Emotional eating as predictor of weight loss 2 years after Roux-en-Y gastric bypass.

There has been little agreement on the predictive value of emotional eating on weight loss outcomes after bariatric surgery. The aim of this study was to examine the predictive value of preoperative emotional eating, in response to clearly labelled emotions and diffuse emotions, on excess weight loss (EWL) and total weight loss (TWL) 2 years after Roux-en-Y gastric bypass (RYGB). All participants included in this retrospective cohort study were screened for RYGB surgery by a multidisciplinary team. The level of emotional eating was derived from the Dutch Eating Behaviour Questionnaire (DEBQ); the level of psychological variables from the Symptom Checklist-90. Participants were clustered, based on their DEBQ score, in high and low emotional eaters. Multiple linear regression analyses were performed to examine the association between preoperative emotional eating and EWL, and TWL. There were no significant differences in EWL of the 172 included participants, defined as either high or low emotional eaters (EWL 82.7% ±18.2 versus 82.4% ±21.3, respectively). Based on the regression analysis, emotional eating was not significantly associated with EWL, nor with TWL. When corrected for psychological, demographic and biological variables, preoperative emotional eating in response to diffuse emotions negatively affected EWL (ß = -0.16, P = 0.048), although this was not applicable for TWL. Preoperative emotional eating does not seem to influence EWL, nor TWL 2 years after RYGB. Since this study faced multiple limitations, further investigation is required regarding the predictive value of emotional eating.

Long-term efficacy and cost-effectiveness of blended cognitive behavior therapy for high fear of recurrence in breast, prostate and colorectal Cancer survivors: follow-up of the SWORD randomized controlled trial.

BACKGROUND: Blended cognitive behaviour therapy (bCBT) is an effective treatment for fear of cancer recurrence (FCR) in curatively-treated breast, colorectal and prostate cancer survivors with high FCR. However, long-term outcomes are unknown. This study investigated the long-term efficacy and cost-effectiveness of bCBT compared with care as usual (CAU). METHODS: Eighty-eight cancer survivors with high FCR (Cancer Worry Scale ≥14) were randomly assigned to bCBT (n = 45) or CAU (n = 43). Data were collected at baseline and at three, nine and fifteen months from baseline and analysed by modified intention-to-treat. Efficacy was investigated with linear mixed-effects models. Cost-effectiveness was investigated from a societal perspective by comparing costs with quality-adjusted life-years (QALYs). RESULTS: Participants who received bCBT reported significantly lower FCR compared with CAU (mean difference of - 1.787 [95% CI -3.251 to - 0.323, p = 0.017] at 15 months follow-up), and proportionally greater self-rated and clinically significant improvement at each follow-up measurement. Total QALYs were non-significantly different between conditions when adjusted for utility score baseline differences (0.984 compared to 0.957, p = 0.385), while total costs were €631 lower (95% CI -1737 to 2794, p = 0.587). Intervention costs of bCBT were €466. The incremental cost-effectiveness ratio amounted to an additional €2049 per QALY gained, with a 62% probability that bCBT is cost-effective at a willingness to pay (WTP) threshold of €20,000 per QALY. Results were confirmed in sensitivity analyses. CONCLUSIONS: bCBT for cancer survivors with FCR is clinically and statistically more effective than CAU on the long-term. In addition, bCBT is a relatively inexpensive intervention with similar costs and QALYs as CAU. TRIAL REGISTRATION: The RCT was registered in the Dutch National Trial Register ( NTR4423 ) on 12-Feb-2014. This abstract was previously presented at the International Psycho-Oncology Society conference of 2018 and published online. (Psycho-oncology, 27(S3):8-55; 2018).

Re-validation and screening capacity of the 6-item version of the Cancer Worry Scale.

OBJECTIVE: Fear of cancer recurrence (FCR) is one of the major existential unmet needs of cancer survivors. Due to growing availability of evidenced-based interventions for high FCR, valid and reliable brief measures of FCR are needed. This study aimed to validate the 6-item Cancer Worry Scale (CWS) and to establish a cut-off score for high FCR. METHODS: Participants in this study were 1033 cancer survivors and patients recruited as part of 5 existing studies on FCR involving patients and survivors with gastro-intestinal stromal tumors, colorectal, breast, and prostate cancer. De-identified data of the CWS, Fear of Cancer Recurrence Inventory (FCRI), Impact of Event Scale, Hospital Anxiety and Depression Scale, and EORTC-QLQ-C30 were amalgamated for the analyses. Confirmatory factor analysis of the CWS was performed. Sensitivity and specificity were tested with the FCRI as gold standard. RESULTS: Results confirmed that the 6-item version of the CWS maintained good construct validity, convergent and divergent validity, and high internal consistency (α 0.90). The optimal cut-off for the 6-item CWS was 9 versus 10 using the 12 vs 13 FCRI-SF score (sensitivity 82%, specificity 83%) and the 15 vs 16 FCRI-SF score (sensitivity 88%, specificity 73%). Using the highest FCRI-SF cut-off (21 vs 22), the optimal CWS cut-off was 11 vs 12 (sensitivity 88%, specificity 81%). CONCLUSIONS: The present results provide researchers and clinicians with a brief valid and reliable measure of FCR which is suitable for measuring FCR in cancer patients and survivors.

Cognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study.

This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient's perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.

Efficacy of Blended Cognitive Behavior Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial.

Purpose Fear of cancer recurrence (FCR) is a common problem experienced by cancer survivors. Approximately one third of survivors report high FCR. This study aimed to evaluate whether blended cognitive behavior therapy (bCBT) can reduce the severity of FCR in cancer survivors curatively treated for breast, prostate, or colorectal cancer. Patients and Methods This randomized controlled trial included 88 cancer survivors with high FCR (Cancer Worry Scale score ≥ 14) from 6 months to 5 years after cancer treatment. Participants were randomly allocated (ratio 1:1, stratified by cancer type) to receive bCBT, including five face-to face and three online sessions (n = 45) or care as usual (CAU; n = 43). Participants completed questionnaires at baseline (T0) and 3 months later (T1). The intervention group completed bCBT between T0 and T1. The primary outcome was FCR severity assessed with the Cancer Worry Scale. Secondary outcomes included other distress-related measures. Statistical (one-way between-group analyses of covariance) and clinical effects (clinically significant improvement) were analyzed by intention to treat. Results Participants who received bCBT reported significantly less FCR than those who received CAU (mean difference, -3.48; 95% CI, -4.69 to -2.28; P < .001) with a moderate-to-large effect size ( d = 0.76). Clinically significant improvement in FCR was significantly higher in the bCBT group than in the CAU group (13 [29%] of 45 compared with 0 [0%] of 43; P < .001); self-rated improvement was also higher in the bCBT group (30 [71%] of 42 compared with 12 [32%] of 38 in the CAU group; P < .001). Conclusion bCBT has a statistically and clinically significant effect on the severity of FCR in cancer survivors and is a promising new treatment approach.

Fear of cancer recurrence: a significant concern among partners of prostate cancer survivors.

OBJECTIVES: The aims of the study were to (1) describe the prevalence of fear of cancer recurrence (FCR) in partners of prostate cancer (PCa) survivors; (2) to compare the proportions of high FCR in partners with high FCR in PCa survivors; (3) to explore partners' demographic and survivors' clinical characteristics associated with high FCR in partners; and (4) to identify the relationship between high FCR and health-related quality of life (HRQoL) in partners. METHODS: Questionnaires were sent to partners of disease-free PCa survivors. Outcomes included FCR severity (Cancer Worry Scale [CWS]) and HRQoL (RAND-36). The t and chi-square tests were used to compare partner FCR with survivor FCR. Regression analyses were performed to determine if demographic and clinical characteristics were significantly associated with partner FCR. The multivariate analysis of variance identified differences in HRQoL between partners with high and low FCR. RESULTS: Questionnaires were completed by 168 partners. Mean levels of FCR were comparable between partners and survivors (P = .144). Thirty-five percent of partners reported high FCR (CWS ≥ 14) compared to 38% of PCa survivors (CWS ≥ 13) (P = .542). Higher survivor FCR and younger partner age were significantly associated with higher partner FCR. Partners with high FCR scored significantly lower on social functioning, emotional role functioning, mental health, general health, and vitality than those with low FCR (all P < .05). CONCLUSIONS: Findings from this study illustrate that FCR is a significant concern for partners of PCa survivors. Clinicians should be aware of partner FCR when delivering care to men with PCa.

Fear of cancer recurrence in prostate cancer survivors.

Background High fear of cancer recurrence (FCR) is an understudied topic in prostate cancer (PCa) survivors. This study aimed to detect the prevalence, consequences and characteristics associated with high FCR in PCa survivors. Material and methods This cross-sectional study included patients diagnosed with localized PCa and treated with curative radical prostatectomy between 1992 and 2012. We administered the Cancer Worry Scale (CWS) to assess FCR severity (primary outcome measure). Secondary outcomes included distress, quality of life (QOL), post-traumatic symptoms, and multidimensional aspects of FCR. χ(2)-tests, t-tests and Pearson's correlations examined the relationship between FCR and medical/demographic characteristics. MANOVA analyses and χ2-tests identified differences between PCa survivors with high and low FCR. Results Two hundred eighty-three PCa survivors (median age of 70.0 years) completed the questionnaires a median time of 7.1 years after surgery. About a third (36%) of all PCa survivors experienced high FCR. High FCR was associated with lower QOL, more physical problems, higher distress and more post-traumatic stress symptoms. PCa survivors with high FCR reported disease-related triggers (especially medical examinations), felt helpless and experienced problems in social relationships. High FCR was associated with a younger age and having received adjuvant radiotherapy. Conclusions Results illustrate that FCR is a significant problem in PCa survivors. Younger men and those treated with adjuvant radiotherapy are especially at risk. Those with high FCR experience worse QOL and higher symptom burden. Health care providers should pay specific attention to this problem and provide appropriate psychosocial care when needed.

Does fear of cancer recurrence differ between cancer types? A study from the population-based PROFILES registry.

OBJECTIVE: Knowledge of factors associated with fear of cancer recurrence (FCR) may inform intervention development and improve patient care. The aims were (1) to compare FCR severity between cancer types and (2) to identify associations between FCR, demographics, medical characteristics, information provision and health-related quality of life. METHODS: Cross-sectional data were obtained from the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship registry. We included stage I and II survivors diagnosed with melanoma (n = 469), colorectal cancer (n = 861), endometrial cancer (n = 688), thyroid cancer (n = 218), Hodgkin (n = 103) and non-Hodgkin lymphoma (n = 276). Cancer survivors completed questionnaires on FCR (Impact of Cancer scale - Health Worries subscale), satisfaction with information provision (European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire (EORTC-QLQ) INFO25, satisfaction scale) and health-related quality of life (EORTC-QLQ C30, Short Form 36-item). RESULTS: A total of 2615 survivors completed the Impact of Cancer scale - Health Worries subscale. No significant differences in FCR severity were found between any of the cancer types (p = 0.063). A younger age, female gender, stage II disease, a shorter time since diagnosis, scheduled follow-up appointments and comorbidity were associated with higher FCR (p < 0.01). Satisfaction with information provision was negatively correlated with FCR severity (r = -0.16, p < 0.05). Demographic and medical factors accounted for 6% of explained variance in FCR. The full model, also including health-related quality of life, explained 15% and 19%, respectively. CONCLUSION: Fear of cancer recurrence seems to be a universal concern of cancer survivors rather than a cancer type-specific problem. Gender, age and medical factors were identified as risk factors. Copyright © 2015 John Wiley & Sons, Ltd.

Study protocol of the SWORD-study: a randomised controlled trial comparing combined online and face-to-face cognitive behaviour therapy versus treatment as usual in managing fear of cancer recurrence.

BACKGROUND: Fear of cancer recurrence (FCR) is one of the most frequently cited problems by cancer survivors. More than one third report high FCR, which is a clinical concern due to its association with negative health outcomes. The aim of the current study is to evaluate the efficacy of cognitive behaviour therapy (CBT) in reducing FCR in high fearful cancer survivors. METHODS/DESIGN: The SWORD-study has a randomised controlled design with two arms. A sample of 104 high fearful cancer survivors (breast, prostate or colorectal cancer) will be recruited from local hospitals. Cancer survivors will be randomised to receive CBT (intervention condition) or treatment as usual (control condition). For those in the intervention condition, the therapy will be individually delivered in a combination of 5 face-to-face therapy sessions and 3 online or telephone sessions by a trained therapist. Furthermore, these survivors will have access to a supportive website (or workbook) throughout the therapy. Survivors in the control condition will not receive the intervention and will not have access to the website. The primary outcome will be severity of fear of recurrence (Cancer Worry Scale). Quality of life (EORTC Quality of Life Questionnaire Core 30) and general psychological wellbeing will be assessed as secondary outcomes. Assessments will take place at baseline (before random assignment), at 3, 9 and 15 months after the baseline assessment. The study has been approved by an ethical review board. DISCUSSION: If the intervention proves to be effective an evidence-based therapy to manage high FCR will become available for use in clinical practice.

Chemotherapy and cognitive complaints in women with breast cancer.

BACKGROUND: Results of existing studies are inconclusive concerning the relationship between chemotherapy and subjective cognitive functioning (SCF). The aim of this study was to evaluate SCF of breast cancer (BC) patients and to find predictors of impaired SCF. Both satisfaction and frequency of complaints about SCF were measured. METHODS: BC patients who were about to receive chemotherapy (N = 74) and patients with a benign breast disease (BBD) (N = 63) participated. Before chemotherapy started (Time 1) and 3 months after ending chemotherapy (and at comparable moments for the BBD group) (Time 2), women completed validated questionnaires concerning the frequency of complaints and satisfaction with SCF, fatigue, perceived stress, anxiety, and depressive symptoms. RESULTS: No differences were found between the BBD and BC patients concerning the frequency of complaints about SCF across time. Satisfaction with SCF decreased across time in BC patients but remained stable across time in BBD patients (p < 0.001; p = 0.003 after controlling for state anxiety and perceived stress). Correlation coefficients between the satisfaction and the frequency of complaints about SCF ranged between -0.26 and -0.49. Depressive symptoms and satisfaction with SCF (Time 1) predicted the frequency of complaints about SCF (Time 2). Diagnosis, frequency of complaints about SCF, and state anxiety (Time 1) predicted satisfaction with SCF (Time 2). CONCLUSIONS: BC patients do not differ in the frequency of complaints about SCF compared with BBD patients, but their satisfaction with SCF decreased after treatment. Psychological factors predicted the frequency of complaints about SCF. Psychological factors and diagnosis predicted satisfaction with SCF.