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Prevalence and Correlates of Worry About Medical Imaging Radiation Among United States Cancer Survivors

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Abstract

Purpose

Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for survivors. The aims of this paper are to describe cancer survivors’ level of worry about medical imaging radiation (MIR) and to identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust.

Method

This cross-sectional study used the 2012–2013 Health Information National Trends Survey of US adults conducted by the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic regression analysis was used to evaluate factors associated with higher MIR worry (reporting “some” or “a lot” of MIR worry).

Results

Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in unadjusted analysis.

Conclusion

Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns of worry could aid efforts to improve these individuals’ survivorship care and education.

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References

  1. American Cancer Society. Cancer treatment & survivorship: facts and figures, 2016–2017. Atlanta: Corporate Center: American Cancer Society Inc.; 2016 [cited 2017 March 28]; Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2016-2017.pdf.

  2. Daly C, Urbach DR, Stukel TA, Nathan PC, Deitel W, Paszat LF, et al. Patterns of diagnostic imaging and associated radiation exposure among long-term survivors of young adult cancer: a population-based cohort study. BMC Cancer. 2015;15:612. https://doi.org/10.1186/s12885-015-1578-1.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300–22. https://doi.org/10.1007/s11764-013-0272-z.

    Article  PubMed  Google Scholar 

  4. McGinty HL, Small BJ, Laronga C, Jacobsen PB. Predictors and patterns of fear of cancer recurrence in breast cancer survivors. Health Psychol. 2016;35(1):1–9. https://doi.org/10.1037/hea0000238.

    Article  PubMed  Google Scholar 

  5. Thompson CA, Charlson ME, Schenkein E, Wells MT, Furman RR, Elstrom R, Ruan J, Martin P, Leonard JP Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors. Ann Oncol 2010;21(11):2262–6. https://doi.org/10.1093/annonc/mdq215, 2266.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Koch L, Bertram H, Eberle A, Holleczek B, Schmid-Hopfner S, Waldmann A, et al. Fear of recurrence in long-term breast cancer survivors-still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the cancer survivorship—a multi-regional population-based study. Psychooncology. 2014;23(5):547–54. https://doi.org/10.1002/pon.3452.

    Article  PubMed  Google Scholar 

  7. Simonelli LE, Siegel SD, Duffy NM. Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psychooncology. 2016;26:1444–54. https://doi.org/10.1002/pon.4168.

    Article  PubMed  Google Scholar 

  8. Janz NK, Friese CR, Li Y, Graff JJ, Hamilton AS, Hawley ST. Emotional well-being years post-treatment for breast cancer: prospective, multi-ethnic, and population-based analysis. J Cancer Surviv. 2014;8(1):131–42. https://doi.org/10.1007/s11764-013-0309-3.

    Article  PubMed  Google Scholar 

  9. Kypriotakis G, Vidrine DJ, Francis LE, Rose JH. The longitudinal relationship between quality of life and survival in advanced stage cancer. Psychooncology. 2016;25(2):225–31. https://doi.org/10.1002/pon.3846.

    Article  PubMed  Google Scholar 

  10. Bresner L, Banach R, Rodin G, Thabane L, Ezzat S, Sawka AM. Cancer-related worry in Canadian thyroid cancer survivors. J Clin Endocrinol Metab. 2015;100(3):977–85. https://doi.org/10.1210/jc.2014-3169.

    Article  CAS  PubMed  Google Scholar 

  11. Waters EA, Liu Y, Schootman M, Jeffe DB. Worry about cancer progression and low perceived social support: implications for quality of life among early-stage breast cancer patients. Ann Behav Med. 2013;45(1):57–68. https://doi.org/10.1007/s12160-012-9406-1.

    Article  PubMed  Google Scholar 

  12. Wang R, Syed IA, Nathan PC, Barr RD, Rosenberg-Yunger ZR, Klassen AF. Exploring cancer worry in adolescent and young adult survivors of childhood cancers. J Adolesc Young Adult Oncol. 2015;4(4):192–9.

    Article  PubMed  Google Scholar 

  13. Consedine NS, Magai C, Krivoshekova YS, Ryzewicz L, Neugut AI. Fear, anxiety, worry, and breast cancer screening behavior: a critical review. Cancer Epidemiol Biomark Prev. 2004;13(4):501–10.

    Google Scholar 

  14. Hay JL, Buckley TR, Ostroff JS. The role of cancer worry in cancer screening: a theoretical and empirical review of the literature. Psychooncology. 2005;14(7):517–34. https://doi.org/10.1002/pon.864.

    Article  PubMed  Google Scholar 

  15. Cameron L, Leventhal EA, Leventhal H. Seeking medical care in response to symptoms and life stress. Psychosom Med. 1995;57(1):37–47.

    Article  CAS  PubMed  Google Scholar 

  16. Diefenbach MA, Leventhal H. The common-sense model of illness representation: theoretical and practical considerations. J Soc Distress Homeless. 1996;5(1):11–38. https://doi.org/10.1007/bf02090456.

    Article  Google Scholar 

  17. Leventhal H. Findings and theory in the study of fear communications. In: Berkowitz L (ed). Adv Exp Soc Psychol: Academic Press; 1970. p. 119–86.

  18. Leventhal H, Cameron L. Behavioral theories and the problem of compliance. Patient Educ Couns. 1987;10(2):117–38. https://doi.org/10.1016/0738-3991(87)90093-0.

    Article  Google Scholar 

  19. Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1–47. https://doi.org/10.1177/109019818401100101.

    Article  CAS  PubMed  Google Scholar 

  20. Calnan M. The health belief model and participation in programmes for the early detection of breast cancer: a comparative analysis. Soc Sci Med. 1984;19(8):823–30.

    Article  CAS  PubMed  Google Scholar 

  21. Champion VL. Instrument development for health belief model constructs. ANS Adv Nurs Sci. 1984;6(3):73–85.

    Article  CAS  PubMed  Google Scholar 

  22. Champion VL. Use of the health belief model in determining frequency of breast self-examination. Res Nurs Health. 1985;8(4):373–9.

    Article  CAS  PubMed  Google Scholar 

  23. Champion VL. The relationship of breast self-examination to health belief model variables. Res Nurs Health. 1987;10(6):375–82.

    Article  CAS  PubMed  Google Scholar 

  24. Maiman LA, Becker MH, Kirscht JP, Haefner DP, Drachman RH. Scales for measuring health belief model dimensions: a test of predictive value, internal consistency, and relationships among beliefs. Health Educ Monogr. 1977;5(3):215–30.

    Article  CAS  PubMed  Google Scholar 

  25. Miller AM, Champion VL. Mammography in women > or = 50 years of age. Predisposing and enabling characteristics. Cancer Nurs. 1993;16(4):260–9.

    Article  CAS  PubMed  Google Scholar 

  26. Champion VL. Attitudinal variables related to intention, frequency and proficiency of breast self-examination in women 35 and over. Res Nurs Health. 1988;11(5):283–91.

    Article  CAS  PubMed  Google Scholar 

  27. Hill D, Gardner G, Rassaby J. Factors predisposing women to take precautions against breast and cervix cancer. J Appl Soc Psychol. 1985;15(1):59–79. https://doi.org/10.1111/j.1559-1816.1985.tb00894.x.

    Article  Google Scholar 

  28. Vernon SW, Myers RE, Tilley BC. Development and validation of an instrument to measure factors related to colorectal cancer screening adherence. Cancer Epidemiol Biomark Prev. 1997;6(10):825–32.

    CAS  Google Scholar 

  29. Robberson MR, Rogers RW. Beyond fear appeals: negative and positive persuasive appeals to health and self-esteem. J Appl Soc Psychol. 1988;18(3):277–87. https://doi.org/10.1111/j.1559-1816.1988.tb00017.x.

    Article  Google Scholar 

  30. W Rogers R, Cacioppo J, Petty R. Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation. 1983. pp. 153–77

  31. Witte K. Putting the fear back into fear appeals: the extended parallel process model. Commun Monogr. 1992;59(4):329–49. https://doi.org/10.1080/03637759209376276.

    Article  Google Scholar 

  32. Janis IL, Feshbach S. Effects of fear-arousing communications. J Abnorm Soc Psychol. 1953;48(1):78–92. https://doi.org/10.1037/h0060732.

    Article  CAS  Google Scholar 

  33. Hay JL, McCaul KD, Magnan RE. Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Prev Med. 2006;42(6):401–8.

    Article  PubMed  Google Scholar 

  34. Nguyen PK, Wu JC. Radiation exposure from imaging tests: is there an increased cancer risk? Expert Rev Cardiovasc Ther. 2011;9(2):177–83. https://doi.org/10.1586/erc.10.184.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Vijayvergia N, Shah PC, Denlinger CS. Survivorship in non-small cell lung cancer: challenges faced and steps forward. J Natl Compr Cancer Netw. 2015;13(9):1151–61.

    Article  CAS  Google Scholar 

  36. Ettinger DS, Wood DE, Aisner DL, Akerley W, Bauman J, Chirieac LR, et al. Non-small cell lung cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2017;15(4):504–35.

    Article  Google Scholar 

  37. Hollada J, Speier W, Oshiro T, Marzan-McGill R, Ruehm SG, Bassett LW, et al. Patients’ perceptions of radiation exposure associated with mammography. AJR Am J Roentgenol. 2015;205(1):215–21. https://doi.org/10.2214/ajr.14.13650.

    Article  PubMed  Google Scholar 

  38. Boone JM, Hendee WR, McNitt-Gray MF, Seltzer SE. Radiation exposure from CT scans: how to close our knowledge gaps, monitor and safeguard exposure—proceedings and recommendations of the Radiation Dose Summit, sponsored by NIBIB, February 24-25, 2011. Radiology. 2012;265(2):544–54. https://doi.org/10.1148/radiol.12112201.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Fletcher JG, Kofler JM, Coburn JA, Bruining DH, McCollough CH. Perspective on radiation risk in CT imaging. Abdom Imaging. 2013;38(1):22–31. https://doi.org/10.1007/s00261-012-9933-z.

    Article  PubMed  Google Scholar 

  40. Brenner DJ, Shuryak I, Einstein AJ. Impact of reduced patient life expectancy on potential cancer risks from radiologic imaging. Radiology. 2011;261(1):193–8. https://doi.org/10.1148/radiol.11102452.

    Article  PubMed  Google Scholar 

  41. Zhang Y, Chen Y, Huang H, Sandler J, Dai M, Ma S, et al. Diagnostic radiography exposure increases the risk for thyroid microcarcinoma: a population-based case-control study. Eur J Cancer Prev. 2015;24(5):439–46. https://doi.org/10.1097/cej.0000000000000169.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Gillan C, Abrams D, Harnett N, Wiljer D, Catton P. Fears and misperceptions of radiation therapy: sources and impact on decision-making and anxiety. J Cancer Educ. 2014;29(2):289–95. https://doi.org/10.1007/s13187-013-0598-2.

    Article  PubMed  Google Scholar 

  43. Bryant AK, Banegas M, Martinez ME, Mell LK, Murphy JD. Trends in radiation therapy among cancer survivors in the United States, 2000-2030. Cancer Epidemiol Biomark Prev. 2017;26:963–70. https://doi.org/10.1158/1055-9965.epi-16-1023.

    Article  Google Scholar 

  44. Gudowska I, Ardenfors O, Toma-Dasu I, Dasu A. Radiation burden from secondary doses to patients undergoing radiation therapy with photons and light ions and radiation doses from imaging modalities. Radiat Prot Dosim. 2014;161(1–4):357–62. https://doi.org/10.1093/rpd/nct335.

    Article  CAS  Google Scholar 

  45. Moye J, Wachen JS, Mulligan EA, Doherty K, Naik AD. Assessing multidimensional worry in cancer survivors. Psychooncology. 2014;23(2):237–40. https://doi.org/10.1002/pon.3381.

    Article  PubMed  Google Scholar 

  46. Gotay CC, Pagano IS. Assessment of Survivor Concerns (ASC): a newly proposed brief questionnaire. Health Qual Life Outcomes. 2007 Mar 13;5:15. https://doi.org/10.1186/1477-7525-5-15.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kroenke K, Spitzer RL, Williams JB, Lowe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613–21. https://doi.org/10.1176/appi.psy.50.6.613.

    Article  PubMed  Google Scholar 

  48. Redberg RF, Smith-Bindman R. We are giving ourselves cancer. The New York Times 2014.

  49. Busey JM, Soine LA, Yager JR, Choi E, Shuman WP. Patient knowledge and understanding of radiation from diagnostic imaging. JAMA Intern Med. 2013;173(3):239–41. https://doi.org/10.1001/2013.jamainternmed.1013.

    Article  PubMed  Google Scholar 

  50. Ludwig RL, Turner LW. Effective patient education in medical imaging: public perceptions of radiation exposure risk. J Allied Health. 2002;31(3):159–64.

    PubMed  Google Scholar 

  51. Thornton RH, Dauer LT, Shuk E, Bylund CL, Banerjee SC, Maloney E, et al. Patient perspectives and preferences for communication of medical imaging risks in a cancer care setting. Radiology. 2015;275(2):545–52. https://doi.org/10.1148/radiol.15132905.

    Article  PubMed  Google Scholar 

  52. Vurnek Zivkovic M, Buljan M, Blajic I, Situm M. Psychological status and illness perceptions in patients with melanoma. Coll Antropol. 2008;32(Suppl 2):75–8.

    PubMed  Google Scholar 

  53. American Cancer Society. Can melanoma skin cancer be found early?: American Cancer Society 2016 [cited 2017 March 28, 2017]; Available from: https://www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/detection.html.

  54. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: U.S. Department of Education: National Center for Education Statistics; 2006; Available from: https://nces.ed.gov/pubs2006/2006483.pdf.

  55. Viswanath K, Breen N, Meissner H, Moser RP, Hesse B, wR S, et al. Cancer knowledge and disparities in the information age. J Health Commun. 2006;11:1–17.

    Article  PubMed  Google Scholar 

  56. Hay JL, Gold GS, Baser RE, Hricak H, Dauer LT. Prevalence and correlates of worry about the health harms of medical imaging radiation in the general population. J Prim Care Community Health. 2016;7(4):219–25. https://doi.org/10.1177/2150131916648917.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Shrout PE, Stadler G, Lane SP, McClure MJ, Jackson GL, Clavel FD, et al. Initial elevation bias in subjective reports. Proc Natl Acad Sci U S A. 2018;115(1):E15–e23. https://doi.org/10.1073/pnas.1712277115.

    Article  CAS  PubMed  Google Scholar 

  58. Lam DL, Larson DB, Eisenberg JD, Forman HP, Lee CI. Communicating potential radiation-induced cancer risks from medical imaging directly to patients. AJR Am J Roentgenol. 2015;205(5):962–70. https://doi.org/10.2214/ajr.15.15057.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Jillisia James for her help in completing this manuscript.

Funding

We received funding support from the Memorial Sloan Kettering Support/Core Grant (P30 CA008748).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA

    Jennifer L. Hay, Joy S. Westerman & Jennifer S. Ford

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Raymond E. Baser

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  1. Jennifer L. Hay
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Correspondence to Jennifer L. Hay.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hay, J.L., Baser, R.E., Westerman, J.S. et al. Prevalence and Correlates of Worry About Medical Imaging Radiation Among United States Cancer Survivors. Int.J. Behav. Med. 25, 569–578 (2018). https://doi.org/10.1007/s12529-018-9730-3

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  • DOI: https://doi.org/10.1007/s12529-018-9730-3

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