Fear of Recurrence in Chinese Cancer Patients: Prevalence, Correlates, and Network Analysis

Xian Luo; Wengao Li; Yu Chen; Hengwen Sun; Gerry Humphris; Ting Liu; Jingying Zhang; Yuan Yang; Bin Zhang

doi:10.3389/fpsyt.2022.803543

Fear of Recurrence in Chinese Cancer Patients: Prevalence, Correlates, and Network Analysis

Front Psychiatry. 2022 Feb 7:13:803543. doi: 10.3389/fpsyt.2022.803543. eCollection 2022.

Authors

Xian Luo¹, Wengao Li², Yu Chen³, Hengwen Sun⁴, Gerry Humphris⁵, Ting Liu¹, Jingying Zhang¹, Yuan Yang⁶, Bin Zhang¹

Affiliations

¹ Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China.
² Department of Psychiatry, 999 Brain Hospital, Guangzhou, China.
³ School of Nursing, Southern Medical University, Guangzhou, China.
⁴ Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
⁵ Department of Health Psychology, School of Medicine, University of St Andrews, St Andrews, United Kingdom.
⁶ Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.

Abstract

Background: Fear of cancer recurrence (FCR) is a significant issue for most cancer patients. Until now, a detailed investigation of the structure of FCR and the interaction among its constituent elements is lacking. This study aims to investigate the phenomenon of FCR by means of network analysis in Chinese cancer patients.

Methods: This is a multi-center, cross-sectional study that included 996 cancer patients from southern China. All participants were assessed by the 7-item Chinese version Fear of Cancer Recurrence Scale (FCR-7). Multivariate logistic regression, and network analyses were conducted. Central symptoms (nodes) in the FCR network were identified.

Results: Among the 996 patients, 543 (54.52%) reported moderate FCR, and 137 (13.76%) reported high FCR. Chemotherapy (OR = 2.954, P = 0.016), and childhood severe illness experience (OR = 2.331, P = 0.016) were positively associated with high FCR, while higher monthly income (OR = 0.403, P = 0.046) was negative associated with high FCR. The node #FCR2 (Worried/anxious about recurrence) was the most central node within the FCR network (Strength = 1.190), while node #FCR6 (Examining for physical signs) was the least central node (Strength = 0.373). The edge FCR1-FCR2 ("Afraid"-"Worried/anxious") was the thickest and most saturated edge in the network. After controlling for age and gender, an almost identical network was obtained with respect to edges magnitude and strength.

Conclusion: Fear of recurrence is a frequently reported issue among Chinese cancer patients. Patients with chemotherapy and childhood severe illness experience were more vulnerable and should be particularly monitored. Compared to behavioral component (i.e., body checking, overscreening and overtreatment) and cognitive component (i.e., intrusions), emotional component (i.e., worry/anxious) is more central to identify FCR and might be potential targets for further interventions.

Keywords: Chinese; cancer; fear; network analysis; psycho-oncology; recurrence.