Associations among physical symptoms, fear of cancer recurrence, and emotional well-being among Chinese American breast cancer survivors: a path model
- 494 Downloads
Most existing studies on fear of cancer recurrence (FCR) are exploratory without theoretical underpinnings and have been conducted among non-Hispanic Whites. Based on theoretical models, we hypothesized that more physical symptoms (pain and fatigue) would be associated with higher FCR, which, in turn would be related to lower emotional well-being among Chinese American breast cancer survivors.
Participants were 77 Chinese American women who were diagnosed with breast cancer of stages 0–III. A cross-sectional path analysis was conducted with a bootstrapping method.
The final model showed that indirect paths from pain interference to emotional well-being and from fatigue to emotional well-being via FCR were significant. That is, higher levels of pain interference and fatigue were associated with higher FCR, which was further related to lower emotional well-being.
To our best knowledge, this is the first theory-driven study that investigates FCR experiences among Chinese American breast cancer survivors. Our study might provide a more comprehensive understanding of FCR as it simultaneously shows predictors and a psychological consequence of FCR. Results need to be replicated in large, racially/ethnically diverse samples and longitudinal studies.
KeywordsFear of cancer recurrence Pain Fatigue Quality of life Asian American
This research was funded by the American Cancer Society (MRSGT-10-011-01-CPPB: PI Qian Lu). We thank to Toyin Ayilara for her proofreading.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
- 4.Lebel S, Ozakinci G, Humphris G, Mutsaers B, Thewes B, Prins J, Dinkel A, Butow P (2016) From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer 24(8):3265–3268. https://doi.org/10.1007/s00520-016-3272-5 CrossRefPubMedGoogle Scholar
- 9.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. https://doi.org/10.1002/(SICI)1099-1611(199706)6:2<95::AID-PON250>3.0.CO;2-B CrossRefPubMedGoogle Scholar
- 14.Custers JA, Gielissen MF, de Wilt JH, Honkoop A, Smilde TJ, van Spronsen DJ, van der Veld W, van der Graaf WT, Prins JB (2017) Towards an evidence-based model of fear of cancer recurrence for breast cancer survivors. J Cancer Surviv 11(1):41–47. https://doi.org/10.1007/s11764-016-0558-z CrossRefPubMedGoogle Scholar
- 22.Kluthcovsky ACGC, Urbanetz AA, de Carvalho DS, Maluf EMCP, Sylvestre GCS, Hatschbach SBB (2012) Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life. Support Care Cancer 20(8):1901–1909. https://doi.org/10.1007/s00520-011-1293-7 CrossRefGoogle Scholar
- 25.Cleeland C (1991) Pain assessment in cancer. In: Osoba D (ed) Effect of cancer on quality of life. CRC Press, Boca Raton, pp 293–305Google Scholar
- 28.Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the Functional Assessment of Cancer Therapy-Breast (FACT-B) quality of life instrument. J Clin Oncol 15(3):974–986. https://doi.org/10.1200/JCO.19184.108.40.2064 CrossRefPubMedGoogle Scholar
- 29.Browne MW, Cudeck R (1993) Alternative ways of assessing model fit. In: Bollen KA, Long JS (eds) Testing structural equation models. Sage, Newbury Park, pp 136–162Google Scholar
- 33.van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J (2017) Efficacy of blended cognitive behavior therapy for high fear of recurrence in breast, prostate, and colorectal cancer survivors: the SWORD study, a randomized controlled trial. J Clin Oncol 35(19):2173–2183. https://doi.org/10.1200/JCO.2016.70.5301 CrossRefPubMedGoogle Scholar
- 34.Dieng M, Butow PN, Costa DS et al (2016) Psychoeducational intervention to reduce fear of cancer recurrence in people at high risk of developing another primary melanoma: results of a randomized controlled trial. J Clin Oncol 34(36):4405–4414. https://doi.org/10.1200/JCO.2016.68.2278 CrossRefPubMedGoogle Scholar
- 35.Lichtenthal WG, Corner GW, Slivjak ET, Roberts KE, Li Y, Breitbart W, Lacey S, Tuman M, DuHamel KN, Blinder VS, Beard C (2017) A pilot randomized controlled trial of cognitive bias modification to reduce fear of breast cancer recurrence. Cancer 8(8):1424–1433. https://doi.org/10.1002/cncr.30478 CrossRefGoogle Scholar
- 37.Hoyle RH, Kenny DA (1999) Sample size, reliability, and tests of statistical mediation. In: Hoyle RH (ed) Statistical strategies for small sample research. Sage, Thousand Oaks, pp 195–222Google Scholar