Predictors for Fear of Cancer Recurrence in Breast Cancer Patients Referred to Radiation Therapy During the COVID-19 Pandemic: A Multi-Center Cross-Section Survey

Abstract

ObjectiveThe outbreak of COVID-19 pandemic has greatly impacted on radiotherapy (RT) strategy for breast cancer patients, which might lead to increased distressing psychological symptoms. We performed a multi-center cross-section survey to investigate prevalence of fear of cancer recurrence (FCR) and predictors for FCR in patients referred to RT during pandemic.Methods542 patients were consecutively enrolled from three regions in China including Yangtze Delta River Region, Guangdong and Shanxi province. Patients’ characteristics were collected using an information sheet, Fear of progression questionnaire-short form, Hospital Anxiety/Depression Scale and EORTC QLQ-C30. The hierarchical multiple regression models were performed.Results488 patients with complete data were eligible. The RT strategy was affected in 265 (54.3%) patients, including 143 with delayed RT initiation, 66 believing to have delayed RT initiation but actually not, 24 with RT interruptions, 19 shifting to local hospitals for RT and the remaining 13 influenced on both RT schedule and hospital level. The model explained 59.7% of observed variances in FCR (p<0.001) and showed that influence of RT strategy had significantly impacted on FCR (△R2 = 0.01, △F=2.966, p=0.019). Hospitals in Shanxi province (β=-0.117, p=0.001), emotional function (β=-0.19, p<0.001), social function (β=-0.111, p=0.006), anxiety (β=0.434, p<0.001) and RT interruption (β=0.071, p=0.035) were independent predictors.ConclusionsRT strategy for breast cancer patients was greatly influenced during pandemic. RT interruption is an independent predictor for high FCR. Our findings emphasize the necessity to ensure continuum of RT, and efforts should be taken to alleviate FCR through psychological interventions.

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

“…Their results indicate that the levels for FCR in those patients who believed to have delayed RT plans, but actually did not, was much higher (31.5%) than in the normal (13.2%) or real delay group (11.4%). In line with previous studies, Xie et al's [ 51 ] investigation indicates a strong negative association between all 5 sub-components of quality of life (physical, role, emotional, cognitive, and social) an FCR, and both emotional (r = −0.103, p˂.001 ) and social functioning (r = −0.052, p=.006 ) were found to be independent predictors for high levels of FCR [ 51 ].…”

“… Significant differences between survivors awaiting surgery and those post-surgery regarding the estimation of risks of cancer progression. Limitations: Sample size was relatively small Participants were generally financially secure, highly educated, and did not report being severely impacted by the COVID-19 pandemic 5 [ 51 ] China 9th-30th Apr 2020 Multi-center cross-sectional survey Online or paper form N = 488 breast cancer survivors referred to radiotherapy Instruments Influence of COVID-19 Pandemic on RT 12-item Fear of Progression Questionnaire ⁃ Short Form (FoP-Q-SF) Hospital Anxiety and Depression Scale (HADS) Quality of life (QoL) during pandemic - EORTC QLQ-C30 - five functional scales (physical, role, emotional, cognitive and social function) and global QoL Inclusion criteria confirmed pathological diagnosis of BC referred to RT during the COVID-19 pandemic Age Gender Employment status Level of education Marital status Stage of tumor Type of recurrent or metastatic breast cancer Surgery Chemotherapy Endocrine therapy RT procedure Influence of RT schedule Change 50% of the patients who had to interrupt RT experienced high levels of FCR. - interruption of RT is an independent predictor of FCR, but not for the postponement of RT.…”

“…The major limitations of this study were represented by the relatively small sample size, and by the fact that most participants were generally financially secure, highly educated, and did not report being severely impacted by the COVID-19 pandemic. Xie et al's [ 51 ] study investigated 488 breast cancer survivors referred to radiotherapy, and who had to postpone or interrupt treatment due to the Covid-19 pandemic. The authors hypothesized that fear of cancer recurrences in these patients would be negatively impacted due postponement of RT treatment.…”

“…Xie et al's [ 51 ] study investigated 488 breast cancer survivors referred to radiotherapy, and who had to postpone or interrupt treatment due to the Covid-19 pandemic. The authors hypothesized that fear of cancer recurrences in these patients would be negatively impacted due postponement of RT treatment.…”

“…According to the results of this study [ 51 ], 17.2% of the entire sample reported high levels of FCR, the two most common sources of fear in the sample being: worrying if medications could damage the body, and worrying about the future of family members. Moreover, 50% of the patients who had to interrupt RT experienced high levels of FCR.…”