Predicting Fear of Breast Cancer Recurrence and Self-Efficacy in Survivors by Age at Diagnosis
Purpose/Objectives: To determine the effect that age at diagnosis has on fear of breast cancer recurrence and to identify the predictors of fear of recurrence using self-efficacy as a mediator.
Design: Cross-sectional survey.
Setting: Two university cancer centers and one cooperative group in the midwestern United States.
Sample: 1,128 long-term survivors.
Methods: Survivors were eligible if they were aged 18-45 years (younger group) or 55-70 years (older group) at cancer diagnosis, had received chemotherapy, and were three to eight years postdiagnosis. Fear of recurrence was compared between younger and older groups. Multiple regression analyses were used to test variables' prediction of fear of recurrence and breast cancer survivor self-efficacy, as well as breast cancer survivor self-efficacy mediation effects.
Main Research Variables: Fear of recurrence, breast cancer survivor self-efficacy, and age at diagnosis.
Findings: Survivors diagnosed at a younger age had significantly higher fear of recurrence, as well as health, role, womanhood, death, and parenting worries. Perceived risk of recurrence, trait anxiety, and breast cancer reminders explained significant variance in fear of recurrence and breast cancer survivor self-efficacy. Breast cancer survivor self-efficacy partially mediated the effects of variables on fear of recurrence.
Conclusions: The findings suggest that breast cancer survivor self-efficacy may have a protective effect for survivors who are younger at diagnosis and have higher perceived risk of recurrence, higher trait anxiety, and more breast cancer reminders. Oncology nurses already use the skills required to support self-efficacy. Additional research is needed to define and test breast cancer survivor self-efficacy interventions.
Implications for Nursing: Oncology nurses are in a key role to assess fear of recurrence and provide self-efficacy interventions to reduce it in breast cancer survivors. Strategies to efficiently address fear of recurrence to reduce psychological distress in survivorship follow-up care are warranted.
American Cancer Society. (2012). What are the key statistics about breast cancer? Retrieved from <a target="_blank" href='http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-ke...
American Society of Clinical Oncology. (2001). <i>A patient's guide: Follow-up care for breast cancer.</i> Alexandria, VA: Author.
Aro, A. R., De Koning, H. J., Schreck, M., Henriksson, M., Anttila, A., & Pukkala, E. (2005). Psychological risk factors of incidence of breast cancer: A prospective cohort study in Finland. <i>Psychological Medicine, 35</i>, 1515-1521. doi:10.1017/s003329/705005313
Bandura, A. (1997). <i>Self-efficacy: The exercise of control.</i> New York, NY: Worth.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. <i>Journal of Personality and Social Psychology, 51</i>, 1173-1182. doi:10.1037/0022-3522.214.171.1243
Bleiker, E. M., Pouwer, F., van der Ploeg, H. M., Leer, J. W., & Adér, H. J. (2000). Psychological distress two years after diagnosis of breast cancer: Frequency and prediction. <i>Patient Education and Counseling, 40</i>, 209-217. doi:10.1016/S0738-3991(99)00085-3
Bloom, J. R., Stewart, S. L., Chang, S., & Banks, P. J. (2004). Then and now: Quality of life of young breast cancer survivors. <i>Psycho-Oncology, 13</i>, 147-160. doi:10.1002/pon.794
Champion, V., Sledge, G., Ziner, K., Monahan, P., & Zho, Q. (March, 2010). <i>Quality of life in younger versus older breast cancer survivors.</i> Paper presented at the European Breast Cancer Conference in Barcelona, Spain.
Champion, V., Ziner, K., Monahan, P., Sledge, G., Cella, D., Smith, L., & Bell, C. (2011). Development and psychometric testing of a breast cancer survivor self-efficacy scale. <i>Manuscript submitted for publication in Health Education Research.</i>
Cimprich, B., Ronis, D., & Martinez-Ramos, G. (2002). Age at diagnosis and quality of life in breast cancer survivors. <i>Cancer Practice, 10</i>, 85-93. doi:10.1046/j.1523-5394.2002.102006.x
Clayton, M. F., Mishel, M. H., & Belyea, M. (2006). Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors. <i>Research in Nursing and Health, 29</i>, 18-39.
Connell, S., Patterson, C., & Newman, B. (2006). Issues and concerns of young Australian women with breast cancer. <i>Supportive Care in Cancer, 14</i>, 419-426. doi:10.1007/s00520-005-0003-8
Cunningham, A. J., Lockwood, G. A., & Cunningham, J. A. (1991). A relationship between perceived self-efficacy and quality of life in cancer patients. <i>Patient Education and Counseling, 17</i>(1), 71-78.
de Haes, J. C., Curran, D., Aaronson, N. K., & Fentiman, I. S. (2003). Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomized clinical trial. <i>European Journal of Cancer Care, 39</i>, 945-951. doi:10.1016/SO959-8049(03)00149-7
Easterling, D. V., & Leventhal, H. (1989). Contribution of concrete cognition to emotion: Neutral symptoms as elicitors of worry about cancer. <i>Journal of Applied Psychology, 74</i>, 787-796.
Ferrell, B., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1998a). Quality of life in breast cancer survivors: Implications for developing support services. <i>Oncology Nursing Forum, 25</i>, 887-895.
Ferrell, B., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1998b). Quality of life in breast cancer: Part II: Psychological and spiritual well-being. <i>Cancer Nursing, 21</i>(1), 1-9.
Ferrell, B. R., Dow, K. H., Leigh, S., Ly, J., & Gulasekaram, P. (1995). Quality of life in long-term cancer survivors. <i>Oncology Nursing Forum, 22</i>, 915-922.
Ferrell, B. R., Grant, M., Funk, B., Garcia, N., Otis-Green, S., & Schaffner, M. L. (1996). Quality of life in breast cancer. <i>Cancer Practice, 4</i>, 331-340.
Figueiredo, M., Fries, E., & Ingram, K. M. (2004). The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients. <i>Psycho-Oncology, 13</i>, 96-105.
Fogarty, L. A., Curbow, B. A., Wingard, J. R., McDonnell, K., & Somerfield, M. R. (1999). Can 40 seconds of compassion reduce patient anxiety? <i>Journal of Clinical Oncology, 17</i>, 371-379.
Frazier, P. A., Tix, A. P., & Barron, K. E. (2004). Testing moderator and mediator effects in counseling psychology research. <i>Journal of Counseling Psychology, 51</i>, 115-134. doi:10.1037/0022-0126.96.36.199
Fredette, S. L. (1995). Breast cancer survivors: Concerns and coping. <i>Cancer Nursing, 18</i>, 35-46.
Härtl, K., Janni, W., Kästner, R., Sommer, H., Strobl, B., Rack, B., & Stauber, M. (2003). Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. <i>Annals of Oncology, 14</i>, 1064-1071. doi:10.1093/annonc/mdg289
Hewitt, M., Greenfield, S., & Stovall, E. (2006). <i>From cancer patient to cancer survivor: Lost in transition.</i> Washington, DC: National Academies Press.
Hewitt, M., Herdman, R., & Simone, J. (2004). <i>Meeting psychosocial needs of women with breast cancer.</i> Washington, DC: National Academies Press.
Hilton, B. A. (1989). The relationship of uncertainty, control, commitment, and threat of recurrence to coping strategies used by women diagnosed with breast cancer. <i>Journal of Behavioral Medicine, 12</i>(1), 39-54. doi:10.1007/BF00844748
Kornblith, A. B., Powell, M., Regan, M. M., Bennett, S., Krasner, C., Moy, B., … Winer, E. (2007). Long-term psychosocial adjustment of older vs younger survivors of breast and endometrial cancer. <i>Psycho-Oncology, 16</i>, 895-903. doi:10.1002/pon.1146
Lazarus, R. (1991). <i>Emotion and adaptation.</i> Oxford, England: Oxford University Press.
Lee-Jones, C., Humphris, G., Dixon, R., & Hatcher, M. B. (1997). Fear of cancer recurrence: A literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. <i>Psycho-Oncology, 6</i>, 95-105.
Lev, E. L., Paul, D., & Owen, S. V. (1999). Age, self-efficacy, and change in patients' adjustment to cancer. <i>Cancer Practice, 7</i>, 170-176.
Loescher, L. J. (2003). Cancer worry in women with hereditary risk factors for breast cancer. <i>Oncology Nursing Forum, 30</i>, 767-772.
Mast, M. E. (1998). Survivors of breast cancer: Illness uncertainty, positive reappraisal, and emotional distress. <i>Oncology Nursing Forum, 25</i>, 555-562.
Mehnert, A., Berg, P., Henrich, G., & Herschbach, P. (2009). Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. <i>Psycho-Oncology, 18</i>, 1273-1280. doi:10.1002/pon.1481
Merluzzi, T. V., Nairn, R. C., Hegde, K., Martinez Sanchez, M. A., & Dunn, L. (2001). Self-efficacy for coping with cancer: Revision of the Cancer Behavior Inventory (version 2.0). <i>Psycho-Oncology, 10</i>, 206-217.
Northouse, L. L. (1981). Mastectomy patients and the fear of cancer recurrence. <i>Cancer Nursing, 4</i>, 213-220.
Ohman, A. (2000). Fear and anxiety: Evolutionary, cognitive, and clinical perspectives. In M. Lewis & J. M. Haviland-Jones (Eds.), <i>Handbook of emotions</i> (pp. 573-593). New York, NY: Guilford Press.
Ridner, S. H., & Dietrich, M. (2010). Development of the lymphedema symptoms intensity and distress survey arm. <i>Journal of Clinical Oncology, 28</i>(Suppl.), 15S.
Spencer, S. M., Lehman, J. M., Wynings, C., Arena, P., Carver, C. S., Antoni, M., … Love, N. (1999). Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. <i>Health Psychology, 18</i>(2), 159-168.
Spielberger, C., Gorsuch, R., Lushene, R., Vagg, P., & Jacobs, G. (1983). <i>State-Trait Anxiety Inventory, Form Y.</i> Redwood City, CA: MindGarden.
van den Beuken-van Everdingen, M. H., Peters, M. L., de Rijke, J. M., Schouten, H. C., van Kleef, M., & Patijn, J. (2008). Concerns of former breast cancer patients about disease recurrence: A validation and prevalence study. <i>Psycho-Oncology, 17</i>, 1137-1145.
Vickberg, S. M. (2001). Fears about breast cancer recurrence. <i>Cancer Practice, 9</i>(5), 237-243. doi:10.1046/j.1523-5394.2001.009005237.x
Vickberg, S. M. (2003). The Concerns About Recurrence Scale (CARS): A systematic measure of women's fears about the possibility of breast cancer recurrence. <i>Annals of Behavioral Medicine, 25</i>(1), 16-24.
Welch-McCaffrey, D., Hoffman, B., Leigh, S. A., Loescher, L. J., & Meyskens, F. L., Jr. (1989). Surviving adult cancer, Part 2: Psychosocial implications. <i>Annals of Internal Medicine, 111</i>, 517-524.
Ziner, K. (2008). <i>Fear of breast cancer recurrence</i> (Doctoral dissertation). Indiana University, Indianapolis. Retrieved from ProQuest database, No. 3297930.