Abstract Objective This population-based longitudinal study assessed the prevalence, incidence and evolution of fear of cancer recurrence (FCR) and its relationship with some cancer characteristics ...in a large sample of patients with mixed cancer sites over an 18-month period. Methods A total of 962 patients scheduled to undergo surgery for cancer completed the severity subscale of the Fear of Cancer Recurrence Inventory at the peri-operative period and 2, 6, 10, 14, and 18 months later. Results Results indicated that FCR levels were highest at baseline, significantly decreased at the 2-month evaluation and then remained stable throughout the remainder of the study. Between 44.0% and 56.1% of the patients reported a clinical level of FCR during the study, with the highest proportion found at baseline. A relationship was obtained between greater FCR and some indices of poorer prognosis (i.e., diagnosis of head and neck cancer, more advanced cancer, cancer recurrence), as well as with the administration of adjuvant treatment, particularly chemotherapy. Patients with clinical FCR at baseline continued to display clinical levels at all subsequent time points. The incidence rate of clinical levels of FCR was 51.7% overall. Conclusion FCR is a highly prevalent and persistent condition. More efforts should be devoted to developing effective treatments for patients with clinical levels of FCR. Early interventions appear particularly relevant in order to prevent the problem from becoming chronic, although patients' acceptability and the efficacy of this approach remain to be demonstrated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Purpose
The prevalence of clinical levels of fear of cancer recurrence (FCR) in cancer survivors is unknown, which may be partly explained by the lack of an assessment method that would make it ...possible to distinguish between normal and clinical levels of FCR. Moreover, despite the apparent overlap between FCR and manifestations of some psychiatric disorders, no study has yet evaluated the comorbidity of clinical levels of FCR. The goals of this study were to assess the capacity of the Fear of Cancer Recurrence Inventory severity subscale, to consider a shorter form of the FCRI (FCRI-SF), to screen for clinical levels of FCR, and to assess its psychiatric comorbidity.
Methods
Sixty French-Canadian cancer survivors (73 % of those eligible) who had been treated within the past 4 years for localized breast, prostate, lung, or colorectal cancer were randomly selected. Participants were administered a clinical interview assessing FCR, the Structured Clinical Interview for DSM-IV, and self-report scales.
Results
A cutoff score of 13 or higher on the FCRI-SF was associated with optimal sensitivity (88 %) and specificity (75 %) rates for the screening of clinical levels of FCR. Cancer survivors with clinical levels of FCR were significantly more likely to meet the criteria for a current psychiatric disorder (60 %) than patients with nonclinical levels (29 %). Anxiety disorders tended to be the most common comorbid disorders.
Conclusions/Implications for Cancer Survivors
The FCRI-SF allows rapid and effective screening of clinical levels of FCR, a condition associated with significant psychiatric comorbidity.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
The current Coronavirus disease 2019 (COVID-19) pandemic is a highly stressful event that may lead to significant psychological symptoms, particularly in cancer patients who are at a greater risk of ...contracting viruses. This study examined the frequency of stressors experienced in relation to the ongoing coronavirus pandemic and its relationship with psychological symptoms (i.e., anxiety, depression, insomnia, fear of cancer recurrence) in breast cancer patients.
Thirty-six women diagnosed with a non-metastatic breast cancer completed the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, the severity subscale of the Fear of Cancer Recurrence Inventory, and the COVID-19 Stressors Questionnaire developed by our research team. Participants either completed the questionnaires during (30.6%) or after (69.4%) their chemotherapy treatment.
Results revealed that most of the participants (63.9%) have experienced at least one stressor related to the COVID-19 pandemic (one: 27.8%, two: 22.2%, three: 11.1%). The most frequently reported stressor was increased responsibilities at home (33.3%). Higher levels of concerns related to the experienced stressors were significantly correlated with higher levels of anxiety, depressive symptoms, insomnia, and fear of cancer recurrence,
s(32) = 0.36 to 0.59, all
s < 0.05.
Cancer patients experience a significant number of stressors related to the COVID-19 pandemic, which are associated with increased psychological symptoms. These results contribute to a better understanding of the psychological consequences of a global pandemic in the context of cancer and they highlight the need to better support patients during such a challenging time.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
Background
Despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors, there is a lack of validated multidimensional instruments to evaluate this ...issue specifically.
Purpose
The goal of this study was to develop and empirically validate a multidimensional self-report scale for assessing the fear of cancer recurrence, the Fear of Cancer Recurrence Inventory (FCRI).
Methods
A provincial medical databank was used to randomly select a pool of 1,704 French-Canadian patients who had been treated for breast, prostate, lung, and colorectal cancer within the past 10 years. Of these, 300 patients were asked to complete the FCRI on two occasions.
Results
The factorial analysis conducted on the final 42-item scale revealed a seven-component solution (64% of the variance) including the following factors: triggers, severity, psychological distress, coping strategies, functioning impairments, insight, and reassurance. The results also supported the internal consistency (
α
= 0.95) and the temporal stability (
r
= 0.89) of the FCRI, as well as its construct validity with other self-report scales assessing fear of cancer recurrence (
r
= 0.68 to 0.77) or related constructs such as psychological distress (
r
= 0.43 to 0.77) and quality of life (
r
= −0.20 to −0.36).
Conclusions
This study suggests that the French-Canadian version of the FCRI is a reliable and valid instrument for evaluating the multidimensional aspects of the fear of cancer recurrence.
Summary Exercise leads to several positive outcomes in oncology. However, the question as to whether exercise is a valuable option for improving patients' sleep, which is frequently disturbed in ...cancer patients, remains unanswered. The aims of this study were to conduct a systematic review and meta-analysis of randomized and non-randomized clinical trials that have investigated the effect of exercise on sleep outcomes, assessed subjectively and objectively. Relevant studies, published before May 2016, were traced through a systematic search of PubMed, Embase, PsycINFO, SportDiscus and Cochrane library databases. The review looked at twenty one trials, including 17 randomized controlled trials. Most interventions were home-based aerobic walking programs and breast cancer patients were the subgroup most represented. Sleep variables were most commonly used as secondary outcomes in the reviewed studies. Studies were highly heterogeneous in terms of methodology. The qualitative review of available evidence suggested a beneficial effect of exercise interventions on sleep in several studies (48%). However, the meta-analysis conducted on RCTs revealed no significant effect either on subjective or on objective sleep measures. This lack of significant effect could be due, at least in part, to a floor effect. More rigorous studies are needed to assess the effect of exercise interventions in cancer patients, in particular randomized controlled trials conducted in patients with clinically significant sleep disturbances at baseline.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background
Cancer patients commonly report experiencing fear of cancer recurrence (FCR), which may lead to several negative consequences. This study aimed at examining whether clinical levels of FCR ...are linked to a greater use of health care services.
Method
This is a secondary analysis of a longitudinal study of 962 cancer patients on the epidemiology of cancer‐related insomnia. They completed the Fear of Cancer Recurrence Inventory—Short form (FCRI‐SF) and reported information on their consultations (medical, psychosocial, and complementary and alternative medicine CAM) and medication usage (anxiolytics/hypnotics and antidepressants) at 6 time points over an 18‐month period.
Results
Results indicated that clinical FCR at baseline was associated with greater consultation rates of medical and psychosocial professionals and a greater usage of anxiolytics/hypnotics and antidepressants. No significant association was found between the FCR level and use of CAM services. While consultation rates of medical and CAM professionals and usage of antidepressants generally increased over time, consultation rates of psychosocial professionals and usage of anxiolytics/hypnotics tended to decrease.
Conclusions
Cancer patients with clinical levels of FCR are more likely to consult health care providers and to use psychotropic medications, which may translate into significant costs for society and the patients themselves.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Objective
The ongoing COVID-19 global pandemic is a stressful experience that is particularly likely to negatively affect cancer patients. The goal of this qualitative study was to explore how breast ...cancer patients experienced the first wave of the COVID-19 outbreak.
Methods
As part of a larger study, 23 women accepted to take part in an individual phone interview investigating the psychosocial consequences of the COVID-19 pandemic.
Results
The hybrid inductive-deductive thematic analysis revealed the following themes: (1) increased general psychological distress; (2) concerns about the impact of treatment-related immunosuppression (i.e., increased risk of catching the SARS-CoV-2 and of developing more severe complications); (3) higher risk of catching the SARS-CoV-2 in the hospital; (4) possible impact of changes in cancer care trajectory on prognosis; (5) distress related to going to treatment alone; (6) social isolation and decreased family relationships; (7) increased responsibility at home; (8) variety of coping strategies used (i.e., adherence to public health measures, seeking professional help, avoidance); (9) difficulty receiving professional mental health services and social support; (10) anxiety related to return to work; and (11) uncertainty about the future.
Conclusions
The COVID-19 outbreak is a major medical, psychological, social, and occupational stressor for women undergoing treatment for breast cancer. We offer recommendations to reduce the impact of subsequent waves of COVID-19 and other epidemics in this population.
Summary This review examined the efficacy of cognitive behavior therapy for insomnia (CBT-I) in people diagnosed with cancer. Studies were identified through November 2014 using multiple databases, ...clinical trial records, and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I conducted in individuals with a cancer diagnosis who had clinically relevant insomnia. The primary outcome variable was sleep efficiency (SE) as measured by sleep diary. Eight studies including data from 752 cancer survivors met inclusion criteria. CBT-I resulted in a 15.5% improvement in SE relative to control conditions (6.1%) from pre- to post-intervention, with a medium effect size (ES: d = 0.53). Overall, sleep latency was reduced by 22 min with an ES of d = 0.43, compared to a reduction of 8 min in the control conditions. Wake after sleep onset was reduced by 30 min with an ES of d = 0.41, compared to 13 min in the control conditions. Large effect sizes were observed for self-reported insomnia severity ( d = 0.77) for those patients who received CBT-I, representing a clinically relevant eight point reduction. Effects were durable up to 6 mo. The quality of the evidence supports a strong recommendation for the use of CBT-I among cancer survivors.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract
Study Objectives
High rates of sleep and mental health problems have been reported during the COVID-19 pandemic, but most of the evidence is retrospective without pre-pandemic data. This ...study documented rates of prevalent, incident, and persistent insomnia and psychological symptoms during the COVID-19 pandemic (2020) compared to pre-pandemic data (2018).
Methods
Data were derived from a longitudinal, population-based study of insomnia in Canada. When the first lockdown started in the province of Quebec, a subsample of participants who had completed the latest 2018 follow-up were surveyed (April to May 2020) about their sleep, insomnia, and psychological symptoms since the beginning of the pandemic. Prevalence, incidence, and persistence rates of insomnia, and severity of stress, anxiety, and depressive symptoms were estimated, as well as their associations with confinement, loneliness, social support, use of electronics, and other lifestyle changes occurring during the pandemic. A sleep/health survey and validated questionnaires of insomnia, sleep quality, stress, fatigue, anxiety, and depression were administered at both assessments.
Results
The sample consisted of 594 adults (mean age: 48.3 ± 13.1 years; 64.0% women). Prevalence of insomnia increased from 25.4% to 32.2% (symptoms) and from 16.8% to 19% (syndrome) from 2018 to 2020, for an overall 26.7% increase in insomnia rates. Of those classified as good sleepers in 2018 (n = 343), 32.6% (n = 112) had developed new insomnia during the COVID-19 pandemic. Among participants who had insomnia in 2018, the persistence rate was 76.5% 2 years later. There was a significant worsening of sleep quality, fatigue, anxiety, and depression (all ps < .005) during the COVID-19 pandemic compared to 2018. Significant associations were found between sleep and psychological symptoms and with living alone and being in confinement, lower social support, increased time using electronic devices, reduced physical exercise, and higher financial stress.
Conclusions
The COVID-19 pandemic is associated with significant increases in insomnia and psychological symptoms compared to the pre-pandemic period. Large scale public sleep and mental health intervention programs should be prioritized during and after a pandemic such as the COVID-19.
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