CONCERNS ABOUT how recurrence of gynecologic cancer can affect a person’s life, and not simply fear of recurrence alone, play an important role in patient distress and functional impairment, according to a presentation at the 2018 American Psychosocial Oncology Society (APOS) Annual Conference in Tucson.1 The results of this presentation address some of the assumptions made about patients with gynecologic cancer or women’s attitude toward cancer screening, according to the presenters.
Alexandra Zaleta, PhD
“Fears of cancer recurrence are very common among gynecologic cancer patients; 8% to 26% of cervical cancer survivors will experience recurrence, and 70% of those with ovarian cancer will experience recurrence,” noted study lead author Alexandra Zaleta, PhD, of the Research and Training Institute at the Cancer Support Community. The study was conducted at The Ohio State University Wexner Medical Center in Columbus.
However, most studies on fear of recurrence focus on breast and cervical cancers, she added. With the current study, the researchers aimed to reach a better understanding of the “unmet needs” of patients with gynecologic cancer in terms or recurrence concerns. They used Leventhal’s Common Sense Model of Illness Representations to create and compare theoretical models: fear of cancer recurrence beliefs (cognition) precede fears (emotion), fear of cancer recurrence precedes beliefs, and fears and beliefs act in parallel.
“There are certain antecedents that precede fears of cancer recurrence and beliefs about the consequences of recurrence, which then affect outcomes, such as depression, anxiety, and insomnia, and then functional impairments,” explained Dr. Zaleta.
Impact of Beliefs About Recurrence
THE STUDY population consisted of 153 women, with an average age of 58.8 years. Of them, 92% were white. The most common cancer diagnosis was endometrial/uterine cancer (42%), followed by ovarian/fallopian/peritoneal, and cervical cancers. The average time since diagnosis was 2.7 years, and 33% had at least one recurrence.
The women completed questionnaires that assessed antecedent variables, such as demographics, clinical history, functional and illness triggers, along with proposed mediators (fear of recurrence severity, beliefs about the life impact of recurrence) and outcomes (psychological distress, functional impairment). Demographic and clinical variables associated with fear of cancer recurrence severity were included in a structural equation model to test whether the effects of antecedent variables on outcomes were mediated by fear of recurrence beliefs and fears.
“Patient beliefs about the potential impact of cancer recurrence on their lives, and not fear alone, played an important role in psychological distress and functional impact.”— Sharla Wells-Di Gregorio, PhD
Tweet this quote
Study coauthor Sharla Wells-Di Gregorio, PhD, of Psychosocial Oncology at The Ohio State University Wexner Medical Center James Cancer Hospital, reported there were no meaningful statistical differences among the three different models. However, “in all the models, the effect of recurrence fears on consequence was fully mediated by beliefs about recurrence.” In other words, patient beliefs about the potential impact of cancer recurrence on their lives, and not fear alone, played an important role in psychological distress and functional impact, she said.
The take-home message for a cancer care professional is that multiple factors can contribute to fear of recurrence and outcomes among gynecologic cancer survivors, Dr. Wells-Di Gregorio noted. Psychosocial interventions for these patients should take into consideration fear of recurrence cognitions. For example, an intervention program may include tools for problem-solving—including learning to manage problems that cannot be solved—and mindfulness, she added. ■
DISCLOSURE: Drs. Zaleta and Wells-Di Gregorio reported no conflicts of interest.
1. Zaleta A, Wells-Di Gregorio S, Bartle-Haring, et al: Fear of cancer recurrence among gynecologic cancer survivors. 2018 APOS Annual Conference. Presented February 23, 2018.
Editor's note: Article updated on May 23, 2018. This version has been revised from the original report published on May 10, 2018. A second study originally included in the report has been removed at the request of the study author on May 23, 2018.