A cross-sectional study of fear of surgery in female breast cancer patients: Prevalence, severity, and sources, as well as relevant differences among patients experiencing high, moderate, and low fear of surgery

Abstract

Background Fear of surgery has been associated with more postoperative pain, disability, and a lower quality of life among patients undergoing various surgical procedures. While qualitative studies indicate breast cancer patients to be afraid of surgery, detailed quantitative analyses are lacking. The present research aimed at investigating the prevalence, severity, and sources of fear of surgery in this patient group and to compare patients reporting different degrees of such fear. Methods This cross-sectional study included 204 breast cancer patients, 18–70 years old, and scheduled for surgery at Oslo University Hospital, Norway. Following their preoperative visit participants completed validated psychological questionnaires online. Among these, the primary outcome measure, the Surgical Fear Questionnaire (SFQ; scores: 0–10 per item, 0–80 overall). Patients were grouped based on SFQ-percentiles (<25th = little, 25th–75th = moderate and >75th percentile = high fear) and compared on psychological (anxiety, depression, experienced injustice, optimism and expected postsurgical pain), sociodemographic, and medical outcomes. Results 195 patients completed the SFQ. On average fear of surgery was low (M = 26.41, SD = 16.0, median = 26, min-max = 0–80), but omnipresent. Only 1.5% (n = 3) indicated no fear at all. Overall, patients feared surgery itself the most (M = 3.64, SD = 2.8). Groups differed significantly (p < .001) in their experience of anxiety, depression, and injustice, as well as their disposition to be optimistic, and expectance of postsurgical pain. Differences between groups concerning demographic and medical information were largely insignificant. Discussion This study was the first to demonstrate fear of surgery to be prevalent and relevant among female breast cancer patients. The higher a patients’ fear group, the poorer their preoperative psychological constitution. This, largely irrespective of their current diagnoses or treatments, medical history, and demographics. Fear of surgery might thus cater as a prognostic marker and treatment target in this patient group. However, given the cross-sectional character of the present data, prognostic studies are needed to evaluate such claims.

Women and Family Members’ Views Regarding Early Decisions about Breast Cancer Treatment: A Qualitative Study

“…This study revealed that some of the participants made the decision to refuse the treatment due to fear of surgery. Fear of surgery is a prevalent and relevant phenomenon among female breast cancer patients (Engel et al, 2023). Saeed et al (2021) reported that the participants in their study purposely delayed the treatment due to the fear of mastectomy and loss of femininity.…”

Measures of preoperative anxiety: Part two

“…A preliminary study conducted among 65 patients awaiting cardiac surgery provided promising results regarding the reliability of the scale (Cronbach's a coefficient for the full scale was 0.93, for short-term aspects of surgery was 0.91, and for long-term surgery aspects was 0.90). The SFQ questionnaire has been used in studies conducted in the Netherlands [28,29], Greece [34], Portugal [35,36], Turkey [21,23,33,[37][38][39][40][41][42][43], Croatia [44], Norway [45], Germany [31], Italy [46], Czech Republic [30], China [32], United States [47,48], Ireland [49], and Hungary [50][51][52]. Most of these publications appeared in the years 2022-2023.…”