Dissertation: Exploring Factors of Fear in Breast Cancer Survivors

This literature review identifies and synthesizes research on factors associated with fear of breast cancer among survivors. The search was conducted across PubMed, Medline, and the International Journal of Nursing databases, resulting in the identification of 25 articles. After removing duplicates and applying inclusion/exclusion criteria, 14 articles were selected for the review, including 8 qualitative and 6 quantitative studies. The PICO strategy guided the search, focusing on breast cancer survivors and factors influencing their fear. Key search terms included 'breast cancer,' 'fear of cancer,' and 'survivors of breast cancer.' The review includes a PRISMA flow diagram illustrating the article selection process and lists the final articles used in the research, highlighting various factors such as physical symptoms, emotional well-being, social inequalities, and lifestyle advice.

DISSERTATION 1
FACTORS ASSOCIATED WITH FEAR OF BREAST CANCER AMONG SURVIVORS
Student’s Name
Code + Course Name
Professor’s Name
University Name
City, State
Date

DISSERTATION 2
The literature review articles were randomly searched across the PubMed and Medline
databases. The whole process was done over the internet. The search criteria were done by
putting specific search names for example breast cancer, into the search boxes of the databases
so that to display the searched articles. The Boolean term AND was commonly used to enhance
the display of more relevant data. Other than that Boolean term was only used to show specific
articles that target specific object and narrow the number of articles to be displaced. For instance,
combining the search terms breast cancer AND its harm will display results which shows the
harms of breast cancer other than showing other aspects of breast cancer.
After searching several articles from the databases using different search terms Around
25 articles were identified from both databases. Pubmed provided the most articles which
included 16 articles and Medline 9 articles. The difference of number in both databases was due
to the fact that Medline database did not produce so many changes in the display of different
articles when different search terms and Boolean term were used. This is the time where most of
the articles were identified. However, each database produced more articles but not all articles
were relevant to the study. Medline had so many articles but, most of them were published
between the year 2000 up to 2010. This did not fit the inclusion criteria where the study only
needed articles that were not older than five years old. However, the articles were used for the
purpose of understanding only since they contained information related to the study. On the other
hand, Pubmed database was highly updated since most of the articles were of the latest years
including the year 2018. Additional searches were done from International Journal of Nursing
databases where several articles were produced.

DISSERTATION 3
During identification, it was noted that most of the articles identified can only be read
online in the databases since producing and downloading documents was not an option. After
identifying articles from both databases, two articles were found to be the same and hence
removed as duplicates. Around 25 articles were screened to check if they were consistent with
the research. Screening included checking if they had an author or authors, year of publication,
the general content of the article and checking if they were peer reviewed or not. At this juncture,
5 articles were excluded and only 20 articles remained.
The eligibility of the articles was also checked. Twenty articles remaining were all read
across to check if they were eligible. Six articles were excluded at this point due to various
reasons. This includes poor grammar use, lack of plain words to an extent the whole documents
were not easily understood, poor graphics and the information in the document were not well
organized. The 14 remaining articles qualified to be used in the literature review of which 8 of
them consisted of qualitative synthesis and 6 quantitative analysis. Below is the prism flow chart
of the whole process.

DISSERTATION 4
Prism Flow Diagram
Records identified through
database searching
(n = 22)
Additional records identified
through other sources
(n = 5)
Records after duplicates removed
(n = 2 )
Records screened
(n = 25 )
Records excluded
(n = 5 )
Full-text articles assessed
for eligibility
(n = 20 )
Full-text articles excluded,
with reasons
(n = 6 )
Studies included in
qualitative synthesis
(n = 8 )
Studies included in
quantitative synthesis
(meta-analysis)
(n = 6 )

DISSERTATION 5
PICO Strategy
P- Women who have been affected by breast cancer and are currently not. All ages included as
far as they are breast cancer survivors. All races, ethnic groups, and cultures included.
I-Demonstrate all associated factors of fear of breast cancer among survivors
C- The difference of the effects among different communities, races and ethnic groups. What are
different perceptions of cancer among survivors? Could it be the cancer survivors think they still
have cancer? Could the psychological pain still be the same?
O-Delivering all available factors associated with fear in breast cancer survivors.
Search terms
Breast cancer, cancer, fear of cancer, fear of breast cancer, survivors of cancer, survivors of
breast cancer, associated factors, fear factors, the harm of cancer, cancer treatment, physical
fears, psychological fears, behavioral fears, breast cancer, surviving cancer, a population with
cancer, cancer self-care, understanding cancer
The boolean term, AND was commonly used, an example is breast cancer AND fear factors.
Inclusion and Exclusion Criteria
The inclusion criteria included all articles that were peer-reviewed and mostly published
concerning breast cancer. This is due to the fact that most of published and peer-reviewed
articles normally provide precise data. Other inclusion criteria included; latest articles not older
than five years, articles with authors, articles about associated fear factors to breast cancer
survivors, articles with a given study population and research title. The exclusion criteria
included all articles that had no impact on the research topic, articles without authors, articles
with insignificant knowledge, articles that had only theories and very little evidence.

DISSERTATION 6
The following are the final result of the final articles that were found of use in the research
concerning factors associated with fear of breast cancer among survivors. Most of these articles
are available online in the databases as the PDF files can only be purchased.
Blödt, S., Kaiser, M., Adam, Y., Adami, S., Schultze, M., Müller-Nordhorn, J. and Holmberg, C.
(2018). Understanding the role of health information in patients’ experiences: secondary analysis
of qualitative narrative interviews with people diagnosed with cancer in Germany. BMJ Open,
8(3),
Cho, D., Chu, Q. and Lu, Q. (2017). Associations among physical symptoms, fear of cancer
recurrence, and emotional well-being among Chinese American breast cancer survivors: a path
model. Supportive Care in Cancer.
Graells-Sans, A., Serral, G., and Puigpinós-Riera, R. (2018). Social inequalities in quality of life
in a cohort of women diagnosed with breast cancer in Barcelona (DAMA Cohort). Cancer
Epidemiology, 54, pp.38-47.
Islam, T., Dahlui, M., Majid, H., Nahar, A., Mohd Taib, N. and Su, T. (2014). Factors associated
with return to work of breast cancer survivors: a systematic review. BMC Public Health,
14(Suppl 3), p.S8.
Jefford, M., Ward, A., Lisy, K., Lacey, K., Emery, J., Glaser, A., Cross, H., Krishnasamy, M.,
McLachlan, S. and Bishop, J. (2017). Patient-reported outcomes in cancer survivors: a
population-wide cross-sectional study. Supportive Care in Cancer, 25(10), pp.3171-3179.

DISSERTATION 7
Koutoukidis, D., Lopes, S., Fisher, A., Williams, K., Croker, H. and Beeken, R. (2018). Lifestyle
advise to cancer survivors: a qualitative study on the perspectives of health professionals. BMJ
Open, 8(3),
Lee, K., Jung, D., Hwang, H., Son, K., Kim, T., Im, S., Lee, K. and Hahm, B. (2018). Pre-
treatment anxiety is associated with persistent chemotherapy-induced peripheral neuropathy in
women treated with neoadjuvant chemotherapy for breast cancer. Journal of Psychosomatic
Research, 108, pp.14-19.
Lu, Q., Yeung, N., Man, J., Gallagher, M., Chu, Q. and Deen, S. (2017). Ambivalence over
emotional expression, intrusive thoughts, and posttraumatic stress symptoms among Chinese
American breast cancer survivors. Supportive Care in Cancer, 25(10), pp.3281-3287.
Matthews, H., Turner, A., Williamson, I., and Clyne, W. (2018). ‘It's a silver lining’: A template
analysis of satisfaction and quality of life following post-mastectomy breast
reconstruction. British Journal of Health Psychology.
Phillips, K., McGinty, H., Gonzalez, B., Jim, H., Small, B., Minton, S., Andrykowski, M. and
Jacobsen, P. (2012). Factors associated with breast cancer worry 3 years after completion of
adjuvant treatment. Psycho-Oncology, 22(4), pp.936-939.
Rodríguez Medina, D., Domínguez Trejo, B., Cortés Esteban, P., Cruz Albarrán, I., Morales
Hernández, L. and Leija Alva, G. (2018). Biopsychosocial Assessment of Pain with Thermal
Imaging of Emotional Facial Expression in Breast Cancer Survivors. Medicines, 5(2), p.30.

DISSERTATION 8
Shumway, D., Leinberger, R., Griffith, K., Zikmund-Fisher, B., Hawley, S., Jagsi, R. and Janz,
N. (2013). Management of worry about recurrence in breast cancer survivors. Journal of Clinical
Oncology, 31(31_suppl), pp.21-21.
Taylor, T., Huntley, E., Sween, J., Makambi, K., Mellman, T., Williams, C., Carter-Nolan, P.
and Frederick, W. (2012). An Exploratory Analysis of Fear of Recurrence among African-
American Breast Cancer Survivors. International Journal of Behavioral Medicine, 19(3),
pp.280-287.
Trindade, I., Ferreira, C., Borrego, M., Ponte, A., Carvalho, C. and Pinto-Gouveia, J. (2018).
Going beyond social support: Fear of receiving compassion from others predicts depression
symptoms in breast cancer patients. Journal of Psychosocial Oncology, pp.1-9.