Fear of Cancer Recurrence in Adult Survivors of Childhood Cancer.

Importance: Fear of cancer recurrence is common among survivors of adult-onset cancer and associated with increased distress, functional impairment, and health care utilization. However, little is known about the prevalence and risk factors of fear of cancer recurrence among adult survivors of childhood cancer who are also at high risk for subsequent malignant neoplasms. Objective: To characterize the prevalence of and risk factors for clinically significant fear of cancer recurrence in adult survivors of childhood cancer. Design, Setting, and Participants: This cross-sectional investigation included participants recruited from the Childhood Cancer Survivor Study, a retrospective cohort study of long-term childhood cancer survivors treated at 31 institutions between 1970 and 1999 across North America. Participants were recruited and completed psychosocial measures via online survey between October 2018 and April 2019. Cancer and treatment-related variables were abstracted from medical records. Data were analyzed from May 2023 to July 2024. Main Outcomes and Measures: Clinically significant fear of cancer recurrence was assessed via the Fear of Cancer Recurrence Inventory-Short Form. Poisson regression models estimated prevalence ratios (PRs) with 95% CIs adjusted for age and sex to examine the associations of demographic, disease, treatment, and psychosocial variables with fear of cancer recurrence. Results: The final sample included 229 adult survivors of childhood cancer (115 female [50.2%]; mean [SD] age, 39.6 [9.9] years; mean [SD] time since diagnosis, 31.7 [8.4] years). Among survivors, 38 (16.6%; 95% CI, 11.6%-21.6%) reported clinically significant fear of cancer recurrence, and an additional 36 (15.7%) reported high fear of cancer recurrence. Clinically significant fear of cancer recurrence was associated with unemployment (PR, 2.5; 95% CI, 1.3-4.8), presence of neurologic chronic health conditions (PR, 3.3; 95% CI, 1.8-6.1), treatment with pelvic radiation (PR, 2.9; 95% CI, 1.5-5.6), and amputation or limb sparing surgery (PR, 2.4; 95% CI, 1.2-4.9). Higher risk of clinically significant fear of cancer recurrence was also associated with having either elevated anxiety or depression (PR, 2.6; 95% CI, 1.2-5.9), having both elevated (PR, 3.2; 95% CI, 1.2-8.4), and perceived poor health status (PR, 3.0; 95% CI, 3.1-9.7). Conclusions and Relevance: Decades following treatment, one-third of childhood cancer survivors in this study reported elevated fear their cancer will recur or a subsequent malignant neoplasm will develop. Findings suggest that fear of cancer recurrence should be routinely screened, and clinically significant symptoms intervened upon as a part of survivorship care.

Fear, anxiety, and knowledge levels of women who underwent gynecologic surgery during the COVID-19 pandemic.

OBJECTIVE: The objective of this study was to evaluate the fear, anxiety, and knowledge level in women who underwent gynecological surgical procedures during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted on 188 women who underwent a gynecologic surgical operation in Mugla, Turkey. Data were collected by using demographics and obstetric detail form, questionnaire on knowledge, attitudes, and practice toward COVID-19, and State-Trait Anxiety Inventory-I (STAI-I). RESULTS: Most of the women perceived their surgical process as very urgent. Women felt fear mostly for being infected with the virus, and they were afraid of transmitting COVID-19 to another one. The COVID-19 knowledge scores of women who had undergone cancer surgery were statistically significantly higher than others (p=0.017). The STAI-I scores of women increased as their COVID-19 knowledge scores increased (p<0.05). CONCLUSION: This study demonstrated that women were afraid of COVID-19 infection during gynecological operation and due to hospitalization, sociodemographic characteristics affected the knowledge levels about COVID-19 infection, and the anxiety levels of the women. Planning appropriate interventions to decrease the fear and anxiety of women who undergo gynecological surgery during the pandemic is important to ensure that women adhere to their treatment and follow-up in the postoperative period.

The Persian version of the fear of pain questionnaire mong Iranian post-surgery patients: a translation and psychometrics.

INTRODUCTION: The Fear of Pain Questionnaire (FOPQ) is a self-report tool designed to measure an individual's fear of pain (FOP). While the Persian version of the FOPQ (FOPQ-P) has been developed, its validity and reliability have not yet been assessed in the Iranian context. This study aims to evaluate the psychometric properties of the FOPQ-P among Iranian patients after surgery. METHODS: A methodological study was conducted in 2023 involving 400 post-surgery patients selected with a convenience sampling. The FOPQ was translated into Persian, and its psychometric properties were analyzed using network analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), as well as assessments of convergent and discriminant validity. Internal consistency was measured using Cronbach's alpha, McDonald's Omega, average inter-item correlation coefficient, Composite Reliability, and Maximal Reliability. RESULTS: The EFA results with Promax and Kaiser Normalization rotation identified two factors that explained 54.32% of the variance, comprising seven items. The CFA confirmed the model's validity. Both convergent and discriminant validity were established. The reliability analyses showed that Cronbach's alpha, McDonald's omega, composite reliability, and MaxR for all constructs were above 0.7. Additionally, the average inter-item correlation coefficient was greater than 0.5, indicating strong internal consistency and construct reliability. CONCLUSION: The findings suggest that the FOPQ-P possesses a valid structure and was acceptable reliability in patients cultural context of Iran post-surgery, making it a suitable instrument for measuring fear of pain in this population.

Research on the comprehensive child life intervention program (CCLIP) for adjusting medical fear in children with central nervous system (CNS) cancers: a randomized controlled trial study protocol.

BACKGROUND: Medical fear is a common psychological reaction in hospitalized children, especially during radiotherapy for central nervous system (CNS) cancers. This fear not only causes negative emotions such as anxiety and depression but also affects children's quality of life and treatment outcomes. It is exacerbated by factors such as unfamiliar environments during radiation therapy and separation from parents. Child Life, as a professional service, offers physical and mental support to children through medical understanding and psychological preparation, addressing their social and psychological needs, among other things. This study aims to construct a comprehensive Child Life intervention program (CCLIP), consisting of four key components: psychological adjustment and preparation, therapeutic play, pain management and coping strategies, and family support. The integration of effective intervention methods aims to reduce medical fear in children undergoing radiotherapy, promote psychological well-being, improve treatment compliance, and enhance quality of life. METHODS: This study is a protocol for a randomized controlled trial. Using a random number table method, we plan to recruit 38 eligible children who meet the inclusion criteria and then randomize them into two distinct groups: the intervention group and the control group. The intervention group will receive the CCLIP, and the control group will receive standardized care. Data will be collected through questionnaires and on-site assessments during the one-month intervention period at four distinct time points: the day of admission (T0), the first radiotherapy positioning (T1), mid-radiotherapy (T2), and postradiotherapy (T3). The primary outcome measure is the effectiveness of the CCLIP in reducing medical fear among children receiving radiation treatment for CNS cancers. Secondary outcomes include anxiety, depression, radiation adherence, quality of life among children, and parental satisfaction. DISCUSSION: This study aims to alleviate medical fear among children with CNS tumors undergoing radiotherapy through the implementation of the CCLIP while enhancing their mental health and quality of life. The expected outcomes of this research include providing effective intervention strategies for clinical practice, improving the treatment experience and long-term prognosis of children, and having positive impacts on children and their families. TRIAL REGISTRATION: This study is registered at the Chinese Clinical Trial Registry, ChiCTR2400082622. Registered 2 April, 2024.

Changes in health-related quality of life, depression, and fear of progression during oncological inpatient rehabilitation and beyond: a longitudinal study.

PURPOSE: Studies evaluating oncological inpatient rehabilitation rarely include follow-up intervals beyond 6 months and larger proportions of patients other than those with breast cancer. Therefore, this study investigated changes in health-related quality of life (HRQoL), depression, and fear of progression of patients with breast, colorectal, or prostate cancer from the beginning to the end of oncological rehabilitation and a 9-month follow-up. METHODS: Three hundred seventy-seven patients with breast, colorectal, or prostate cancer undergoing oncological inpatient rehabilitation (median age 61 years, 49% female) completed the EORTC QLQ-C30, the PHQ-9, and the FoP-Q-SF at each measurement point. Data analysis used 3 (tumor site) × 3 (time of measurement) repeated measures ANCOVAs with patient age and time since diagnosis as covariates. At each time point, we also compared our sample to the general population on the measures used. RESULTS: Having controlled for the covariates, we found significant effects of tumor site, which were small except for Diarrhea. Effects of time of measurement were often significant and in part at least medium in size indicating improvement of HRQoL and depression during rehabilitation. At follow-up, some HRQoL domains and depression deteriorated. Women with breast cancer, in particular, showed a greater decrease in emotional functioning then. Compared to the general population, the sample's HRQoL and depression were significantly worse on most occasions. CONCLUSION: Oncological inpatient rehabilitation may improve HRQoL. The subsequent and in part differential deterioration in some HRQoL domains suggests a need for further follow-up care within survivorship programs.

Study of knee pain, fear of falling, and quality of life among community-dwelling older adults, Northern Thailand.

Fall is the leading cause of disability and mortality due to unintentional injury in older adults. The aim of this study was to determine the prevalence and risk factors associated with knee pain, fear of falling, and quality of life among community-dwelling older adults in Northern Thailand. A cross-sectional study was conducted among older adults aged 60 and over. A total of 369 participants were enrolled from April to May 2024. Oxford knee score, a short version of the Falls Efficacy Scale International (FES-I) and World Health Organization quality of life-BREF-Thai, was measured. The results showed that the mean age was 69.4 years and 47 (12.7%) had a history of falls in the previous year. The prevalence of fear of falling was 39.3% for low, 22.5% for moderate, and 38.2% for high concern. Age, marital status, alcohol, history of falls, hypertension, arthritis, and osteoporosis were associated with fear of falling. After adjusting to age, gender, body mass index, education, marital status, smoking, alcohol, history of falls, and chronic disease, osteoarthritis of the knee was positively associated with increasing fear of falling (ß: 0.361; p<0.001), while quality of life was negatively associated with fear of falling (ß: -0.064; p<0.011). In conclusion, the identified determinants of fear of falling among the elderly indicated the need for fear of falling prevention programs targeting not only individual lifestyles but also chronic diseases. This study provides useful information that might help to develop and adopt effective policies for fear of falling control in Thailand.

Mediating effects of rumination on insomnia in cancer survivors: Influences of cancer-related fatigue, fear of recurrence, and psychological distress.

BACKGROUND: While advancements in cancer treatments have improved survival rates, they also lead to adverse effects such as insomnia, which significantly impacts survivors' sleep quality. OBJECTIVE: This study explores the influence of cancer-related fatigue (CRF), Fear of Cancer Recurrence (FCR), and psychological distress, with rumination serving as a mediating factor, on the insomnia experienced by cancer survivors. METHODS: The study involved 220 cancer survivors attending Shohada-e-Tajrish Hospital's oncology center in Tehran, Iran. Participants were selected through convenience sampling and completed several questionnaires: the Insomnia Severity Index, Fear of Cancer Recurrence Inventory, Cancer Fatigue Scale, Kessler Psychological Distress Scale, and Rumination Response Scale. RESULTS: The results showed that the tested model had a good fit, and the correlation matrix demonstrated significant positive correlations between CRF (0.46), FCR (0.15), psychological distress (0.55), and rumination (0.42) with insomnia in cancer survivors (p < 0.05). Notably, CRF (B = 0.356, p < 0.001) and psychological distress (B = 0.339, p < 0.001) affect insomnia both directly and indirectly through mediation by rumination, while the impact of FCR on insomnia was indirectly significant (B = 0.73, p < 0.05). CONCLUSION: The findings suggest that interventions focused on managing rumination could be potential targets to alleviate insomnia and improve the sleep quality of cancer survivors.

Score of fear of COVID-19 and physical activity level are related to the habitual consumption of dietary supplements.

The measures implemented to contain the COVID-19 pandemic resulted in both behavioral and lifestyle changes. The "Changes in Lifestyle-Related Behavior" instrument was developed to assess lifestyle-related behaviors in the Indian population. However, considering current knowledge, this instrument was not adapted for the Brazilian population. In addition, the relationship between fear of COVID-19 and consumption of dietary supplements has not yet been evaluated. Thus, we aimed to investigate the relationship between the use of dietary supplements with lifestyle behavior and the fear of COVID-19, as well as assess the psychometric properties of the Brazilian version of the "Changes in Lifestyle-Related Behavior" instrument. An online questionnaire assessed sociodemographic, occupational, anthropometric, physical activity (International Physical Activity Questionnaire-short form), fear of COVID-19, and lifestyle behavior data from 416 Brazilian adults (237 females; 18-60y). Mann-Whitney, Chi-square test, exploratory, and confirmatory analyses were applied. Exploratory and confirmatory analyses showed a satisfactory adequacy level of the questionnaire (CMIN/DF = 2.689; Cronbach's α = 0.60) with 5 domains ('Bad eating behavior'; 'Healthy eating'; 'Sleep quality'; 'Interest in cooking'; 'Number of portions and meals'). Lower fear of COVID-19 scores and higher levels of physical activity were found in participants who reported previous dietary supplement intake during the pandemic; in addition, the group that did not ingest dietary supplements reported greater changes in stress and anxiety levels during the pandemic (p<0.05). The intake of dietary supplements before the pandemic was associated with greater energy expenditure and better coping with the fear of COVID-19 during the pandemic. Additionally, the Changes in Lifestyle-Related Behavior tool can be used to assess lifestyle-related variables during the pandemic.

Determination of the effect of the pre-surgery COVID-19 fear level and hygiene behaviours of the patients on the personal protective clinical measures developed after the surgery: A cross-sectional study.

AIM: This study aims to examine patients' preoperative COVID-19 fear levels, hygiene behaviours, postoperative personal protective clinical measures, and their correlations with each other. DESIGN: This research is a cross-sectional type of study. METHODS: The study sample consisted of 131 patients hospitalized in the general surgery inpatient ward of a hospital in Turkey. The sample was determined by G-Power analysis. The data were collected in two stages in a research hospital between 1 April 2021 and 1 March 2022. Sociodemographic and Clinical Information Form, COVID-19 Fear Scale, COVID-19 Hygiene Scale were used before surgery; COVID-19 personal protective clinical measures questionnaire was used after surgery. Descriptive statistics, independent t-test, ANOVA test, Wilcoxon test and Spearman correlation analysis were used to evaluate the data. RESULTS: It was determined that preoperative COVID-19 fear levels, hygiene behaviours, and the personal protective clinical measures developed after the surgery were above moderate. A statistically significant and positive correlation was found between the COVID-19 Fear Scale and the preoperative COVID-19 Hygiene Scale and postoperative COVID-19 personal protective clinical prevention questionnaire total score and sub-dimension score averages. Patients' COVID-19 fears, preoperative and postoperative hygiene behaviours are statistically significantly associated with each other at a low level; postoperative clinical precautions and preoperative hygiene behaviours are statistically significantly associated with each other at a high level. CONCLUSION: The results of this study show that patients are terrified of COVID-19 while they are hospitalized due to surgical intervention during the pandemic process, and they increase their hygiene measures. It is thought that the results of the study will guide the regulation of clinical measures, patient education, and nursing care to be developed for patients during pandemic periods. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Influence of the kinesiophobia and its pain intensity relationship in subjects with onychocryptosis.

Background: Onychocryptosis is a nail deformity that occurs when the side of the nail grows into soft tissue, which causes pain, sepsis and the formation of granulation. The aim of the study was to evaluate and compare different levels of kinesiophobia in subjects with onychocryptosis before and after surgery to eliminate this condition. Methods: A descriptive and observational study was conducted with a total sample size of 25 subjects with a mean age of 40.96 ± 18.25 years. The pretest sample was composed of the 25 subjects before the surgical treatment of onychocryptosis and the posttest sample was composed of the same 25 subjects after the surgical treatment of onychocryptosis. Kinesiophobia levels and total scores were self-reported using the Spanish version of the Tampa Scale for Kinesiophobia (TSK-11). Results: The Wilcoxon test for related samples and the Mann-Whitney U test for independent samples were used to compare the results before and after the surgical treatment. It was observed that in all the items as well as in the total score, there were significant changes in the levels of kinesiophobia, after the surgical intervention for onychocryptosis (P < 0.05) compared to the levels before surgery, except for items 4 and 11 in which there were no significant differences (P > 0.05). Before surgery, 0% of the subjects with onychocryptosis reported not being afraid of movement, 16% reported mild fear of movement, 8% reported moderate fear of movement and 76% of the subjects with onychocryptosis reported severe and maximum fear of movement. On the other hand, 100% of the subjects did not report kinesiophobia after surgical treatment (P < 0.01). Conclusions: The levels of kinesiophobia were higher in the subjects with onychocryptosis compared to the subjects after having undergone surgery to eliminate onychocryptosis.

[Anxiety and fear at the end of life]. / Angst und Furcht am Lebensende.

INTRODUCTION: Fears and anxieties are a common cause of suffering for patients at the end of life. These are often either fears about dying - for example, fear of unbearable pain or fear of suffocation - or fear of death itself. If unrecognized and untreated, fears and anxieties can contribute to a considerable reduction in the quality of life in the last phase of life. Careful diagnosis of anxiety and fear is therefore crucial. Multimodal treatment, which includes psychotherapy and other non-pharmacological and - if necessary - pharmacological treatments, can provide significant relief.

Predictors of return to work after spinal surgery : systematic review and Meta-analysis.

PURPOSE: To analyze the situation and influencing factors of patients returning to work after spinal surgery, and to provide reference for clinical intervention measures of patients returning to work after spinal surgery. METHODS: A computer search was conducted in Chinese and English database on the situation and influencing factors of patients returning to work after spinal surgery from the establishment of the database to February 2023. Meta-analysis was performed using RevMan 5.3 and StataMP 17.0 software. RESULTS: A total of 10 literatures were included, involving 11,548 subjects. Meta-analysis results showed that 58% of patients returned to work after spinal surgery [95%CI (0.47-0.69)]. Gender [OR = 2.41, 95%CI (1.58-3.37)], age [OR = 1.32, 95%CI (1.03-1.51)], job nature [OR = 5.94, 95%CI (3.54-9.62)], education level [OR = 0.23, 95%CI (0.06-0.48)], fear of disease progression [OR = 0.82, 95%CI (0.84-0.95)], and social support [OR = 1.21, 95%CI (1.12-1.37)] were the influencing factors for patients returning to work after spinal surgery. CONCLUSION: The rate of patients returning to work after spinal surgery is low, and is affected by many factors. Medical personnel should pay comprehensive attention to the above high-risk groups and give timely intervention and support.

The effect of brochure-assisted education given before septorhinoplasty on surgical fear and anxiety: A randomized controlled trial.

This study is a randomized controlled interventional study aimed to determine the effect of preoperative brochure-assisted education on surgical fear and anxiety in patients scheduled for septorhinoplasty surgery. The study was conducted between May 2022 and February 2023 in the Otorhinolaryngology services and clinics of a training and research hospital in the southern region of Turkey. The study included 61 patients, with 29 in the education group and 32 in the control group. All patients received routine nursing care before surgery, with the education group receiving additional education through an informative brochure. The data were collected using the "Personal Information Form", "Surgical Fear Questionnaire", and "Surgical Anxiety Questionnaire". There was no significant difference in the mean scores of surgical fear between the groups on the morning of the surgery (p > 0.05). However, a significant difference was found in the mean scores of surgical anxiety between the groups (p < 0.05). In conclusion, patients in the education group who received preoperative brochure-assisted education had lower anxiety compared with the control group.

Understanding sex differences in extinction retention: Pre-extinction stress and sex hormone status.

Difficulties in fear regulation can sometimes result in maladaptive fear responses. To better understand how to improve fear regulation, it is important to determine how known factors, such as sex hormone status and stress, might interact to influence fear memory. Research has shown that women with high estradiol levels (mid-cycle) and men exhibit better extinction retention compared to women with low estradiol levels (women in the early follicular cycle or using oral contraceptives). Stress has also been demonstrated to affect both the learning and retention of extinction. Despite documented interactions between stress and sex hormones, their combined effects have not been thoroughly studied. This study aims to examine the impact of stress as a function of sex hormone status on extinction learning and retention. A total of 168 non-clinical participants were studied, including men (n = 46), women using oral contraceptives (n = 38), women in the early follicular phase (n = 40), and women in mid-cycle (n = 44). On Day 1, fear acquisition training was performed. On day 2, prior to extinction training, half of the participants were exposed to a psychosocial stressor, while the other half performed a non-stressful control task. On day 3, extinction retention was tested. Fear was quantified using skin conductance responses, while stress hormones were quantified through saliva samples. Exposure to stress prior to extinction training did not affect extinction learning, regardless of sex hormone status. In contrast, pre-extinction stress exposure had different effects on extinction retention depending on hormone status. Stressed men showed impairment in extinction retention compared to controls, while the experimental condition had no effect on naturally cycling women. Regardless of stress exposure, early follicular women exhibited a deficit in fear regulation, while mid-cycle women showed effective fear regulation. Among women using oral contraceptives, the stress group demonstrated better extinction retention compared to the control group. These results demonstrate the importance of considering sex hormone status and stress exposure during extinction learning, as both components may modulate extinction retention. These results could help identifying hormonal conditions that may enhance the effectiveness of extinction-based psychological therapies used in the treatment of fear-related disorders.

Ecosystem Barriers and Facilitators Linked to the Fear of Cancer Recurrence: An Umbrella Review.

The fear of cancer recurrence is an important topic in the healthcare field. In general, approximately 40% of survivors experience high levels of fear of recurrence. This study aims to fill this gap by synthesizing the findings of systematic reviews studies investigating ecosystems, correlates or predictors, and barriers and facilitators of fear of cancer recurrence among cancer survivors. An umbrella meta-synthesis was conducted using the following databases: MEDLINE, PsycINFO, PsycARTICLES, CINAHL, Business source premier, and SOCindex, ending in April 2024 with PRISMA methods. A total of 24 systematic reviews, representing 729 articles, were included in the study. In total, six ecosystems were identified, including family, work, friends, the healthcare system, caregivers, and religion. As part of this umbrella review, 55 specific ecosystemic factors were identified that may contribute to fear of cancer recurrence. Furthermore, the umbrella review identified 12 facilitators and 12 barriers related to fear of cancer recurrence. This umbrella meta-synthesis contributed significantly to our review's strength in synthesizing the main ecosystem and its influence on fears of cancer recurrence. Understanding the interdependence of ecosystems should enable future research on intervention effectiveness or the development of interventions that could reduce the fear of cancer recurrence.

Beyond breast cancer: An exploration of the experiences of middle-aged female breast cancer survivors in Australia.

OBJECTIVES: Middle-aged women (i.e., aged 40-65 years) who live with, through and beyond breast cancer (survivors) are an under-researched population, particularly within an Australian context. The unmet needs reported within this population include fatigue, psychological distress, body image concerns, early-onset menopause, and a lack of information on these issues. This study explores how the experiences of breast cancer survivorship impact the lives of Australian middle-aged women. STUDY DESIGN: Qualitative analysis of written comments in an open text field of a survey completed by 644 women reporting breast cancer in the middle-aged cohort of the Australian Longitudinal Study of Women's Health gathered between 1996 and 2013. Data was collected from any participants who reported breast cancer in any survey. Researchers conducted a thematic analysis using consensus coding on data and identified key themes. MAIN OUTCOME MEASURES: Any data where participants described their experiences of breast cancer survivorship. RESULTS: This cohort reported a unique experience of breast cancer survivorship due to their age group. Analysis developed the following themes: the middle-aged context of breast cancer; care and support, body changes, overcoming fears and maintaining balance; and finding a 'new normal'. CONCLUSIONS: Breast cancer survivorship is a diverse experience. For many it involves chronic limitations and challenges. Investigation and application of survivorship care plans in Australia could benefit breast cancer survivors by including multidisciplinary health professionals in their care. Unmet needs and psychological distress were described by participants rather than biomedical concerns. Further recommendations include development of online support groups providing access to rehabilitation professionals, especially for otherwise isolated rural women.

In the medium term, more than half of males report kinesiophobia after anterior cruciate ligament reconstruction.

OBJECTIVES: Anterior cruciate ligament rupture is a serious trauma with long-term consequences for the patient. Psychological and physiological factors may negatively affect patient recovery after anterior cruciate ligament reconstruction (ACLR), and development of kinesiophobia is possible. The aim of this study was to examine the presence of kinesiophobia and lower-leg muscle strength recovery in both sexes after ACLR. METHODS: 140 ACLR patients agreed to participate in the study. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). The Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Tegner Activity Scale (TAS) were used for patient-related outcome measurements. In both legs quadriceps and hamstring muscle strength at 60°/s and 180°/s were measured with an isokinetic dynamometer. For dynamic balance and leg function, the Y-balance test and single-leg hop test were used. RESULTS: 100 (71%) males and 40 (29%) females-mean age 32.5 (±8.3)-were examined 5.5 (±1.25) years after ACLR. 68/140 patients (48.6%) reported a TSK kinesiophobia score equal to or higher than 37 points: 54/100 (54%) males and 14/40 (35%) females (p â€‹= â€‹0.04). Patients with kinesiophobia had significantly lower KOOS values (p â€‹< â€‹0.001). In terms of the TAS no significant differences were found between those with or without kinesiophobia. Knee strength deficiency at 180°/sec and 60°/sec was significantly higher in the kinesiophobia group in knee extension in males (p â€‹= â€‹0.009) and knee flexion in females (p â€‹= â€‹0.001). Normalized body weight isokinetic average peak torque strength tests were significantly better in males compared to females in both groups (p â€‹< â€‹0.001). CONCLUSION: Both sexes reported high rates of kinesiophobia, but males are at higher risk of developing kinesiophobia than females in the medium term after ACLR. Furthermore, patients with kinesiophobia have significantly lower total KOOS scores, and females were significantly weaker than males in knee flexion and extension according to normalized body weight muscle strength tests. Also, a longer time from injury to surgery increases the risk of kinesiophobia in females. LEVEL OF EVIDENCE: Level IV. TYPE OF STUDY: Retrospective case series study. CLINICAL TRIAL REGISTRATION: Trial registration in ClinicalTrials.gov. Identifier: NCT05762809.

Fear of cancer recurrence experienced by pediatric survivors of childhood cancer: a scoping review.

PURPOSE: In contrast to the extensive literature on fear of cancer recurrence (FCR) experienced by adults, literature evaluating pediatric FCR has just begun to emerge. Given the rapidly expanding body of work assessing FCR in childhood and adolescence, a scoping review was conducted to synthesize existing findings. We aimed to assess (1) the characteristics and methods of this literature, (2) how pediatric FCR has been measured, and (3) the extant knowledge of FCR experienced by pediatric survivors of cancer. METHODS: Inclusion criteria were: (1) original reports, (2) participants diagnosed with cancer before age 18, (3) current mean age under 18, (4) FCR was explicitly measured (quantitatively) or captured (qualitatively) via survivor self-report, and (6) published in English. Exclusion criteria were: (1) case studies, and (2) grey literature. Three databases (Embase, MEDLINE, PsycINFO) and reference lists from included studies were searched. All studies were screened for inclusion by two authors and all data were extracted by a single author. RESULTS: Of 3906 identified studies, 19 were included. Studies (published 1991 - 2023) encompassed diverse geographical locations, study designs, and measurement methods. Few assessed FCR as a primary aim (n = 6, 32%). FCR was experienced by 43 - 90% of pediatric survivors. FCR was often positively associated with somatic symptoms and negatively associated with quality of life and emotional functioning. CONCLUSION: FCR is a prevalent issue for children and adolescents. Additional evidence is needed to explore and confirm preliminary findings. Future pediatric FCR studies should aim to align with published priority research areas.

Music Therapy and Music Intervention for NSCLC Patients Undergoing PET with Fear of Cancer Recurrence.

Background: Cancer and psychiatric symptoms are associated. Fear of cancer recurrence (FCR) is the most common psychological problem for cancer survivors. Pharmacological interventions can help, but also have major drawbacks. Music therapy and music interventions have been shown to be a safe and practical complementary treatment. Objective: This randomized, controlled trial aimed to investigate the effects of music therapy and music intervention in attenuating non-small cell lung cancer (NSCLC) patients' anxiety related to FCR. Methods: NSCLC patients with FCR were randomly allocated to a music therapy and intervention group (G1) and Control group (G2). Patients' anxiety was measured using the State-Trait Anxiety Inventory scores and heart rates. Primary outcome measure were PET scans. Secondary measures were salivary cortisol, salivary α-amylase levels and heart rate. Findings: Patients in G1 showed higher glucose metabolism of 18F-FDG in the superior frontal gyrus, anterior cingulate, superior temporal gyrus, and parahippocampal gyrus, compared to those in G2 (all P < .001). Heart rates and salivary α-amylase area under the curve (AUC) and relative variation (VAR) in G1 were significantly lower than those in G2 (all P < .05). State-Trait Anxiety Inventory scores and cortisol AUC in G1 were significantly lower than those in G2 (all P < .05). Conclusions: Music therapy and interventions can reduce anxiety and endocrinological responses and change glucose metabolism of 18F-FDG in fear-related brain regions.Trial registration: Registered retrospectively, ISRCTN Registry, www.isrctn.com, ISRCTN23276302Clinical Implications: Cancer treatment centers and physical examination centers should consider providing music therapy and intervention to the appropriate patients as a routine component of a comprehensive clinical care during medical examinations.

Differences in Fear and Negativity Levels Between Formal and Informal Health-Related Websites: Analysis of Sentiments and Emotions.

BACKGROUND: Searching for web-based health-related information is frequently performed by the public and may affect public behavior regarding health decision-making. Particularly, it may result in anxiety, erroneous, and harmful self-diagnosis. Most searched health-related topics are cancer, cardiovascular diseases, and infectious diseases. A health-related web-based search may result in either formal or informal medical website, both of which may evoke feelings of fear and negativity. OBJECTIVE: Our study aimed to assess whether there is a difference in fear and negativity levels between information appearing on formal and informal health-related websites. METHODS: A web search was performed to retrieve the contents of websites containing symptoms of selected diseases, using selected common symptoms. Retrieved websites were classified into formal and informal websites. Fear and negativity of each content were evaluated using 3 transformer models. A fourth transformer model was fine-tuned using an existing emotion data set obtained from a web-based health community. For formal and informal websites, fear and negativity levels were aggregated. t tests were conducted to evaluate the differences in fear and negativity levels between formal and informal websites. RESULTS: In this study, unique websites (N=1448) were collected, of which 534 were considered formal and 914 were considered informal. There were 1820 result pages from formal websites and 1494 result pages from informal websites. According to our findings, fear levels were statistically higher (t2753=3.331; P<.001) on formal websites (mean 0.388, SD 0.177) than on informal websites (mean 0.366, SD 0.168). The results also show that the level of negativity was statistically higher (t2753=2.726; P=.006) on formal websites (mean 0.657, SD 0.211) than on informal websites (mean 0.636, SD 0.201). CONCLUSIONS: Positive texts may increase the credibility of formal health websites and increase their usage by the general public and the public's compliance to the recommendations. Increasing the usage of natural language processing tools before publishing health-related information to achieve a more positive and less stressful text to be disseminated to the public is recommended.