| Objective:Fear of Cancer Recurrence(FCR)is the most common negative emotion among breast cancer patients,with a high incidence that does not disappear with the passage of time and seriously affects the quality of life and physical and mental health of individuals.Due to insufficient understanding of the mechanisms underlying the occurrence of cancer recurrence fear,targeted interventions to reduce cancer recurrence fear cannot be provided.The cognitive model of cancer recurrence fear and the self-regulatory executive function model point out that the level of cancer recurrence fear is related to attentional bias and that attentional bias to cancer-related stimuli may influence cancer recurrence fear.In addition,a small number of existing studies have explored the attentional bias characteristics of breast cancer patients with clinical and nonclinical cancer recurrence fear through a dot-probe task,but have not examined the specific components of attentional bias in depth.Attentional bias includes three components: attentional enhancement,attentional avoidance,and attentional disengagement difficulties.The specific components of attentional bias can be measured by presenting stimuli using a modified version of the dot-probe task.Stimulus presentation includes both subthreshold(unconscious)and suprathreshold(conscious)modalities.Therefore,the present study was conducted to understand the relationship between attentional bias and fear of cancer recurrence in breast cancer patients through a cross-sectional questionnaire to explore the role of perceived stress and experiential avoidance in attentional bias and fear of cancer recurrence.At the behavioral level,a modified version of the dot-probe task was used to explore the characteristics and specific components of attentional bias in breast cancer patients with clinical and non-clinical cancer recurrence fears under subthreshold(17ms)and suprathreshold(500ms)stimulus conditions,and to compare whether there are differences in attentional bias between breast cancer patients with clinical and non-clinical cancer recurrence fears.This study provides a reference for deeper understanding of the mechanisms of cancer recurrence fear and finding intervention methods to reduce cancer recurrence fear in breast cancer patients.Methods:1.338 breast cancer survivors were surveyed using the general demographic information questionnaire,the Attention to Positive and Negative Information Scale(APNIS),the Fear of Cancer Recurrence Inventory-Short Form(FCRI-SF),the Chinese Perceived Stress Scale(CPSS)and the Acceptance Action Questionnaire-2nd Edition(AAQ-II).328 valid questionnaires were returned,with an effective rate of 97.04%.The differences of different demographic variables on the fear of cancer recurrence scores and the relationships between positive attentional bias,negative attentional bias,perceived stress,avoidance,and fear of cancer recurrence were analyzed.2.The attentional bias characteristics and specific components of different types of words were examined in 94 breast cancer patients with clinical(FCRI-SF ≥ 13 points)and non-clinical fear of cancer recurrence(FCRI-SF < 13 points)under two temporal stimulus conditions,subthreshold(17ms)and suprathreshold(500ms),using a modified version of the dot-probe task.The correctness,reaction time,attentional bias score,attentional orienting score,and attentional disengagement difficulty score were analyzed.Results:1.There were statistically significant differences in cancer recurrence fear scores among breast cancer patients with different age,education level,and employment status(P< 0.05).The differences in cancer recurrence fear scores among breast cancer patients were shown as follows: age group of 39 years and younger > 40-59 years group,college and higher education level group > junior high school and lower education level group,and working group > unemployed and retired group.There was no statistically significant difference in the fear of cancer recurrence scores among breast cancer patients with different marital status,child status,duration of disease,surgery,treatment,and recurrence or metastasis or not(P > 0.05).2.Correlation analysis showed that negative attentional bias(r = 0.37,P < 0.01),perceived stress(r = 0.46,P < 0.01)and avoidance(r = 0.64,P < 0.01)were all positively correlated with fear of cancer recurrence;negative attentional bias was positively correlated with perceived stress(r = 0.42,P < 0.01)and avoidance(r = 0.49,P < 0.01);perceived stress was positively correlated with avoidance(r = 0.61,P < 0.01);positive attentional bias was negatively correlated with perceived stress(r =-0.50,P < 0.01),avoidance(r =-0.30,P< 0.01)and fear of cancer recurrence(r =-0.18,P < 0.01).3.Perceived stress mediated between negative attentional bias and fear of cancer recurrence with a mediating effect value of 0.15(95% CI: 0.10 ～ 0.22);the mediating role of perceived stress between negative attentional bias and fear of cancer recurrence(the latter half of the pathway)was moderated by high avoidance with a moderated mediation index of 0.07(95% CI: 0.04 ～ 0.10).Perceived stress also mediated between positive attentional bias and fear of cancer recurrence,with a mediating effect value of-0.24(95%CI:-0.33 ～-0.17).The mediating role of perceived stress between positive attentional bias and fear of cancer recurrence(the latter half of the pathway)is moderated by avoidance,with a moderated mediation index of-0.08(95% CI:-0.12 ～-0.04).4.In the subthreshold stimulus condition,breast cancer patients with clinical cancer recurrence fear had attentional bias and attentional orienting to negative cancer-related words and no attentional disengagement difficulties or disengagement ease for all types of words.Breast cancer patients with non-clinical cancer recurrence fear did not have attentional bias for all types of words.There were no statistically significant differences between groups in the attentional bias scores(F(1,92)= 0.361,P > 0.05),attentional orientation scores(F(1,92)= 0.235,P > 0.05)and attentional disengagement difficulty scores(F(1,92)= 0.634,P > 0.05)for all types of words in breast cancer patients with clinical and non-clinical cancer recurrence fear.5.In the suprathreshold stimulus condition,breast cancer patients with clinical cancer recurrence fear had an attentional bias for cancer-related negative words,attentional avoidance for cancer-related positive words,attentional orientations to neutral words matched by cancer-related negative words and cancer-related positive words and attentional disengagement difficulty for cancer-related negative words.Breast cancer patients with non-clinical cancer recurrence fears did not have attentional bias for all types of words.6.In the suprathreshold stimulus condition,breast cancer patients with clinical cancer recurrence fear had significantly greater attentional bias scores for cancer-related negative words than for cancer-related positive words(P < 0.01).There was a statistically significant difference between two groups of subjects in the attentional bias scores for cancer-related positive words(P < 0.05).7.In the suprathreshold stimulus condition,breast cancer patients with clinical cancer recurrence fear had significantly greater attentional disengagement difficulty scores for all negative words(cancer-related and cancer-unrelated)than for all positive words(P < 0.01).There was a statistically significant difference between two groups of subjects in the attentional disengagement difficulty scores for all negative words(P < 0.05).Conclusion:1.Age,education level and employment status may be the main demographic influences on the fear of cancer recurrence in breast cancer patients.2.Negative attentional bias was positively associated with fear of cancer recurrence and positive attentional bias was negatively associated with fear of cancer recurrence in breast cancer patients.Perceived stress mediated the relationship between negative attentional bias and fear of cancer recurrence and positive attentional bias and fear of cancer recurrence,respectively.In both mediation models,high avoidance moderated the negative effect of perceived stress on fear of cancer recurrence.Positive and negative attentional bias,perceived stress and avoidance may jointly influence fear of cancer recurrence in breast cancer patients.3.In both subthreshold and suprathreshold stimulus conditions,breast cancer patients with clinical cancer recurrence fear had an attentional bias for cancer-related negative words,whereas breast cancer patients with non-clinical cancer recurrence fear did not have an attentional bias for all types of words.4.Breast cancer patients with fear of clinical cancer recurrence showed different components of attentional bias in subthreshold and suprathreshold stimulus conditions.In the subthreshold stimulus condition,breast cancer patients with clinical cancer recurrence fear showed attentional orienting to cancer-related negative words.In the suprathreshold stimulus condition,breast cancer patients with clinical cancer recurrence fear showed attentional orienting to neutral words matched to cancer-related negative words and attentional disengagement difficulties to cancer-related negative words and also showed attentional avoidance to cancer-related positive words and attentional orienting to neutral words matched to cancer-related positive words.5.In the suprathreshold stimulus condition only,there were between-group differences between breast cancer patients with clinical and nonclinical cancer recurrence fears in attentional bias scores for positive cancer-related words and in attentional disengagement difficulty scores for all negative words.Therefore,younger,more educated and working breast cancer patients should be given higher priority.Increased attention to positive stimuli as well as reduced avoidance,such as attentional bias modification training and acceptance and commitment therapy,can be used to reduce the level of fear of cancer recurrence in breast cancer patients. |
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