Research Status of Fear of Cancer Recurrence in Breast Cancer Patients

Yun Ding^*, Liping Zhang^*, Lijuan Zhang^#, Qiaoling Zhong^#

State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.

DOI: 10.4236/jct.2024.159030                

Abstract

Fear of disease progression is one of the most common psychological problems in the treatment of cancer patients. Early recognition and intervention can effectively control the level of fear of disease progression and improve the quality of life of patients. The present situation and influencing factors of FoP in breast cancer patients were reviewed in this paper, in order to provide reference for clinical research of breast cancer patients.

Keywords

Fear of Cancer Recurrence, Breast Cancer, Cancer, Nursing

1. Fear of Cancer Recurrence in Cancer Patients

A systematic review showed that the incidence of fear of cancer recurrence in young cancer survivors aged 15 to 39 years ranged from 31% to 85.2% [1]. According to Lane et al. [2], 84% of current cancer patients aged 19 years and older experienced fear of cancer recurrence, and more than 59% of them showed significant fear of cancer recurrence. The study also found that women make up the majority of this group. Cancer recurrence fear score was significantly different among survivors of different types of cancer. When the cancer recurrence fear score was ≥ 34 points, the level of cancer recurrence fear was clinically significant. According to the results of the study [3], among all types of cancer, patients with breast and gynecological related cancers had the highest fear of recurrence, while patients with prostate cancer had the lowest score, with only 4.9% of patients scoring more than 34 points. In contrast, 14.1 percent of patients with head and neck cancer scored more than 34 points, ranking second only to prostate cancer patients. Simard [4] showed that the fear of cancer recurrence in prostate cancer patients was significantly lower than that in lung cancer, breast cancer and colorectal cancer patients. In addition, a study by Krok Schoen [5] found that in the elderly cancer patient population, approximately 16% of patients showed high levels of recurrence fear, but there was no significant difference in this fear among elderly patients with breast, ovarian, colorectal, and endometrial cancers. The fear of recurrence is often present from the moment a patient is diagnosed with cancer and may continue to affect them. A longitudinal study of patients with head and neck cancer conducted by Llewellyn [6] showed that about 30% of patients already showed fear of recurrence before treatment, and this condition did not show significant improvement in 6 to 8 months after treatment. In addition, according to a study of 1002 German cancer patients [3], the fear of cancer recurrence may persist even years later. In the study, 17 percent of patients scored more than 34 points on the Fop-Q-SF score, compared with 19 percent and 13.4 percent five and 10 years after cancer diagnosis, data that highlight the prevalence and persistence of cancer recurrence fears among patients.

2. Research Status of Recurrence Fear in Breast Cancer Patients

In the 1980s, foreign scholars began to study the fear of cancer recurrence in cancer patients. According to a survey of breast cancer patients in Korea, about 54.3% of them are experiencing a high level of fear of cancer recurrence [7]. This long-term high level of fear of relapse not only increases the psychological pressure of patients, but also leads to more serious dysfunction in their function. Kallay [8] reviewed the literature on factors related to fear of cancer recurrence in breast cancer patients during the COVID-19 pandemic, and found that high levels of fear of cancer recurrence were associated with the impact of the COVID-19 pandemic, because of the disruption or delay of treatment plans, obstruction of communication with medical personnel, and difficulty in obtaining drugs. In the study of Schapira [9], they tracked the recurrence fear of 365 young breast cancer patients, and found that 60% of them showed a medium-high level of cancer recurrence fear, and this fear did not decrease with time, so it is of great significance to continuously monitor the level of cancer recurrence fear. Thewes [10] showed in qualitative interviews that when breast cancer patients’ fear of cancer recurrence was at a high level, they mostly adopted avoidance coping styles. The fear of cancer recurrence in breast cancer patients is also related to disease perception [11], anxiety and depression [12], social support [13] and other factors. Existing studies have shown that the fear of recurrence of breast cancer patients in China is at a moderate to severe level [14]-[16]. Ye Chunli [17] evaluated 180 patients with breast cancer after surgery by using the simplified fear of disease progression scale, and the results showed that 64.4% of the patients’ fear of cancer recurrence reached the clinically meaningful standard. The study also found that the fear of cancer recurrence was negatively correlated with social support and positively correlated with the feeling of disease uncertainty, indicating that the fear of cancer recurrence of patients after breast cancer surgery was high. Clinicians need to take targeted intervention measures to help patients reduce the feeling of disease uncertainty and improve the level of social support, so as to reduce the fear of cancer recurrence. In the study of Jiang Liling [18], they used the Chinese version of the simplified Fear of disease progression scale to investigate 110 cases of breast cancer patients, and found that the recurrence fear of breast cancer patients was in a medium to low state, and found that the recurrence fear was negatively correlated with health literacy. In addition, the greater the psychological burden patients experienced, their fear of cancer recurrence increased correspondingly. At present, there are relatively few studies on the fear of cancer recurrence in China. However, according to the existing literature reports, the fear of cancer recurrence is not only at a high level in the breast cancer population, but also has become one of the most prominent psychological problems in this group. In view of this, it is particularly critical to conduct in-depth research on the current situation and influencing factors of recurrence fear in breast cancer patients, which will help to explore ways to reduce the level of recurrence fear of cancer, so as to improve their physical and mental health. This research direction can provide more effective psychological support measures for clinical practice, help breast cancer patients better cope with the psychological challenge of cancer recurrence, and promote the full recovery of their physical and mental health.

3. Factors Influencing the Fear of Cancer Recurrence in Breast Cancer Patients

3.1. Demographic Factor

Studies have shown that age, family income and education level are key factors that influence the fear of cancer recurrence, but these factors are expressed differently in different populations. Vachon [19] found a significant negative correlation between age and fear of cancer recurrence when studying the relationship between fear of cancer recurrence and health care behavior in breast cancer survivors. Zhang Yang [20] showed that the younger the age of cancer patients, the higher the fear of cancer recurrence. Niu [21] conducted a survey on 342 patients after breast cancer surgery and found that family income was negatively correlated with patients’ fear of cancer recurrence. According to the study of Wu Qiyun [22], family income is one of the factors affecting the fear of cancer recurrence. Another study conducted by Hu Zewei [23], through a survey of 124 patients after breast cancer surgery, found that patients with higher education levels experienced lower fear of cancer recurrence. In addition, the fear of cancer recurrence is influenced by other demographic factors. Pang [24] found in the meta-analysis that because women are better at expressing vulnerability and fear, the overall level of cancer recurrence fear in women is higher than that in men. Anderson [25] analyzed 19 literatures from European and American countries and found significant differences in the average level of fear of cancer recurrence between ethnic minorities and major ethnic groups. At the same time, the study of Ashing [26] surveyed Asian Americans, and the results showed that women from China reported lower levels of fear of cancer recurrence than women from other Asian countries (such as South Korea, the Philippines and Vietnam), which may be related to the cultural background of different ethnic groups.

3.2. Disease and Therapeutic Factors

Multiple studies have found that while various cancer types can cause varying levels of fear of recurrence, breast cancer patients report the most significant levels of fear [27] [28]. In a population-based cohort study in Germany, patients experienced greater fear of recurrence when their cancer recurred or metastasized [29]. A study conducted by Xing Jiwei [30] on 300 breast cancer patients also found that the severity of the disease was positively correlated with the fear of recurrence. Regarding the surgical treatment of breast cancer, studies have shown that patients with breast-conserving surgery often experience a higher level of fear of recurrence compared with patients who receive modified radical surgery [31]. In addition, studies [32] have shown that different treatments for breast cancer have an impact on the level of fear of recurrence, with patients receiving radiotherapy generally having a lower level of fear of recurrence than those receiving chemotherapy.

3.3. Psychological Factors

Depression and anxiety have a significant impact on the fear of cancer recurrence in breast cancer patients. Chirico [12] found that breast cancer patients with high anxiety and depression have higher sensitivity to stressful events, which not only increases psychological pressure, but also may lead to higher fear of recurrence. KOCH [33] also observed a positive correlation between the degree of anxiety and depression and the fear of cancer recurrence in a survey of 2671 breast cancer patients. In addition, Lebel [34] also showed that breast cancer patients with symptoms of depression and anxiety tended to experience more severe fear of recurrence. The research of Niu Yaling [15], a domestic scholar, revealed that the recurrence fear of patients with breast cancer after surgery is negatively correlated with the level of psychosocial adaptation, indicating that psychological maladaptation may exacerbate the recurrence fear. Ye Chunli [17] also found in a survey of 180 patients after breast cancer surgery that the more uncertain patients were about the disease, the more serious their fear of cancer recurrence.

3.4. Social Support

Social support plays a crucial role in how individuals cope with stressful events. It is not only an effective external resource that can be used, but also an important reason for individual psychological adjustment in the face of stressful events. It can relieve stress and improve physical and mental condition through emotional interaction, information exchange, tool support and re-evaluation [35]. Studies [17] [20] have shown that the fear of recurrence in breast cancer patients is negatively correlated with social support. Based on the social cognitive processing model that validated breast cancer patients and their spouses, Soriano [13] analyzed the impact of social environment on the recurrence fear of breast cancer patients, and pointed out that patients with fewer social resources and their spouses may suffer greater psychological pressure, resulting in a higher recurrence fear level. On the other hand, Huang Jialian [36] randomly divided 180 breast cancer patients into intervention group and control group. The intervention group received information support, while the control group received routine nursing education. The results showed that information support significantly reduced patients’ fear of recurrence and feelings of uncertainty about their disease, while increasing their confidence and determination to cope with their cancer.

Self-Disclosure

Self-disclosure is a core concept in the field of psychology, originally proposed by American psychologist Jourard, who describes self-disclosure as the process of revealing information about oneself to others and sharing one’s private thoughts and emotions [37]. Self-disclosure is a positive and effective way of communication, which has a direct negative predictive effect on the fear of cancer recurrence. It not only helps individuals gain understanding and support from others through expressing bad emotions, and enhances the function of social support system, but also promotes the adjustment of cognitive structure, enhances positive perception, and improves their social relations through revealing extreme thinking. Thus reducing the fear of cancer recurrence [38]. In the study of Chen Jiao [39], 88 postoperative breast cancer patients who received chemotherapy were randomly assigned to the control group and the intervention group. The control group received standard chemotherapy care, while the intervention group added self-disclosure intervention measures on the basis of routine care. This helps reduce the fear of cancer recurrence. In addition, Xu [40] also showed that through effective communication with others, patients can change their wrong understanding of the fear of cancer recurrence, establish a correct disease concept, and then reduce the fear of cancer recurrence.

3.5. Coping Style

Coping style is a coping strategy that involves cognitive and behavioral measures taken by individuals in response to frustration and stress. Adopting positive coping strategies can help individuals proactively deal with stressors and increase confidence in treatment [41]. Simard [42] found that patients who adopted religion as a coping strategy showed a lower level of fear of cancer recurrence, which may be because they believed that they could gain more power to fight cancer through faith. Chinese scholar Ren Jialei’s research shows [43] that when breast cancer patients adopt active coping methods, their reported fear level of cancer recurrence is lower.

4. Conclusion

To sum up, domestic and foreign studies on the influencing factors of fear of cancer recurrence mainly focus on breast cancer patients, and the main influencing factors include demographic factors, disease and treatment factors, and cognitive psychosocial factors (disease perception, social support, anxiety and depression, etc.).

NOTES

^*Co-first author.

^#Corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

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