mental well-being also improved significantly in the intervention group and remained stable in the control group. These improvements remained at 10months follow up. This easily accessible and relatively inexpensive intervention effectively reduces FCR and has potential to replace or precede existing more intensive psychological treatments, improving patients' access to care. The trial was prospectively registered in the Netherlands Trial Register on 25-02-2019 with number NL7573.

Fear of Cancer Recurrence (FCR) in Human Papillomavirus-Associated Oropharyngeal Cancer (HPVOPC) Patients 12 months (12m) after (Chemo)Radiation (RT/CRT)

This study constitutes a planned secondary endpoint analysis from a longitudinal unmet needs study. The aim was to: (1) describe FCR outcomes 12m after RT/CRT; (2) examine associations between FCR severity scores 12m after RT/CRT and patient and disease characteristics and other patient-reported outcomes (PROs); and (3) to evaluate preferred FCR referral pathways. Eligible HPVOPC patients scheduled for curative RT/CRT were approached for enrolment. FCR was assessed with the 42-item Fear of Cancer Recurrence Inventory (FCRI) 12m after RT/CRT, as were patients' preferences for FCR referral pathways, using customized questions. Optimism (LOT-R) and resilience (Connor-Davidson Resilience Scale) were assessed at enrolment. Health-related quality of life (HRQL, EORTC QLQ-C30), disease-specific symptom severity and interference (MDASI-HN) and emotional distress (PROMIS Anxiety 7a, Depression 8a) were assessed 12m after RT/CRT. A total of 100/129 eligible patients were enrolled between October 2020 and November 2021. 85/93 (91%) alive patients without recurrence completed the FCRI; patients were mostly men (n = 73, 86%), with a median age of 60 years (range 44-77). A majority had stage I disease (n = 46, 54%) and received CRT (n = 82, 96%). The mean FCRI total score was 45.4 (SD = 26.3, range 0-102, possible range 0-168). The mean FCRI severity score was 12.1 (SD = 7.4, median = 11.0, range 0-29); 13%, 31% and 56% of respondents scored in the severe (≥22), moderate (>12-22) and low (≤12) range, respectively. Univariable regression analysis indicated that lower resilience, lower HRQL (global health status, all functional domains), higher emotional distress (anxiety, depression), and higher symptom severity and interference were associated with higher FCR severity scores 12m after RT/CRT. Apart from lower levels of education, associations between FCRI severity scores and other patient and disease factors were not statistically significant. If FCR had been a problem (n = 66), 86%, 44%, 14% and 5% of patients indicated they would like to discuss it with their oncologist, primary care physician, a psychologist or nurse, respectively (multiple responses allowed). If specific FCR interventions were available, 70/85 indicated their preferred sources for delivery (ordered by median rank) were oncologist, primary care physician, psychologist or nurse (tied), self-management or group sessions (tied). Almost half of HPVOPC patients reported moderate-to-severe FCR 12m after RT/CRT. Increased FCR severity was associated with education and self-reported resilience at baseline and with other measures of HRQL, toxicity and emotional distress at 12m. While patients view oncologists as central in FCR management, education about the benefits of other FCR-reducing approaches may be necessary.

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.

Correction to Maheu et al. (2023).

Most fear of cancer recurrence (FCR) interventions have small effects, and few target FCR. This randomized controlled trial (RCT) with breast and gynecological cancer survivors evaluated the efficacy of a cognitive-existential fear of recurrence therapy (FORT) compared to an attention placebo control group (living well with cancer [LWWC]) on FCR. One hundred and sixty-four women with clinical levels of FCR and cancer distress were randomly assigned to 6-weekly, 120 min FORT (n = 80) or LWWC (n = 84) group sessions. They completed questionnaires at baseline (T1), posttreatment (T2; primary endpoint), 3 (T3), and 6 months (T4) posttreatment. Generalized linear models were used to compare group differences in the fear of cancer recurrence inventory (FCRI) total score and secondary outcomes. FORT participants experienced greater reductions from T1 to T2 on FCRI total with a between-group difference of -9.48 points (p = .0393), resulting in a medium effect of -0.530, with a maintained effect at T3 (p = .0330) but not at T4. For the secondary outcomes, improvements were in favor of FORT, including FCRI triggers (p = .0208), FCRI coping (p = .0351), cognitive avoidance (p = .0155), need for reassurance from physicians (p = .0117), and quality of life (mental health; p = .0147). This RCT demonstrated that FORT, compared to an attention placebo control group, resulted in a greater reduction in FCR posttreatment and at 3 months posttreatment in women with breast and gynecological cancer, indicating its potential as a new treatment strategy. We recommend a booster session to sustain gains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Use of complementary and alternative medicine for reducing fear of cancer recurrence among cancer survivors: Does it work?

ObjectiveFear of cancer recurrence is a significant psychosocial concern impacting the recovery and quality of life of cancer survivors. Many survivors turn to complementary and alternative medicine to manage drug side effects and alleviate anxiety and fear of cancer recurrence. This study aims to investigate the relationship between the use of complementary and alternative medicine and the fear of cancer recurrence in cancer survivors. MethodsThis cross-sectional descriptive correlational study involved 280 cancer survivors selected through convenience sampling from oncology centers and medical offices in Kerman. Research instruments included a questionnaire on complementary and alternative medicine usage and the fear of cancer recurrence inventory. Data analysis was performed using IBM SPSS Statistics version 25. ResultsThe study revealed that 78.2% of participants had used at least one form of complementary and alternative medicine in the past year. Among these, 71.8% used medicinal herbs, 19.6% used nutritional supplements, 7.5% practiced relaxation and meditation, 7.1% utilized dry cupping, and 5.7% tried wet cupping. The mean score for the fear of cancer recurrence was 80.72 ± 18.46, which was close to the midpoint of the inventory score (84). Notably, fear of cancer recurrence and its associated dimensions did not exhibit significant differences between users and non-users of complementary and alternative medicine. ConclusionsThe results indicate that a substantial number of cancer survivors have utilized at least one form of complementary and alternative medicine in the past year, with medicinal herbs and nutritional supplements being the most common choices. It is essential for cancer patients to be informed about the potential effects of various complementary and alternative medicine approaches. The study found a moderate level of fear of cancer recurrence, with no discernible difference between users and non-users of complementary and alternative medicine. As a result, health managers and planners should implement effective psychological interventions and strategies to mitigate the fear of cancer recurrence among cancer survivors.

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

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. 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. 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). 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.

Supportive care needs of breast cancer survivors with different levels of fear of cancer recurrence: A cross-sectional survey study

PurposeTo examine the supportive care needs of breast cancer survivors with nonclinical, subclinical, or clinical fear of cancer recurrence. MethodsIn this cross-sectional study, 385 breast cancer survivors consented and completed a set of online questionnaires. Supportive care needs were assessed by using the 34-item Supportive Care Needs Survey. Fear of cancer recurrence was assessed by using the Fear of Cancer Recurrence Inventory. ResultsOne hundred eighty-four (47.8%) participants reported nonclinical fear of cancer recurrence, 147 (38.2%) reported subclinical fear of cancer recurrence, and 54 (14.0%) reported clinical fear of cancer recurrence. Higher levels of fear of cancer recurrence were associated with higher levels of supportive care needs in five domains (β = 0.30–0.60, P < 0.001) after adjusting for places of residence, education, motherhood, and time since diagnosis. Among participants with nonclinical fears of cancer recurrence, the most common needs were in the ‘Health care system/Information’ domain (50.5%). Among participants with subclinical or clinical fear of cancer recurrence, the most common needs were in the ‘Psychological’ domain (85.7% and 96.3%, respectively). ConclusionFear of cancer recurrence was associated with supportive care needs. The most common needs among participants with subclinical or clinical fears of cancer recurrence were psychological needs.

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

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. Pragmatic, multicentre randomised trial. Four Danish departments of gynaecology between May 2013 and May 2016. 212 women diagnosed with stage I low-intermediate risk endometrial carcinoma. 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. 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. 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). 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.

Fear of cancer recurrence inventory scores and their correlation with quality of life and stress levels in breast cancer survivors.

e24073 Background: For survivors of early stage breast cancer, the fear of cancer recurrence (FCR) can be distressing. A clinical challenge is recognizing which patients reporting FCR may need psychological intervention. Prior studies have suggested clinically significant FCR if the validated FCR Inventory (FCRI) scale score is &gt; = 22 while others suggest as low as &gt; = 13 may be an optimal threshold. Our goal was to understand the optimal thresholds for detection of clinically significant impairments in quality of life and high levels of stress. We thus examined FCRI thresholds that optimized detection with two standardized screening modalities of quality of life and perceived stress respectively: the Functional Assessment of Cancer Therapy-General (FACT-G) and the Perceived Stress Scale (PSS). Methods: A previously published cohort of breast cancer survivors at our institution consented to complete self-reported psychological measures and gave access to their medical records. The 2 measures being compared to the FCRI were PSS and FACT-G. FCRI, is a 9-item self-report measure, that evaluates worry about health status and illness returning, triggers that influence worry, uncertainty, and the concerns of significant others. FACT-G, a 28-item self-report measure, assesses quality of life in cancer patients, including physical well-being, social/family well-being, emotional well-being, and functional well-being; we examined the binary threshold score for reduced health related quality of life ( &lt; = 62) vs not reduced health related quality of life (&gt; 62). PSS, assesses the degree to which situations in one’s life are appraised as stressful; we examined the threshold score for low stress (0-13) vs moderate or high stress ( &gt; 13). Sensitivity (Sen) and specificity (Spe) were calculated for each cutoff value for the FCRI score between 16 and 22 (two proposed cutoffs) when compared to the FACT-G and the PSS binary cut points. Results: A total of 177 breast cancer survivors participated in the study. The mean age of participants was 57.6 (SD 13.1) years. Mean scores were 18.6 (SD 7.5) for the FCRI (n = 170), 13.92 (SD 7.0) for the PSS (n = 176) and 80.6 (SD 14.9) for the FACT-G (n = 155). FCRI &gt; = 20 appeared to optimize sensitivity and specificity both on the FACT-G (Sen: 82.4, Spe: 56.1) and PSS (Sen: 63.2 Spe: 69.1) in our patient population. Conclusions: Our results suggest that a FCRI cutoff of 20 may optimize inclusion of patients likely to have poorer quality of life and higher levels of stress. This may allow for more patients in this vulnerable population to be identified for possible intervention, without losing specificity to those with significant distress.[Table: see text]