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

项目摘要/摘要 乳腺癌(BC)是最常见的诊断癌症，也是癌症的第二大病因。 美国女性癌症死亡率(美国癌症协会，2017年)。高基线流行率，不断增加 筛查率和更好的治疗都为不列颠哥伦比亚省的大量幸存者做出了贡献 这将从2016年的估计350万人增加到未来10年的450万人 年(美国计算机协会，2017)。多项研究表明，对癌症复发的恐惧(FCR)是一种长期的 癌症幸存者和他们的另一半对生活质量的长期关注。 尽管在文献中越来越强调FCR，但在知识方面的一个关键差距是FCR如何 会产生健康行为后果，并对长期健康产生已知的影响 结果。这项建议的总体目标是检查服药依从性、体格检查 活动/久坐行为和睡眠作为三种近端健康行为结果，分别是 可修改，并与(患者)复发以及发病率和死亡率有关 (适用于患者和配偶/伴侣)。此外，FCR和健康行为是一致的 内部-反映相互依赖和人际关系的背景，如果忽略，将限制 对FCR的重要健康后果有全面的了解。来自美国的初步数据 新近完成的NCI资助的R21项目形成了科学的前提和动力的基础 具体目标和探索性目标的分析。使用纵向的、面对面的方法 以及个体和并元多层结构方程建模，我们将追求 以下是假设驱动的目标：1)确定FCR对身体活动的影响；2) 确定FCR对坚持激素辅助治疗的后果；以及3)确定 FCR对睡眠数量和质量的影响。最后，使用有氧生物标记物- 代谢健康风险(即HbA1c、血脂、胰岛素抵抗、身体成分)，我们将探讨 有针对性的健康行为和这些健康结果之间的联系。一个长期的 拟议工作的目标是影响干预措施的发展和完善 对于FCR和健康行为最终增加最佳的身心健康 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.