Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other

Abstract

Purpose To identify explanatory factors of fear of recurrence (FOR) in breast cancer survivors of different sexual orientations and their caregivers, and to assess the directionality in the survivor and caregiver dyads’ FOR. Methods We recruited survivors of non-metastatic breast cancer of different sexual orientations and invited their caregivers into this study. Using a telephone survey, we collected data from 167 survivor and caregiver dyads. Using simultaneous equation models and a stepwise selection process, we identified the significant determinants of survivors and caregivers’ FOR and determined the directionality of survivors and caregivers’ FOR. Weighting the model by the inverse propensity score ensured that differences by sexual orientation in age and proportion of life in the caregiver-survivor relationship were accounted for. Results Caregivers’ FOR predicted survivors’ FOR, and sexual orientation had a significant effect on survivors’ FOR, in that sexual minority women reported less FOR than heterosexual women. Other determinants of survivors’ FOR included their medical characteristics, co-residence with caregivers, and caregivers’ social support and use of counseling. Caregivers’ FOR was related to their social support and survivors’ medical characteristics. Conclusions This study suggests a need for caregiver interventions. Because survivors’ FOR is affected by caregivers’ FOR caregiver interventions will likely benefit survivors’ FOR. Implications for Cancer Survivors Both sexual minority and heterosexual breast cancer survivors’ FOR are affected by their caregivers’ FOR, which suggests the caregivers of breast cancer survivors are central for the survivors’ well-being and shall therefore be integrated into the care process.

Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review

“…However, 3 studies of women with breast cancer found that SGM survivors had comparable or even better adjustment than heterosexual survivors . In addition, fear of recurrence, a commonly reported outcome among cancer survivors, was reported at lower levels among SM women than among heterosexual women with breast cancer . Another study found that resilience mediated the association between perceived discrimination and distress in SM women with breast cancer .…”

“…We identified 14 studies that characterized the mental health impact and degree of adjustment to cancer . In 1 large survey study of individuals with a history of cancer that compared SGM with propensity score‐adjusted heterosexual peers, SGM survivors reported higher rates of depression and relationship difficulty .…”

“…We identified 14 studies that characterized the mental health impact and degree of adjustment to cancer. 22,28,[38][39][40][41][42][43][44][45][46][47][48][49] In 1 large survey study of individuals with a history of cancer that compared SGM with propensity score-adjusted heterosexual peers, SGM survivors reported higher rates of depression and relationship difficulty. 22 SM status and gender appeared to interact with symptom reporting, such that worse symptoms were reported by SGM versus heterosexual men, but not by SGM versus heterosexual women.…”

Recruitment of breast cancer survivors and their caregivers: implications for dyad research and practice

“…Compared to heterosexuals, sexual minority cancer survivors and their caregivers experience (and anticipate) sexual and gender prejudice, microaggressions (i.e., commonplace social exchanges that carry disparaging messages), and discriminatory and heteronormative policies within healthcare settings [34]. With the exception of a focused line of research by one team showing that sexual minority breast cancer survivors and their caregivers had similar levels of distress [35] and interdependent fear of cancer recurrence [35,36], studies, to date, have not explicitly assessed differences in dyads' participation in breast cancer research by sexual orientation. Given the high translational significance of understanding dyad participation in breast cancer survivorship research, the overall objective of this study was to identify factors associated with successful dyad enrollment (i.e., caregiver participation) into a telephone-based study with particular attention to differences in caregiver recruitment between heterosexual and sexual minority breast cancer survivors.…”

Fear of cancer recurrence promotes cancer screening behaviors among family caregivers of cancer survivors

“…Fear, worry, or concern about this uncertainty, collectively called fear of cancer recurrence (FCR), has been associated with greater depression and poorer quality of life among cancer survivors . Studies also have reported that FCR among family caregivers sometimes is higher than that of their patients . Caregivers' FCR that their patient's cancer may return or progress has been associated with their own greater anxiety, depression, and loneliness, and a poorer quality of life as well …”