title: Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other.
abstract: The purpose of this study was to identify explanatory factors of fear of recurrence (FOR) in breast cancer survivors of different sexual orientations and their caregivers and to assess the directionality in the survivor and caregiver dyads' FOR.
  
  
  
  We recruited survivors of non-metastatic breast cancer of different sexual orientations and invited their caregivers into this study. Using a telephone survey, we collected data from 167 survivor and caregiver dyads. Using simultaneous equation models and a stepwise selection process, we identified the significant determinants of survivors' and caregivers' FOR and determined the directionality of survivors' and caregivers' FOR. Weighting the model by the inverse propensity score ensured that differences by sexual orientation in age and proportion of life in the caregiver-survivor relationship were accounted for.
  
  
  
  Caregivers' FOR predicted survivors' FOR, and sexual orientation had a significant effect on survivors' FOR, in that sexual minority women reported less FOR than heterosexual women. Other determinants of survivors' FOR included their medical characteristics, coresidence with caregivers, and caregivers' social support and use of counseling. Caregivers' FOR was related to their social support and survivors' medical characteristics.
  
  
  
  This study suggests a need for caregiver interventions. Because survivors' FOR is affected by caregivers' FOR, caregiver interventions will likely benefit survivors' FOR.
  
  
  
  Both sexual minority and heterosexual breast cancer survivors' FOR are affected by their caregivers' FOR, which suggests that the caregivers of breast cancer survivors are central for the survivors' well-being and shall therefore be integrated into the care process.
authors.affiliation: Department of Community Health Sciences, Boston University, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA. boehmer@bu.edu.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Boehmer
authors.affiliation: Department of Biostatistics, Boston University, Boston, MA, USA.
authors.forename: Yorghos
authors.initials: Y
authors.lastname: Tripodis
authors.affiliation: Department of Community Health Sciences, Boston University, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Bazzi
authors.affiliation: Data Coordinating Center, Boston University, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Winter
authors.affiliation: Warren Alpert School of Medicine and School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Clark
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D020010:Heterosexuality / Q000523:psychology; D018452:Homosexuality, Female / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D012725:Sexual Behavior / Q000523:psychology*; D017741:Survivors / Q000523:psychology*
keywords: Breast cancer; Caregiving; Dyads; Fear of recurrence; Psychological needs