Fear of disease progression, self-management efficacy, and family functioning in patients with breast cancer: a cross-sectional relationship study

Introduction: Fear of disease progression (FoP) has been identified as one of the most prevalent unmet needs among breast cancer patients in recent years. The aim of this study was to examine FoP in patients with breast cancer and explore its associations with demographic and clinical characteristics, self-management efficacy, and family functioning. We also aimed to create a clinically-relevant prediction model based off of these factors (i.e., a "nomogram") to help identify patients' probability of experiencing high FoP. Methods: A cross-sectional survey of breast cancer in patients at the Affiliated Hospital of Jiangnan University was conducted from June 2023 to February 2024. The study included the Demographic and Clinical Characteristics Questionnaire, the Fear of Disease Progression Scale (FoP-Q-SF), the Chinese Self-Management Efficacy Scale for Cancer Patients (C-SUPPH), and the Family Care Index Questionnaire (APGAR). Data analysis included descriptive statistics, independent-samples t-test, one-way ANOVA, Pearson correlation analysis, and multiple regression analysis. A nomogram was constructed based on multiple regression results and the model performance was evaluated. Results: A total of 151 breast cancer patients were enrolled in the study. The mean (standard deviation) FoP score of the patients was 35.87 +/- 9.24. The average score of C-SUPPH was 96.97 +/- 17.29, and the average score of APGAR was 6.74 +/- 2.98. Pearson correlation analysis showed that FoP was negatively correlated with self-management efficacy (r = -0.544, p < 0.01) and family functioning (r = -0.730, p < 0.01). Multiple regression analysis showed that age (B = -4.038), self-management efficacy (B = -0.085) and family functioning (B = -1.972) were significantly related to FoP, and together explained 36% of FoP variation (R-2 = 0.360, F = 20.50, p < 0.001). The nomogram of these variables showed satisfactory prediction performance [the Bootstrap Correction Consistency Index (C-index) = 0.872]. According to previous studies, a C-index of >0.70 indicates that the model is acceptable. Conclusion: We found that greater fear of cancer progression (FoP) was associated with younger age, lower self-management efficacy and poorer family functioning in breast cancer patients. Based on these variables, our exploratory prediction model should be further investigated in order to help identify breast cancer patients who may be at highest risk of experiencing high FoP.