Psycho-Oncology

Factors influencing human papillomavirus vaccination uptake in European women and adolescents: A systematic review and meta‐analysis

AbstractObjectiveCervical Cancer (CC) lingers as a severe public health issue due to low vaccination coverage and poor screening addressability. Hence, this systematic review explored psychological factors influencing the Human Papilloma Virus (HPV) vaccination uptake in European women.MethodsAs of September 2022, PubMed, EMBASE, Scopus, and Web of Science were systematically searched to include English studies assessing diverse factors influencing vaccination uptake in European women. Only studies comparing vaccinated with unvaccinated women were included. Quality assessment, publication attrition assessment, and sensitivity analyses were performed.ResultsEighteen studies were included, totaling a population of 18,611 participants. Results indicated that knowledge about HPV infection could positively influence vaccination rates with an Odds Ratio (OR) of 1.82 and a confidence interval (CI) between 1.27 and 2.61, showing statistical significance at aZvalue of 3.24 with ap‐value of 0.001. Neither knowledge about HPV vaccination (OR = 1.39, CI: 0.73–2.65,Z = 1.01,p = 0.31) nor knowledge about CC screening (OR = 1.05, CI: 0.55–1.98,Z = 0,14,p = 0.89) seem to affect vaccination rates. Regardless, intention to undertake CC screening (CCS) showed an OR = 1.68 in favor of the group intending to perform it, with a CI between 1.37 and 2.07, showing statistical significance at aZ = 4.94 andp = 0.00001. Other aspects affecting vaccination uptake were fear of side effects, insufficient information, and belief that chances of being infected are low.ConclusionsResults demonstrated that diverse aspects could affect the vaccination intent, while personalized interventions focusing on population and country characteristics need to be assembled to mitigate vaccination coverage.

The Effect of a Mobile Application for Gynecological Cancer Patients on Their Physical and Psychosocial Adaptation: A Randomized Controlled Trial

ABSTRACTObjectiveThis study aimed to examine the effect of a mobile application developed for gynecological cancer patients on their physical and psychosocial adaptation.MethodsThis is a parallel groups, single blind, randomized, controlled study. The patients included in the study were contacted through social media sites of an association with a high number of members and followers. Block randomization was used and 32 patients were assigned to an intervention group and 32 into a control group. The intervention group used the mobile application and the control group received routine care. Data were gathered with a descriptive characteristics form, The M.D. Anderson Symptom Inventory, The Adaptation to Chronic Illness Scale, The Hospital Anxiety and Depression Scale, The Assessment of Survivor Concerns, The Eastern Cooperative Oncology Group Performance Status. The intervention lasted 8 weeks and a total of three follow‐ups were performed: one follow‐up before the intervention and two follow‐ups after the intervention.ResultsSymptom severity, anxiety risk and cancer‐related worry decreased and physical, social and psychological adaptation increased in the intervention group compared to the control group.ConclusionsThe mobile application developed for gynecological cancer patients can reduce symptom severity, anxiety risk and cancer‐related worry and improves physical, social and psychological adaptation. It can be recommended that mobile applications with reliable content should be utilized to enhance physical and psychosocial adaptation of gynecological cancer patients receiving chemotherapy in addition to healthcare.

Genetic cancer risk assessment: A screenshot of the psychosocial profile of women at risk for hereditary breast and ovarian cancer syndrome

AbstractObjectiveThere is a lack of information describing Brazilian women at risk of hereditary breast and ovarian cancer syndrome (HBOC) who undergo genetic cancer risk assessment (GCRA). This study aims to characterize the psychosocial profile of women at risk for HBOC at their first GCRA to obtain an overview of their families’ profiles and the challenges of the oncogenetics setting.MethodsThis was a cross‐sectional study in which interviews were conducted with 83 cancer‐affected women at their first GRCA appointment after the pedigree draw. Tools to evaluate psychological outcomes were applied. The pedigree genogram and ecomap were constructed and analyzed with content analysis using the “life course perspective” theory.ResultsIndividuals perceived their breast/ovarian cancer risk to be equal to that of the general population, although they were highly concerned about developing cancer. No evidence of anxiety or depressive symptoms was identified. Participants used the coping strategy of searching for religiosity. The genograms and ecomaps resulted in five major themes: support and social support; attitudes, feelings and emotions; cancer causes; communication; and relationships with relatives. Individuals between 20‐29 years of age and those with no family history of cancer tended not to communicate with relatives, which may indicate future problems in the GCRA process regarding genetic testing.ConclusionsThis study demonstrated that knowing the families who undergo the GCRA process can help professionals provide more individualized and thorough attention during GCRA and genetic testing, which results in better follow‐up and prevention strategies.

‘How Did That Make You Feel?’ Latinas' Use of Genetic Counseling and Testing for Hereditary Cancer Risk After Watching a Culturally Targeted Video and Receiving Patient Navigation

ABSTRACT Objective Culturally targeted narrative education is a promising approach to cancer prevention and control. This study evaluates the uptake of genetic counseling and testing (GCT) in Latinas at risk for hereditary breast and ovarian cancers (HBOC) after watching a culturally targeted narrative video and being navigated to GCT services. Methods Latina women at increased risk for HBOC were recruited through community‐based organizations. Participants responded to surveys before and after watching Spanish‐language telenovela‐style video. Surveys measured sociodemographic and clinical variables, HBOC and GCT knowledge, transportation with the story, identification with characters, and emotions elicited by the video. After watching video, participants were offered patient navigation services to free or low‐cost GCT and completed a 3‐month follow‐up phone survey to assess GCT uptake. Results Participants ( N  = 40) were 47.35 years old on average (SD = 9.48); all were born outside the United States. At the 3‐month follow‐up ( N  = 37), 27 (72.9%) and 26 (70.27%) participants had attended genetic counseling and genetic testing, respectively. U Mann Whitney tests found statistically significant differences between women who attended counseling versus those who did not at baseline knowledge ( U  = 216.00, p =  0.000) and distress elicited by the video ( U  = 73.5, p =  0.03). A logistic regression with distress elicited by the video as a predictive variable reached statististical significance ( β  = −0.27, p  = 0.037, CI 95% 0.58–0.98). Conclusions GCT uptake was promising, supporting a role for culturally targeted narrative video education along with a patient navigation component in increasing interest in cancer prevention and reducing healthcare disparities in HBOC genetic services. Trial Registration NCT03075540 (Initial release 2/22/2017)

Fear of cancer recurrence in ovarian cancer caregivers: A qualitative study

AbstractAimAlthough there is growing research exploring survivor fear of cancer recurrence (FCR), little is known about caregiver FCR. To date, examination of caregiver FCR has largely been conducted through the lens of survivor conceptualisations, limiting the development of caregiver‐specific models, measures, and interventions. This study aimed to explore experiences of FCR among caregivers of people with ovarian cancer.MethodsSemi‐structured telephone interviews were conducted with caregivers of people with ovarian cancer. Participants, recruited through Ovarian Cancer Australia, also completed an online survey collecting participant and patient demographic characteristics, information about the survivor's disease and caregiver levels of FCR using the Fear of Cancer Recurrence Inventory (Caregiver) (FCRI‐c). Qualitative interviews explored caregiver fears, how fears and concerns were experienced and the frequency and timing of FCR. Thematic analysis using a Framework Approach was used to analyse the results.ResultsTwenty‐four caregivers (54% male) participated in an interview. Most caregivers were providing care for their partner (n = 14). Thematic analysis identified four inter‐related themes and associated sub‐themes: (1) Fear and uncertainty; (2) Liminality; (3) Hopelessness and (4) Caregiver's protection of the person and self (caregiver's role as protector). Underpinning these themes was an overarching fear of one's family member dying.ConclusionsCaregivers supporting people with ovarian cancer experience worries and concerns related to cancer recurrence or progression. These experiences are conceptually different to survivor experiences. Fear of one's family member dying, and the dual nature of caregiver protection/self‐protection mean it is imperative that interventions are tailored specifically to caregiver needs. Future research facilitating the development of appropriate measures and interventions is essential to reduce caregiver FCR.

Effect of Couple‐Based Virtual Intervention on Spousal Support and Quality of Life for Women With Breast and Gynecological Cancers in Nigeria

ABSTRACTBackgroundBreast and gynecological cancers contribute significantly to cancer‐related mortality among Nigerian women. Despite the proven benefits of spousal support in improving cancer outcomes, male involvement in caregiving remains limited due to cultural norms, stigma, and systemic healthcare challenges.AimsThis study evaluated the effectiveness of a couple‐based virtual intervention in enhancing spousal support and improving the quality of life (QoL) of women undergoing cancer treatment in Nigeria.MethodsAn embedded mixed‐methods design was employed involving 133 Nigerian couples, where women were receiving treatment for breast or gynecological cancer. The intervention consisted of an 8‐week virtual peer support program for male partners, delivered via Zoom. Quantitative data were collected using validated instruments assessing spousal support and QoL, and analyzed using descriptive and inferential statistics. Qualitative data were obtained through semi‐structured interviews with 21 male participants and analyzed thematically using NVivo 14.ResultsPost‐intervention, significant improvements were recorded in spousal support across emotional (p = 0.0413), practical (p = 0.0296), financial (p = 0.0493), and health‐related (p = 0.0313) domains. Women's QoL significantly improved in physical (p = 0.0109), psychological (p = 0.0452), social (p = 0.0024), and spiritual (p = 0.0417) domains. Thematic analysis revealed five key themes: emotional growth and support, understanding of partner's needs, building confidence, value of peer connections, and cultural or logistical barriers.ConclusionsThe couple‐based virtual intervention significantly improved male caregiving engagement and the quality of life of women undergoing cancer treatment. Findings support culturally tailored, gender‐sensitive interventions in oncology care within resource‐limited settings.

Psychological Safety in the Medical Care of Black Breast and Ovarian Cancer Patients and Families

ABSTRACTBackgroundPsychological safety is critical to early and continued engagement with healthcare providers, yet no studies have explored this concept in relationship to cancer care. Black/African American (“Black”) individuals experience disparities in breast and ovarian cancer beyond what can be explained biologically.AimsWe explored factors influencing psychological safety among Black breast and ovarian cancer patients and their family members.MethodsSocioeconomically diverse patients with a personal diagnosis or family history of breast and/or ovarian cancer were invited to complete a semi‐structured qualitative interview on their cancer and healthcare experiences between September 2020 and April 2021. Informed by principles of grounded theory, interview transcripts were qualitatively analyzed for thematic content related to psychological safety.ResultsBlack breast and ovarian cancer patients and their family members described personal and community experiences and structural components of the healthcare system that suggested they may receive differential cancer care due to their race, placing them on guard. This posture was mediated by several self‐identified factors that added to or detracted from their comfort, including provider racial and gender concordance in healthcare, personalized care, and effective communication. The priorities and perceptions of care in participants receiving care in safety net clinics were more focused on what was feasible given resource limitations rather than what was ideally desired.ConclusionsImplementation of strategies to promote psychological safety with Black cancer patients may foster improved patient experiences, as well as encourage early screening, patient engagement, and treatment continuation.

Development and validation of the CARE‐FCR: A caregiver‐specific measure of fear of cancer recurrence and progression

AbstractObjectivesFear of cancer recurring or progressing (FCR) is a concern reported by people living with cancer and caregivers alike. Whilst advances in survivor FCR have been made, less is known about caregiver FCR. As a result, measurement of caregiver FCR has relied on instruments developed for survivor populations. Findings from qualitative research indicate caregiver experiences of FCR differ. This study aimed to develop and evaluate the psychometric properties of a caregiver specific measure of FCR (CARE‐FCR).MethodsFour‐hundred and thirty‐eight caregivers (56% female, Mage = 50.53 years, SD = 17.38) completed the online survey including demographic questions, information about care provided, the person they care for, as well as the CARE‐FCR. Convergent validity was assessed using pre‐existing measures of fear of recurrence and progression, depression, anxiety, death anxiety and meta‐cognitions. The extraversion dimension of the Big Five Personality Trait questionnaire was used to assess divergent validity. The survey was completed 2 weeks later to assess test‐retest reliability. Exploratory factor analysis (EFA) was used to determine factor structure, followed by confirmatory factor analysis.ResultsEFA indicated a 3‐factor structure: progression, recurrence, and communication. Evidence for convergent, divergent, and test‐retest reliability was adequate. Internal consistency for the CARE‐FCR was strong, overall Cronbach's α = 0.96 (progression = 0.94, recurrence = 0.92 and communication = 0.78).ConclusionsWe present a theoretically informed and psychometrically robust measure of caregiver FCR. The CARE‐FCR facilitates quantification of caregiver FCR, capturing unique aspects specific to this population.

Sociocultural Factors Influencing Late Presentation for Health Care Among Cervical Cancer Patients: A Qualitative Exploratory Study

ABSTRACTIntroductionMalawi has the highest cervical cancer mortality rates in the world. Late presentation for care associated with late diagnosis and poor survival rates remain a huge issue. Research into social and cultural factors and how these influence women's access to early healthcare in Malawi is still scanty.ObjectiveThis study aimed to explore sociocultural factors that influence late presentation for healthcare among cervical cancer patients at Zomba Central Hospital, Malawi.MethodsThis qualitative exploratory descriptive study recruited purposively selected women with advanced cancer of the cervix attending Zomba Central Hospital in Southeastern Malawi. Data were collected through one‐on‐one audio‐taped interviews using a pilot‐tested semi‐structured interview guide. Thematic data analysis was used. Data saturation was reached at the 21st interview.Results21 patients living with cervical cancer participated. Two broad domains and six main themes; three themes under each domain emerged: Domain 1: Sociocultural barriers (knowledge gap about cervical cancer, influence of culture and social networks, poverty and financial cost as a barrier) and Domain 2: Healthcare system‐related barriers (access barriers related to limited health (cancer) care services, delays in the healthcare and referral system, human resource and knowledge gaps among health professionals).ConclusionAll the participants in this study narrated that they presented late when the cancer was already advanced with no possibility of cure. Ignorance about cervical cancer was common to all the participants in this study and appeared to be a wider sociocultural issue. There is an urgent need for multistakeholder and multicultural involvement and strengthening mass education of the community about cancer to improve awareness, destigmatize cancer, and dispel harmful cultural beliefs and practices regarding causes and treatment of cervical cancer. Training of health professionals at all levels about early detection and effective referral pathways is also urgent.

Factors affecting cervical screening using the health belief model during the last decade: A systematic review and meta‐analysis

AbstractAimsTo examine the utility of the health belief model (HBM) and other socioeconomic factors in shaping cervical screening behaviors. Also, to provide recommendations on improving screening uptake.MethodologyA systematic literature search was conducted using the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science databases for articles reporting on the factors associated with cervical screening using the HBM within the period from January of 2002 to January of 2023. Effect sizes for the various HBM constructs were pre‐determined using the log odds ratio (logOR) and expressed with their confidence intervals. All reporting was in line with the PRISMA guidelines.ResultsA total of 21 studies were included in the final analysis comprised of 15,365 participants. Our pooled analysis demonstrated that perceived susceptibility (OR: 1.40, 95% CI, 1.03–1.89), perceived benefits (OR: 1.30; 95% CI, 1.13–1.50), and self‐efficacy (OR: 1.11; 95% CI, 1.05–1.17) were significantly associated with both the uptake of and intention to adopt preventive measures against cervical cancer. Conversely, women with higher perceptions of barriers were less likely to adopt any measure for cervical cancer screening or prevention (OR: 0.72; 95% CI, 0.57–0.91). In terms of sociodemographic effectors, older age (OR: 1.09; 95% CI, 1.01–1.19), graduate/post‐graduate education (OR: 2.80; 95% CI, 1.46–5.37), higher knowledge of cervical cancer (OR: 2.21; 95% CI, 1.27–3.84), and being married (OR: 3.89; 95% CI, 1.38–10.92) were all associated with altering preventive behaviors and intentions toward cervical cancer.ConclusionThis review delineates the most important and effective cognitive components that should be targeted within interventions aiming to promote cervical cancer prevention.

The impact of ovarian cancer on individuals and their caregivers: A qualitative analysis

AbstractObjectiveOvarian cancer remains an understudied cancer with poor prognosis, few effective treatments and little understanding of the how individuals and their families face the challenges and uncertainty following diagnosis. This study synthesized the subjective experiences of individuals and their caregivers in the face of the uncertainty produced by the disease.MethodsQualitative data were obtained from the Ovarian Cancer Australia 2017 Consumer Survey. An inductive thematic analysis was conducted on responses from 219 individuals with ovarian cancer and 78 caregivers.ResultsNine themes were identified from the individual's responses and seven themes from the caregivers. For both groups, the uncertainty created at diagnosis led to a cascade of complex responses. For the individuals, uncertainty gave rise to fears for the future, which were exacerbated by unmet healthcare needs or treatment‐related difficulties. For some individuals, these fears led to disruption to their lives, isolation and emotional distress. For others, helpful coping styles and social support protected them from these negative consequences. For caregivers, the processes were similar, but uncertainty predominantly led to feelings of hopelessness and “survivor guilt.”ConclusionsOur results identified processes that may guide future interventions and research targeting unmet needs and protective factors for individuals with ovarian cancer and their caregivers. Findings also suggest the potential to facilitate effective support between individuals and their caregivers.

Use of antidepressants in women after prophylactic bilateral oophorectomy: A Danish national cohort study

AbstractObjectiveTo investigate the association between prophylactic bilateral oophorectomy and use of antidepressants in women with a family history of cancer.MethodsNationwide population‐based cohort study using Danish National Registries including women oophorectomized due to a family history of cancer (n = 2,002) and an age matched reference group (n = 18,018). Analyses were stratified by age at time of bilateral oophorectomy and use of hormone replacement therapy (HRT).ResultsWomen oophorectomized at age ≤ 45 years were more likely to use antidepressants from the first year after bilateral oophorectomy (OR = 1.34; 95 % CI: 1.08‐1.65) compared to the reference group. Women oophorectomized at age 46‐55 years and at age >55 years had no significantly increased use of antidepressants (OR = 0.90; 95 % CI: 0.68‐1.18 and OR = 1.14; 95 % CI: 0.81‐1.61). The increased use of antidepressants in women oophorectomized at age ≤ 45 years was limited to women treated with HRT (OR = 1.51; 95 % CI: 1.18‐1.94) whereas women oophorectomized at age ≤ 45 years not treated with HRT had no increased use of antidepressants (OR = 1.03; 95 % CI: 0.70‐1.51).ConclusionsWomen oophorectomized due to a family history of cancer at age ≤ 45 years were more likely to use antidepressants after bilateral oophorectomy. The increased use of antidepressants was limited to women treated with HRT. The study calls for further large‐scale studies to understand how bilateral oophorectomy and concomitant HRT affects risk of depression in women with a family history of cancer.

The role of interpretation biases and symptom burden in fear of cancer recurrence/progression among ovarian cancer survivors

AbstractBackgroundModels of fear of cancer recurrence or progression (FCR/P) suggest that the way in which people interpret ambiguous physical symptoms is an important contributor to the development and maintenance of FCR/P, but research has not investigated this claim. The aim of this study is to fill that gap.MethodsThis was a cross‐sectional study. Sixty‐two women with ovarian cancer reported completed measures of FCR/P, an interpretation bias task and a symptom checklist. The healthy control group (n = 96) completed the interpretation bias task.ResultsWomen with ovarian cancer were more likely to interpret ambiguous words as health‐related compared to healthy women (p < 0.001; Cohen's d = 1.28). In women with cancer, FCR/P was associated with overall symptom burden (r = 0.25; p = 0.04) and interpretation bias score (r = 0.41; p = 0.001), but interpretation bias and symptom burden were not related (r = 0.22; p = 0.09). Interpretation bias did not moderate the relationship between symptoms and FCR/P.ConclusionsWe found that women with ovarian cancer interpreted ambiguous words as health related more often compared to women without cancer, and this bias was greater for women with higher FCR/P. Symptom burden was also associated with FCR/P. However, interpretation bias did not moderate the relationship between physical symptoms and FCR/P. Hence, the central tenet of the Cancer Threat Interpretation model was not supported in women with ovarian cancer.

Chronic difficulties are associated with poorer psychosocial functioning in the first year post‐diagnosis in epithelial ovarian cancer patients

AbstractObjectiveOvarian cancer is characterized by poor prognosis, high levels of distress, disturbed sleep, and compromised quality of life (QOL). Although life stressors have been shown to significantly impact physical and psychological health in cancer populations, no studies have used a high‐resolution stress assessment to differentiate effects of acute versus chronic stressors among women with ovarian cancer. We addressed this issue in the present prospective longitudinal study by examining how acute and chronic stress exposure in the year pre‐diagnosis relate to depressive symptoms, sleep quality, and QOL over the first year post‐diagnosis in women with ovarian cancer.MethodsOne hundred thirty‐seven women completed the Life Events and Difficulties Schedule within a month of initial treatment for suspected ovarian cancer. Depressive symptoms, sleep, and QOL were measured pre‐treatment, at six months, and one‐year post‐diagnosis. Mixed models were used to examine associations of acute and chronic stress pre‐diagnosis with (a) change in psychosocial outcomes over the first year post‐diagnosis and (b) levels of psychosocial outcomes across all time points.ResultsBoth the number and severity of chronic difficulties (but not acute life events) were related to significantly greater depression, and poorer sleep quality and QOL, across all time‐points. In contrast, these stress indices were unrelated to changes in psychosocial functioning over time.ConclusionsChronic but not acute stress exposure predicted average levels of depression, sleep, and QOL in the first year post‐diagnosis among women with ovarian cancer. Assessing stressors and designing interventions for reducing stress may thus be beneficial for ovarian cancer patients.

Exploring the lived experience of partners of women impacted by cervical cancer and the CervicalCheck screening failure in Ireland

Key Points The aim of the study was to explore partners’ experiences of cervical cancer and perspectives on the CervicalCheck controversy. Seven male partners of women who were diagnosed with cervical cancer following a false‐negative screening result were interviewed between May and July 2020. Thematic analysis was conducted on the data. Three superordinate themes were identified; the adverse impact of a cervical cancer diagnosis on partners; the unsatisfactory treatment of partners throughout the trajectory of cervical cancer diagnosis and treatment, and partners’ attitudes surrounding the CervicalCheck controversy. The findings highlight the unique challenges experienced by the partners of women diagnosed with cervical cancer and the impact of the CervicalCheck screening failure on partners. The findings also highlight the need for appropriate structures to be established within Ireland's health service to better support the informational and psychological needs of partners of women with cervical cancer.

A prevalence and psychometric study on fear of cancer in women with abnormal cervical cytology undergoing colposcopy

AbstractObjectiveTo determine the levels of fear of cancer in women who were referred for colposcopy and to determine validity and reliability of the Cancer Worry Scale (CWS) in gynaecology patients.MethodsThe study was conducted between March‐November 2017 with 200 women at the Gynaecologic Oncology Clinic at Akdeniz University Hospital in Turkey. Reliability analysis, confirmatory factor analyzes, and multidimensional sum‐score estimation were used for psychometric analyzes. One‐way ANOVA and independent samplest‐test were also used.ResultsTotal score for the CWS of the participants was determined as 20.05 ± 7.87 in colposcopy patients. Marital status, information about the Papanicolaou (Pap) smear test and colposcopy, and fear of colposcopy were strongly associated with fear of cancer. We determined that a one‐factor structure emerged for the scale and that the total contribution of this factor to the explained variance was 53.35%. CFA was applied to obtain additional evidence of structural validity in line with the scores obtained from the scale. The overall Cronbach's alpha coefficient of the scale was 0.87.ConclusionsOur study revealed that levels of fear of cancer were high in women who were referred for colposcopy. Furthermore, the CWS was determined as a valid and reliable tool to measure the fear of cancer in women undergoing cervical screening/follow‐up for abnormal cytology.

Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women

AbstractObjectiveTo examine factors longitudinally associated with cervical cancer screening uptake among rural Chinese women, guided by protection motivation theory (PMT).MethodsA large sample of women (n = 2408, aged 35‐65 years old) was randomly selected from a rural county in China in 2015 and followed up for 2 years. Data for demographic factors, knowledge of cervical cancer screening, screening outcome, and six PMT constructs measured at the baseline in 2015 were used to predict cervical cancer screening participation at the follow‐up in 2017 using structural equation model method.ResultsAmong the 2408 women at the baseline, 1879 (78.03%) participated in the screening services at the follow‐up. In addition to significant direct effect of age, social status and baseline screening outcome, and three (perceived severity, fear arousal and response efficacy) of the six PMT subconstructs, four variables (age, social status, knowledge of cervical cancer screening, and baseline screening outcome) at the baseline were indirectly associated with screening participation, mediated by the three significant PMT subconstructs.ConclusionsFindings of this study indicate that the rate of participating in cervical cancer screening for rural women needs to be further improved. In addition to the commonly reported influential factors, PMT subconstructs play important roles in encouraging rural women in China to participate in cervical cancer screening. These longitudinal findings provided data much needed for future research to develop evidence‐based intervention programs to enhance cervical cancer screening among rural women in China.

A Qualitative Study of Smoking‐Related Causal Attributions and Risk Perceptions in Cervical Cancer Survivors

AbstractObjectiveThe prevalence of smoking among cervical cancer survivors typically exceeds what is found among women in the general population and other cancer survivors. Yet, there is a dearth of literature on risk and protective factors related to smoking among cervical cancer survivors, especially when it comes to identification of variables that are amendable to intervention. To help fill this gap in the literature, this qualitative study examines the nature of smoking‐related causal attributions and risk perceptions in cervical cancer survivors who smoked at cancer diagnosis.MethodsParticipants are 21 female cervical cancer survivors (M=45.7, SD=8.4 years old), all diagnosed in the past five years. Nearly three‐quarters of participants reported smoking in the past month. Results: Smoking was not uniformly recognized as a cause of cervical cancer (whether in general or participants' own cancer); the link between smoking and lung, head‐neck, and other cancers was more readily accepted. Despite generally weak endorsements of causal attributions, many participants reported smoking significantly increases risk for poor clinical (e.g., recurrence) and quality of life (e.g., pain) outcomes after cervical cancer diagnosis.ConclusionsFindings suggest cervical cancer survivors may not fully understand or appreciate the role of smoking in cervical cancer risk whereas their beliefs about the role of smoking in cervical cancer prognosis are more well‐formed. This study highlights the potential role of causal attributions and risk perceptions in understanding and addressing the smoking‐related experience of cervical cancer survivors.

Exploring the psychological impact of the cervical cancer screening failures on women in Ireland: A qualitative study

Perceived psychosexual dimensions of cervical cancer survivors in India—An exploratory study

AbstractObjectiveCervical cancer is the second most common cancer among women in India. Medical advancements have led to increased survival. However, sexuality and sexual concerns remain as major worries of patients after treatment. This study aims to understand the psychosexual experiences of cervical cancer survivors.MethodsCervical cancer survivors (n = 30) aged 35–55 years were interviewed using a semi‐structured interview schedule, after obtaining consent. The audio‐recorded in‐depth interviews were transcribed and analysed using thematic analysis.ResultsThree major themes in each group namely sexually active and sexually inactive evolved on analysis. Three themes were derived under sexually active group namely (i) Enablers of active sexual functioning (ii) Impediments of active sexual functioning (iii) Sexual health communication. The three themes under sexually inactive include (i) Attributes of sexual abstinence (ii) Impact of sexual abstinence (iii) Barriers of sexual health communication.ConclusionsBoth sexually active and inactive survivors in India experience various psychosexual concerns post cancer treatment indicating a strong need for psychosocial care and focused clinical interventions.

Factors promoting breast, cervical and colorectal cancer screenings participation: A systematic review

AbstractObjectiveThe present study aims at systematically reviewing research conducted on factors promoting breast, cervical and colorectal cancer screenings participation.MethodsA literature search in MEDLINE/PubMed and PsycInfo from January 2017 to October 2021 was performed. Data extraction, researchers' full agreement and the inclusion criteria produced 102 eligible studies. Data were narratively synthesized and critically interpreted.ResultsMultiple factors favoring or hindering breast, cervical and colorectal cancer screenings were identified and summarized as factors operating at the individual level (background information, individual characteristics, emotions related to screening procedure and to cancer, knowledge and awareness), at the relational level (relationships with healthcare staff, significant others, community members), and at the healthcare system level (systems barriers/policy, lack of staff). A critical appraisal of studies revealed a fragmentation in the literature, with a compartmentalization of studies by type of cancer screening, country and specific populations of destination.ConclusionsOverall findings indicated that greater integration of research results obtained independently for each cancer diagnosis and within the different countries/populations could foster a more comprehensive understanding of factors potentially enhancing the participation in breast, cervical and colorectal cancer screenings worldwide. This review, which is grounded in the current context of globalization and superdiversification in population, can help to enhance a better integration between research and practices, by supporting the development of more effective and inclusive evidence‐based interventions and health‐promotion campaigns worldwide. Research and practical implications are highlighted and discussed.

The Process of Cancer Prevention Behaviors in Individuals at High Risk of Hereditary Cancer: A Grounded Theory Study

ABSTRACT Objective This study aimed to explore the process of cancer prevention behaviors in individuals at high risk of hereditary cancer in Korea. Methods We included 10 adults with pathogenic variants in genes related to hereditary breast and ovarian cancer syndrome, hereditary non‐polyposis colorectal cancer, or familial adenomatous polyposis, but who had never been diagnosed with cancer. Data were collected through in‐depth interviews at the cancer prevention center of a tertiary hospital in Korea. Data were analyzed using the grounded theory method proposed by Corbin and Strauss. Results 50 concepts, 20 subcategories, and 10 categories were identified. The categories were as follows: (1) identifying genetic vulnerability, (2) facing the risk of cancer, (3) negative emotions caused by the cancer risk–like destiny, (4) support from medical staff and providing information for hereditary cancer, (5) expanding support for medical expenses at the national level, (6) Exploring information on hereditary cancer and cancer prevention, (7) cancer screening for early detection, (8) lifestyle for cancer prevention, (9) risk‐reduction surgery to relieve cancer fear, and (10) living with fear and worry. The core category for the process of cancer prevention behavior in individuals at high risk of hereditary cancer was “managing cancer fear”. Conclusion Person‐centered counseling and educational interventions to support cancer prevention in individuals at high risk of hereditary cancer should be developed and should include assessing psychosocial symptoms, including fear of cancer, and managing it. Making an appropriate system for medical expenses should be considered.

Communication Between Japanese Patients With Hereditary Breast and Ovarian Cancer and Healthcare Providers on Sexual Health After Risk‐Reducing Bilateral Salpingo‐Oophorectomy

ABSTRACTBackgroundRisk‐reducing bilateral salpingo‐oophorectomy (RRBSO) is recommended for BRCA1/2 carriers to reduce ovarian cancer risk. Although RRBSO affects sex life, discussing this with healthcare professionals (HCPs) can be challenging. Moreover, research on this topic in Asia is limited.AimsThis study aims to clarify HCPs' communication on RRBSO's impact on sex life and to consider the preferred communication methods of Japanese BRCA1/2 carriers and their partners.MethodsA web survey was conducted with BRCA1/2 carriers and their partners using snowball sampling. Participants who agreed to the additional interview underwent interviews. Thematic analysis was performed on free‐text responses and interview data. A pamphlet reflecting experiences with RRBSO was published after the survey, and feedback was obtained online.ResultsOf the 50 surveyed participants, 10 underwent interviews. Three themes emerged: (1) hesitancy to ask questions about sex life, (2) the need to inform and support couples on their sex life after RRBSO, and (3) the unhelpfulness of receiving explanations from those who have not undergone RRBSO. Only 34.0% of participants received information on post‐RRBSO sex life. Many expressed the need for themselves and their partners to receive information before RRBSO. The feedback survey revealed that digital pamphlets and paper were the preferred tools.ConclusionsProviding couples with information about post‐RRBSO sex life is essential. Additionally, cultural taboos hinder discussions on sex life leading to a preference for indirect sources of information. In Japan, some patients may face challenges in directly communicating with HCPs, highlighting the value of pamphlets and digital resources.

Suicide in Gynecological and Breast Cancer: A Systematic Review

ABSTRACTObjectivesDepression and suicide rates are high among cancer sufferers. Women with breast and gynecological cancer show high levels of distress, depressive symptoms, cognitive impairment, and anxiety. Understanding suicide rates and risk factors in this population would represent a viable tool in planning tailored, prevention strategies. The objective of this study was to estimate suicide rate and identify the determinants of suicide risk in women with breast and other gynecologic cancer.MethodsA systematic research was performed in PubMed and PsycINFO from anytime to September 26, 2023. The following search strategy was used: (Gynaecol* OR Gynecolog*) AND (cancer OR tumor OR tumor OR neoplas* OR malignan*) AND suicid*. In this review, we adhered to PRISMA statement.ResultsNine papers met inclusion criteria. Women with breast or gynecological cancers showed higher suicide rates compared to the general population. Ovarian cancer was associated with higher suicide risk and suicidal ideation compared to other gynecological cancers. The extent of surgical demolition was positively associated with both. Psychological factors, such as self‐perceived burden and alexithymia, might also influence suicidal thinking.ConclusionsWomen with breast and gynecological cancer are at high risk of suicide. Intervention aimed to reduce burden related to psychological factors might help reducing such risk.

Living a Cancer Surveillance Life: A Meta‐Ethnographic Synthesis of Everyday Experiences and Ambivalences for Women Living With Hereditary Risk of Breast and/or Ovarian Cancer

ABSTRACTObjectiveWomen with or at risk of hereditary breast‐ and ovarian cancer (HBOC) often live a surveillance‐focused life from young adulthood. As they navigate a life of heightened medical vigilance, or a “cancer surveillance life,” we explore how women with HBOC, as well as their partners and families, experience this particular kind of living through a thorough literature review of existing qualitative research.MethodsWe performed Boolean searches in PubMed, EMBASE, EBSCOhost, PSYCHinfo, Scopus, and Web of Science from April–May 2022, identifying 506 relevant articles. After eliminating duplicates and quantitative studies, we systematically analyzed 53 articles. Articles examining all aspects of living with HBOC were eligible for inclusion. Following quality assessment by a verified appraisal tool, 28 articles were included in this review. We undertook an “a‐lines‐of‐argument synthesis,” and identified key similarities across studies to highlight generalizable aspects of living with HBOC.ResultsWe discovered five central themes which capture the ambivalences experienced by women living with HBOC: (1) an unresolved balancing act regarding genetic testing (2) burdens of relaying genetic information within the family (3) experienced risk discrepancies (4) preservation of the self and: (5) unsettled reproductive feelings.ConclusionsLiving with HBOC is filled with ambivalences, which are critical for decision making concerning disclosing risks to family members and children, choosing between risk‐reducing surgeries or surveillance, and family planning. Healthcare professionals should be aware of these findings when counseling women and families with HBOC to provide the best support possible in navigating their unique kind of living.

Decision‐making for bilateral risk‐reducing mastectomy for an increased lifetime breast cancer risk: A qualitative metasynthesis

AbstractObjectivePrevivor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk‐reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision‐making process for BRRM among previvors.MethodsA theory‐generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk‐reduction surgery.ResultsA theory and corresponding model emerged, comprised of seven themes addressing the decision‐making process for or against BRRM. While some factors to decision‐making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision‐making for a period of time.ConclusionsRegardless of the decision previvors make about BRRM, physical and psychosocial well‐being should be considered and promoted through shared decision‐making in the clinical setting.

Maternal Communication of BRCA Risk to Adolescent and Young Adult Children: Implications for Supportive Care Intervention

ABSTRACT Background High‐risk mothers undergoing BRCA testing must decide whether, when, and how to disclose hereditary cancer risk information to their adolescent and young adult (AYA) children. Aims This study explored maternal preferences/values and cognitive‐affective factors influencing these decisions during genetic counseling. Methods Mothers ( N  = 282) reported on the perceived risks/benefits of AYA disclosure. Multivariable regression identified predictors of disclosure, and paired t ‐tests evaluated changes over time in maternal‐AYA communication, distress, and decisional conflict following genetic counseling. Results Mothers reported valuing the benefits of disclosure more than risks ( p  < 0.001). Those who valued disclosure tended to have female ( t  = −1.74, p  = 0.08) and older ( r  = 0.14, p  = 0.03) children but were less knowledgeable about cancer risk ( r  = −0.17, p  = 0.005). Conversely, mothers who perceived disclosure to AYAs as riskier tended to be non‐white ( t  = 1.80, p  = 0.072), Hispanic ( t  = 1.66, p  = 0.098), lower‐income ( t  = 2.56, p  = 0.011), and with younger children ( r  = −0.28, p  < 0.001) in poorer mental health ( r  = 0.12, p  = 0.047). These findings were reaffirmed though a multivariable regression model controlling for benefits (adjusted R 2  = 0.11; age B  = −1.09, p  < 0.001; mental health B  = 0.36, p  = 0.04). Post‐counseling, participants showed reduced decisional conflict ( t  = 2.4, p  = 0.009) but increased depression/anxiety ( t  = −1.4, p  = 0.08) and lower parent‐child relationship quality ( t  = 2.7, p  < 0.001). Conclusions Clinicians should be attuned to the factors shaping parental disclosure decisions and consider offering additional support to manage distress. Tailored educational tools for parents may aid family communication and improve psychosocial outcomes alongside genetic counseling.

Exploring Women's Experiences of Information Across Their Endometrial Cancer Diagnosis and Treatment: A Qualitative Analysis

ABSTRACT Background Access to timely and appropriate information is a key component of quality cancer care. Aims This study aimed to fill an important gap regarding the information experiences of women with endometrial cancer from diagnosis to treatment. Methods This study is based on 24 interviews with women diagnosed with endometrial cancer in Queensland, Australia in 2022–2023. Reflexive thematic analysis was used to provide an in‐depth exploration of women's accounts of information across their diagnosis and treatment journeys. Results The researchers identified three implicit and socially constructed assumptions women negotiated when it came to information. These included: (1) the physical body is of central importance; (2) more information is better; and (3) medical knowledge is most credible. These assumptions were not always upheld or accepted; at times, they were rejected by women and ultimately shaped how women made sense of, and spoke about, their experiences of information. Conclusions Together, these findings point to the need for women to be supported to engage with contextually sensitive information regarding their cancer. In particular, health professionals should be actively involved in ensuring women understand their cancer (including treatment side‐effects and risk of recurrence), are supported with psycho‐social impacts, and that alternative and holistic sources of information are acknowledged alongside medical information. These findings point to the need for health professionals to reflect on their own communication practices and how they may reinforce assumptions that shape women's experiences of endometrial cancer.

Life Experiences of Women Diagnosed With Cervical Cancer in Sub‐Saharan Africa: A Systematic Review of Qualitative Studies

ABSTRACT Background Sub‐Saharan Africa (SSA) bears the highest global burden of cervical cancer. Living with the disease is a complex experience, leading to significant changes across various biopsychosocial dimensions, which in turn affect the quality of life of affected women. Aims This review aimed to synthesize available scientific evidence on the life experiences of women diagnosed with cervical cancer in SSA in order to generate valuable insights into the care of the affected population. Methods Seven electronic databases were searched in August 2024, supplemented by manual reference list searching and snowballing to identify additional relevant studies. The eligibility criteria for inclusion were studies that sampled women (≥ 18 years) diagnosed with cervical cancer, used qualitative methodology, explored life experiences with cervical cancer as a primary aim, and were published between January 2015 and August 2024. The 10‐item Critical Appraisal Skills Program (CASP) checklist was used to assess the methodological quality of individual studies. The findings of the studies were thematically synthesized to generate analytical themes. Results A total of 14 studies were included, with the largest proportion of studies conducted in Ghana and South Africa. Four main themes highlighting the life experiences of women diagnosed with cervical cancer emerged from the synthesis: physical and psychosexual disruptions, knowledge of cervical cancer, socio‐economic challenges, and treatment experiences. Conclusions The findings highlight the profound physical, psychological, sexual, and socio‐economic experiences of cervical cancer on women in SSA. To improve cervical cancer outcomes in the region, it is crucial to provide comprehensive, culturally sensitive care that emphasizes public awareness, early detection, psychological support, socio‐economic interventions, and both curative and palliative treatment options.

Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study

AbstractObjectiveTo explore reasons for variations in anxiety in women testing positive for human papillomavirus (HPV) with normal cytology at routine HPV primary cervical cancer screening.MethodsIn‐depth interviews were conducted with 30 women who had tested HPV‐positive with normal cytology, including 15 with low‐to‐normal anxiety and 15 with high anxiety. Data were analysed using Framework Analysis to compare themes between low and high anxiety groups.ResultsSeveral HPV‐related themes were shared across anxiety groups, but only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). In comparison to those with low anxiety, women with high anxiety more strongly voiced cognitions about the 12‐month wait for follow‐up screening, relationship infidelity, a lower internal locus of control and HPV‐related symptom attributions.ConclusionsReceiving an HPV‐positive with normal cytology result related to various emotional, cognitive, behavioural and physiological responses; some of which were specific to, or more pronounced in, women with high anxiety. If our observations are confirmed in hypothesis‐driven quantitative studies, the identification of distinct themes relevant to women experiencing high anxiety can inform targeted patient communications and HPV primary screening implementation policy.

The Experience of Women With Breast or Gynecological Cancer After Participation in an Online Mindfulness‐Based Cancer Recovery (e‐MBCR) Program: Secondary Outcomes Analysis of a Pilot Mixed Methods Randomized Controlled Trial

ABSTRACT Background Mindfulness‐Based Interventions (MBIs) are recognized as beneficial in oncology supportive care. While qualitative analyses of mindfulness program experiences exist, this is the first mixed methods study to examine patients' experiences after participating in the online Mindfulness‐Based Cancer Recovery (e‐MBCR) program. Methods The SERENITY study was a pilot randomized controlled trial evaluating the early implementation, and effects of the e‐MBCR program for women with breast or gynecological cancer in a French‐speaking context. This article reports on secondary outcomes from a mixed methods analysis, exploring psychosocial aspects through questionnaires and participants' experiences through interviews. Sixty‐two patients were randomized in a 2:1 ratio. Quantitative assessments were carried out at three timepoints; qualitative interviews only post‐intervention. Both datasets were analyzed separately, then merged for interpretation. Results The intervention group showed a significant reduction in depression compared to the control group, with a medium effect size post‐intervention. While other psychological measures did not show significant differences, this exploratory analysis revealed favorable trends, particularly in anxiety, spiritual well‐being, and post‐traumatic growth. At 3‐month follow‐up, most scales showed a diminished effect compared to post‐intervention. Qualitative interviews revealed four themes: a safe and validating environment, acquiring skills and taking action, enhanced well‐being, and exposure to memories of cancer. This last dimension was a source of beneficial inner work for most participants, although it was a deeply challenging experience for four women. Conclusion Participation in the e‐MBCR program led to beneficial experiences, notably self‐exploration, and enhanced self‐efficacy. However, MBIs can also bring up challenging experiences, which are important to acknowledge. Trial Registration NCT04564768

Feasibility and Acceptability of the Fear‐Less Screening and Stratified‐Care Model for Fear of Cancer Recurrence Among People Affected by Early‐Stage Cancer

ABSTRACTObjectivesFear of cancer recurrence (FCR) is a prevalent unmet need for people affected by cancer, in the context of limited healthcare resources. Stratified‐care models have potential to meet this need, while reducing resource demands. This study aimed to evaluate the feasibility and acceptability of screening procedures and interventions within the Fear‐Less stratified‐care model among those impacted by early‐stage cancer.MethodsPeople affected by breast, head and neck, or gynaecological cancer, who had completed curative treatment, were screened for FCR. Individuals experiencing moderate FCR (scored 13–21 on the Fear of Cancer Recurrence Inventory‐Short Form; FCRI‐SF) were offered a purpose‐developed clinician‐guided self‐management intervention, while those experiencing severe FCR (FCRI‐SF score ≥ 22) were offered individual therapy (ConquerFear). Re‐screening and evaluation measures were completed post‐intervention.ResultsSeventy‐six (70%) of 109 eligible people completed screening, with 53/76 participating in the Fear‐Less model evaluation. Thirty‐nine of 53 participants reported FCR and were referred to an intervention; 30/39 (77%) accepted the referral. Fifteen (83%) of 18 participants completing the self‐management intervention reported reading ≥ 75% of the resource at 5 weeks, with 10/18 (56%) reporting clinically meaningful (≥ 10%) reductions on the FCRI‐SF post‐intervention. Qualitative feedback indicated screening and the stratified‐care received were acceptable.ConclusionsScreening procedures and interventions forming the Fear‐Less model appear feasible and acceptable for identifying and treating FCR among people affected by early‐stage cancer. Although further research is required to evaluate its efficacy, this model has the potential to meet a major unmet need, where psychosocial services are limited amid increased demand.Trial RegistrationThis study was retrospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622000818730) on 10/6/2022.

Anxiety and stress in women with suspected endometrial cancer: Survey and paired observational study

AbstractObjectiveTo determine the anxiety and stress levels of women with suspected endometrial cancer and factors affecting this.MethodsProspective survey and paired observational study of consecutive women with suspected endometrial cancer in a rapid access gynaecology clinic. Structured questionnaire including a GAD‐7 anxiety test and a modified stress thermometer were used. Patients ranked their perception of a cancer diagnosis on 0‐5 Likert scale (0 = confident not cancer and 5 = cancer). Patients requiring an endometrial tissue biopsy were asked to rank their pain on a visual analogue scale (VAS), this was paired with the survey results.Results250 patients completed the study and 23 of which underwent an endometrial tissue biopsy. The median age was 50‐59 years old and 59% of women spoke English as their first language. 32% of patients had significant levels of anxiety with GAD‐7 score ≥10. The median stress score was three out of five on Likert scale. GAD‐7 anxiety scores were higher in women who perceived that they received insufficient information prior to clinic (sufficient information 5 vs. insufficient information 9.5, P = 0.00036) or had a disability (disability 9 vs. no disability 5.5, P = 0.00374). The median VAS score from the biopsies was seven out of 10 (range 1‐10). Patients with higher anxiety levels (GAD‐7 scores) were more likely to believe they had cancer P <0.00001.ConclusionsThese findings confirm high levels of anxiety and stress in women with suspected endometrial cancer. Adequate pre‐clinic information is essential, particularly for minority groups.

An investigation of fear of recurrence, attachment and caregiving experiences among ovarian cancer partner‐caregivers

AbstractObjectiveFear of cancer recurrence (FCR) is a common concern for both cancer patients and their caregivers. Attachment insecurity is an established contributor to poorer mental health, particularly as it relates to social support. This study sought to evaluate whether attachment and caregiver experiences in cancer care were predictors of FCR.MethodsA cross‐sectional questionnaire study involving partner‐caregivers of patients with ovarian cancer was conducted. Correlation analyses and multiple hierarchical regressions were used to determine the roles of attachment and caregiving experiences in cancer care on FCR, including the possible moderating role of attachment on the relationship between caregiving experiences and FCR.ResultsParticipants (n = 82), mostly identified as white men, had post‐secondary education and incomes of over $100,000 CAD, and cared for patients with advanced ovarian cancer. Forty percent of participants had clinically elevated FCR. Among the evaluated caregiving experiences in cancer care, caregiving workload (r = 0.33; p = 0.005), needing more help from healthcare providers (r = 0.28; p = 0.02), and lacking time for social relations because of caregiving (r = 0.47; p < 0.001) correlated with FCR. Attachment anxiety correlated significantly with FCR (r = 0.43; p < 0.001), but attachment avoidance did not. Attachment anxiety (ΔR2 = 0.14; p = 0.002) and lacking time for social relations (ΔR2 = 0.18; p < 0.001) contributed to the variance on FCR. Attachment insecurity did not moderate the relationships between caregiving experiences and FCR.ConclusionsPartner‐caregiver attachment anxiety correlates with FCR; however, this does not influence FCR's relationship with poorer perceived support from cancer care institutions. Partner‐caregivers may benefit from psychotherapies for FCR and more practical support from cancer care teams.

Psychosocial interventions for ovarian cancer survivors: A systematic review

AbstractObjectivesOvarian cancer survivorship is complex and is associated with greater symptom burden, fear of reoccurrence, sexual dysfunction, lower quality of life and heightened existential distress in contrast to other cancers. This systematic review aimed to investigate the effectiveness for, and perspective of, psychosocial interventions encompassing psychological, social, and emotional support, tailored to, or involving ovarian cancer survivors at all stages of disease.MethodsAdhering to the PRISMA‐SR statement guidelines, a systematic search was conducted across PsycINFO, MEDLINE, Embase, Emcare, CINAHL, Scopus, Cochrane Library databases, Google, and Google Scholar. Two reviewers independently undertook a two‐stage screening process. The Mixed Methods Appraisal Tool was utilised to assess the methodological quality of included studies. Data were extracted using customised data extraction tools and narratively synthesised.ResultsThirteen studies were included in this review. Generally positive effects of psychosocial interventions were observed across a range of outcome domains (meaning enhancing, cognitive, social, emotional, and cancer‐specific). However, the characteristics of interventions and outcome measures varied across studies. Psychoeducational interventions were identified as the most common psychosocial approach, while Acceptance and Commitment Therapy showed promise in addressing the disease's high symptom burden. Women's perspectives of psychosocial interventions were described as “useful” and promoted positive self‐regard.ConclusionWhile the evidence base largely support positive effects of psychosocial interventions for ovarian cancer survivors, this finding is constrained by heterogeneity of interventions and modest gains. Future research may explore the standardisation of psychosocial interventions for this demographic, investigating its effects on less explored but prevalent concerns among ovarian cancer survivors such as fear of cancer recurrence and sexual dysfunction.

“It wasn't just for me”: Motivations and implications of genetic testing for women at a low risk of hereditary breast and ovarian cancer syndrome

AbstractObjectiveGenetic testing for hereditary breast and ovarian cancer (HBOC) due to pathogenic variants in BRCA1 or BRCA2 is why most women present to familial cancer centers. Despite being assessed as low risk for HBOC, many women proceed with genetic testing. This study explored the genetic testing experiences of unaffected women at low risk of HBOC to clarify what motivates these women to have testing, and what are the implications of the results.MethodsA qualitative approach was taken. Participants included women who had genetic testing for HBOC from 2016‐2018 at the Parkville Familial Cancer Centre in Melbourne, Australia. In‐depth, semi‐structured interviews were conducted, and thematic analysis was undertaken on transcripts; transcripts were coded, codes were organized into a hierarchical system of categories/subcategories, and key themes were identified.ResultsAnalysis of 19 transcripts identified five themes: family underpinned all motivators for HBOC genetic testing; health professionals were influential throughout the process; participants were planning for a positive result; results influenced screening‐anxiety and frequency; and negative results gave participants relief in many different ways. The three participants with positive results reported feeling shocked at the results and empowered giving this information to family members.ConclusionsWomen at low HBOC risk may be motivated to seek genetic testing, and access to this is increasingly offered through non‐genetic health professionals. Professionals can support clients through genetic testing by recognizing familial experiences, providing accurate information, addressing risk perceptions, and understanding cancer anxiety felt by many women.

A Double‐Blind Randomized Sham‐Controlled Trial of Two Online Cognitive Bias Modification Interventions for Fear of Cancer Recurrence in People With Breast or Ovarian Cancer

ABSTRACT Objective In the context of cancer, pain demands interpretation. Our research has found that fear of cancer recurrence (FCR) is associated with the tendency to interpret ambiguous information as health‐related. We aimed to determine whether we could modify these interpretation biases to improve FCR, and pain outcomes. Methods We conducted a double‐blind randomized controlled trial comparing two fully automated Cognitive Bias Modification for Interpretation (CBM‐I) programs to a matched sham. We randomized 174 people with breast or ovarian cancer to one of three groups (pain‐related CBM, cancer‐specific CBM or sham). Participants completed four training sessions, and outcomes were assessed before and after intervention and 2 weeks later. We nominated co‐primary outcomes as FCR and fear of progression (FoP) so that measures were suited to those with and without active disease and measured pain outcomes and other secondary psychosocial outcomes. Results We analyzed data using mixed‐model linear regression and intention‐to‐treat. Results indicated that both the cancer‐specific and pain‐related training groups showed significant improvements in FCR ( F (2,440)  = 17.19, p  < 0.0005) and FoP ( F (2,440)  = 15.03, p  < 0.0005) over time compared to sham. Both versions of CBM were associated with benefits in pain intensity ( F (2,440)  = 6.14, p  < 0.0005) and pain interference ( F (2,440)  = 5.223, p  = 0.001) compared to sham. No other secondary outcomes improved. Conclusion CBM for interpretation is an efficacious treatment for FCR, FoP and pain outcomes in ovarian and breast cancer. This intervention was delivered wholly online, had high completion rates (80%) and therefore is highly scalable. CBM‐I could be part of a stepped care model to meet the large unmet need for people who are living with and beyond cancer.

How to facilitate psychosocial adjustment in women tested for hereditary breast or ovarian cancer susceptibility? Insights from network analysis

AbstractBackgroundIncreasingly complex genetics counseling requires guidance to facilitate counselees' psychosocial adjustment. We explored networks of inter‐relationships among coping strategies and specific psychosocial difficulties in women tested for hereditary breast or ovarian cancer.MethodsOf 752 counselees consecutively approached, 646 (86%) completed questionnaires addressing coping strategies (Brief‐COPE) and psychosocial difficulties (PAHC) after the initial genetic consultation (T1), and 460 (61%) of them again after the test result (T2). We applied network analysis comparing partial correlations among these questionnaire scales, according to the type of genetic test ‐ single gene‐targeted or multigene panel, test result and, before and after testing.ResultsOverall, 98 (21.3%), 259 (56.3%), 59 (12.8%) and 44 (9.6%) women received a pathogenic variant, uninformative negative (panel testing), variant of uncertain significance (VUS) or true negative (targeted testing) result, respectively. In most networks, connections were strongest between avoidance and general negative emotions. Cognitive restructuring was inter‐related to lower psychosocial difficulties. Avoidance and familial/social relationship difficulties were strongly related in women receiving a pathogenic variant. Stronger inter‐relationships were also noticed between avoidance and worries about personal cancer and concerns about hereditary predisposition in women receiving a VUS result. Differences in the prominence of inter‐relationships were observed by type of testing and assessment time.ConclusionsNetwork analysis may be fruitful to highlight prominent inter‐relationships among coping strategies and psychosocial difficulties, in women tested for HBOC susceptibility, offering guidance for counseling.

Development and Psychometric Testing of a Scale Evaluating Traditional Health Practices for Cervical Cancer Prevention Among Haitian Migrant Women

ABSTRACT Objective Haitian migrant women experience disproportionate rates of cervical cancer. Cultural worldviews have been implicated as a factor influencing cervical cancer behaviors. However, no validated or reliable scale has been developed to measure the influence of cultural worldviews on cervical cancer risk and behaviors in this community. Methods We detail the original development and psychometric testing of the Traditional Health Practices for Cervical Cancer Prevention Scale (THP‐CCP). A total of N  = 151 Haitian women who recently migrated to the U.S. participated in the study. Scale items were newly developed based on qualitative interviews conducted by our team. Items were administered to participants, and the scale's construct validity, reliability, and concurrent validity were evaluated. We hypothesized that the scale would be associated with women's education levels and superstitious beliefs toward cancer, which we tested with an ANOVA and Pearson's correlation. Results A total of 30 items were developed in Haitian Creole and were evaluated by an expert panel of reviewers. Factor analysis yielded a one‐factor solution consisting of 11‐items interpreted as traditional health practices and cultural beliefs influencing cervical cancer risk and behaviors. The total scale Cronbach's alpha reliability coefficient was 0.79. The THP‐CCP scores demonstrated concurrent validity with women's education level ( F  = 3.56, p  = 0.031) and superstitious beliefs toward cancer ( r  = 0.26, p value = 0.001). Conclusion The THP‐CCP scale demonstrated strong psychometric properties and can assist researchers in better understanding cultural influences toward engagement in cervical cancer prevention behaviors among Haitian women.

Depressive symptoms, neuroticism, and participation in breast and cervical cancer screening: Cross‐sectional and prospective evidence from UK Biobank

AbstractObjectiveTo assess the cross‐sectional and prospective associations between depressive symptoms, neuroticism, and participation in breast and cervical screening in the UK.MethodsWomen in the UK Biobank cohort with complete data who were eligible for breast cancer screening (aged 50‐70 years, N = 143 461) and/or cervical screening (<65 years, N = 141 753) at baseline recruitment (2006‐2010) and those with follow‐up data (2014‐2019) were identified (N = 11 050 and N = 9780 for breast and cervical screening). Depressive symptoms and neuroticism were self‐reported at baseline (range 0‐12 with higher scores reflecting greater severity). Primary outcomes were reporting being up to date with breast and cervical screening. For prospective analyses, patterns of screening participation from baseline to follow‐up were identified. Logistic regression was used to analyse associations, adjusted for potential confounding factors.ResultsMore severe depressive symptoms were associated with reduced likelihood of breast (OR = 0.960, 95% CI: 0.950,0.970) and cervical (OR = 0.958, 95% CI: 0.950,0.966) screening participation, in cross‐sectional analyses. Higher neuroticism scores were associated with reduced cervical screening participation, but the opposite was found for breast cancer screening. Examination of individual neuroticism items revealed that anxiety and worry were associated with increased breast screening. At follow‐up, higher baseline depressive symptoms were related to decreased cervical screening (OR = 0.955, 95% CI: 0.913,0.999), but not with breast screening.ConclusionsMore severe depressive symptoms may be a barrier for breast and cervical screening and could be an indicator for more proactive strategies to improve uptake.

Self‐reported cognitive impairment in cervical cancer survivors: A cross‐sectional study

AbstractObjectiveCancer‐related cognitive impairment (CRCI) is a major obstacle for cervical cancer survivors, preventing the return to their social life. This study assessed the prevalence of CRCI in cervical cancer survivors and studied the association of self‐reported cognitive impairment with treatment regimen and the quality of life (QoL) domains depression, anxiety, and fatigue.MethodsSix hundred twenty one cervical cancer survivors, treated with combined chemo‐radiotherapy (CCRT) (n = 458) or surgery only (n = 163) were invited in this cross‐sectional study. Self‐reported cognitive function was assessed using the Functional Assessment of Cancer Therapy‐Cognitive Function (FACT‐Cog). Fatigue and psychological distress were assessed using EORTC‐QLQ C30 and Hospital Anxiety and Depression Scale (HADS).ResultsData of 254 women (40.9%) was available for the analysis. Of those, 204 (80.3%) women had received CCRT and 50 (19.7%) surgery only. In the whole cohort, 42.5% reported significant cognitive impairment. In both treatment groups cognitive complaints were significantly associated with anxiety, depression, and fatigue (all p < 0.001). CCRT was strongly associated with increased risk of CRCI (OR = 4.02, 95% CI = 1.57–10.25). Anxiety, depression, and fatigue increased the risk of CRCI by 13% (OR: 1.13, 95% CI 1.03–1.23), 16% (OR 1.16, 95% CI 1.04–1.28) and 2% (OR 1.02, 95% CI 1.00–1.03), respectively.ConclusionAlmost half of the cervical cancer survivors after CCRT report significant cognitive impairment. CRCI is associated with other indicators of poor QoL, such as depression, anxiety and fatigue. An increased understanding of the specific cognitive domains affected and of the associated late effects like fatigue is crucial to customize successful interventions.

Psychosocial impact of testing human papillomavirus positive in Australia's human papillomavirus‐based cervical screening program: A cross‐sectional survey

AbstractObjectiveTo examine the impact of self‐reported human papillomavirus (HPV) test result (HPV negative, HPV positive, HPV result unknown) on a range of psychosocial outcomes.MethodsWomen and other people with a cervix in Australia aged 25–74 years who reported having participated in cervical screening since December 2017 were recruited through Facebook and Instagram to complete an online survey. The primary outcome measures were anxiety, emotional distress, and general distress.ResultsNine hundred fifteen participants completed the online survey; 73.2% reported testing HPV negative (‘HPV−’), 15% reported testing HPV positive (‘HPV+’) and 11.8% reported that they did not know/remember their test result (‘HPV unknown’). Compared to participants testing HPV−, participants testing HPV+ had higher mean anxiety (41.67 vs. 37.08, p < 0.001) and emotional distress scores (11.88 vs. 7.71, p < 0.001). Concern about test result (34.3% vs. 1.3%, p < 0.001), perceived risk compared to average women (55.4% vs. 14.1%, p < 0.001), and cancer worry (27.8% vs. 5.9%, p < 0.001) were also greater among HPV+ participants than participants testing HPV−. Participants testing HPV+ felt less reassured about their screening result than participants testing HPV− (16% vs. 75.1%, p < 0.001). Participants testing HPV+ had greater knowledge of HPV (11.96 vs. 10.36 out of 16, p < 0.001) and HPV testing (3.94 vs 3.28 out of 5, p < 0.001) than participants who reported testing HPV−.ConclusionsElevated levels of anxiety and emotional distress were found in those testing HPV+ compared with those testing HPV−. Future research should examine what strategies should be used to deliver test results and what additional information is provided, in order to alleviate anxiety among individuals testing HPV+.

The Psychological Impact of Screen‐Detected Cancer: A Systematic Review

ABSTRACT Background The benefits and harms of cancer screening must be balanced for all participant groups, including those who go on to have cancer diagnosed. The psychological impact of having cancer diagnosed through screening, rather than via another route, is currently unclear. Aims We conducted a systematic review to describe the psychological impact of detecting cancer through screening (screen‐detected) compared to other routes (non‐screen‐detected). Methods Eligible studies investigated the psychological impact of screen‐detected cancer. PubMed, Embase, and PsycINFO were searched. Two reviewers independently screened all titles, abstracts and full texts. We assessed quality using the Mixed Methods Appraisal Tool. Psychological outcome data were extracted for groups with screen‐detected and non‐screen‐detected cancers, calculating Cohen's d where relevant. Results were narratively synthesized. Results We included 33 papers presenting quantitative results from 31 studies. All were considered medium to high quality. Studies measured psychological outcomes across six cancer screening programmes (breast, prostate, colorectal, lung, cervical and ovarian) using 31 different outcome measures. Receiving a screen‐detected cancer diagnosis seemed to be associated with a small or moderate short‐term increase in adverse psychological outcomes. In studies comparing outcomes by detection route, most found no difference ( n  = 16 studies), or that patients with screen‐detected cancers fared better than those with non‐screen‐detected cancers ( n  = 11 studies), but effect sizes were small. Conclusions A screen‐detected cancer diagnosis can lead to short‐term adverse psychological outcomes; however, there is no strong evidence for a difference in psychological outcomes by detection route. Greater consistency of measures and timepoints would facilitate between‐study comparisons. PROSPERO registration PROSPERO 2017 CRD42017075269.