A cross-sectional study of fear of surgery in female breast cancer patients: Prevalence, severity, and sources, as well as relevant differences among patients experiencing high, moderate, and low fear of surgery

Abstract

Background: Fear of surgery has been associated with more postoperative pain, disability, and a lower quality of life among patients undergoing various surgical procedures. While qualitative studies indicate breast cancer patients to be afraid of surgery, detailed quantitative analyses are lacking. The present research aimed at investigating the prevalence, severity, and sources of fear of surgery in this patient group and to compare patients reporting different degrees of such fear.

Methods: This cross-sectional study included 204 breast cancer patients, 18-70 years old, and scheduled for surgery at Oslo University Hospital, Norway. Following their preoperative visit participants completed validated psychological questionnaires online. Among these, the primary outcome measure, the Surgical Fear Questionnaire (SFQ; scores: 0-10 per item, 0-80 overall). Patients were grouped based on SFQ-percentiles (<25th = little, 25th-75th = moderate and >75th percentile = high fear) and compared on psychological (anxiety, depression, experienced injustice, optimism and expected postsurgical pain), sociodemographic, and medical outcomes.

Results: 195 patients completed the SFQ. On average fear of surgery was low (M = 26.41, SD = 16.0, median = 26, min-max = 0-80), but omnipresent. Only 1.5% (n = 3) indicated no fear at all. Overall, patients feared surgery itself the most (M = 3.64, SD = 2.8). Groups differed significantly (p < .001) in their experience of anxiety, depression, and injustice, as well as their disposition to be optimistic, and expectance of postsurgical pain. Differences between groups concerning demographic and medical information were largely insignificant.

Discussion: This study was the first to demonstrate fear of surgery to be prevalent and relevant among female breast cancer patients. The higher a patients' fear group, the poorer their preoperative psychological constitution. This, largely irrespective of their current diagnoses or treatments, medical history, and demographics. Fear of surgery might thus cater as a prognostic marker and treatment target in this patient group. However, given the cross-sectional character of the present data, prognostic studies are needed to evaluate such claims.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright: © 2023 Engel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Figures

Fig 1. Flowchart of the inclusion process.

Abbreviations: SFQ, Surgical Fear Questionnaire.

Fig 2. Violin plot of total scores on the Surgical Fear Questionnaire (SFQ).

The shape of the figure represents a density plot. Wider regions indicate more frequent values. In the middle a boxplot is displayed. Whiskers illustrate the total spread of scores and the box the interquartile range (IQR). The median (= 26) is indicated by a black line. Statistical outliers (1.5xIQR) are indicated by black dots. The three fear groups are represented by different colors: th percentile = low fear = grey, 25th to 75th percentile = moderate fear = beige, >75th percentile = high fear = pink.

Fig 3. Violin plots of total scores on the subscales, short- and long-term fears, of the Surgical Fear Questionnaire (SFQ-S & SFQ-L).

For both scales the full range of possible scores was achieved (0–40). Means were similar (SFQ-S, M(SD) = 13.47(8.86); SFQ-L, M(SD) = 12.95(8.90)).

Fig 4. Venn diagrams displaying the overlap among high fear of surgery, symptoms of anxiety and depression and the expectance of severe postoperative pain.