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In 2020, there were 8.6 million new cases of female malignant tumors and 6.6 million deaths, and the proportion of new cases and deaths of cervical cancer in the world was 6.5% and 7.7%, respectively, both ranking fourth. In 2016, there were about 120,000 new cases and 37,200 deaths in China.
In 2005, the standardized incidence and mortality rate of cervical cancer in mainland China were 7.5/100,000 and 1.7/100,000, respectively, and reached 11.2/100,000 and 3.3/100,000 in 2016, showing a continuous upward trend. Cervical cancer can be prevented by HPV vaccination and screening of key populations, so cervical cancer is considered the most promising malignancy to eliminate.
However, the mainland cervical cancer screening program was only implemented in 2009, and the HPV vaccine was approved in 2016, but the current population coverage rate of the whole population screening program is only 21.4%, and the HPV vaccine has not yet been included in the national immunization plan, and the vaccination coverage rate is low.
A study on cervical cancer elimination modeling in China reported that under the current cervical cancer prevention strategy, the incidence of cervical cancer will continue to increase, and it is expected that by 2100, the annual standardized incidence of cervical cancer in China will reach 32.58 per 100,000.
If China implements an optimal vaccination and screening program from 2020 onwards, achieving 95% vaccination coverage for 12-year-old girls, 90% for women aged 45 and older and 30% in urban areas and 30% in rural areas, China could eliminate cervical cancer as early as 2060.
At present, patients with early cervical cancer and no contraindications to surgery mainly take radical hysterectomy + lymphatic dissection as the treatment plan, and implement a comprehensive treatment plan in a planned manner through postoperative pathological high-risk factor examination. The five-year survival rate of patients with early-stage cervical cancer with surgical resection and comprehensive treatment can reach 90%, and the five-year survival rate of patients with advanced cervical cancer IIB-IVA is 70%.
As treatment ends, cancer patients generally report restlessness, fear, and fear, and managing cancer recurrence is more challenging than coping with a cancer diagnosis. In a study of 996 Chinese cancer patients, 54.52% of cancer patients reported moderate fear of cancer recurrence and 13.76% of cancer patients reported high fear of cancer recurrence. The potential likelihood of recurrence and prolonged survival of cervical cancer increase the psychological experience of fear of cancer recurrence.
The negative effects of fear of cancer recurrence on all aspects of the patient persist from diagnosis to completion of treatment, and even though the objective risk of recurrence is low, there is still a high fear of cancer recurrence. Low levels may play an adaptive function by keeping cancer survivors alert for signs of recurrence.
Higher levels of fear of cancer recurrence may lead to lower emotional experiences, looser relationships, lack of planning for the future and significant reduced quality of life, as well as unnecessary medical examinations and increased healthcare costs. Regarding the factors influencing the fear of cancer recurrence, results were reported to vary. Based on the common sense model, the predictors of fear of cancer recurrence were explored, and low self-esteem, female gender, and longer time after diagnosis were important predictors of cancer patients.
There was a statistical association between fear of cancer recurrence and receiving radiotherapy/chemotherapy in patients who underwent radical surgery who may experience higher levels of fear of cancer recurrence, and often requiring adjuvant chemoradiotherapy after radical surgery.
Not only that, radical cervical cancer resection increases the burden on patients' self-image, but also suffers from unique gynecological cancers involving personal privacy, sexual history, future fertility and marital relationships, and fears that cancer recurrence will bring a deeper burden to themselves and their families, which may lead to higher levels of fear of cancer recurrence in patients after radical cervical cancer resection.
Coping is a practical effort by an individual to assess cognitive and coping resources for dealing with a stressful event in order to control stress within a tolerable range and minimize psychological distress.
In three longitudinal studies of 248 survivors, no cancer coping style was found to be significantly associated with cancer survival or recurrence, but significantly associated with persistent anxiety, which increases fear of cancer recurrence and reduces treatment adherence in the long term.
Positive coping can effectively reduce anxiety levels and reduce psychological stress, so guiding patients to adopt adaptive coping styles may be beneficial in managing the fear of cancer recurrence. Psychological and social factors are closely related to cancer patients, and social support can make cancer patients more accurately predict and understand their experiences, underestimating the destructive nature of stressful situations.
and alleviating fear of cancer recurrence by improving subjective perception and self-coping skills and reducing the assessment of the severity of stressful disease events. In a study of 342 breast cancer patients in Yancheng, China, it was found that social support was an independent predictor of cancer recurrence fear, and social support could promote positive psychological adjustment and improve cancer recurrence fear.
On the other hand, social support is one of the interpersonal resources that help to cope with stressors, and social support can promote social cognitive changes through a positive reassessment of one's own situation, and increase an individual's ability to solve problems and cope with stress.
Positive coping plays a part-mediating role in the social support and psychological stress of cancer patients, and cervical cancer patients have unmet needs in terms of information acquisition, emotional experience, care access, work and economy, which will cause patients to have a higher perceived risk of recurrence, resulting in persistent worry and anxiety about cancer recurrence, and lead patients to adopt poor coping methods, thereby increasing the fear of cancer recurrence.
Fear of cancer recurrence refers to the psychological state in which patients are worried about disease progression in a stable state and afraid of disease recurrence and metastasis after treatment, which will bring various biosocial and psychological changes to patients.
Have five distinct features of high sensitivity to physical symptoms, persistent anxiety, rumination or frequent belief in relapsing intrusive thoughts; Subjective avoidance of cancer information, frequent seeking of medical examinations and other ineffective coping methods; potential and persistent adverse effects on physical and mental functioning; Excessive anxiety disease conditions; Loss of confidence and behavior in planning for the future.
Social support is a resource or means for an individual to relieve stressful events and improve physical and mental well-being through emotional interaction, information exchange, instrumental support, and re-evaluated interpersonal interaction. Social support from different sources can effectively reduce the negative effects associated with stress by actively reassessing one's own situation, promoting social cognitive change, increasing an individual's ability to solve problems and cope with stress.
Coping style is the actual effort made by the individual to deal with the assessment of cognitive and coping resources to deal with stressful events, in order to control stress within a tolerable range and minimize psychological pain, better personal coping resources and psychological resilience are related to positive coping styles, adaptive coping styles can effectively cope with stress and conflict life events, reduce patients' psychological state and improve quality of life.
Fear of cancer recurrence status quo
Foreign attention to the fear of cancer recurrence is increasing year by year. Cancer recurrence fear was originally mainly studied in breast cancer patients, and now it has been deeply extended to other types of cancer, paying more attention to the influencing factors, assessment scales and different cancer recurrence fear theoretical models and interventions guided by them.
However, it can be determined that different age characteristics and heavier physical symptoms are significantly associated with high fear of cancer recurrence, and 85.2% of adolescents and young adult (15-39 years old) cancer survivors will have a higher fear of recurrence than other age stratifications, which is related to their stronger treatment intensity and more serious psychological burden, so it is necessary to timely assess the physical and mental status of adolescents and young adult cancer patients to identify possible cancer recurrence and improve their quality of life.
The lower intestinal microbial diversity caused by chemotherapy can affect the fear of cancer recurrence, and another study has reported that the invasive idea of post-traumatic stress symptoms causes the fear of cancer recurrence and the cognitive processing model of cancer recurrence fear, which is believed to be related to the intrusive thinking that is difficult for patients to eliminate, and post-traumatic stress symptoms can significantly predict the incidence of fear of cancer recurrence, and even higher than the influence of sociodemographic factors on fear of recurrence.
The three major fears of cancer recurrence in cervical cancer survivors were identified: (1) fear of what would happen to their families; (2) fear of pain; (3) Fear of disease progression. and finding that anxiety and low functioning status are independent predictors of high levels of fear of cancer recurrence in cervical cancer survivors, and qualitative research expands the understanding of the significance of fear of cancer recurrence in cervical cancer survivors.
The clinical screening ability and clinical cut-off values of the Cancer Recurrence Fear Simplified Scale were evaluated in 2 samples to identify clinically significant survivors of cancer recurrence fear, and the Cancer Recurrence Fear Simplified Scale had high sensitivity and specificity for population screening when the cut-off value was N22.
Interventions based on the theoretical model of fear of cancer recurrence mainly include psychological interventions, and cognitive behavioral therapy and mindfulness therapy have been shown to be beneficial in reducing the fear of cancer recurrence. The traditional implementation methods mainly include individual face-to-face and group intervention, but in recent years, the rise of electronic consultation based on the Internet or network has produced better intervention effects.
A targeted e-health intervention that used cognitive behavioral skills training and remote coach coaching in 196 patients with stage I-III breast cancer to promote patient ignorance and avoidance of fear of recurrence drove the development of e-health intervention models in fear of cancer recurrence.
The use of receptive and committed therapies to promote adaptive responses to manage fear of cancer recurrence in 91 breast cancer patients with high adherence and participation showed that the intervention showed a reduction in fear of cancer recurrence at any point during the six-month intervention period.
Cancer recurrence fears the current situation in China
Cervical cancer patients in different states were reported in China to have significant fear of cancer recurrence, and the FOP-Q-SF scores were higher than the norm. It was found that age, monthly household income, family resilience, and cancer health literacy could explain 57.2% of the mutations in the fear of disease progression in patients with concurrent chemoradiotherapy for cervical cancer, while the differences in marital status and medical expense payment methods were not statistically significant, and family resilience and cancer health literacy of cervical cancer patients should be improved.
The self-management behavior of cervical cancer patients is significantly correlated with the fear of cancer recurrence, and helping patients to adopt positive coping methods can improve the patient's self-management level, thereby reducing the fear of cancer recurrence. Fear of cancer recurrence not only exists in cancer patients, but also in caregivers of cancer patients due to the burden of care and the experience of care, and there is a certain relationship between the two cancer recurrence fears.
The high psychological resilience of spouses can positively increase family resilience and close relationship between husband and wife, make patients optimistic and positive, better resist cancer recurrence stressors, reduce patients' fear of cancer recurrence, and promote spouses to maintain a good emotional state, adopt healthy behaviors, and reduce the fear of cancer recurrence in spouses.
The professionalism and convenience of professional management of the network mobile platform can effectively improve the health literacy of patients, reduce the misinterpretation of benign physical symptoms and the correct identification of recurrent symptoms, avoid the fear of recurrent cancer, enhance patients' ability to manage cancer, improve the prognosis of breast cancer patients, and improve the quality of continuous care for patients with nasopharyngeal carcinoma.
Therefore, on the basis of foreign research, we can devote ourselves to developing specialized assessment tools for various cancer types to effectively identify the optimal tipping point of clinical recurrence fear in different types of cancer patients, and at the same time manage the efficacy and economic cost of cancer recurrence fear intervention, so as to achieve better prognosis and higher quality of life for patients.