Health Consequences of Fear of Cancer Recurrence in Breast Cancer Survivors and Partners

项目总结/摘要 乳腺癌（BC）是最常见的诊断癌症，也是导致乳腺癌的第二大原因。 美国女性癌症死亡率（ACS，2017）。基线流行率高， 筛查率和更好的治疗都有助于BC幸存者的大量人口 这将从2016年的估计350万增加到未来10年的预计450万 年（ACS，2017）。多项研究表明，对癌症复发的恐惧（FCR）是一个长期的问题， 长期关注癌症幸存者和他们的重要他人，影响生活质量。 尽管在文献中越来越强调FCR，但知识上的一个关键空白是FCR如何 可产生对长期健康具有已知影响的健康行为后果 结果。本提案的总体目标是检查药物依从性、身体状况、 活动/久坐行为和睡眠作为三个近端健康行为结果， 可改变，并与复发（患者）以及发病率和死亡率有关 (for患者和配偶/伴侣）。此外，食物消费率与健康行为之间存在着一致性 夫妇内部反映了相互依存和人际关系，如果忽视，将限制 全面了解FCR的重要健康后果。的初步数据 最近完成的国家癌症研究所资助的R21项目的科学前提和基础的权力形式 分析具体的和探索性的目标。使用纵向的、个人内部的方法， 以及个人和二元多层次结构方程模型，我们将追求 以下假设驱动的目标：1）确定FCR对身体活动的后果; 2） 确定FCR对坚持辅助激素治疗的后果;以及3）确定 FCR对睡眠数量和质量的影响。最后，使用心脏的生物标志物- 代谢健康风险（即，HbA 1c、血脂、胰岛素抵抗、身体成分），我们将探讨 目标健康行为和这些健康结果之间的联系。长期 拟议工作的目标是影响干预措施的制定和完善 对于FCR和健康行为，最终提高最佳的精神和身体健康， 癌症幸存者及其配偶/伴侣。

Project Summary/Abstract Breast cancer (BC) is the most commonly diagnosed cancer and the second leading cause of cancer mortality among women in the US (ACS, 2017). High baseline prevalence, increasing screening rates, and better treatments have all contributed to a large population of BC survivors that will increase from an estimated 3.5 million in 2016 to a projected 4.5 million in the next 10 years (ACS, 2017). Multiple studies document fear of cancer recurrence (FCR) as a top long- term concern of both cancer survivors and their significant others that impacts on quality of life. Despite an increasing emphasis on FCR in the literature, a critical gap in knowledge is how FCR can produce health behavior consequences with known implications for long-term health outcomes. The overall objective of this proposal is to examine medication adherence, physical activity/sedentary behavior, and sleep as three proximal health behavior outcomes that are modifiable and have been linked to recurrence (for patients) as well as morbidity and mortality (for both patients and spouses/partners). Moreover, FCR and health behaviors are concordant within-couple reflecting an interdependent and interpersonal context that, if ignored, would limit a complete understanding of important health consequences of FCR. Preliminary data from a recently completed NCI-funded R21 project form the scientific premise and the basis of power analyses for the specific and exploratory aims. Using longitudinal, within-person methods as well as individual and dyadic multilevel structural equation modeling, we will pursue the following hypothesis-driven aims: 1) identify the consequences of FCR for physical activity; 2) identify the consequences of FCR for adherence to adjuvant hormonal treatment; and 3) identify the consequences of FCR for sleep quantity and quality. Finally, using biomarkers of cardio- metabolic health risk (i.e., HbA1c, lipids, insulin resistance, body composition), we will explore the links between the targeted health behaviors and these health outcomes. A long-term objective of the proposed work is to influence the development and refinement of interventions for FCR and health behaviors ultimately increasing optimal mental and physical well-being of cancer survivors and their spouses/partners.