Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. The health-related quality of life of long-term survivors of melanoma treated with isolated limb perfusion. Predictors of change in unmet supportive care needs in cancer. Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients Fear of recurrence and possible cases of anxiety and depression in orofacial cancer patients. Religion and spirituality among patients with localized prostate cancer. Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomised clinical trial. Quality of life after surgery for localized renal cell carcinoma: comparison between radical nephrectomy and nephron-sparing surgery. Quality of life in breast cancer survivors: implications for developing support services. Family survivorship and quality of life following a cancer diagnosis. Evaluation of two group therapies to reduce fear of progression in cancer patients Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer Development and validation of disease-specific measures for choroidal melanoma: COMS-QOLS report No. 2. Fear of cancer recurrence: specific profiles and nature of intrusive thoughts GRADE guidelines: 3. Rating the quality of evidence. Can we predict which head and neck cancer survivors develop fears of recurrence? Breast cancer follow up: a randomised controlled trial comparing point of need access versus routine 6-monthly clinical review. An Intervention to Improve Communication Between Breast Cancer Survivors and Their Physicians Coping among older-adult, long-term cancer survivors. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Patients' supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. Spirituality, patients' worry, and follow-up health-care utilization among cancer survivors. Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Impact of radical prostatectomy positive surgical margins on fear of cancer recurrence: results from CaPSURE. Quality of life after iodine 125 brachytherapy vs enucleation for choroidal melanoma: 5-year results from the Collaborative Ocular Melanoma Study: COMS QOLS Report No. 3. A Population-Based Study of the Quality of Life of Cancer Survivors and Their Family Caregivers Fear of recurrence, symptom burden, and health-related quality of life in men with prostate cancer. The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment. Correlates of bother following treatment for clinically localized prostate cancer. Fear of recurrence and psychological distress in head and neck cancer patients and their carers. A Comparison of Nurse and Patient Perceptions of Chemotherapy Treatment Stressors [Quality of life and psychological state in patients with choroidal melanoma: longitudinal study]. Screening and comorbidity of clinical levels of fear of cancer recurrence
Background Despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors , there is a lack of vali date d multidimensional instruments to evaluate this issue specifically . Purpose The goal of this study was to develop and empirically vali date a multidimensional self-report scale for assessing the fear of cancer recurrence , the  Fear of Cancer Recurrence Inventory ( FCRI ) . Methods A provincial medical data bank was used to r and omly select a pool of 1,704 French-Canadian patients who had been treated for breast , prostate , lung , and colorectal cancer within the past 10 years . Of these , 300 patients were asked to complete the FCRI on two occasions . Results The factorial analysis conducted on the final 42-item scale revealed a seven-component solution ( 64 % of the variance ) including the following factors : triggers , severity , psychological distress , coping strategies , functioning impairments , insight , and reassurance . The results also supported the internal consistency ( α = 0.95 ) and the temporal stability ( r = 0.89 ) of the FCRI , as well as its construct validity with other self-report scales assessing fear of cancer recurrence ( r = 0.68 to 0.77 ) or related constructs such as psychological distress ( r = 0.43 to 0.77 ) and quality of life ( r = −0.20 to −0.36 ) . Conclusions This study suggests that the French-Canadian version of the FCRI is a reliable and valid instrument for evaluating the multidimensional aspects of the fear of cancer recurrence OBJECTIVES Considerable morbidity persists among survivors of breast cancer ( BC ) including high levels of psychological stress , anxiety , depression , fear of recurrence , and physical symptoms including pain , fatigue , and sleep disturbances , and impaired quality of life . Effective interventions are needed during this difficult transitional period . METHODS We conducted a r and omized controlled trial of 84 female BC survivors ( Stages 0-III ) recruited from the H. Lee Moffitt Cancer and Research Institute . All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and /or chemotherapy .  Subjects were r and omly assigned to a 6-week Mindfulness-Based Stress Reduction ( MBSR ) program design ed to self-regulate arousal to stressful circumstances or symptoms ( n=41 ) or to usual care ( n=43 ) . Outcome measures compared at 6 weeks by r and om assignment included vali date d measures of psychological status ( depression , anxiety , perceived stress , fear of recurrence , optimism , social support ) and psychological and physical subscales of quality of life ( SF-36 ) . RESULTS Compared with usual care , subjects assigned to MBSR(BC ) had significantly lower ( two-sided p<0.05 ) adjusted mean levels of depression ( 6.3 vs 9.6 ) , anxiety ( 28.3 vs 33.0 ) , and fear of recurrence ( 9.3 vs 11.6 ) at 6 weeks , along with higher energy ( 53.5 vs 49.2 ) , physical functioning ( 50.1 vs 47.0 ) , and physical role functioning ( 49.1 vs 42.8 ) . In stratified analyses , subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning . CONCLUSIONS Among BC survivors within 18 months of treatment completion , a 6-week MBSR(BC ) program result ed in significant improvements in psychological status and quality of life compared with usual care AIMS To evaluate the generic and condition-specific health-related quality of life ( HRQL ) of long-term survivors of extremity melanoma treated with isolated limb perfusion ( ILP ) .  METHODS Between 1978 and 2001 , 292 patients with melanoma of the limbs underwent ILP in our institution . Of these patients , 59 were alive and disease-free for at least six months prior to study entry . Fifty-one of these 59 patients completed a mailed question naire assessing generic HRQL ( SF-36 ) , condition-specific HRQL ( limb function , cosmetic results , fear of recurrence ) , and problems regarding work and insurance .  An age- and gender-matched , normative sample of the Dutch general population was available for comparison of SF-36 scores . RESULTS Mean age of patients was 57 years , 90 % female , with a median time since ILP of 14 years ( range 3 - 25 years ) . The SF-36 scores of the patient group were equal to or better than that of the general population , significantly for bodily pain , general health perceptions , and the physical and mental health component scores . Nevertheless , the patients reported a number of specific problems : complaints of limb function were reported by 49 - 55 % , cosmetic problems by 31 - 38 % and fear of local disease recurrence and distant metastases by 77 and 63 % of the patients , respectively . Less than 10 % of patients reported problems in obtaining a mortgage or life insurance . CONCLUSIONS The HRQL of long-term survivors of melanoma treated with ILP appears comparable to , and sometimes better than that of healthy peers within the general population . Nevertheless , this survivor group reports a number of specific problems that impact on daily life . Although these findings need to be confirmed with larger , prospect i ve studies , they suggest that rehabilitation should focus on improving limb functionality , and addressing chronic fear of disease recurrence OBJECTIVE Patient Reported Outcome ( PRO ) assessment s can assist health professionals to tailor their health practice s to the individual needs of patients and improve patient care over time . The present study assessed prospect i ve predictors of unmet supportive care needs in cancer patients over a six-month period . METHODS Participants were recruited from a regional cancer treatment centre in Australia and completed the Supportive Care Needs Survey ( SCNS )  at recruitment ( n=439 ; 61.4 % response rate ) and six months follow-up ( n=396 ) . Hierarchical logistic regression was used to identify predictors of change in unmet needs across each supportive care domain . Predictor variables were socio-demographic , treatment and psychosocial factors including depression , anxiety , social support , and patient satisfaction . RESULTS Unmet needs were reported by approximately two-thirds of patients at baseline and half of patients at six months follow-up . Having unmet needs at baseline was the strongest predictor of unmet needs at six months . Longer time since diagnosis was a consistent predictor of greater unmet needs , associated with change in physical/daily living , psychological and health system and information unmet needs over time . By contrast , a complex relationship was found in that patient satisfaction , psychosocial and treatment characteristics predicted higher needs in some domains and lower needs in others . CONCLUSIONS Unmet supportive care needs persist over time and psychological needs may emerge later in the illness continuum . Interventions to meet the needs of longer term cancer survivors are needed and should closely articulate with reported supportive care needs Anxiety and fear are often associated with chronic conditions such as cancer . This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy ( CBT ) in comparison to a client-centered , supportive-experiential group therapy ( SET ) in cancer patients with dysfunctional fear of progression . An incremental cost-effectiveness analysis was performed using data from a r and omized controlled trial among cancer patients receiving inpatient rehabilitation . The means , 95 % confidence intervals [ 95 % CI ] , incremental cost-effectiveness graphic and acceptability curve were obtained from 1,000 bootstrap replications . A total of 174 patients were included in the economic evaluation . The estimated means [ 95 % CI ] of direct costs and reduction of fear of progression were € 9,045.03 [ 6,359.07 ; 12,091.87 ] and 1.41 [ 0.93 ; 1.92 ] for patients in the SET and € 6,682.78 [ 4,998.09 ; 8,440.95 ] and 1.44 [ 1.02 ; 1.09 ] for patients in the CBT . The incremental cost-effectiveness ratio [ 95 % CI ] amounts to minus € 78,741.66 [ −154,987.20 ; 110,486.32 ] for an additional unit of effect . Given the acceptability curve , there is a 92.4 % chance that the CBT , compared with the SET , is cost-effective without the need of additional costs to payers . Our main result is the superior cost-effectiveness of the cognitive-behavioral intervention program in comparison to the non-directive encounter group for our sample of cancer patients with high levels of anxiety Recurrence risk in orofacial cancer patients is relatively high in comparison to other cancers . Little information exists on whether patients are unduly concerned over the possibility of recurrence and the association of this concern with psychological morbidity . Aim of study was to assess fear of recurrence and psychological morbidity in orofacial cancer patients . Two sample s of patients with orofacial cancer were followed prospect ively . First sample ( n = 87 ) were consecutively drawn 3 months and 7 months following initial treatment . Second sample ( n = 100 ) were cross-sectionally drawn from out-patient list and followed 2 years later . A single question item was employed to assess fear of recurrence used in previous work . Hospital Anxiety and Depression Scale was adopted as the measure of psychological morbidity . A prospect i ve survey design was employed . Over 80 % of patients expressed concern over the possibility of recurrence at 3 months post treatment . This level reduced to 72 % at 7 months ( P=0.06 ) . Approximately two-thirds of patients sample d cross-sectionally were concerned at both assessment occasions . Psychological morbidity was greatest at 3 months post treatment ( possible cases : anxiety 37 % and depression 28 % ) . Women were more likely to report anxiety ( at possible case level ) than men 3 months following treatment ( P<0.05 ) . Patients aged 65 or more years were less concerned about recurrence . This effect was significant on both occasions that sample two patients were assessed ( P's<0.002 ) . Very few patients who expressed no concern about recurrence , at 3 months , were found to report anxiety or depression sufficient to be recognized as a possible case ( 3 and 0 % respectively ) . The positive association between psychological morbidity and fears of recurrence was significant at the majority of data collection points , with the exception that depression was more independent of these concerns OBJECTIVE To examine : ( 1 ) daily religious and spiritual experiences among localized prostate cancer patients as compared to a national age and race-matched male sample ; ( 2 ) cognitive-affective and clinical predictors of prostate cancer diagnosis-related increases in religiosity and spirituality ; ( 3 ) short-term impact of daily religious and spiritual experiences on cancer recurrence worry . METHODS Analyses of data from a longitudinal question naire study among patients ( N = 254 ) diagnosed with localized prostate cancer and data from a r and om sample ( N = 238 ) of respondents to the national General Social Survey . RESULTS Compared to the national sample , prostate cancer patients reported higher levels of daily spiritual experiences . Patients with higher worry about prostate cancer and elevated levels of prostate-related symptoms around diagnosis were more likely to report a diagnosis-related increase in religiosity and spirituality . Positive benefits ( reduced recurrence worry ) of religious coping/ practice s were restricted to those patients with higher versus lower level of postdiagnosis increase in religiosity ; patients not reporting postdiagnosis increases in religion who are not engaging in religious coping/ practice adjusted equally well . Results suggest that the development of religious/spiritual interventions is premature . SIGNIFICANCE OF RESULTS This is the first prospect i ve study to report on the prevalence and influence of  daily spiritual and religious experiences  among prostate cancer patients Mastectomy and breast-conserving treatment have proven equally effective in terms of survival in early breast cancer , but studies continue to provide evidence that patients undergoing breast-conserving procedures  have a better quality of life ( QOL ) . Age is not considered to be a contraindication for breast-conserving treatment , but retrospective studies have indicated that elderly patients are less likely to be treated conservatively . In the present study , survival , QOL and treatment preference have been investigated in a multicentre , r and omised clinical trial of elderly patients with early breast cancer undergoing mastectomy or tumour excision plus tamoxifen . Eligible patients were aged 70 years or more and had histologically- or cytologically-confirmed operable breast cancer . A QOL question naire consisting of 36 items was constructed covering 9 scales assessing different QOL domains . Patients completed their assessment between 2 and 12 months after r and omisation . 136 patients ( 65 in the mastectomy arm and 71 in the local excision arm ) from six centres filled out a QOL form during the first year of follow-up . No significant difference in the duration of survival between the two treatment arms was observed when including patients included in the QOL sub- study ( P=0.33 ) . Patients undergoing tumour excision and tamoxifen did not differ from those undergoing mastectomy in terms of fatigue , emotional functioning , fear of recurrence , social support , physical functioning and leisure time activities . However , conservatively treated patients reported fewer arm problems ( P=0.04 ) and a shift , although borderline significant , in the direction of a benefit in body image ( P=0.06 ) . As QOL seems to be better after conservative treatment , such treatment is to be preferred in both elderly and younger patients OBJECTIVES To compare the impact of radical nephrectomy and nephron-sparing surgery ( NSS ) for localized renal cell carcinoma on quality of life ( QOL ) . METHODS Retrospectively , 357 patients who had undergone NSS ( n = 158 ) or radical nephrectomy ( n = 199 ) for localized renal cell carcinoma completed postal question naires , including measures of QOL with vali date d instruments ( SF-36 , European Organization for Research and Treatment of Cancer Quality of Life Question naire C30 [ EORTC QLQ-C30 ] ) , the impact of the stress of cancer , fear of recurrence , and worry about having fewer than two normal kidneys . A subset of 51 patients diagnosed after 2000 were followed up prospect ively for at least 1 year . RESULTS The mental and physical health composite scores were not significantly different from the vali date d norms for an age and sex-matched community sample . Although the type of operation had no influence on patients ' overall QOL , all patients who underwent elective NSS showed a significantly greater score on physical function than patients treated with radical nephrectomy ( P < 0.001 ) . Predictors for higher scores included elective NSS , comorbidity ( assessed with st and ardized checklist ) , tumor size , and time since nephrectomy . The overall QOL scores and recovery of stress from cancer in patients treated with NSS for tumor less than 4 cm with a normal contralateral kidney were significantly superior to those who underwent NSS for tumor greater than 4 cm ( P < 0.05 ) . Patients question ed after m and atory NSS were significantly more concerned about cancer recurrence . CONCLUSIONS Patients without evidence of disease have relatively normal physical and mental health after operative treatment for localized renal cell carcinoma , independent of the kind of surgery . The QOL correlates proportionally with the size of tumor and is significantly better for patients undergoing NSS for tumor less than 4 cm with a normal contralateral kidney PURPOSE / OBJECTIVES Quality of life ( QOL ) is becoming more important in regard to breast cancer as treatment advances extend the period of survivorship . The purpose of this article is to share the results of a cancer center 's attempt to evaluate the QOL needs of breast cancer survivors in order to provide improved supportive-care services . DESIGN Descriptive mailed survey . SETTING A medical center in southern California . SAMPLE A r and om sample of breast cancer survivors ( N = 298 ) . METHODS Breast cancer survivors completed a mailed survey that included major outcome variables of QOL and pain .  Subjects were stratified by three age groups : younger than 40 years , 40 - 60 years , and older than 60 years . MAIN RESEARCH VARIABLES QOL subscales ( physical , psychological , social , and spiritual well-being ) and overall QOL score and pain as assessed by the Brief Pain Inventory .  FINDINGS Results indicated continued physical dem and s of breast cancer , including fatigue and pain , as well as psychological burdens related to fear of breast cancer recurrence and anxiety . The social well-being domain indicated some unique aspects of QOL when applied to breast cancer survivorship such as the fear of breast cancer in female relatives . The spiritual well-being domain illustrated the unique QOL aspects of life-threatening illness such as living with uncertainty and maintaining hope . Breast cancer survivors also reported positive aspects and life changes after successfully facing breast cancer . CONCLUSIONS Breast cancer survivors experience many dem and s of illness across the physical , psychological , social , and spiritual domains . IMPLICATION S FOR NURSING PRACTICE The study 's findings can be useful in directing cancer centers ' efforts to provide comprehensive care for breast cancer survivors . Nurses play a critical role in leading these efforts for supportive-care services intended to improve the QOL of breast cancer survivors The objectives of this study were : ( a ) to examine the quality of life of the family as a unit during the long-term survivor phase of illness and ( b ) to test a family model of factors that may influence family quality of life . The family survivorship model , which includes illness survival stressors ( family stressors , fear of recurrence , and patient somatic concerns ) , re sources ( family hardiness and family social support ) , appraisal ( family meaning of the illness ) , and the outcome ,  family quality of life  , was used to guide this exploratory cross-sectional study . A r and om , stratified sample of 123 families ( N = 246 individuals ) was interviewed 1 - 5 years after treatment ended . The model explained 63 % of the variance in family quality of life , with the strongest predictors being concurrent family stressors , family social support , family member fear of recurrence , family meaning of the illness , and patient employment status . The study findings suggest the importance of addressing cancer-related stressors , family re sources , and family meaning as key factors related to family quality of life Purpose This paper aims to evaluate the effects of two psychotherapeutic interventions on dysfunctional fear of progression ( FoP ) in cancer patients and to investigate illness-specific influences . Methods One hundred seventy-four cancer patients were recruited from two rehabilitation clinics and r and omly assigned to either a four-session cognitive-behavioral group therapy or a supportive-experiential group therapy . The main outcome criterion was FoP that was assessed with the Fear of Progression Question naire ( FoP-Q ) directly before ( T1 ) and after ( T2 ) the intervention , as well as 3 ( T3 ) and 12 months ( T4 ) after discharge . Secondary outcomes were anxiety , depression , and quality of life that were assessed with the following question naires : Questions on Life Satisfaction , Question naire for General Health Status , and the Hospital Anxiety and Depression Scale .  Patients from the control group ( n = 91 ) who received treatment as usual  were recruited 1 year later with the same inclusion criteria and assessed with the FoP-Q at T1 , T2 , and T4 . Results Analyses showed a significant main effect for time and a significant interaction for group × time for the main outcome variable . FoP decreased significantly over time in both intervention groups in contrast to the control group that showed only short-term improvements . The interventions were also effective in improving secondary outcomes except general life satisfaction . Analyses of cancer specific influences on FoP indicated a significant influence of disease status , i.e. , patients with metastases and recurrence of cancer gained most from the interventions . Conclusions Fear of progression , one of the main sources of distress for cancer patients , can be reduced with short psychotherapeutic interventions Fear of cancer recurrence ( FCR ) is a common and persistent concern among breast cancer survivors . Little is known about factors associated with FCR in women with ductal carcinoma in situ ( DCIS ) or early invasive breast cancer ( EIBC ) . Women with first primary DCIS , or stages I – IIA breast cancer were prospect ively enrolled in a quality -of-life study and completed interviews at 4–6 weeks , 6 months , and 2 years after definitive surgical treatment . In three stepwise multivariable linear regression models , including both time-independent and time-varying variables measured at each respective interview , we identified independent correlates of mean FCR scores ( range 1–6 ) using four items from the Concern About Recurrence Scale ( CARS ) at 2-year follow-up . Of 506 disease-free patients at 2-year follow-up ( mean [ SD ] age , 58 [ 10 ] years ; 81 % White ; 34 % DCIS ) , the average FCR score of 2.0 was low . However , 145 ( 29 % ) reported moderate-to-high levels of FCR ( scores 3.0–6.0 ) . All three models showed that younger age , stage IIA breast cancer ( vs. DCIS ) , lower social support , and elevated anxiety were consistently associated with higher FCR at 2-year follow-up ( each P < 0.05 ; final models R2 = 0.25–0.32 ) . DCIS patients reported lower FCR than stage IIA patients ( each P ≤ 0.01 ) but had similar FCR as stage I patients . Although mean FCR was low , 29 % of DCIS and EIBC survivors reported moderate-to-high levels of FCR at 2-year follow-up . Management of anxiety , provision of social support , and patient education may help reduce FCR among DCIS and EIBC survivors , especially among younger survivors OBJECTIVE To develop and vali date scales measuring common concerns of patients with choroidal melanoma : perception of appearance , concern about cancer recurrence , and difficulty with vision-dependent activities requiring stereopsis or binocularity . DESIGN Cross-sectional study within a r and omized multicenter clinical trial . METHODS Eight-hundred forty-two of 1317 patients with choroidal melanoma enrolled in the Collaborative Ocular Melanoma Study ( COMS ) for medium-sized tumors and r and omized to receive iodine 125 brachytherapy or enucleation were interviewed . Scale reliability was evaluated using Cronbach 's alpha , and validity was investigated through correlation with existing scales and with data collected during COMS clinical examinations . RESULTS All 3 proposed scales had good internal consistency reliability . The appearance and recurrence scales had low to moderate correlation with the 36-Item Short-Form Health Survey mental health scale ( r = 0.26 and 0.31 , respectively ) and with the the Hospital Anxiety and Depression Scale depression ( r = -0.22 and -0.19 ) and anxiety ( r = -0.27 and -0.42 ) scales . Appearance scores were significantly associated with occurrence of appearance-altering complications and conditions , recurrence scores were associated with recent removal of the brachytherapy-treated eye , and stereopsis/binocularity scores were higher in patients with good visual acuity in both eyes than in those with good visual acuity in one eye and an enucleated fellow eye . CONCLUSIONS All 3 proposed scales have good internal consistency , range , and SDs of measurement in the tested population . Based on clinical data , there is evidence of good construct validity for all 3 scales , although there also is evidence that the stereopsis/binocularity scale is sensitive to other aspects of vision in addition to stereopsis and binocularity . The appearance and recurrence scales capture clinical ly relevant information not available from st and ard mental health scales Introduction Although the fear of cancer recurrence ( FCR ) is to varying degrees almost universal in cancer survivors , few studies have been carried out specifically on this issue partly because of the complexity and the heterogeneity of the phenomenon . Purpose To explore the presence of specific profiles of FCR and to describe the nature of intrusive thoughts associated with FCR . Methods A medical data base was used to r and omly select a large pool of French-Canadian patients who had been treated for breast , prostate , lung , or colorectal cancer within the past ten years . A sample of 1 984 participants completed , by mail , the  Fear of Cancer Recurrence Inventory ( FCRI ) and the Cognition Intrusive Question naire ( CIQ ) .  Results Cluster analysis revealed four distinct groups of FCR patients : Mild FCR-Low Copers , Mild FCR-High Copers , Moderate FCR-High Copers and High FCR-High Copers . Percentages of endorsement obtained on CIQ items suggested that intrusive thoughts associated with FCR share many characteristics with worries ( i.e. , egosyntonic , verbal content ) . However , intrusive thoughts associated with High FCR presented more characteristics of obsessions . Conclusion There are different profiles of FCR , which vary according to its severity and the type of coping strategies used . Characteristics of intrusive thoughts associated with FCR suggested different targets for FCR specific intervention This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence OBJECTIVES The objectives of this study were to investigate longitudinal predictors of fear of recurrence in survivors of head and neck cancer ( HNC ) using Leventhal 's Common Sense Model ( CSM ) as a framework . The research questions were as follows : ( a ) to what extent do HNC patients report fear of cancer recurrence ? ( b ) To what extent are fears of recurrence manifestations of illness-related anxiety ? ( c ) Are fears of recurrence closely related to current symptoms , disease , and treatment-related factors , or psychological/socio-demographic factors ? ( d ) What factors are predictive of long-term fears of recurrence ? METHODS A prospect i ve repeat measures design was employed whereby a sample of 82 newly diagnosed HNC patients ( 54 males , 28 females , mean age 60 years ) completed measures of fears of recurrence , illness perceptions , coping , and anxiety and depression , prior to treatment and 6 - 8 months after treatment ( fears of recurrence only ) . RESULTS A third of HNC patients at diagnosis reported relatively high levels of fears of recurrence , with 12 % still reporting similar levels of fear 6 - 8 months after treatment . Fears of recurrence were not related to any socio-demographic factor ( age , gender , ethnicity , marital status , and educational attainment ) or disease , treatment , or symptom-related factors . Path analyses demonstrated that fears of cancer recurrence after treatment were directly predicted by pre-treatment fears and optimism . CONCLUSION Although components of the CSM ( cognitive and emotional representations , coping strategies ) were associated with fears of recurrence , optimism was found to be the strongest predictor of fear , independent of anxiety and level of fear reported prior to treatment AIM To examine a model of care for breast cancer patients based on the concept of point of need access and investigate the effectiveness of this model compared to routine 6-monthly clinical review s. DESIGN A parallel r and omised controlled trial was used to examine point of need access to specialist care via the nurse specialist , compared to routine hospital based 6-monthly clinical review at year two post breast cancer diagnosis . A total of 237 patients were recruited to the study . METHODS Outcome measures at baseline , 9 and 18 months included psychological morbidity using the GHQ12 question naire , quality of life using the FACT-B plus endocrine subscale , fear and isolation . An analysis of covariance was used to detect changes over time . Recurrences and methods of detection were recorded as secondary outcome measures . RESULTS Two hundred and fourteen patients completed the study . Overall patients were not exposed to risks of increased psychological morbidity ( p=0.767 ) or decline of quality of life ( p=0.282 ) when routine review was discontinued and no significant differences were detected during an 18-month period . Patients not receiving regular review did not feel isolated , and at the end of 18 months did not wish to return to 6-monthly clinical review s. The presentation of recurrences and short symptom history demonstrate that the recurrences observed were unlikely to have been detected at a routine visit . CONCLUSIONS Point of need access is acceptable to the majority of patients . Although a third of patients may wish to maintain a regular review , patient choice is important . Findings suggest that after 2 years following the diagnosis of breast cancer there is no evidence to support the view that regular clinical review improves psychological morbidity or quality of life . Patients do not appear to be compromised in terms of early detection of recurrence . Point of need access can be provided by suitably trained specialist nurses and provides a fast , responsive management system at a time when patients really need it Breast cancer survivors often use clues to convey their concerns to their oncologists . The authors conducted a r and omized trial of a communication coaching intervention in which 22 female breast cancer survivors were r and omized to the coaching and 22 to treatment as usual .  They hypothesized that the intervention would increase breast cancer self-efficacy , improve mood , and reduce fears of recurrence . Through a series of ANCOVAs they found that the intervention led to increases in self-efficacy . Changes in self-efficacy predicted changes in anxiety , depression , and womanhood fears . This coaching intervention shows promise but requires additional studies to establish is efficacy and effectiveness This research focuses on the coping behavior of older adult , long-term cancer survivors . Specifically , it identifies the personal ( including race and gender ) and illness/treatment characteristics of survivors that are significantly associated with the use of specific coping styles : planning , acceptance , venting , denial and seeking social support . It also examines the mediating role that these forms of coping play in terms of psychological distress : anxiety , depression and cancer-related worries . Multivariate analysis of data from a r and om sample of 321 long-term survivors in a major cancer center tumor registry is used to address the above issues . The most prominent forms of coping used by long-term survivors were planning and  acceptance ; least used were  venting  and denial . Increased age was associated with lower use of all forms of coping , but cancer type was not . Denial as a form of coping was associated with higher anxiety , depression and cancer-related worries . While race was not found to be a significant predictor of coping style , it was a significant predictor of three dimensions of psychological distress , anxiety , depression and cancer-related worries , with African Americans exhibiting lower levels of distress than Whites . The relevance of these findings for health and social service practitioners is discussed While long-term survivors ( 5 years+ ) do not face the stressors of diagnosis and treatment , they continue to face the uncertainties that survivorship brings : recurrence , other cancers , late effects of treatment , and the potential of a shortened life expectancy . This research focuses on the cancer-related health worries of older adult , long-term cancer survivors , the factors that predict these worries , and their link to traditional measures of psychological distress . Specifically , a model is proposed that identifies the personal ( including race and gender ) and illness/treatment characteristics of survivors that are significantly associated with cancer-related health worries and their effects on anxiety and depression . Descriptive and multivariate analyses of a r and om sample of 321 long-term survivors in a major cancer center tumor registry are used to address these issues . About one-third of survivors continue to report worries about recurrence , worries about a second cancer , and worries that symptoms they experience may be from cancer . The regression analyses show that cancer-related health worries is a significant predictor of both depression ( beta=0.36 ) and anxiety ( beta=0.21 ) . Race is a significant predictor ; being African American is related to fewer cancer-related health worries ( beta=-0.22 ) . Having more symptoms during treatment is also a predictor of having more cancer-related health worries ( beta=0.20 ) . The most consistent predictor of psychosocial distress is dispositional optimism/pessimism , with more optimistic individuals reporting fewer cancer-related health worries ( beta=-0.27 ) , lower levels of both anxiety ( beta=-0.16 ) and depression ( beta=-0.23 ) . Overall , for many older adult , long-term survivors , the legacy of cancer continues in terms of cancer-related health worries . In spite of these , for most survivors , their quality of life is not dramatically compromised either physically or psychologically PURPOSE To estimate prevalence and severity of patients ' self-perceived supportive care needs in the immediate post-treatment phase and identify predictors of unmet need . PATIENTS AND METHODS A multicenter , prospect i ve , longitudinal survey was conducted . Sixty-six centers recruited patients for 12 weeks . Patients receiving treatment for the following cancers were recruited : breast , prostate , colorectal , and gynecologic cancer and non-Hodgkin 's lymphoma . Measures of supportive care needs , anxiety and depression , fear of recurrence , and positive and negative affect were completed at the end of treatment ( T0 ) and 6 months later ( T1 ) . RESULTS Of 1,850 patients given question naire packs , 1,425 ( 79 % ) returned question naires at T0 , and 1,152 ( 62 % ) returned question naires at T1 . Mean age was 61 years ; and most respondents were female ( 69 % ) and had breast cancer ( 57 % ) . Most patients had no or few moderate or severe unmet supportive care needs . However , 30 % reported more than five unmet needs at baseline , and for 60 % of these patients , the situation did not improve . At both assessment s , the most frequently endorsed unmet needs were psychological needs and fear of recurrence . Logistic regression revealed several statistically significant predictors of unmet need , including receipt of hormone treatment , negative affect , and experiencing an unrelated significant event between assessment s. CONCLUSION Most patients do not express unmet needs for supportive care after treatment . Thirty percent reported more than five moderate or severe unmet needs at both assessment s. Unmet needs were predicted by hormone treatment , negative mood , and experiencing a significant event . Our results suggest that there is a proportion of survivors with unmet needs who might benefit from the targeted application of psychosocial re sources BACKGROUND Spirituality may aid cancer survivors as they attempt to interpret the meaning of their experience . OBJECTIVE We examined the relationship between spirituality , patient-rated worry , and health-care utilization  among 551 cancer survivors with different malignancies , who were evaluated prospect ively . METHODS Baseline spirituality scores were categorized into low and high spirituality groups . Patient-rated worries regarding disease recurrence/progression , developing new cancer , and developing complications from treatment were collected at baseline and at 6 and 12 months . Follow-up health-care utilization was also examined at 6 and 12 months . RESULTS Among the survivors , 271 ( 49 % ) reported low spirituality and 280 ( 51 % ) reported high spirituality . Of the cohort , 59 % had some kind of worry regarding disease recurrence/progression , development of new cancers , and treatment complications . Highly spiritual survivors were less likely to have high levels of worries at both 6 and 12 months . Highly worried survivors were significantly more likely to place phone calls to their follow-up providers and had more frequent follow-up visits at 6 and 12 months . No interactions between spirituality and level of worry were noted to affect follow-up health-care utilization . CONCLUSION Given spirituality 's effect on anxiety , spirituality-based intervention may have a role in addressing cancer survivors ' worries but may not improve health-care utilization In 1980 the EORTC-BCCG initiated a multicentre r and omised clinical trial comparing  modified radical mastectomy ( MRM ) with breast-conserving therapy ( BCT ) in stage I and II breast cancer . The main endpoint of the trial was survival . A brief  quality of life ( QoL ) question naire consisting of two multi-item scales ( body image and fear of recurrence ) and two single items ( satisfaction with treatment and cosmetic result ) was included in the trial . A cosmetic evaluation of the breast after conservative surgery was also performed . This report concentrates on the results of the QoL study and the cosmetic evaluation . Multitrait scaling analysis was employed to verify the hypothesised scale structure of the question naire . Treatment comparison of the QoL scores at 2 years post-treatment was performed using a stratified Wilcoxon rank sum test . Both patients ' and doctors ' ratings of the cosmetic result were documented on the clinical follow-up form . A multivariate analysis was performed to identify which factors influenced the cosmetic outcome . In total , 127 patients in the MRM arm and 151 in the BCT arm completed a QoL question naire at approximately 2 years after r and omisation ( months 25 - 36 ) . The Cronbach 's alpha coefficients were 0.79 and 0.73 for the body image and fear of recurrence scales , respectively . Significant benefit in body image and satisfaction with treatment was observed in the BCT patients . No significant difference was observed in fear of recurrence between the two groups . Ratings of cosmetic results decreased with time , in line with clinical observations of long-term side-effects of radiotherapy . Wide excision appeared to be the most important predictive factor for poor cosmetic result . In this multicentre r and omised study , BCT helped to maintain the patients ' body image , result ed in higher satisfaction with treatment and yielded no significant difference from MRM with respect to fear of recurrence PURPOSE Fear of cancer recurrence ( FCR ) is a significant source of distress in men with prostate cancer and could affect clinical decision-making , especially in those with positive margins following radical prostatectomy ( RP ) . We examined the influence of positive surgical margin status on fear of cancer recurrence in men undergoing radical prostatectomy .  METHODS Five hundred eight-four men underwent RP from 1999 to 2002 in CaPSURE , a prospect i ve , longitudinal , national cohort . All men had both baseline and follow-up assessment of FCR using a vali date d Kornblith scale . Statistical analysis included chi(2 ) test , Wald test , and linear as well as repeated measures ANOVA mixed model . RESULTS One hundred sixty ( 27 % ) men had positive surgical margins . Baseline FCR and clinical variables did not differ based on margin status . Men with positive margins experienced greater FCR after RP than negative margins ( OR , 1.94 , 95 % CI , 1.22 - 3.07 ) . Men who had received adjuvant therapy experienced greater FCR ( OR , 2.78 , 95 % CI , 1.21 - 6.39 ) . Repeated measures analysis showed greater FCR over time ( 14-month mean follow-up , range 2 - 31 months ) for positive vs. negative margins ( P = 0.02 ) . This difference in fear widened over time . There were no significant differences in health-related quality of life scores based on margin status . CONCLUSION Positive surgical margin status is associated with greater fear of cancer recurrence , a difference not alleviated by adjuvant therapy use . Men with positive margins remain more fearful over the course of several years compared with those with negative margins . Clinicians should be aware of the potential stressful impact of positive surgical margins OBJECTIVE To describe health- and vision-targeted quality of life following treatment with iodine 125 brachytherapy vs enucleation for choroidal melanoma in a subgroup of patients who were treated and observed prospect ively as part of a large r and omized clinical trial . MAIN OUTCOME MEASURES Difficulty with driving , near vision activities , and activities using stereopsis or binocularity ; anxiety ; and depression . PARTICIPANTS Two hundred nine patients who enrolled in the Collaborative Ocular Melanoma Study trial for medium-sized tumors between March 1995 and July 1998 and gave informed consent prior to r and omization to participation in an ancillary study of quality of life .  METHODS Patients were interviewed by telephone by a trained interviewer from the Collaborative Ocular Melanoma Study Coordinating Center at baseline ( prior to r and omization ) , at 6 months , and on annual anniversaries of enrollment . The question naire battery included the Medical Outcomes Study Short Form 36 , the Activities of Daily Vision Scale , the National Eye Institute Visual Function Question naire , and the Hospital Anxiety and Depression Scale . Additional questions concerning satisfaction with posttreatment appearance and concerns about cancer recurrence also were included in posttreatment interviews . RESULTS There was a significant increase in both treatment groups in levels of reported difficulty for most vision-oriented activities , and in bodily and ocular pain , 6 months following treatment . Differences in visual function between treatment groups reported during follow-up were relatively small , but significant differences favoring brachytherapy-treated patients were observed for driving during the first year of follow-up and for peripheral vision during the first 2 years of follow-up . Anxiety levels in both groups decreased significantly following treatment , but patients treated with brachytherapy with symptoms of anxiety were less likely to report later resolution of symptoms than patients with symptoms of anxiety who were treated with enucleation . This study was unable to assess impact of treatment on satisfaction with appearance and concern about cancer recurrence during the first year after treatment , but no treatment-related differences were found on these measures at 2 years and later follow-up times . CONCLUSIONS Patients treated with brachytherapy reported significantly better visual function than patients treated with enucleation with respect to driving and peripheral vision for up to 2 years following treatment . Differences between treatments in visual function diminished by 3 to 5 years posttreatment , paralleling decline in visual acuity in brachytherapy-treated eyes . Patients treated with brachytherapy were more likely to have symptoms of anxiety during follow-up than patients treated with enucleation . APPLICATION TO CLINICAL PRACTICE Given that no significant differences in survival between enucleation and brachytherapy have been found , the differences demonstrated here for driving and anxiety will allow the individual patient and physician to make informed choices regarding treatment based on personal preferences Although survival rates for all cancers continue to increase , few studies have examined the quality of life of both cancer survivors and family caregivers during the survivorship period after treatment has ended . Information is lacking on the stressors , re sources , meaning , and quality of life reported by survivors and family caregivers and the interrelationship between survivors ' and family caregivers ' quality of life . A stratified , r and om sample of 123 cancer survivors and 123 family caregivers ( N = 246 ) were interviewed in an exploratory , cross-sectional design 1 - 6 years after  cancer treatment had ended . Approximately half ( N = 62 ) of the dyads were white and half ( N = 61 ) were African American . Results indicated that cancer survivors reported significantly higher quality of life , less fear of cancer recurrence , and more support than their family caregivers . The strongest predictors for cancer survivors ' quality of life were family stressors , social support , meaning of the illness , and employment status , whereas the strongest predictors for family caregivers ' quality of life were fear of recurrence and social support . Both the survivor 's and family caregiver 's quality of life independently contributed to the other 's quality of life . Findings from this study suggest the importance of including both survivors and family caregivers in programs of care OBJECTIVES To examine the contributions of fear of recurrence and the more commonly examined treatment-related symptoms to the health-related quality of life ( HRQOL ) of men treated for localized prostate cancer . METHODS A total of 730 men with localized disease were identified from the Cancer of the Prostate Strategic Urologic Research Endeavor , a national , prospect i ve study of men with prostate cancer .  Pre- to post-treatment changes in fear of recurrence , treatment-specific symptoms and burden , comorbidities at diagnosis , number of new symptoms , and post-treatment HRQOL data  were analyzed . RESULTS Linear regression , adjusted for clinical and demographic characteristics , showed that improved fear of recurrence ( P < 0.01 ) , higher number of post-treatment symptoms ( P < 0.01 ) , and improved bowel function ( P < 0.01 ) significantly predicted better mental health scores . For physical health , improved urinary bother ( P < 0.01 ) and lower number of post-treatment symptoms ( P < 0.01 ) were associated with better physical health . CONCLUSION Underst and ing men 's fears about cancer recurrence and how these fears influence physical and mental health are important components of providing care to this growing population Given the marked individual variability in psychological adjustment in response to breast cancer , it is important to specify factors contributing to adaptive survivorship . This longitudinal study of 70 women with Stage I or II breast cancer tested the ability of situation-specific coping strategies and a more stable attribute , hope , to predict adjustment prospect ively from the point shortly following diagnosis through the first year . Consonant with previous studies , coping through active acceptance at diagnosis predicted more positive adjustment across time , and avoidance-oriented coping predicted greater fear of cancer recurrence , over and above participant age and initial status on dependent variables . The hypothesis that coping through turning to religion would be more effective for less hopeful women was supported , and mixed support emerged for the hypothesis that approach-oriented coping strategies would yield greater adaptational benefits for women high in hope . Findings suggest that risk and protective factors for adjustment across the first year of survivorship can be identified even prior to definitive surgery for breast cancer , particularly when both dispositional characteristics such as hope and situation-specific coping strategies are considered PURPOSE We determined factors associated with bother , the distress patients experience as a result of functional detriments after treatment for localized prostate cancer . MATERIAL S AND METHODS A prospect i ve cohort of men treated for clinical ly localized prostate cancer completed a question naire comprising the UCLA-PCI , Medical Outcomes Study Short Form-36 , American Urological Association Symptom Index and Memorial Anxiety Scale for Prostate Cancer fear of recurrence subscale . We used nonlinear mixed models to identify factors associated with severe urinary , sexual and bowel bother . RESULTS Worse function scores were associated with severe urinary , sexual and bowel bother following treatment ( OR 0.88 - 0.94 , p < 0.001 ) . Worse American Urological Association Symptom Index score was associated with severe urinary bother ( OR 1.22 , 95 % CI 1.16 - 1.28 ) . Time since treatment was inversely associated with urinary ( OR 0.68 , 95 % CI 0.54 - 0.83 ) and bowel bother ( OR 0.63 , 95 % CI 0.47 - 0.80 ) early after treatment but not for the entire 48-month study period . Receipt of concomitant and rogen deprivation therapy was not associated with bother 48 months after radiation . CONCLUSIONS Addressing functional detriment may confer improvement in urinary , sexual and bowel bother . Patient distress related to dysfunction improves with time . Measuring health related quality of life after prostate cancer treatment should incorporate functional and bother assessment BACKGROUND Fear of recurrence ( FOR ) has been increasingly recognised as an issue of significant burden for most cancer patients , and has been associated with psychological morbidity and reduced quality of life . More recently , the impact of recurrence fears has been indicated in the families of cancer patients . However , there has been a lack of prospect i ve research . AIM To systematic ally examine distress and illness concerns among patient-carer dyads . METHODS A multi-centre prospect i ve study of head and neck cancer patients and their carers ( patients , n=101 ; carers , n=101 ) , surveyed at two time-points following diagnosis . RESULTS Carers recorded higher recurrence concerns on average than the patient group ( p<0.001 ) . A predictive path model of patient and carer self-reports of distress and FORs was explored , with an excellent overall fit of the final model ( chi(2)=15.4 , df=12 , p=0.22 , Comparative Fit Index (CFI)=0.994 , Root Mean Square Estimate of Approximation (RMSEA)=0.053 ) . CONCLUSIONS The preliminary results establish that early fears and distress within individuals govern later reports on these same attributes , but that there is some weak evidence of influence from one attribute to another within and across individuals in the dyad . Future prospect i ve dyadic research is warranted to ascertain the level of these fears over an extended time and their relationship to patient and carer adaptation . Intervention may be needed to reduce this disease concern to a manageable level at an early stage of the illness trajectory To assess how closely nurses and patients considered various situations as causing stress in chemotherapy treatment , this study was design ed to compare nurse and patient perceptions of chemotherapy treatment stressors for patients in an oncology hospital . This descriptive study was conducted in the summer of 1997 . Fifty patients receiving cytotoxic treatment were chosen by r and om sample . All 21 registered nurses of the Tabriz University of Medical Sciences who worked in the oncology department were contacted . A Likert-type question naire was design ed to measure the stressfulness of commonly occurring items in chemotherapy treatment . The intensity of each item was measured by a scale with response choices ranging from the most to the least important . The patients were asked to indicate their perceptions of the seriousness of stress by sorting items . The nurses were asked to complete the same question naire as the patients completed . The greatest physical stressor mentioned by the patients was fatigue ( 66 % ) , and by nurses , alopecia ( 62 % ) . The nurses ’ perceptions of psychosocial items causing the greatest stress included fear of disease recurrence ( 90.5 % ) , fear of death ( 90.5 % ) , economic problems ( 90.5 % ) , and appearance changes ( 90.5 % ) , whereas the patients perceived dependency ( 80 % ) , economic problems ( 70 % ) , and loss of social activity ( 66 % ) , as the greatest stressors ( p < 0.05 ) . The findings showed disagreement between the two groups on intensity of physical and psychosocial stressors ( p < 0.05 ) . The results from this study increased nurses ’ awareness of important stress factors in chemotherapy treatment . Identification of the situations perceived to be more stressful than others helped clinical nurses to modify their care and provide for their patients in a way that removes or reduces the stressors UNLABELLED Treatments for choroidal melanoma ( CM ) generate largely unknown consequences on the level of the quality of life ( QoL ) and psychological state . Prospect i ve published work is relatively rare and their results are not consistent . The objective of this study is to describe the QoL and psychological state 's evolution in patients treated by conservative treatment for CM . POPULATION Sixty-nine patients treated for CM by conservative treatment ( proton beam irradiation or iodine plaques ) .  QoL ( EORTC-QLQ-C30 + QLQ-OPT-30 ) , anxiety and depression ( HADS , STAI-B-trait ) . DATA COLLECTION Prospect i ve study comprising four evaluations T0 : before the beginning of the treatment , T1 : one month , T2 : six month , T3 : one year after the treatment . The preliminary results of the first two evaluations showed that the level of the QoL remained relatively good and stable with an exception for the social functioning , which decreased after the treatment . More than half of the patients had a moderated rate of anxiety before the beginning of the treatment , which decreased significantly a month later . The depressive symptoms were lower and remained stable one month after the treatment . These results confirmed the importance of exploration and screening the fear of cancer recurrence among choroidal melanoma patients Purpose The prevalence of clinical levels of fear of cancer recurrence ( FCR ) in cancer survivors is unknown , which may be partly explained by the lack of an assessment method that would make it possible to distinguish between normal and clinical levels of FCR . Moreover , despite the apparent overlap between FCR and manifestations of some psychiatric disorders , no study has yet evaluated the comorbidity of clinical levels of FCR . The goals of this study were to assess the capacity of the Fear of Cancer Recurrence Inventory  severity subscale , to consider a shorter form of the FCRI ( FCRI-SF ) , to screen for clinical levels of FCR , and to assess its psychiatric comorbidity . Methods Sixty French-Canadian cancer survivors ( 73 % of those eligible ) who had been treated within the past 4 years for localized breast , prostate , lung , or colorectal cancer were r and omly selected . Participants were administered a  clinical interview assessing FCR , the Structured Clinical Interview for DSM-IV , and self-report scales .  Results A cutoff score of 13 or higher on the FCRI-SF was associated with optimal sensitivity ( 88 % ) and specificity ( 75 % ) rates for the screening of clinical levels of FCR . Cancer survivors with clinical levels of FCR  were significantly more likely to meet the criteria for a current psychiatric disorder ( 60 % ) than patients with non clinical levels ( 29 % ) . Anxiety disorders tended to be the most common comorbid disorders . Conclusions / Implication s for Cancer SurvivorsThe FCRI-SF allows rapid and effective screening of clinical levels of FCR , a condition associated with significant psychiatric comorbidity
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