4.7 Article

Network connectivity between fear of cancer recurrence, anxiety, and depression in breast cancer patients

Journal

JOURNAL OF AFFECTIVE DISORDERS
Volume 309, Issue -, Pages 358-367

Publisher

ELSEVIER
DOI: 10.1016/j.jad.2022.04.119

Keywords

Anxiety; Breast cancer; Depression; Fear of cancer recurrence; Network

Funding

  1. National Natural Science Foundation of China [72101107]
  2. Clinical Research Program of Nanfang Hospital, Southern Medical University [2021CR014]
  3. Guangzhou Science and Technology Project [201904010326]
  4. Guangdong Provincial Administration of Traditional Chinese Medicine [20222028]
  5. Medical Scientific Research Foundation of Guangdong Province of China [B2022011]
  6. Construction project of Team Construction in Guangdong Province Teaching Quality and Teaching Reform Project (Higher Education in Guangzhou) [[2020] 19]
  7. College Innovation and Entrepreneurship (Employment) Education Project in Guangzhou (Higher Education in Guangzhou) [[2019] 15]
  8. Guangdong Province Degree and Postgraduate Education Reform Research Project [2021JGXM026]

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This study investigated the network connectivity between fear of cancer recurrence (FCR), anxiety, and depressive symptoms in a representative sample of breast cancer patients. The results showed that anxiety and depression symptoms were highly interconnected, while FCR emerged as a distinct cluster with weak links to anxiety and depression. Anxiety symptoms, particularly 'uncontrollable worry', acted as important bridging symptoms connecting different communities.
Background: Fear of cancer recurrence (FCR), anxiety, and depression are common psychological disturbances that frequently occur together among cancer patients. This study investigated network connectivity between FCR, anxiety, and depressive symptoms in a large representative sample of breast cancer patients. Methods: This was a multicenter, cross-sectional study of 803 women with breast cancer. All participants completed the 4-item FCR scale, Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances. Results: The generated network model indicated that anxiety and depression symptom communities were wellconnected with each other, while FCR emerged as a distinct cluster with only a few weak links to anxiety and depression communities. Depressive and anxiety symptoms were more central than FCR symptoms were in the model. 'Having trouble relaxing' (#GAD4, strength = 1.147) was the most central node within the whole network, and 'strong feelings about recurrence' (#FCR4, strength = 0.531) was the least central node. Several anxiety symptoms (e.g., 'feeling afraid', 'uncontrollable worry', and 'restlessness') acted as important bridging symptoms connecting FCR, depression and anxiety communities. 'Uncontrollable worry' (#GAD2) had the highest node specific predictive betweenness value. The network stability of this model was high. Conclusion: Depression and anxiety symptoms are highly interactive with each other among women with breast cancer. Conversely, FCR may have attenuated relations with anxiety and depression communities and emerged as a relatively independent, unique experience. Anxiety symptoms, particularly 'uncontrollable worry', acted as important trans-diagnostic symptoms that connected different communities. Findings suggested interventions to alleviate excessive worries and enhance feelings of personal control might be helpful in preventing or reducing related symptoms of FCR, anxiety and depression.

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