Investigation and correlation analysis of fear of cancer recurrence

Understanding Fear of Cancer Recurrence (FCR)

Cancer is a major public health challenge worldwide, and the second-leading cause of death after cardiovascular disease. While advancements in medical technology have significantly improved survival rates and life expectancy for cancer patients, the threat of cancer recurrence and metastasis remains a primary concern.

Fear of cancer recurrence (FCR) is a common psychological experience that persists in cancer patients during and after treatment. It is defined as the “fear, worry, or concern related to the possibility of cancer recurrence or progression in the same organ or other parts of the body.” FCR can range from 33% to as high as 96% among cancer patients, often appearing immediately after diagnosis and continuing for many years.

Uncontrolled FCR can have detrimental consequences, including:

Sleep disorders and dysfunction: High levels of FCR can lead to sleep problems and overall dysfunction, seriously affecting the patient’s well-being and quality of life.

Anxiety and depression: FCR can exacerbate patients’ anxiety and depression, which in turn impacts the efficacy of chemotherapy drugs and increases the incidence of adverse drug reactions.

Excessive medical behavior: Patients with high FCR may undergo excessive physical examinations, become hypervigilant, and interpret any physical symptoms as signs of disease progression, leading to overuse of healthcare resources.

Psychiatric disorders: In extreme cases, FCR can result in serious psychiatric disorders such as somatic symptom disorder or post-traumatic stress disorder (PTSD).

Given the significant impact of FCR on cancer patients’ physical and mental health, as well as the financial burden on the healthcare system, understanding the factors that influence FCR is crucial. One such crucial factor is social support (SS).

The Role of Social Support in Mitigating FCR

Cancer is a traumatic and stressful event that often leads to a series of physical, emotional, and social changes for patients. During this challenging time, having a strong support system is critical for successful post-cancer psychological adjustment.

Social support (SS) refers to the various services provided by social networks that can improve mental health or lessen psychological problems. It can be categorized into two main types:

1. Actual Social Support (Objective Support): This includes tangible assistance, such as material aid, presence, and engagement in group connections.

2. Perceived Social Support (Subjective Support): This refers to the extent to which individuals can subjectively feel, understand, and comprehend various types of support from family, friends, or others.

Numerous studies have shown that SS plays a pivotal role in the quality of life and health outcomes for cancer patients. Effective SS can enhance cancer patients’ psychological resilience and hope, while also serving as a protective factor against the detrimental effects of stress.

Exploring the Relationship between Social Support and Fear of Cancer Recurrence

The theory of SS and stress-buffering suggests that increased SS can protect individuals under stress and improve their ability to cope with stressful events, such as a cancer diagnosis and treatment. Several studies have investigated the relationship between SS and FCR among Chinese cancer patients, with mixed results:

• Negative Correlation: Some studies have reported a relatively large negative correlation between SS and FCR, indicating that higher levels of SS are associated with lower levels of FCR.
• Small Negative Correlation: Other studies have found a small negative correlation between SS and FCR.
• Positive Correlation: Interestingly, a few studies have even reported a positive correlation between SS and FCR, suggesting that increased SS may not always lead to reduced FCR.

These conflicting findings highlight the need for a comprehensive analysis of the relationship between SS and FCR among Chinese cancer patients. By understanding the degree of this correlation and the factors that may influence it, healthcare professionals and social workers can develop more targeted interventions to effectively mitigate FCR and improve the well-being of cancer patients.

Systematic Review and Meta-Analysis: Investigating the Correlation between Social Support and FCR

To bridge the knowledge gap and provide a Chinese perspective on the management of social workers and medical staff around the world, we conducted a systematic review and meta-analysis to investigate the correlation between SS and FCR among Chinese cancer patients.

Methodology

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO).

A comprehensive literature search was performed in nine databases, including PubMed, Embase, Web of Science, Cochrane, and several Chinese databases, from inception to May 2022. The key terms used in the search included “neoplasm/tumor/cancer/malignancy/carcinoma,” “fear/worry/concern/uncertainty/fear of cancer recurrence,” “recurrence/relapse/progress/exacerbation/return,” and “social support/perceived social support.”

Observational studies that reported the relationship between FCR and SS, such as correlation coefficients (r) or regression coefficients (β’), were included in the analysis. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools.

Results

The meta-analysis included 37 studies involving 8,190 participants. The key findings are as follows:

1. Negative Correlation between SS and FCR: The meta-analysis showed a significant negative correlation between SS and FCR, with a pooled regression coefficient (β’) of -0.27 (95% CI: -0.364 to -0.172) and a moderate negative correlation (summary r = -0.52, 95% CI: -0.592 to -0.438).

2. Heterogeneity and Moderating Factors: Meta-regression and subgroup analyses revealed that the type of cancer and study design were sources of heterogeneity, while the type of SS (actual SS, perceived social support, and others), source of actual SS, and source of perceived social support were not significant moderators.

3. Robustness and Sensitivity Analysis: Sensitivity analysis showed that the results were stable, and there was no significant publication bias.

These findings suggest that increased social support is associated with a lower risk of fear of cancer recurrence among Chinese cancer patients. The type of cancer and study design were identified as potential moderating factors, highlighting the need for further research to explore the nuances of this relationship.

Implications and Future Directions

The results of this systematic review and meta-analysis have several important implications:

1. Importance of Social Support: The findings underscore the critical role of social support in mitigating fear of cancer recurrence among Chinese cancer patients. Social workers and medical staff should prioritize enhancing the use of social support and establishing a robust support system for cancer patients.

2. Moderating Factors: The identification of cancer type and study design as potential moderating factors suggests the need for further research to understand the specific mechanisms by which these factors influence the relationship between social support and fear of cancer recurrence.

3. Longitudinal and Mixed-Methods Approaches: The majority of the included studies were cross-sectional in nature, highlighting the need for longitudinal research and mixed-methods approaches to gain a deeper understanding of the dynamic relationship between social support and fear of cancer recurrence.

4. Generalizability and Cultural Considerations: While this study focused on the Chinese population, future research should extend the scope to include other countries and cultures to assess the generalizability of the findings and explore the potential influence of cultural differences on the relationship between social support and fear of cancer recurrence.

By addressing these research gaps and building on the insights provided by this systematic review and meta-analysis, healthcare professionals and social workers can develop more effective interventions and strategies to enhance social support and mitigate the detrimental effects of fear of cancer recurrence among cancer patients, ultimately improving their overall well-being and quality of life.

Conclusion

This comprehensive analysis of the relationship between social support and fear of cancer recurrence among Chinese cancer patients provides valuable insights for healthcare professionals and social workers. The findings underscore the importance of social support in mitigating fear of cancer recurrence and highlight the need for further research to explore the nuances of this relationship, including the influence of cancer type and study design.

By leveraging these insights, healthcare providers and social workers can develop targeted interventions and strategies to enhance social support and effectively address the fear of cancer recurrence, ultimately improving the physical, mental, and emotional well-being of cancer patients in China and beyond.