High Fear Of Cancer Recurrence In Chinese Newly Diagnosed Cancer Patients

BackgroundFear of cancer recurrence(FCR)is commonly seen in cancer patients from diagnosis through survivorship.FCR is often defined as:fear,worry,or concern relating to the possibility that cancer will come back or progress.FCR is a key unmet need among cancer patients.Research suggests that FCR is a unique,independent,and multidimensional construct distinct from anxiety,depression,and distress,with its own profile and mechanisms.Increased levels of FCR could be dysfunctional and significantly influence an individual’s wellbeing.It often coexists with high psychological distress and poor Health-related Quality of Life(HRQoL).Patients with elevated FCR are more likely to report anxiety,depressive,and insomnia symptoms,and report more difficulties planning for the future.FCR also negatively affects treatment adherence and may lead to higher risk of mortality.For newly diagnosed cancer patients,the days and weeks after diagnosis could be overwhelming,scary and lonely.However,inconclusive evidence was found of the association between FCR and time since diagnosis.There is a paucity of evidence regarding the unmet needs of newly diagnosed cancer patients.These patients have unique biological and psychological needs,therefore,more efforts should be made to provide better insights into this population.ObjectiveThis study explores the prevalence and correlates of FCR in Chinese newly-diagnosed(≤6 months)cancer population.Based on previous theoretical framework and empirical evidence,the association between sociodemographic/clinical variables and FCR were often conflictive.However,psychological/emotional variables(such as stress,anxiety,and depression)were consistently found to be risk factors of clinical levels of FCR,and explained most of the variance in FCR.Moreover,several sociodemographic/clinical variables,such as gender,financial status,and prior depression history have been proved to be risk factors for emotional disturbances.Researchers suggested that anxiety and depression are causes of FCR rather than consequences.Therefore,we hypothesized that:(1)psychological variables(anxiety and depression)will be significantly associated with high FCR;(2)psychological variables will mediate the association between sociodemographic/clinical variable and FCR;and(3)compared to sociodemographic/clinical variables,psychological variables will have greater total effect on FCR.MethodsThis is a multicentre,cross-sectional study that includes 996 patients with mixed cancer diagnosis.All recently diagnosed patients completed a questionnaire consisting of the following:a demographic information sheet,Fear of Progression Questionnaire-Short Form(FoP-Q-SF),Patient Health Questionnaire(PHQ-9)and General Anxiety Disorder Questionnaire(GAD-7).Univariate analyses,binary logistic regression analyses,structural equation modelling(SEM),and network analyses were performed to examine the association between tested variables and FCR.ResultsOf the 996 patients,643(64.6%)reported high FCR(scored≥34 in the FoP-Q-SF).Chemotherapy(OR=1.941),Childhood severe illness experience(OR=2.802),depressive(OR=1.153)and anxiety(OR=1.249)symptoms were positively associated with high FCR,while higher monthly income(OR=0.592)was negatively associated with high FCR.SEM indicated that emotional disturbances(anxiety and depression)directly influenced FCR,while emotional disturbances partly mediated the association between personal monthly income and FCR.The main finding of the network analysis is the node#GAD4(’having trouble relaxing’,strength=1.141),#PHQ2(’Feeling depressed or hopeless’,strength=1.118),#GAD2(’can’t stop or control worry’,strength=1.107),#GAD5(’can’t sit’,strength=1.017),及#FoP1(’Being afraid of disease progression’,strength=1.016)were the central nodes within the network.ConclusionHigh FCR is a frequently reported problem among newly-diagnosed cancer patients.Various factors include Chemotherapy,Childhood severe illness experience,lower monthly income,depressive and anxiety symptoms increased the likelihood of the development of FCR.Compared with sociodemographic/clinical variables,psychological variables have greater total effect on FCR and may be more important in predicting FCR.Dynamic monitoring and systematic management are necessary,especially for patients with high FCR,specific and flexible psychological interventions should be given.Central nodes in a network model are more important predictors of clinical outcomes and might be relevant as targets for future interventions.