Christa Torrisi

Introduction: Informal caregivers (caregivers) in rural areas experience many stressors affecting their mental and physical health. This review will synthesize the current needs of cancer caregivers in rural areas to inform future research and interventions. Methods: Five databases (PsycInfo, CINAHL, EMBASE, PubMed, and Family & Society Studies Worldwide) were queried to identify studies examining mental health and quality‐of‐life outcomes in rural caregivers of cancer patients worldwide, using the Arksey and O'Malley principled analytic framework. A priori criteria included rural caregivers of adult cancer patients in peer‐reviewed studies from 2005 to 2025. Results: Database searches yielded 337 records. After title and abstract screening, 134 articles were reviewed, and of these, 35 met a priori criteria. The most frequent problems identified among rural cancer caregivers were mental health issues (depression and anxiety), loneliness or isolation, fatigue and physical issues, provider issues, and financial issues, especially related to travel, balancing duties, and cultural differences between rural populations and urban providers. Most articles were from outside the U.S.; however, results from rural caregivers in the U.S. described needs reflected in literature from other countries. Conclusions: Given increased utilization of caregivers in the U.S. and the rural burden of cancer, it is crucial to identify caregivers' unmet needs. Home‐based cancer care is increasing, necessitating additional studies to determine needs and develop effective interventions for rural caregivers. Rurally competent care from healthcare providers who interface with caregivers of their cancer patients is vital, as caregivers are well‐positioned to partner with providers to improve the well‐being of those patients.

Objective: Pathogenic variants (PVs) in genes create a unique population of “previvors,” individuals who have no personal history of a cancer diagnosis, but carry chronically elevated lifetime cancer risk. PVs in breast cancer previvors negatively impact body image and family planning, and increase uncertainty and anxiety. How fear of cancer occurrence (FOCO) is experienced in previvors is not well described in the literature. This scoping review aimed to describe how FOCO manifests among breast cancer previvors. Methods: Guided by Joanna Briggs Institute (JBI) scoping review methodology, a search was conducted across CINAHL, PsycINFO, PubMed, and Scopus databases. Records were screened and data extracted using Covidence. Inclusion criteria were female sex, presence of a breast cancer PV, no personal history of breast cancer, and description(s) of cancer-related fear. Results: 1,022 records were screened, 10 articles ( n = 620 previvors) met inclusion criteria. FOCO manifested among breast cancer previvors in three ways, (1) perception of cancer occurrence, particularly if a cancer diagnosis was perceived by the previvor as inevitable; (2) misinterpretation of information from clinician communications, websites, or somatic sensations; and (3) heightened “scanxiety” of a cancer diagnosis during routine breast screening. Conclusion: FOCO may represent a distinct and clinically important experience to individuals living with an increased predisposition to developing breast cancer. Previvors must navigate both present and future cancer fears, distinguishing them from both average-risk individuals and cancer survivors. However, more research is needed to better characterize and measure FOCO among individuals with an increased risk of developing breast cancer.

Background and Purpose: Fear of cancer recurrence (FCR) is a disruptive concern among young breast cancer survivors (YBCS). Although coping strategies may help mitigate FCR, coping in YBCS remains understudied. This study examined associations between FCR and coping among YBCS and explored whether coping patterns varied across sociodemographic characteristics. Methods: This cross‐sectional secondary analysis used baseline data from a phase III randomized controlled trial. A purposive sample of 89 post‐treatment YBCS was recruited from the Midwestern US between 2021 and 2023 to complete a self‐reported survey to assess FCR, coping, mental health, and sociodemographic characteristics. Multiple linear regression and partial correlation analyses were performed to examine the associations between coping and FCR. Results: Greater FCR was associated with avoidant coping ( p = 0.0003). Emotion‐focused coping was more common among Black than White YBCS ( p = 0.0011) and among those experiencing financial strain ( p = 0.0024). Better mental health was associated with less avoidant coping ( p = < 0.0001). Conclusions: Greater FCR was associated with avoidant coping and poorer mental health. Longitudinal assessment of FCR and coping may help identify YBCS who could benefit from supportive interventions during survivorship. Trial Registration: Clinical Trial Registration Number: NCT05364450

Breast cancer is a significant cause of cancer death in young women in the United States. Inherited pathogenic variants, like BRCA1 and BRCA2, contribute to an increased lifetime breast cancer risk in this population. For women with a known pathogenic variant but without a previous cancer diagnosis, also known as “previvors,” the bilateral risk-reducing mastectomy (BRRM) most effectively reduces breast cancer risk. However, this surgery often causes physical change to the body. While existing research has examined the effect of BRRM and body image among previvors across the lifespan, the effect of prophylactic breast removal to decrease lifetime breast cancer risk in young previvors less than 40 years of age is less understood. A descriptive phenomenological approach, along with participant-submitted images, from a sample of 13 young previvors from the Midwestern United States, aged 29 to 39, explored the lived experience of BRRM and body image in the first 12 months following surgery. Narrative data served as the primary source, augmented by participant-submitted visual data. Essential themes were intuited to include BRRM to promote health, the importance of adaptation and acceptance to a changed body, and unexpected challenges following surgery; body image was found to be largely positive after healing occurred.

Objective: Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk‐reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision‐making process for BRRM among previvors.Methods: A theory‐generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk‐reduction surgery.Results: A theory and corresponding model emerged, comprised of seven themes addressing the decision‐making process for or against BRRM. While some factors to decision‐making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision‐making for a period of time.Conclusions: Regardless of the decision previvors make about BRRM, physical and psychosocial well‐being should be considered and promoted through shared decision‐making in the clinical setting.