{"id":3284,"date":"2024-12-09T07:18:09","date_gmt":"2024-12-09T07:18:09","guid":{"rendered":"https:\/\/practicalhealthpsychology.com\/?p=3284"},"modified":"2026-03-03T08:46:22","modified_gmt":"2026-03-03T08:46:22","slug":"what-if-it-comes-back-the-question-that-is-on-the-minds-of-those-who-experienced-cancer-treatment-and-their-loved-ones","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/pl\/2024\/12\/what-if-it-comes-back-the-question-that-is-on-the-minds-of-those-who-experienced-cancer-treatment-and-their-loved-ones\/","title":{"rendered":"A co je\u015bli to wr\u00f3ci? Pytanie, kt\u00f3re zaprz\u0105ta umys\u0142y os\u00f3b, kt\u00f3re do\u015bwiadczy\u0142y raka, i ich bliskich"},"content":{"rendered":"

Gozde Ozakinci, University of Stirling, Szkocja<\/strong><\/p>\n

Rak jest mocno kojarzony z przera\u017caj\u0105cymi statystykami. Na przyk\u0142ad \u201e1 na 2 osoby zachoruje na jak\u0105\u015b form\u0119 raka w ci\u0105gu swojego \u017cycia<\/a>\u201d.\u00a0 Istniej\u0105 jednak obiecuj\u0105ce dane, kt\u00f3re sugeruj\u0105, \u017ce wska\u017aniki prze\u017cywalno\u015bci raka poprawiaj\u0105 si\u0119<\/a>.\u00a0 Ostatnie dane z \u00a0roku 2018\u00a0 sugeruj\u0105, \u017ce na \u015bwiecie jest ju\u017c prawie 44 miliony os\u00f3b, kt\u00f3re prze\u017cy\u0142y diagnoz\u0119 i leczenie raka<\/a>. To dobra wiadomo\u015b\u0107 dla tych, kt\u00f3rzy do\u015bwiadczaj\u0105 diagnozy i leczenia tej choroby.<\/p>\n

<\/p>\n

Poprawa wska\u017anik\u00f3w prze\u017cywalno\u015bci oznacza r\u00f3wnie\u017c, \u017ce coraz wi\u0119cej os\u00f3b \u017cyje z konsekwencjami leczenia raka. Jedn\u0105 z tych konsekwencji jest do\u015bwiadczanie l\u0119ku przed nawrotem choroby. W literaturze jest on definiowany jako \u201estrach, martwienie si\u0119 lub obawy zwi\u0105zane z mo\u017cliwo\u015bci\u0105 nawrotu lub progresji raka\u201d<\/a> i powszechnie uznawany za jedn\u0105 z najwa\u017cniejszych kwestii wp\u0142ywaj\u0105cych na jako\u015b\u0107 \u017cycia os\u00f3b po diagnozie nowotworu z\u0142o\u015bliwego.<\/p>\n

Jak powszechne s\u0105 te obawy?<\/strong><\/p>\n

Odpowied\u017a na to pytanie nie jest prosta, poniewa\u017c w badaniach stosuje si\u0119 r\u00f3\u017cne narz\u0119dzia do pomiaru l\u0119ku przed nawrotem raka. Systematyczny przegl\u0105d 130 bada\u0144<\/a> wykaza\u0142, \u017ce w zale\u017cno\u015bci od lokalizacji choroby i sposobu pomiaru \u015brednio 49% badanych zg\u0142osi\u0142o umiarkowany lub wysoki stopie\u0144 l\u0119ku przed nawrotem raka, a 7% zg\u0142osi\u0142o stopie\u0144 wysoki. Najnowsza metaanaliza<\/a> wykaza\u0142a, \u017ce jedna na pi\u0119\u0107 os\u00f3b, kt\u00f3re prze\u017cy\u0142y lub aktualnie choruj\u0105 na nowotw\u00f3r z\u0142o\u015bliwy, do\u015bwiadczy\u0142a wysokiego poziomu l\u0119ku przed nawrotem raka, co wskazuje na potrzeb\u0119 specjalistycznego wsparcia psychologicznego.\u00a0 Co wi\u0119cej, przegl\u0105dy te pokazuj\u0105, \u017ce obawy te nie znikaj\u0105 z czasem. Bycie kobiet\u0105, m\u0142odszy wiek i ni\u017cszy poziom wykszta\u0142cenia wi\u0105\u017ce si\u0119 z wy\u017cszym nasileniem obaw przed nawrotem raka.\u00a0 Jednym z wa\u017cnych czynnik\u00f3w jest do\u015bwiadczanie objaw\u00f3w fizycznych, kt\u00f3re mog\u0105 by\u0107 interpretowane jako oznaki nawrotu choroby.<\/p>\n

Jaki jest zwi\u0105zek tych obaw z dobrostanem psychologicznym?<\/strong><\/p>\n

Osoby, kt\u00f3re prze\u017cy\u0142y raka, identyfikuj\u0105 te obawy b\u0105d\u017a jako g\u0142\u00f3wny problem, b\u0105d\u017a jako jeden z pi\u0119ciu najwi\u0119kszych problem\u00f3w<\/a>.\u00a0 Obawy te s\u0105 dla nich nie tylko g\u0142\u00f3wnym zmartwieniem, ale a\u017c 79% z nich zg\u0142asza, \u017ce jest to jedna z najbardziej niezaspokojonych potrzeb<\/a>. Stwierdzono, \u017ce obawy przed nawrotem raka s\u0105 zwi\u0105zane z ni\u017csz\u0105 jako\u015bci\u0105 \u017cycia, wy\u017cszym poziomem l\u0119ku, depresji i niepokoju.<\/a> Istniej\u0105 r\u00f3wnie\u017c przes\u0142anki, kt\u00f3re wskazuj\u0105, i\u017c wi\u0119ksze obawy przed nawrotem choroby nowotworowej wi\u0105\u017c\u0105 si\u0119 z cz\u0119stszym korzystaniem z systemu opieki zdrowotnej<\/a>.<\/p>\n

Cho\u0107 wi\u0119kszo\u015b\u0107 bada\u0144 przeprowadzono w\u015br\u00f3d os\u00f3b, kt\u00f3re prze\u017cy\u0142y raka, niedawny przegl\u0105d<\/a> wykaza\u0142, \u017ce obawy przed jego nawrotem s\u0105 r\u00f3wnie\u017c problemem dla opiekun\u00f3w. W\u015br\u00f3d nich 48% zg\u0142osi\u0142o poziom wskazuj\u0105cy na potrzeb\u0119 wsparcia psychologicznego.\u00a0 Inny przegl\u0105d<\/a> wykaza\u0142, \u017ce obawy opiekun\u00f3w mog\u0105 by\u0107 tak samo wysokie, je\u015bli nie wi\u0119ksze, jak os\u00f3b, kt\u00f3re prze\u017cy\u0142y chorob\u0119. Ponadto wi\u0105za\u0142y si\u0119 z gorsz\u0105 jako\u015bci\u0105 \u017cycia zar\u00f3wno samych opiekun\u00f3w, jak i ich podopiecznych.<\/p>\n

Czym charakteryzuje si\u0119 kliniczny poziom l\u0119ku przed nawrotem raka?<\/strong><\/p>\n

Oczywiste jest, \u017ce obawy przed nawrotem raka s\u0105 zjawiskiem wielowymiarowym.\u00a0 W ramach ustalania konsensusu ekspert\u00f3w<\/a> zasugerowano nast\u0119puj\u0105ce kluczowe cechy \u201eklinicznego\u201d \u00a0charakteru tych obaw: 1) wysoki poziom zaabsorbowania; 2) wysoki poziom zamartwiania si\u0119; 3) uporczywo\u015b\u0107; oraz 4) nadmierna czujno\u015b\u0107 wobec objaw\u00f3w somatycznych.<\/p>\n

Jak mierzymy obawy przed nawrotem raka?<\/strong><\/p>\n

Pierwszy systematyczny przegl\u0105d miar l\u0119ku przed nawrotem raka<\/a> zidentyfikowa\u0142 20 skal, a w kolejny p\u00f3\u017aniejszym<\/a> dodano jeszcze osiem takich skal. Podj\u0119to pr\u00f3by ustalenia klinicznego punktu odci\u0119cia w celu zidentyfikowania os\u00f3b potrzebuj\u0105cych wsparcia psychologicznego. Inwentarz The Fear of Cancer Recurrence Inventory<\/em><\/a> \u00a0sk\u0142ada si\u0119 z 42 pozycji i umo\u017cliwia dog\u0142\u0119bn\u0105 ocen\u0119 tych obaw. Ma on kilka podskal, a sk\u0142adaj\u0105ca si\u0119 z 9 stwierdze\u0144 podskala Powagi objaw\u00f3w<\/em><\/a> jest szeroko stosowana oraz ma okre\u015blony punkt odci\u0119cia identyfikacji os\u00f3b wymagaj\u0105cych interwencji psychologicznej (\u226522). Skale takie jak FCR4 i FCR7<\/a> s\u0105 r\u00f3wnie\u017c u\u017cywane jako kr\u00f3tsze miary, z proponowanymi percentylami jako podstaw\u0105 identyfikacji os\u00f3b z umiarkowanym i wysokim nasileniem l\u0119ku przed nawrotem. Aby u\u0142atwi\u0107 badanie przesiewowe, zaproponowano r\u00f3wnie\u017c 1-punktow\u0105 miar\u0119<\/a> nasilenia tych obaw.<\/p>\n

Jakie s\u0105 skuteczne sposoby wspierania pacjent\u00f3w onkologicznych z tymi obawami?<\/strong><\/p>\n

Metaanaliza interwencji psychologicznych wobec obaw przed nawrotem<\/a> wykaza\u0142a, \u017ce interwencje te mog\u0105 one mie\u0107 niewielki, ale stabilny efekt ko\u0144cowy, kt\u00f3ry jest w du\u017cej mierze utrzymywany r\u00f3wnie\u017c w pomiarze odroczonym od przeprowadzonego oddzia\u0142ywania.\u00a0 Wi\u0119ksze efekty uzyskiwano w terapiach poznawczo-behawioralnych koncentruj\u0105cych si\u0119 raczej na sposobie (np. ruminowanie) ni\u017c na tre\u015bci przetwarzania poznawczego oraz nastawionych na zmian\u0119 odnoszenia si\u0119 do swoich wewn\u0119trznych do\u015bwiadcze\u0144.<\/p>\n

Zalecenia praktyczne:<\/strong><\/p>\n

    \n
  1. U\u0142atwienie rozmowy na temat obaw:<\/strong> Niekt\u00f3rzy pacjenci mog\u0105 nie chcie\u0107 rozmawia\u0107 z lekarzem o swoich obawach przed nawrotem raka z racji tego, \u017ce oka\u017c\u0105 si\u0119 niewdzi\u0119czni<\/a>. Jednak rozpocz\u0119cie takiej rozmowy mo\u017ce by\u0107 bardzo pomocne dla pacjenta i u\u0142atwi\u0107 mu otrzymanie dalszego wsparcia. Uznanie istnienia tych obaw mo\u017ce by\u0107 niezwykle wa\u017cne dla os\u00f3b, kt\u00f3re prze\u017cy\u0142y raka.<\/li>\n
  2. Przekazanie informacji na temat objaw\u00f3w raka<\/strong>: Rozmowa o objawach nowotworu z\u0142o\u015bliwego, kt\u00f3re faktycznie uzasadniaj\u0105 skontaktowanie si\u0119 z lekarzem, mo\u017ce by\u0107 okazj\u0105 do rozwiewania mit\u00f3w na ten temat.<\/li>\n
  3. Nie zapominaj o opiekunach<\/strong>: Podczas gdy skupienie si\u0119 na pacjencie jest konieczne, pracownicy s\u0142u\u017cby zdrowia musz\u0105 pami\u0119ta\u0107, \u017ce opiekunowie r\u00f3wnie\u017c do\u015bwiadczaj\u0105 wysokiego poziomu l\u0119ku przed nawrotem raka u ukochanej osoby i mog\u0105 r\u00f3wnie\u017c potrzebowa\u0107 wsparcia.<\/li>\n
  4. Badania przesiewowe nie wystarcz\u0105<\/strong>: Badania przesiewowe nasilenia obaw przed nawrotem s\u0105 pomocne, nadal jednak istnieje potrzeba zapewnienia adekwatnego wsparcia psychologicznego pacjentom i opiekunom.<\/li>\n
  5. Uwa\u017caj na oznaki l\u0119ku<\/strong>: Wczesne oznaki l\u0119ku i zmiany poziomu l\u0119ku<\/a> s\u0105 zwi\u0105zane z p\u00f3\u017aniejszym wzrostem obaw przed nawrotem raka w pierwszym roku leczenia. Nale\u017cy zatem monitorowa\u0107 ten l\u0119k i zapewnia\u0107 wsparcie, aby zapobiec jego p\u00f3\u017aniejszej eskalacji.<\/li>\n<\/ol>\n

    przet\u0142umaczone przez Zuzann\u0119 Kwiss\u0119-Gajewsk\u0105 i Ew\u0119 Gruszczy\u0144sk\u0105<\/p>\n","protected":false},"excerpt":{"rendered":"

    By Gozde Ozakinci, University of Stirling\u00a0 Cancer is very much associated with scary statistics. For instance, like the one \u20181 in 2 people will develop some form of cancer in their lifetime\u2019.\u00a0 But there are encouraging developments too that suggests […]<\/p>\n","protected":false},"author":9,"featured_media":3285,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"By Gozde Ozakinci, University of Stirling\u00a0<\/span>\r\n\r\nCancer is very much associated with scary statistics. For instance, like the one \u2018<\/span>1 in 2 people will develop some form of cancer in their lifetime\u2019<\/span><\/a>.\u00a0 But there are encouraging developments too that suggests that <\/span>cancer survival rates are improving<\/span><\/a>.\u00a0 The last count in 2018 suggests that <\/span>there are nearly 44 million people who survived the cancer diagnosis and treatment in the world<\/span><\/a>. This is welcome news to those who have experienced cancer diagnosis and treatment.\u00a0<\/span>\r\n\r\nThe improvement in survival rates also means that more and more people live with the consequences of cancer treatment. One of these consequences is experiencing fears about cancer coming back. In the literature, it is defined as \u201c<\/span>fear, worry, or concern relating to the possibility that cancer will come back or progress<\/span><\/a>\u201d and recognised widely as one of the most significant issues that impact on the quality of life of those living after a cancer diagnosis.\u00a0<\/span>\r\n\r\nHow common are these fears?<\/b>\r\n\r\nAnswering this question is not straightforward as the studies have used different tools to measure fears of cancer recurrence. A <\/span>systematic review of 130 studies<\/span><\/a> showed that across different cancer sites and assessment strategies, 49% on average reported moderate to high degree of Fear of Cancer Reoccurrence (FCR), and 7% on average reported high degree. <\/span>A more recent meta-analysis<\/span><\/a> reported that one in 5 cancer survivors and patients experienced high levels of fears of cancer recurrence, indicating a need for specialised psychological support.\u00a0 Moreover, these reviews show that these fears do not go away over time. Being women, of younger age, and having less education have been associated with higher fears of cancer recurrence.\u00a0 One of the important factors that is associated with these fears is the experience of physical symptoms which can be interpreted as signs of cancer coming back.<\/span>\r\n\r\nWhat\u2019s the relationship of these fears with psychological wellbeing?<\/b>\r\n\r\nCancer survivors identify these fears as the major concern or one of <\/span>the top 5 greatest concerns<\/span><\/a>.\u00a0 Not only are these fears a major concern for them but <\/span>also up to 79% report that this is one of the most unmet needs<\/span><\/a>.\u00a0 <\/span>Fears about cancer recurrence have been found to be related to lower quality of life, higher anxiety, depression, and distress<\/span><\/a>. There is also indication that <\/span>higher fears of cancer recurrence are related to increased health care use<\/span><\/a>.\u00a0\u00a0<\/span>\r\n\r\nMoreover, although majority of the research has been conducted with cancer survivors, <\/span>a recent review<\/span><\/a> shows that fears about cancer recurrence is also a problem for caregivers, with 48% reporting levels that would indicate need for psychological support.\u00a0 <\/span>Another review<\/span><\/a> showed that caregivers\u2019 fears can be as high as the survivors\u2019 if not greater and the caregivers\u2019 fears were associated with poorer quality of life in caregivers and survivors.<\/span>\r\n\r\nWhat are the features of clinical levels of fears of cancer recurrence?<\/b>\r\n\r\nIt is clear that fears of cancer recurrence are a multidimensional phenomenon.\u00a0 An <\/span>expert consensus study<\/span><\/a> suggested the following as key features of \u2018clinical\u2019 fears of cancer recurrence: 1) high levels of preoccupation; 2) high levels of worry; 3) persistency; and 4) hypervigilance to bodily symptoms.\u00a0<\/span>\r\n\r\nHow do we measure these fears?<\/b>\r\n\r\nAn early review of fears of cancer recurrence measures<\/span><\/a> identified 20 scales and <\/span>another review<\/span><\/a> soon after found additional eight scales. There have been attempts for establishing a clinical cut-off score to identify those needing psychological support. <\/span>The Fear of Cancer Recurrence Inventory<\/span><\/a> is a 42-item measure that enables an in-depth assessment of these fears. It has several sub-scales and the <\/span>9-item Severity sub-scale<\/span><\/a> is widely used which has a cut-off to identify those who need psychological intervention (\u226522). Scales such as <\/span>FCR4 and FCR7<\/span><\/a> are also being used as shorter measures with suggested percentiles for identifying those with moderate and high fears. To facilitate screening of these fears, <\/span>1-item measure<\/span><\/a> has been put forward as well.<\/span>\r\n\r\nWhat are the effective ways of supporting cancer patients with these fears?<\/b>\r\n\r\nA meta-analysis of psychological interventions for fears of cancer recurrence<\/span><\/a> showed that they can have a small but robust effect at the end of intervention which be largely maintained at the follow-up.\u00a0 Cognitive Behavioural Therapies that were focused on processes of cognition such as rumination rather than the content and which aimed to change the way in which the individual relates to their inner experiences had larger effects.\u00a0<\/span>\r\n\r\nPractical recommendations:<\/b>\r\n

      \r\n \t
    1. Facilitate a conversation on fears:<\/b> Some patients may not want to approach their health care provider about their fears of cancer coming back <\/span>for fear of appearing ungrateful<\/span><\/a>. But starting these conversations can be very helpful for the patient to facilitate further support. Validating those fears can be immensely helpful to the cancer survivors.<\/span><\/li>\r\n \t
    2. Provide information on signs of cancer: <\/b>Talking through what might be signs of cancer that will warrant reaching out to their health care providers may provide opportunities for dispelling myths about cancer symptoms.\u00a0<\/span><\/li>\r\n \t
    3. Don\u2019t forget the caregivers:<\/b> While the focus on the cancer patient and survivor is necessary, healthcare professionals need to bear in mind that caregivers experience high levels of fear of cancer recurrence for their loved one and may need support too.<\/span><\/li>\r\n \t
    4. Screening is not enough:<\/b> Although screening for these fears is helpful, there is a need to ensure that there is appropriate psychological support that can be offered to the patients and caregivers.<\/span><\/li>\r\n \t
    5. Watch out for signs of anxiety:<\/b> Early signs of anxiety and changes in anxiety levels<\/span><\/a> are associated with later increases in fears of cancer recurrence in the first year of treatment. Monitor for signs of anxiety frequently and provide support to prevent further escalation of these fears.<\/span><\/li>\r\n<\/ol>","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[64,15],"tags":[],"class_list":["post-3284","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cancer","category-fear"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"pl","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","fi","sv","tr","uk"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":false,"content":false,"excerpt":false},"my":{"title":false,"content":false,"excerpt":false},"bg":{"title":true,"content":true,"excerpt":false},"zh":{"title":false,"content":false,"excerpt":false},"hr":{"title":false,"content":false,"excerpt":false},"cz":{"title":false,"content":false,"excerpt":false},"da":{"title":false,"content":false,"excerpt":false},"de":{"title":false,"content":false,"excerpt":false},"es":{"title":false,"content":false,"excerpt":false},"fr":{"title":false,"content":false,"excerpt":false},"gr":{"title":false,"content":false,"excerpt":false},"he":{"title":true,"content":true,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":false,"content":false,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":false,"content":false,"excerpt":false},"lt":{"title":false,"content":false,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":false,"content":false,"excerpt":false},"no":{"title":false,"content":false,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":false,"content":false,"excerpt":false},"ro":{"title":false,"content":false,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":false,"content":false,"excerpt":false},"fi":{"title":true,"content":true,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":false,"content":false,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false}}},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/posts\/3284","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/comments?post=3284"}],"version-history":[{"count":34,"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/posts\/3284\/revisions"}],"predecessor-version":[{"id":4771,"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/posts\/3284\/revisions\/4771"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/media\/3285"}],"wp:attachment":[{"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/media?parent=3284"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/categories?post=3284"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/practicalhealthpsychology.com\/pl\/wp-json\/wp\/v2\/tags?post=3284"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}