TY - JOUR

T1 - The association between education and fear of recurrence among breast cancer patients in follow-up–and the mediating effect of self-efficacy

AU - Larsen, Cecilie

AU - Kirchhoff, Kirstine S.

AU - Saltbæk, Lena

AU - Thygesen, Lau C.

AU - Karlsen, Randi V.

AU - Svendsen, Mads N.

AU - Høeg, Beverley L.

AU - Horsbøl, Trine A.

AU - Bidstrup, Pernille E.

AU - Christensen, Helle G.

AU - Johansen, Christoffer

AU - Dalton, Susanne O.

N1 - Funding Information: The study was supported by Danish Cancer Society, Region Zealand and Copenhagen University Hospital, Rigshospitalet (grant numbers not applicable). Publisher Copyright: © 2023 Acta Oncologica Foundation.

PY - 2023

Y1 - 2023

N2 - Background: Major restructuring of surveillance after breast cancer treatment with less follow-up consultations may result in insecurity and fear of recurrence (FCR) among the less resourceful breast cancer patients. We investigate the association between breast cancer patients’ education and FCR and if self-efficacy mediates the associations between education and FCR. Material and methods: A questionnaire survey was conducted from 2017 to 2019, among 1773 breast cancer patients shortly after having their follow-up switched from regular outpatient visits with an oncologist to either nurse-led or patient-initiated follow-up, with a subsequent questionnaire after 12 months. Data on disease and treatment characteristics were extracted from medical records and the Danish Breast Cancer Group Database. Logistic regression analyses were used to examine the association between education and FCR. Separate analyses were conducted for patients ≤ and >5 years since diagnosis and all models were adjusted for age and cohabitation status. To explore potential mediation by self-efficacy, we conducted regression analyses on education and FCR further adjusting for self-efficacy. Results: The participation rate was 57%, and after the exclusion of patients due to missing data, 917 were included in analyses. Patients with long education had significantly less FCR compared to patients with short education (OR (95% CI) 0.71 (0.51;0,99)). When separated by time since diagnosis, there was no association among patients >5 years since diagnosis while the OR was 0.51 (95% CI, 0.30;0.85) for patients ≤5 years since diagnosis. Further adjusting for self-efficacy among patients <5 years since diagnosis resulted in an OR of 0.56 (95% CI, 0.33;0.95) among patients with long compared to short education. Conclusion: Up to 5 years after diagnosis, breast cancer patients with long education are less likely to experience FCR than patients with short education. Self-efficacy mediated only a very small part of this association, indicating that other factors play a role in socioeconomic differences in FCR among breast cancer patients.

AB - Background: Major restructuring of surveillance after breast cancer treatment with less follow-up consultations may result in insecurity and fear of recurrence (FCR) among the less resourceful breast cancer patients. We investigate the association between breast cancer patients’ education and FCR and if self-efficacy mediates the associations between education and FCR. Material and methods: A questionnaire survey was conducted from 2017 to 2019, among 1773 breast cancer patients shortly after having their follow-up switched from regular outpatient visits with an oncologist to either nurse-led or patient-initiated follow-up, with a subsequent questionnaire after 12 months. Data on disease and treatment characteristics were extracted from medical records and the Danish Breast Cancer Group Database. Logistic regression analyses were used to examine the association between education and FCR. Separate analyses were conducted for patients ≤ and >5 years since diagnosis and all models were adjusted for age and cohabitation status. To explore potential mediation by self-efficacy, we conducted regression analyses on education and FCR further adjusting for self-efficacy. Results: The participation rate was 57%, and after the exclusion of patients due to missing data, 917 were included in analyses. Patients with long education had significantly less FCR compared to patients with short education (OR (95% CI) 0.71 (0.51;0,99)). When separated by time since diagnosis, there was no association among patients >5 years since diagnosis while the OR was 0.51 (95% CI, 0.30;0.85) for patients ≤5 years since diagnosis. Further adjusting for self-efficacy among patients <5 years since diagnosis resulted in an OR of 0.56 (95% CI, 0.33;0.95) among patients with long compared to short education. Conclusion: Up to 5 years after diagnosis, breast cancer patients with long education are less likely to experience FCR than patients with short education. Self-efficacy mediated only a very small part of this association, indicating that other factors play a role in socioeconomic differences in FCR among breast cancer patients.

KW - Breast cancer

KW - breast cancer patients

KW - education

KW - fear of recurrence

KW - self-efficacy

KW - socioeconomic position

U2 - 10.1080/0284186X.2023.2197122

DO - 10.1080/0284186X.2023.2197122

M3 - Journal article

C2 - 37039679

AN - SCOPUS:85152447131

VL - 62

SP - 714

EP - 718

JO - Acta Oncologica

JF - Acta Oncologica

SN - 1100-1704

IS - 7

ER -