Characteristics Of Fear Of Cancer Recurrence Among Breast Cancer Survivors And Mindfulness Intervention

Objective:Fear of Cancer Recurrence(FCR)has become a prominent emotional feature of breast cancer survivors and an important inducement of cancer recurrence,which seriously affects the rehabilitation of the disease.At present,there are few reports on the characteristics of FCR among breast cancer survivors in China and the intervention research on how to reduce FCR is relatively lagging behind.Therefore,this study surveyed breast cancer survivors by the short version of the Fear of Cancer Recurrence Inventory(FCRI)to get the cut-off score to distinguish between high and low FCR of breast cancer survivors,and divided them into high and low FCR groups and then compared their resilience and mindfulness level,quality of life,attention bias and brain function between the two groups.On the basis of the studies,mindfulness intervention training on breast cancer survivors was conducted and the effects on reducing their FCR and improving quality of life were explored.Methods:1.The Short Form of Fear of Cancer Recurrence Inventory(the Short Form of FCRI),10 item Connor-Davidson Resilience Scale(CD-RISC-10),Five Facet Mindfulness Questionnaire(FFMQ),Hospital Anxiety and Depression Scale(HADS)and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30)were surveyed in 338 breast cancer survivors and the characteristics of FCR as well as the impact on emotion and quality of life were explored,and the relationships between FCR and other variables were analyzed.2.Operator Characteristic Curve was used to test the cut-off score of FCRI for breast cancer survivors.On this basis,the differences among mindfulness,resilience and quality of life among breast cancer survivors between high and low FCR groups were compared.3.Dot-probe task was conducted to investigate the difference of attentional bias among breast cancer survivors with high and low FCR.4.Functional Magnetic Resonance Imaging(f MRI)was used through the method of Regional Homogeneity(Reho)and Voxel-mirrored Homotopic Connectivity(VMHC)to compare the brain functional differences between high and FCR groups.5.The control study design of experimental group(conventional treatment combined 6-week mindfulness intervention group,n=28)and waiting group(n=29)was conducted.The patients' FCR,resilience,mindfulness and quality of life of the two groups before the intervention(T1),at the end of the intervention(T2)and 1 month after the intervention(T3)respectively were assessed.Besides,questions about the attitude on mindfulness training were surveyed in the experimental group.Results:1.Correlation analysis found that FCR was significantly negatively correlated with mindfulness,physical function,role function,emotional function,cognitive function and overall health status of breast cancer survivors(P<0.01).Mindfulness mediated FCR and physical function,emotional function,cognitive function,social function and general health status.2.Operator Characteristic Curve showed that the score of 12 was the optimal cut-off score to distinguish high FCR from low FCR;Compared to breast cancer survivors with high FCR,breast cancer survivors with low FCR had higher levels of mindfulness and resilience and better quality of life.3.Behavioral experiment of dot-probe task found that the main effect of emotional word category of breast cancer survivors was not significant on the accuracy [F(2,56)=2.243,P>0.05],and the main effect of group was not significant [F(1,57)=2.771,P>0.05],and the interaction between the two was not significant [F(2,56)=2.376,P>0.05].The results showed that on the reaction time,the main effect of emotional word category was not significant[F(2,56)=0.384,P>0.05],and the main effect of emotional category was not significant[F(1,57)=1.181,P>0.05],and the interaction between them was not significant[F(2,56)=0.539,P>0.05].4.The independent sample t-test was used to compare the Re Ho images between the high FCR group and low FCR group,the results showed that compared to the low FCR group of breast cancer survivors,the increased Re Ho of BOLD signal part of the brain was the left caudate nucleus of high FCR group,and the lower part was the right precuneus(P<0.01).Caudate nucleus were positively correlated with resilience and mindfulness(P<0.05),and the correlation coefficient were 0.313 and 0.295 respectively;Caudate nucleus were negatively correlated with FCR and anxiety(P<0.05),and the correlation coefficient were 0.501 and0.369 respectively.The precuneus negatively correlated with resilience and mindfulness level(P<0.05),and the correlation coefficient was 0.315 and 0.381 respectively.Additionally,The precuneus was significantly positively related FCR and anxiety(P<0.05),and the correlation coefficient were 0.505 and 0.333 respectively.The VMHC images were analyzed by independent sample t-test to compare the two groups.The results found that there were significant differences in posterior cerebellar,superior frontal/orbital,inferior frontal,occipital,subparietal and superior middle frontal between the two groups(P<0.05).The brain regions with significant differences between the two groups were taken as the regions of interest,and the average VMHC values of the regions of interest of each subject were extracted.Finally,the correlation between the regions of interest and resilience,FCR,anxiety and mindfulness was calculated.The results showed that VMHC of bilateral superior occipital gyrus was significantly positively correlated with the total score of FCR and anxiety(P<0.05),and the correlation coefficients were 0.438 and 0.481 respectively;Additionally,VMHC of bilateral superior occipital gyrus was negatively correlated with resilience and mindfulness(P<0.05),and the correlation coefficients were-0.379 and-0.397 respectively.5.It was found that after 6-week groups(training group,waiting group)× test time(pre-test,post-test,1 month follow-up)had significant interaction effect;Simple effect analysis showed that the grouping effect was significant in mindfulness,FCR,emotional function and cognitive function when patients were survey in the post-test and follow-up;Mindfulness level,emotional function and cognitive function of experimental group was significantly higher than those of the waiting group,while the FCR was significantly lower than that of the control group;The long-term effect of mindfulness intervention training was tested,and it was found that the mindfulness level and FCR in the experimental group were significantly higher than those in the waiting group.The scores of emotional function and cognitive function were significantly different from those of pre-test.In conclusion,compared to the waiting group,the mindfulness level,emotional function and cognitive function of the experimental group were significantly improved after mindfulness intervention,and the FCR was significantly alleviated,and these effects were still significant 1 month after the end of the intervention.In addition,through semi-structured interviews with the intervention group,it was found that all the participants did not reject mindfulness exercises,46.43% of the patients could fully accept mindfulness exercises;60.71% of the patients thought that mindfulness was very helpful to their daily life;82.14% of the patients performed mindfulness exercises at least three times a week;75% of the patients thought their improvement was closely related to mindfulness exercises.In mindfulness exercises,the most helpful technique was body scanning(71.43%).Conclusion:1.Fear of cancer recurrence is closely related to breast cancer survivors' mindfulness,resilience and the quality of life.The higher the level of FCR of breast cancer survivors,the lower the level of mindfulness and resilience,the worse each functional area of quality of life,Mindfulness adjusts the negative effects of FCR to their quality of life,which indicates mindfulness training can reduce breast cancer survivors' FCR and improve their quality of life.2.The score of 12 is the optimal cut-off point to screen high and low FCR of breast cancer survivors.Compared to the breast cancer survivors with low FCR,breast cancer survivors with high FCR have lower resilience,mindfulness level and quality of life.3.Breast cancer survivors with high and low FCR show no significant difference in attention bias of cancer-related cancer threat word cues.4.There are significant differences in the consistency and coordination of spontaneous neuronal activity between the left caudate nucleus and the right anterior wedge.There are significant differences in the coordination of brain signal activity and functional connections among the high and low FCR group in the posterior cerebellar lobe,frontal rear/orbital region,frontal subfrontal Gyrus,Occipital Gyrus,subparate lobules,and frontal Gyrus.5.Mindfulness intervention training can reduce FCR in breast cancer survivors,alleviate their negative emotions,and improve emotional function and cognitive function,and is a scientific method to help breast cancer survivors to recover from cancer.