title: Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis.
abstract: OBJECTIVE
  To determine the effect that age at diagnosis has on fear of breast cancer recurrence and to identify the predictors of fear of recurrence using self-efficacy as a mediator.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Two university cancer centers and one cooperative group in the midwestern United States.
  
  
  METHODS
  1,128 long-term survivors.
  
  
  METHODS
  Survivors were eligible if they were aged 18-45 years (younger group) or 55-70 years (older group) at cancer diagnosis, had received chemotherapy, and were three to eight years postdiagnosis. Fear of recurrence was compared between younger and older groups. Multiple regression analyses were used to test variables' prediction of fear of recurrence and breast cancer survivor self-efficacy, as well as breast cancer survivor self-efficacy mediation effects.
  
  
  METHODS
  Fear of recurrence, breast cancer survivor self-efficacy, and age at diagnosis.
  
  
  RESULTS
  Survivors diagnosed at a younger age had significantly higher fear of recurrence, as well as health, role, womanhood, death, and parenting worries. Perceived risk of recurrence, trait anxiety, and breast cancer reminders explained significant variance in fear of recurrence and breast cancer survivor self-efficacy. Breast cancer survivor self-efficacy partially mediated the effects of variables on fear of recurrence.
  
  
  CONCLUSIONS
  The findings suggest that breast cancer survivor self-efficacy may have a protective effect for survivors who are younger at diagnosis and have higher perceived risk of recurrence, higher trait anxiety, and more breast cancer reminders. Oncology nurses already use the skills required to support self-efficacy. Additional research is needed to define and test breast cancer survivor self-efficacy interventions.
  
  
  CONCLUSIONS
  Oncology nurses are in a key role to assess fear of recurrence and provide self-efficacy interventions to reduce it in breast cancer survivors. Strategies to efficiently address fear of recurrence to reduce psychological distress in survivorship follow-up care are warranted.
authors.affiliation: School of Nursing, Indiana University, Indianapolis, IN, USA. kwagler@iupui.edu
authors.forename: Kim Wagler
authors.initials: KW
authors.lastname: Ziner
authors.forename: George W
authors.initials: GW
authors.lastname: Sledge
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Bell
authors.forename: Shelley
authors.initials: S
authors.lastname: Johns
authors.forename: Kathy D
authors.initials: KD
authors.lastname: Miller
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Champion
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000451:nursing / Q000523:psychology; D001943:Breast Neoplasms / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D003430:Cross-Sectional Studies; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D009859:Oncology Nursing; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D020377:Self Efficacy; D017741:Survivors / Q000523:psychology*; D055815:Young Adult