Discussion
This study showed that the incidence of CRF in CC patients was high. 283
patients had CRF of different degrees, and the incidence of CRF is as
high as 99%, of which the incidence of mild and moderate CRF is 53.2%,
and the incidence of severe CRF is 46.8%. The CPMs of severe CRF is
Logit(P)=1.276-0.947 Monthly income+0.989 Long-term passive
smoking-0.952 Physical exercise+1.512 Diagnosis type+1.040 Coping
style-0.726 PSS-2.350 SOC. In addition to demographic and clinical
characteristics, patients’ psychological conditions were more
influential in the CPMs, similar to Meglio’s model of breast cancer
CRF10.
Long term passive smoking, tumor recurrence, avoidance and yielding are
risk factors for severe CRF in CC patients. The concentrations of many
carcinogenic and toxic chemicals in second-hand smoke are higher than
those inhaled by smokers themselves, which may lead to some malignant
diseases, and the patients whose husbands do not smoke have worse
negative emotions and sleep quality than those who
smoke24. When the tumor relapses, the patient will
fear the disease, and the psychological defense line will collapse.
Patients will doubt the possibility of curing the disease, affecting
their confidence in treatment, and their mental health will be
poor25. CC patients who adopted avoidance and
surrender coping styles had a higher risk of serious CRF than those who
adopted facing coping style. They did not care about the development of
the disease and did not seek help actively. These patients had no
confidence in the prognosis and was resigned to fate, which might
increase the their negative mood and thus aggravated
CRF26.
Monthly income, physical exercise, PSS, and SOC are protective factors
for severe CRF in CC patients. After CC was diagnosed, patients usually
needed to receive comprehensive treatment, and the medical cost was
high. Patients with higher income had more and better treatment options
and less psychological pressure, so the risk of CRF was relatively
low27. Exercise can improve the blood oxygen content
of the body, accelerate the metabolism of the body, stimulate the
central nervous system, and then improve the mental state of patients,
so as to eliminate fatigue28. The social support
provided by role relationship is a valuable resource, which helps to
stabilize and develop positive self-esteem and self-confidence,
enhancing the patient’s ability to withstand pressure, and reduce the
possibility of negative extreme emotions29. There were
physiological and psychological stressors in the diagnosis and treatment
of cancer. SOC can strengthen the management of stressors, that is, use
existing resources to successfully deal with stressors. Therefore, a
high level of SOC can promote the good physical and mental health of
cancer patients30.
The areas under the ROC curve of both groups were greater than 0.8,
indicating that the CPMs of severe CRF for CC patients constructed can
better distinguish mild/moderate CRF patients from severe CRF
patients31. In the consistency test of the two groups,
the calibration curves were well fitted (P <0.05),
indicating that the probability of severe CRF predicted by the model was
consistent with the actual probability of severe CRF in CC patients, and
the accuracy of the model prediction was high. The DCA analysis showed
that the net benefit of applying the model to most thresholds in the
model building group and the model validation group was good. In
addition, this study visualized the CPMs in the form of Nomogram, which
was more intuitive and convenient for calculation, and was conducive to
the practical application of the model in clinical practice. According
to the best cut-off value 0.444 in ROC curve, CC patients can be divided
into high-risk group and low-risk group of CRF. For patients whose
prediction probability is close to or higher than the optimal threshold,
early intervention can be carried out according to their coping style,
social support, psychological consistency, etc.
The patients’ SOC improved after MBSR (from 55.07 to 59.95), and the
effect lasted until 6 months (64.17). The facing dimension score
increased after MBSR (from 19.20 to 21.15), and also maintained at 6
months (20.95). At the same time, the yielding dimension score decreased
after MBSR (from 12.10 to 10.85) and continuous decreased to 8.90 at 6
months. The CRF after MBSR were significantly improved (from 37.70 to
31.25), and maintained at 6 months (31.25 months). These results fully
indicated that online MBSR can effectively improve the SOC, coping
style, and CRF of CC patients, and the intervention effect lasted for a
short time, with scores significantly lower than those of the control
group. Previous studies have proved that MBSR has achieved good results
in promoting positive psychology and improving negative emotions and
also tried to explore the lasting effect of MBSR through longitudinal
research at different time points. Salvador proved that MBSR could
improve the psychological distress, general well-being, and
fatigue-related quality of life32. Gaboury showed that
up to 12 months after MBSR, anxiety, depression, emotion-oriented
coping, sleep and function significantly improved33.
Elimimian showed cancer survivors who participated in an 8-week MBSR
reported persistent benefits with reduced anxiety, depression, and
improved mental health over 24 months of follow-up34.
Green indicated mindfulness meditation had the potential to decrease
stress and burnout by decreasing self-judgment and over-identification
with experience, and by increasing resiliency, compassion, and emotional
regulation35. The above researches fully proved the
good intervention effect of MBSR, which may be due to the mechanism of
mindfulness, that is, when patients were threatened, injured or wasted
by specific events beyond their ability, individuals will actively
reassess stress events, redefine or construct stress events, thus
triggering positive emotions that can relieve stress, and ultimately
achieve internal balance and understanding36. Although
Carlson proved social support improved to a lesser degree after
MBSR37, our study showed that MBSR had no significant
impact on social support of CC patients. This may be because social
support usually emphasizes the emotion and help provided by personal
social networks, and tends to external factors. MBSR, as an internal
resource, requires the subject to actively explore and develop
themselves.
Limitations: first, influenced by the COVID-19, the time of arrival and
the way of visiting the hospital of the research objects had changed,
therefore, the missed follow-up rate was lightly high; second, the
tracking of the intervention effect was only 6 months, and the
evaluation results cannot reflect the long-term intervention effects.
Strengths: first, the model constructed in this study can help clinical
workers to identify high-risk groups of CRF, and provide a reference for
taking targeted intervention programs; second, we conducted an
intervention study based on the model and proved the effectiveness,
which was a complete study.