The relationships between fear of cancer recurrence, spiritual well‐being and psychological resilience in non‐metastatic breast cancer survivors during the COVID‐19 outbreak

Abstract

Objectives This study examines the relationships between fear of cancer recurrence (FCR), spiritual well‐being (SWB) and psychological resilience in breast cancer survivors during the COVID‐19 outbreak, and investigates to what extent breast cancer survivors’ sociodemographic characteristics affect FCR, SWB and psychological resilience levels. Methods The study was conducted at Canakkale University Hospital in Turkey. Included in the study were 82 non‐metastatic breast cancer patients whose clinical outcomes were followed‐up after primary treatment, but suspended due to the COVID‐19 outbreak. FCR, SWB and psychological resilience were assessed using the FCR inventory‐short form (FCRI‐SF), SWB scale and the brief resilience scale (BRS), respectively. Results The mean scores of breast cancer survivors concerning FCR, SWB, and psychological resilience were 17.77 ± 5.38, 36.20 ± 6.21 and 20.01 ± 4.51, respectively. A significant negative correlation was noted between the scores of FCR and SWB and psychological resilience ( r = −0.329, p < 0.001 and r = −0.316, p = 0.004, respectively). Additionally, a significantly positive correlation was identified between psychological resilience and SWB ( r = 0.501, p = 0.003). A hierarchical linear regression analysis with FCRI‐SF as the dependent variable, and SWB and BRS as explanatory variables, indicated that SWB affects FCRI‐SF scores and is a potential predictor of FCR. A mediation analysis revealed that SWB partially mediated the relationship between psychological resilience and FCR. Conclusion Breast cancer survivors with high SWB and psychological resilience scores experience less FCR, despite their failure to maintain the medical follow‐up due to the COVID‐19 outbreak. Efforts should be made to increase the psychological resilience and SWB of patients diagnosed with breast cancer.

On top of that all, now Covid-19, too. A scoping review of specificities and correlates of fear of cancer recurrence in breast cancer patients during COVID-19

“…Of utmost importance is the fact that the certainty of access to periodic follow-up examinations were reported to reduce the experience of FCR [ 32 ], while disruption of access to healthcare services was found to increase worry and concerns about the progression and recurrence of the disease [ 33 ].…”

“… No. Study, country Study design Sample size, Cancer type Measures of FCR Other variables usually associated with greater FCR, also measured in the study Results Limitations of the study 1 [ 48 ] South Korea April–June 2020 Descriptive correlational Cross-sectional Quantitative Qualitative N = 154 Breast cancer survivors Instruments Fear of Cancer Recurrence Inventory (K-FCRI) subscales: triggers severity psychological distress coping strategies functional impairments insight reassurance validated instrument Age Marital status Nr of children Nr of children living together Ages of children living together Level of education Monthly income Economic burden Area of residence Timing of diagnosis Treatment type Time required to visit medical institutions Experience of quarantine due to Covid-19 suspicion Whether diagnosed with Covid-19 FCR high (84.31 ± 24.23) Triggers (21.30 ± 6.50) Coping strategies (20.58 ± 6.09) Severity Demographic variables FCR significantly higher among unmarried (F = 3.649, P-.028) Without children (t = −2.043, P = .043) Radiotherapy (t = 2.790, P = .006) Monthly income (F = 4.259, P = .016) Convenience sample, Online assessment Selection bias Restricted access to rural areas South Korea – high quality of health insurance and medical infrastructure Did not exclude patients with psychiatric diagnoses No investigation on categories of FCR Not controlling of variables that could have affected psychological status 2 [ 33 ] Turkey 10–20 May 2020 Descriptive cross-sectional online survey N = 82 female, non-metastatic breast cancer survivors Instruments Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF)– Turkish validated form 12-item Spiritual well-being (SWB) scale (Peterman et al, 2002) – adapted to Turkish 6-item brief resilience scale (BRS) (Smith et al, 2008) – Turkish validated form Demographic variables: - marital status - age Smoker-non-smoker - income 84.1% of the participants experienced high levels of FCR ...…”

“…A very important finding of this study is that unmarried, childless and less financially potent breast cancer survivors may be more prone to experience significantly higher levels of FCR due to the implications related to the Covid-19 pandemic [ 48 ]. Koral and Cirak [ 33 ] investigation was conducted on 82 Turkish, non-metastatic breast cancer survivors indicated that 84.1% of the participants experienced high levels of FCR, and that there existed a statistically significant negative correlation between fear of cancer recurrence and resilience (r = −0.316, p=.004 ), as well as spiritual well-being (r = −0.329, p=.003 ). Hierarchical linear regression analysis indicated that SWB significantly affects FCRI-SF Scores (SC Beta = 0.255, p = .041), while the mediation analysis revealed that SWB plays a partial mediating role in the relationship between BRS and FCR.…”

“…Hierarchical linear regression analysis indicated that SWB significantly affects FCRI-SF Scores (SC Beta = 0.255, p = .041), while the mediation analysis revealed that SWB plays a partial mediating role in the relationship between BRS and FCR. Variance analyses did not indicate any statistically significant differences in FCR depending on the assessed demographic variables [ 33 ].…”

“…Moreover, age was the only risk factor for higher levels of fear of Covid-19 than of fear related to the oncological diagnosis, patients older than 70 years being more concerned about COVID-19 than about their cancer progression (Gultekin et al, 2020). Some studies [ 33 , 54 ] did not identify statistically significant differences in FCR depending on the assessed demographic variables, while others [ 49 , 51 ] presented limited information regarding results about the investigated demographic variables.…”