Fear of cancer recurrence before treatment in newly diagnosed breast cancer patients: Identification of predictive factors

Fear of cancer recurrence before treatment in newly diagnosed breast cancer patients: Identification of predictive factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fear of cancer recurrence before treatment in newly diagnosed breast cancer patients: Identification of predictive factors Yun Ding, Huiting Zhang, Huiying Qin, Lijuan Zhang, Qiaoling Zhong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8272695/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Fear of cancer recurrence (FCR) is a common psychological disorder among cancer patients. In newly diagnosed breast cancer patients, fear and condition about recurrence often influence treatment decision-making. However, the prevalence of FCR before treatment and its key risk factors—such as age, sleep quality, economic status, self-disclosure, and social support—remain unclear. Objective To describe the prevalence and severity of FCR before treatment in newly diagnosed breast cancer patients and analyze its predicting factors, thereby providing a scientific basis for interventions to reduce such fear. Methods A cross-sectional study was conducted among newly diagnosed breast cancer patients prior to treatment at a specialized oncology hospital in Guangdong Province, China, between February and July 2023. Sociodemographic data were collected, including age, gender, ethnicity, religious belief, education level, and marital status. Clinical data included pathological stage, tumor type, and family history of cancer. The Distress Disclosure Index, the Chinese version of the Medical Social Support Scale, and the short form of the Fear of Progression Questionnaire were utilized. Univariate analyses and bivariate correlations were conducted to explore relationships between variables. Multiple regression analysis was performed to identify predictors of FCR. Results A total of 350 newly diagnosed breast cancer patients were enrolled. Among participants, 48.3% experienced FCR before initiating treatment. The mean total score for FCR was 33.44 ± 8.00. Age, sleep quality, financial burden, monthly household income per capita, family relationships, self-disclosure, and social support accounted for 33.7% ( R² ) of the variance in FCR. Conclusion FCR prior to treatment is common and relatively severe among newly diagnosed breast cancer patients. Healthcare professionals should encourage patients to actively enhance self-disclosure and strengthen their social support networks. These strategies may reduce pre-treatment FCR, thereby facilitating more informed and appropriate treatment decision-making. The findings of this study underscore the urgent need for early identification and management of fear of cancer recurrence (FCR) in newly diagnosed breast cancer patients. High levels of pre-treatment FCR may impair patients' psychological well-being and influence treatment decision-making, potentially leading to suboptimal treatment choices. Healthcare professionals should implement targeted interventions that promote self-disclosure and strengthen social support networks to alleviate FCR. These measures can enhance patients' psychological readiness for treatment, facilitate informed decision-making, and ultimately improve clinical outcomes. Fear of Cancer Recurrence Breast Cancer Self-Disclosure Social Support Figures Figure 1 Introduction According to the latest data released by the International Agency for Research on Cancer, breast cancer ranks as the second most common cancer globally, following lung cancer. In 2022, approximately 2.3 million new cases of breast cancer were reported worldwide, accounting for 11.7% of all newly diagnosed malignancies [ 1 ]. In recent years, significant advances have been made in the diagnosis and treatment of malignant tumors. However, the challenges of recurrence and metastasis remain unresolved. These remain formidable barriers that modern medicine has yet to overcome. Even patients with ductal carcinoma in situ of the breast face a recurrence risk ranging from 4% to 20% [ 2 ]. Fear of cancer recurrence (FCR) refers to the fear, worry, and anxiety experienced by patients regarding the potential return or progression of cancer [ 3 ]. This psychological state often begins at the time of cancer diagnosis and may persist for many years thereafter, affecting patients' emotional well-being and behavioral responses[ 4 ]. A study by Lidia et al. revealed that approximately 64.5% of breast cancer patients experience FCR prior to treatment [ 5 ]. Pre-treatment FCR is likely to influence patients' treatment decisions. For example, a systematic review indicated that some Asian women opt for mastectomy due to concerns about recurrence and a desire to avoid further treatment. As a result, they may miss the opportunity for breast-conserving surgery[ 6 ]. A qualitative study also indicated that breast cancer survivors carrying BRCA1/2 mutations may undergo prophylactic mastectomy due to fears of recurrence[ 7 ]. Thus, recognizing and addressing pre-treatment FCR in breast cancer patients is essential to support optimal treatment choices. However, current literature primarily focuses on the occurrence of FCR among breast cancer patients during or after treatment. Findings indicate that approximately half of these patients experience moderate to high levels of FCR, which negatively impacts their quality of life, psychological well-being, and treatment adherence[5; 7]. In contrast, limited research has been conducted on newly diagnosed breast cancer patients prior to treatment. Only a few studies have reported the presence of FCR during the period between diagnosis and the initiation of treatment[5; 7]. However, the severity of this fear and its associated factors remain sufficiently explored. Therefore, conducting in-depth research on FCR before treatment in newly diagnosed breast cancer patients holds significant clinical importance. Such research not only addresses a critical a gap in the existing literature but also provides a foundation for early intervention strategies. According to social cognitive theory[ 8 ], individual factors (such as age, gender, and self-disclosure) and the social-interpersonal environment (including social support or constraints) can influence patients’ psychosocial adaptation by altering cognitive processing mechanisms, ultimately affecting their level of FCR (see Fig. 1 ). Self-disclosure, a core concept in psychology, refers to the process by which individuals share personal and private thoughts and emotions with others [ 9 ]. As a positive and effective form of communication, self-disclosure has been shown to negatively predict FCR[ 10 ]. Several studies have demonstrated that interventions promoting self-disclosure can enhance cancer patients’ communication with others, correct misconceptions regarding cancer recurrence, foster accurate illness beliefs, and ultimately reduce FCR[ 11 – 13 ]. Furthermore, social support has been identified as an independent predictor of FCR and plays a crucial role in alleviating it [ 14 ]. Low levels of social support are associated with increased FCR among breast cancer patients, whereas high levels of support can encourage positive perceptions of health status and buffer the psychological distress caused by stressful events, thereby mitigating the FCR [15; 16]. Newly diagnosed breast cancer patients represent a unique population in which psychological factors play a pivotal role in treatment decision-making. Despite growing interest in the psychological dimensions of cancer care, no existing studies have empirically established the relationship between pre-treatment FCR and self-disclosure or social support in this specific group. Given the potential influence of psychological readiness on treatment choices, it is crucial to explore whether targeted interventions that enhance self-disclosure and strengthen social support networks can effectively reduce FCR. Such interventions may ultimately empower patients to make more informed and appropriate treatment decisions. However, further research is needed to examine these associations and assess the clinical value of early psychosocial interventions in newly diagnosed breast cancer patients. Therefore, the present study aims to describe the current status of FCR prior to treatment in newly diagnosed breast cancer patients and to identify its risk factors based on social cognitive theory. The objectives of this study are as follows: (1) to explore the incidence and severity of pre-treatment FCR in newly diagnosed breast cancer patients; and (2) to identify the key risk factors contributing to pre-treatment FCR in this population, thereby providing empirical evidence to inform the development of effective intervention strategies aimed at reducing FCR levels. Materials and Methods Study design This study utilized a cross-sectional design and was conducted from February to July 2023. Ethical approval was obtained from the hospital's ethics committee (Approval No.B2023-700-01), and all procedures were carried out in strict accordance with the principles of the Declaration of Helsinki. Subjects A convenience sampling method was used to recruit breast cancer patients who sought medical care at a specialized oncology hospital in Guangdong Province, China, between February and July 2023. Inclusion criteria were as follows: (1) age ≥ 18 years; (2) first-time pathological diagnosis of stage 0–III breast cancer; (3) no prior breast cancer-related treatment; and (4) educational level of primary school or above. Exclusion criteria included: (1) metastatic or recurrent breast cancer; (2) history of other major organ diseases or malignancies; and (3) diagnosis of psychiatric disorders or cognitive impairment. Written informed consent was obtained from all participants. According to the empirical sample size calculation method based on regression analysis [17], the sample size should be 5 to 10 times the number of variables. The predictive factors included self-disclosure, social support, tumor stage, type, and a total of 23 influencing factors. Considering a 20% rate of invalid responses, the minimum sample size was calculated as =287.5 cases. Therefore, the minimum required sample size for this study was determined to be 288 cases. Measures Sociodemographic and Clinical Characteristics Sociodemographic data collected in this study included age, sex, ethnicity, religious belief, education level, marital status, number of children, average age of the youngest child, average age of all children, educational attainment, monthly household income per capita, financial burden, place of residence, living arrangement, family relationships, occupation prior to diagnosis, and method of medical expense payment. Disease-related variables included clinical stage, tumor type, comorbidities, family history of cancer, and sleep quality. The Short Form of the Fear of Progression Questionnaire （ FoP-Q-SF ） FoP-Q-SF was developed by German scholar Mehnert et al. in 2006 by simplifying the original Fear of Progression Questionnaire, and is designed to assess the level of fear of disease progression in cancer patients[18]. In 2015, Wu Qiyun and colleagues[19] translated and culturally adapted the scale into Chinese. The FoP-Q-SF consists of 12 items, categorized into two dimensions: physical health and social/family concerns. Each item is rated on a 5-point Likert scale, with all items scored positively. The total score ranges from 12 to 60, with higher scores indicating a greater level of FCR. A total score of 34 or above suggests a high level of fear [20]. The Cronbach’s alpha coefficient of the scale in this study was 0.883, indicating good internal consistency. Revised Distress Disclosure Index (DDI) The DDI was originally developed by Kahn and Hessling to assess an individual’s tendency to disclose distressing experiences [21]. In 2008, Chinese scholar Li Xinmin translated and revised the scale for use in the Chinese population to evaluate levels of self-disclosure [22]. The revised Chinese version consists of 12 items and uses a 5-point Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"). Items 2, 4, 5, 8, 9, and 10 are reverse scored. The total score ranges from 12 to 60, with higher scores indicating a greater level of self-disclosure, while lower scores reflect a higher tendency toward concealment. The Cronbach’s alpha coefficient of the scale is 0.86, indicating good internal consistency. Simplified Chinese Medical Outcomes Study Social Support Survey （ MOS-SSS-CM ） MOS-SSS-CM was originally developed by Sherbourne et al. in 1991 to assess perceived social support among patients with chronic illnesses[23]. In 2012, Li Huan adapted the scale into a simplified Chinese version (MOS-SSS-CM) for use in the Chinese population[24]. The total scale demonstrated good reliability, with a Cronbach’s alpha coefficient of 0.889 and a test-retest reliability of 0.77, indicating high internal consistency and stability. The scale contains 20 items across four dimensions: emotional/informational support, tangible support, affectionate support, and positive social interaction. Each item is rated using a 5-point Likert scale ranging from 1 to 5, based on the individual’s perceived frequency of support. The total score is converted to a 0-100 scale, with higher scores reflecting a higher level of perceived social support. Data Collection For patients who met the inclusion and exclusion criteria, data collection was conducted after hospital admission and pathological diagnosis, but prior to the initiation of treatment. Upon obtaining written informed consent, a professionally trained research staff member was responsible for distributing and guiding the completion of the questionnaires. After completion, the researcher checked each questionnaire for completeness. Prior to the start of the study, this staff member received comprehensive training on research ethics, questionnaire content, completion guidelines, and communication skills with patients, ensuring effective interaction and the provision of appropriate support throughout the process. To ensure objectivity and the reliability of the study results, a blinded design was implemented. Specifically, the researcher responsible for questionnaire administration was not provided with information about the patients' treatment plans or clinical conditions during data collection, thus minimizing potential bias in the data collection process. Data analysis Data analysis was conducted by an independent researcher with extensive experience in clinical research and a professional background in oncology and statistics. This researcher remained blinded to participants' treatment groups and clinical conditions throughout the analysis process to ensure objectivity and scientific rigor. The researcher received specialized training in data analysis and was proficient in the use of relevant statistical software and methodologies for effective data interpretation. All statistical analyses were performed using SPSS version 25.0, with a significance level set at α = 0.05; p -values less than 0.05 were considered statistically significant. Descriptive statistics were used to characterize participants' sociodemographic and clinical characteristics. Univariate analyses or bivariate correlations were initially conducted to identify potential factors associated with levels of FCR. Analysis of variance (ANOVA) was used to examine differences in FCR scores across various sociodemographic and clinical characteristics (e.g., education level, marital status, employment status, and household income). Pearson correlation analysis was performed to assess the relationships among self-disclosure, social support, and FCR in breast cancer patients. Variables demonstrating statistical significance in univariate analyses were subsequently entered into a multivariate regression model. A multiple linear regression analysis was conducted to identify independent predictors of FCR. The squared correlation coefficient ( R² ) was used to indicate the proportion of variance in the dependent variable that could be explained by the independent variables. A P -value of 0.05 was considered the threshold for statistical significance. Results Analysis of Demographic Characteristics, Self-Disclosure, Social Support, Fear of Cancer Recurrence Among Newly Diagnosed Breast Cancer Patients Prior to Treatment A total of 362 patients met the inclusion criteria and provided informed consent. As 12 patients refused to participate in the study, 350 patients finally completed the questionnaire with a loss rate of 3.31%. The descriptive data on sociodemographic and clinical characteristics as well as DDI and MOS-SSS-CM scores are summarized in Table 1 . A total of 350 breast cancer patients, aged between 25 and 77 years (mean age = 45.39 ± 9.68), were included in the study, with 99.1% being female. The majority reported a per capita monthly household income above 5,000 RMB. Financial concerns were prevalent, with 63.7% of patients experiencing some degree of economic burden and 15.7% reporting severe financial stress. Additionally, 55.7% rated their sleep quality as average. The mean scores for self-disclosure and social support were 38.86 ± 9.31 and 70.57 ± 14.04, respectively. The mean FCR score among breast cancer patients was 33.43 ± 8.00, with the physical health dimension (18.11 ± 4.12) scoring higher than the social/family dimension (15.32 ± 4.66). Notably, 48.3% of patients reported experiencing fear of recurrence prior to the initiation of treatment. Analysis of Demographic Characteristics, Self-Disclosure, Social Support, and Their Correlations with Fear of Cancer Recurrence in Newly Diagnosed Breast Cancer Patients Before Treatment The results of the ANOVA indicated that there were statistically significant differences in FCR related to age, average age of the youngest child, average age of all children, monthly per capita household income, financial burden, place of residence, family relationships, occupation before diagnosis, and sleep status ( P < 0.05). Pearson correlation analysis revealed that both self-disclosure ( r = -0.394, P < 0.01) and social support ( r = -0.393, P < 0.01) were significantly and negatively associated with fear of cancer recurrence (Table 1 ). Table 1 Correlation of FoP-Q-SF with Sociodemographic Characteristics, Clinical Characteristics, DDI and MOS-SSS-CM(N = 350) Variables N(%) and M ± SD Fop score, M ± SD t / F P Age(y) 45.39 ± 9.68 10.99 a < 0.001 Young adults(18 ~ 40) 121 (34.6) 35.34 ± 7.41 Middle-aged adults(41 ~ 60) 202 (57.7) 33.05 ± 8.06 Older adults(61 ~ 77) 27 (7.7) 27.78 ± 7.21 Gender -1.914 a 0.056 Men 3 (0.9) 24.67 ± 6.02 Women 347 (99.1) 33.51 ± 7.98 Nation -0.192 a 0.848 Han ethnicity 338 (96.6) 33.0 ± 10.46 Minority 12 (3.4) 33.45 ± 7.91 Faith 0.596 a 0.551 No 330 (94.3) 33.50 ± 7.97 Yes 20 (5.7) 32.40 ± 8.61 Marital status 0.178 a 0.837 Unmarried 17 (4.9) 33.65 ± 8.90 Divorced/widowed 19 (5.4) 34.47 ± 8.43 Married 314 (89.7) 33.36 ± 7.94 Number of children 0.491 a 0.689 Nulliparous 29 (8.3) 32.66 ± 8.24 1 140 (40.0) 33.05 ± 7.65 2 145 (41.1) 33.68 ± 8.23 ≥ 3 37 (10.6) 34.58 ± 8.31 Average age of the youngest child 2.487 a 0.013 <18 222 (60.1) 34.24 ± 7.94 ≥ 18 128 (36.6) 32.05 ± 7.94 Average age of all children 2.433 a 0.015 <18 206 (55.1) 34.30 ± 7.89 ≥ 18 144 (41.1) 32.20 ± 8.01 Educational level 1.866 a 0.156 Junior high school or below 96 (27.4) 34.77 ± 7.73 High school or technical secondary school 84 (24.0) 33.07 ± 9.39 College degree or above 170 (48.6) 32.86 ± 7.33 Monthly per capita household income 3.695 a 0.026 ≤ 3000 48 (13.7) 33.56 ± 8.30 3001 ~ 5000 111 (31.7) 35.05 ± 8.55 >5000 191(54.6) 32.47 ± 7.46 Financial burden 20.624 < 0.001 No financial burden 72 (20.6) 29.64 ± 7.26 Moderate financial burden 223 (63.7) 33.45 ± 7.56 Severe financial burden 55 (15.7) 38.368.08± Place of residence 3.442 a 0.033 Rural area 81 (23.1) 35.26 ± 8.29 Town area 88 (25.1) 33.69 ± 7.37 Urban area 181 (51.8) 32.50 ± 8.05 Living arrangement 0.863 a 0.423 Living alone 20 (5.7) 35.60 ± 8.83 Living with friends 5 (1.4) 34.80 ± 11.16 Living with family 325 (92.9) 33.28 ± 7.90 Family relationship 10.963 a < 0.001 Poor 2 (0.6) 35.50 ± 7.77 Fair 53 (15.1) 38.02 ± 7.60 Harmonious 295 (84.3) 32.60 ± 7.81 Occupation before diagnosis 4.820 a 0.009 Retired 52 (14.9) 30.46 ± 8.27 Unemployed 62 (17.7) 34.85 ± 7.81 Employed 236 (67.4) 33.72 ± 7.86 Type of healthcare payment 0.488 a 0.614 Self-paid 7 (2.0) 36.0 ± 6.21 Medical insurance 335 (95.7) 33.72 ± 7.97 Government-funded healthcare 8 (2.3) 32.0 ± 10.66 Pathological staging 1.428 a 0.234 0 31 (8.9) 34.29 ± 10.95 Ⅰ 93 (26.6) 32.34 ± 8.02 Ⅱ 157 (44.9) 34.24 ± 6.54 Ⅲ 69 (19.7) 32.70 ± 9.28 Tumor type 0.582 a 0.561 Non-invasive carcinoma 37 (10.6) 34.16 ± 10.21 Invasive carcinoma 313 (89.4) 33.35 ± 7.71 Family history of cancer -0.381 a 0.703 No 251 (71.7) 33.33 ± 8.00 Yes 99 (28.3) 33.70 ± 8.03 Comorbidity 0.599 a 0.550 No 283 (80.9) 33.56 ± 7.87 Yes 67 (19.1) 32.91 ± 8.57 Sleep status 9.399 a < 0.001 Poor 67(34.6) 35.04 ± 8.83 Fair 195(34.6) 34.28 ± 7.34 Good 88(34.6) 30.35 ± 8.01 Self-disclosure scores 38.86 ± 9.31 -0.377 b < 0.001 Social support scores 70.57 ± 14.04 -0.393 b < 0.001 a Means comparing the Fop of different characteristics with the ANOVA test. b Means Pearson correlation with FoP-Q-SF. Multiple Regression Analysis of Fear of Cancer Recurrence in Newly Diagnosed Breast Cancer Patients A standard enter method linear regression analysis was performed, with FCR set as the dependent variable. Independent variables were those found to be statistically significant ( P < 0.05) in univariate and correlation analyses, including patient age, average age of the youngest child, average age of all children, monthly per capita household income, financial burden, place of residence, family relationship, occupation before diagnosis, sleep quality, self-disclosure, and social support. A significant regression equation ( F = 9.91, P < 0.001) was found, with a R 2 of 0.337 (Table 2 ). FCR was jointly explained by age, sleep quality, household income, family relationship, financial burden, self-disclosure, and social support. Table 2 Multiple Linear Regression Analysis of Fear of Cancer Recurrence in Breast Cancer Patients Variables B SE B Beta t p R 2 95% CI (constant) 41.00 2.88 14.24 < 0.001 0.337 35.34 to 46.67 Age(y) Older adults(61 ~ 77) - / / / / / / Young adults(18 ~ 40) 6.47 1.83 0.386 3.53 < 0.001 2.86 to 10.0 Middle-aged adults(41 ~ 60) 3.94 1.55 0.244 2.52 0.012 0.87 to 7.01 Sleep status Good - / / / / / / Fair 3.12 0.88 0.195 3.52 5000) - / / / / / / Middle income(3001 ~ 5000) 0.01 0.92 0.001 0.01 0.10 -1.81 to 1.82 Low income(≤3000) -2.68 1.33 -0.115 -2.01 0.045 -5.30 to -0.06 Financial burden No financial burden - / / / / / / Severe financial burden 4.35 1.47 0.199 2.95 0.003 1.45 to 7.26 Moderate financial burden 2.30 0.99 0.139 2.31 0.021 0.35 to 4.25 Family relationship Harmonious - / / / / / / Fair 2.26 1.11 0.102 2.03 0.043 0.07 to 4.44 Poor -1.46 4.81 -0.014 -0.30 -0.761 -10.925 to 8.00 Self-disclosure -0.24 0.04 -0.283 -5.58 < 0.001 -0.32 to -0.15 Social support -0.09 0.03 -0.17 -3.10 0.002 -0.15 to -0.03 Discussion Newly diagnosed breast cancer patients represent a unique population, in which psychological factors play a critical role in treatment decision-making. To our knowledge, this study is the first to investigate the relationships between sociodemographic and clinical characteristics, self-disclosure, social support, and FCR prior to treatment, and to identify significant predictors of FCR in this population. Fear of Cancer Recurrence before Treatment in Newly Diagnosed Breast Cancer Patients This study found that FCR was a prevalent psychological issue among newly diagnosed breast cancer patients prior to treatment, with approximately 50% experiencing clinically significant levels of fear. This proportion was lower than that reported by Han et al.[ 25 ] but higher than that found by Li et al.[ 26 ], suggesting heterogeneity in FCR across different patient groups. The discrepancy may be due to differences in study populations and timing of assessment. Han et al. [ 25 ] focused on patients undergoing chemotherapy, during which FCR may be intensified by side effects and prolonged stress (including financial, occupational, and familial stressors). In contrast, the participants in this study were at the pre-treatment stage, not yet exposed to treatment-related stressors, which may explain their relatively lower FCR. Li et al.'s study[ 26 ] mainly involved postoperative patients. In our study, patients were newly diagnosed, facing difficulty accepting the diagnosis and perceiving uncertainty about future treatment, potentially contributing to high FCR. These findings highlight the importance of early psychological intervention for newly diagnosed patients. Younger Patients, Poor Sleep Quality, Low Income, and Financial Burden Exhibit Higher Levels of Fear of Cancer Recurrence This study identified age as a significant factor influencing FCR in breast cancer patients ( P < 0.001), consistent with the findings of Zhang et al.[ 27 ]. Younger patients tend to be more concerned with body image, and treatment-related changes such as hair loss from surgery or chemotherapy, may trigger feelings of inferiority or depression, exacerbating FCR. Sleep quality was also found to be an independent predictor of FCR, with poorer sleep associated with higher FCR [ 28 ]. A possible mechanism is that negative thoughts induced by FCR may lead to sleep disturbances, which in turn intensify psychological stress, creating a vicious cycle. Nursing staff should closely monitor sleep problems and provide pharmacological support when necessary to improve sleep, enhance psychological well-being, and ultimately reduce FCR. Both univariate and multivariate analyses in this study indicated that patients with lower household income experienced higher levels of FCR, consistent with the findings by Niu et al.[ 14 ]. Possible explanations include the high cost of cancer treatment and the additional financial burden associated with recurrence. Low-income patients may also experience guilt, which can exacerbate anxiety. Notably, patients with medical insurance reported significantly lower FCR than those paying out-of-pocket. Since breast cancer patients often require adjuvant therapies after surgery, such as chemotherapy or radiotherapy, the high cost and limited reimbursement of anti-cancer drugs may increase financial stress and fear of recurrence among economically disadvantaged patients. These findings suggest that healthcare providers should consider patients’ financial situations when planning treatment, offer cost-effective options, and strengthen psychological support to promote recovery. At the policy level, improving the medical insurance system and expanding coverage for major illnesses are essential to reducing patients’ financial burdens. Lower Levels of Self-Disclosure Lead to Higher Levels of Fear of Cancer Recurrence This study found a significant negative correlation between self-disclosure and FCR. Self-disclosure, typically expressed through verbal communication of one’s thoughts and emotions, serves both as a personal coping mechanism and psychological intervention strategy. It has been shown to alleviate psychological distress and improve quality of life [ 29 ]. Prior research supports these findings. Xu et al. [ 11 ] reported that effective communication helps patients correct misconceptions about recurrence and fosters healthier beliefs, thereby reducing FCR. In a controlled trial by Chen et al.[ 12 ], a self-disclosure intervention significantly increased disclosure levels, reduced negative emotions, and lowered FCR in postoperative breast cancer patients undergoing chemotherapy. Another study found that enhancing spousal self-disclosure also reduced FCR[ 13 ]. This may be due to the fact that individuals with higher levels of self-disclosure receive more external feedback—such as encouragement, experiential guidance, or health-related information—which improves their understanding of the disease and relieves emotional stress. Sharing one’s illness experience and feelings can also enhance emotional support. Therefore, clinical staff should encourage newly diagnosed patients to engage in active and meaningful communication, such as journaling or peer discussion, to express their thoughts and expectations. This practice can enhance self-disclosure, help patients cope with stress, and assist them in making informed treatment decisions. Lower Levels of Social Support Are Associated with Higher Levels of Fear of Cancer Recurrence Social support was significantly and negatively correlated with FCR, encompassing both the physical and social/family dimensions. This finding is consistent with the results of Niu et al. [ 14 ] and Yu et al.[ 15 ]. A meta-analysis also demonstrated that low levels of social support are associated with increased FCR in breast cancer patients, while higher levels of support promote positive health perceptions and reduce stress-related recurrence fears [ 16 ]. As a protective factor, social support facilitates emotional regulation through interpersonal interaction and helps alleviate symptom distress and fear of recurrence [ 30 ]. In the context of FCR, social support acts as a "buffer," mitigating the negative psychological impact of stressful events[ 31 ]. Strong social support not only reduces symptom sensitivity and psychological distress, such as anxiety and depression, but also enhances mental health, decreases FCR, and improves quality of life. Furthermore, it enables patients to approach treatment and recovery with greater positivity and optimism. Limitations This study has several limitations. (1) Data were collected from a single tertiary cancer hospital in Guangzhou, which may limit the generalizability of the findings to other regions or healthcare settings. (2) The study captured self-disclosure, social support, and FCR at a single time point. Consequently, it lacks longitudinal data to assess how these psychological variables change over time or impact patients across different stages of treatment and disease progression. Conclusions Prior to initial treatment, 50% of newly diagnosed breast cancer patients experienced high levels of FCR. Healthcare providers should pay greater attention to FCR in younger and middle-aged patients, actively address sleep disturbances, enhance social and financial support, and encourage self-disclosure. These interventions may help alleviate FCR and foster a more positive psychological state, thereby supporting the development of more appropriate treatment strategies. Declarations Consent for publication Not applicable. Data availability The datasets used in this study can be obtained from the corresponding author upon reasonable request. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Competing interests The authors declare that they have no competing interests. Ethical approval Approval was obtained from the ethics committee of Sun Yat-sen University Cancer Center (Approval No.B2023-700-01). The procedures used in this study adhere to the tenets of the Declaration of Helsinki, which emphasize respect for the dignity, autonomy, and privacy of research participants, the minimization of potential risks and the maximization of possible benefits, as well as the requirement for voluntary and informed consent prior to participation. Participants’ personal data were treated with strict confidentiality, and their rights and well-being were protected throughout the research process. Acknowledgements The authors thank all the participants for their contributions to this study. References International Agency for Research on Cancer . Global Cancer Observatory: Cancer Today [DB/OL]. https://gco.iarc.who.int/today/en Association, The Society of Breast Cancer China Anti-Cancer. (2023). Guidelines for breast cancer diagnosis and treatment by China Anti-cancer Association (2024 edition) China Oncology , 33 (12), 1092-1187. https://doi.org/10.19401/j.cnki.1007-3639.2023.12.004 Butow, P., Sharpe, L., Thewes, B., Turner, J., Gilchrist, J., & Beith, J. (2018). Fear of Cancer Recurrence: A Practical Guide for Clinicians. Oncology (Williston Park) , 32 (1), 32-38. Lebel, S., Rosberger, Z., Edgar, L., & Devins, G. M. (2009). Emotional distress impacts fear of the future among breast cancer survivors not the reverse. J Cancer Surviv , 3 (2), 117-127. https://doi.org/10.1007/s11764-009-0082-5 Schapira, L., Zheng, Y., Gelber, S. I., Poorvu, P., Ruddy, K. J., Tamimi, R. M., . . . Rosenberg, S. M. (2022). Trajectories of fear of cancer recurrence in young breast cancer survivors. Cancer , 128 (2), 335-343. https://doi.org/10.1002/cncr.33921 Galeano Machuca, M. P., Cheng, S. C., Jou, T. H., & Cheng, C. T. (2021). Determinants of Breast-Conserving Therapy in the Asian Population: A Systematic Review. World J Surg , 45 (3), 799-807. https://doi.org/10.1007/s00268-020-05814-6 Savard, J., Filion, C., Brearty, C. M., Caplette-Gingras, A., Chiquette, J., & Dorval, M. (2024). Fear of cancer recurrence in breast cancer survivors carrying a BRCA1/2 mutation: A qualitative study. Cancer Med , 13 (1), e6889. https://doi.org/10.1002/cam4.6889 Bandura, A. (2001). Social cognitive theory: an agentic perspective. Annu Rev Psychol , 52 , 1-26. https://doi.org/10.1146/annurev.psych.52.1.1 Mugo, C., Firdawsi, O., Wang, J., Njuguna, I. N., Wamalwa, D. C., Slyker, J. A., . . . Wagner, A. D. (2023). "When they are all grown, I will tell them": Experience and perceptions of parental self-disclosure of HIV status to children in Nairobi, Kenya. BMC Public Health , 23 (1), 519. https://doi.org/10.1186/s12889-023-15387-3 Wang, Jingjing, & Zhu, Binghua. (2022). Analysis of the Influencing Factors of Postoperative Cancer Recurrence Fear in Young Female Patients with Breast Cancer. Chinese General Practice Nursing , 20 (28), 3988-3991. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2vnmDOQWKmW2uejo54aobp3mM1_9YmeDMdlr9NR7JZqj0iPYXZBFC-Vfhfwj1SlFwtWwHz2wLoJ0eSMfDhXtPlbJGKXX3pgt5WKpb34MDA9HPsRqst3VcM0okoHZ0ZaEcSLHJToRsVuPrzcQxevPbSija-kw_aeTT4UZk4QAu0Pcn4W2XGEDMDOSzxw6d_ZMDg=&uniplatform=NZKPT&language=CHS Xu, W., Wang, J., & Schoebi, D. (2019). The role of daily couple communication in the relationship between illness representation and fear of cancer recurrence in breast cancer survivors and their spouses. Psychooncology , 28 (6), 1301-1307. https://doi.org/10.1002/pon.5082 Chen Jiao , Cheng Hong , Wei Qingfeng ,Zhong Chunxia ,Xu Yanhong ,Xia Ye ,Zhong Yan. (2022). Self-disclosure intervention for patients undergoing chemotherapy following breast cancer surgery Journal of Nursing Science , 37 (14), 86-89. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2uBg0v4oPq6uzV3wC6TcZOkSy6F3FxOKmj9eHhsD57GOZlz8qfQUbPzOc-6APenp7GOO2_iICWpfyzp9QoLE0JF5oHlFM7C5hlO9OanvUT-th0lVajZfG7mQrBG_3mfVW8_Qy0bWRj0dWIjjhJsjs2CsJRSLAzBzbguThUdC9dbW_6uno-rEGU5AJnln60Y9os=&uniplatform=NZKPT&language=CHS Zhang Xianxian , Zhang Lixia , Jia Zhihui ,Chen Yuanzun. (2019). Application and effect evaluation of marital selfdisclosure intervention on the fear of cancer recurrence in young breast cancer patients. Chinese Journal of Nursing , 54 (11), 1610-1614. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2sJvWZi26wDAbmGpWHCFBQo5akHLYa4ldYDq70Jr3cJOE62y8Q8k35HS2Fdu6rFjL-XyKL7JSP2iftnXuB_q7WCRZT8bt9pmQnjmHU4aKFpQ9v7UzgVAcZIHFbeCjjokNPz_BckeSsaAGcbQP958-iYhEQeP4DFE7U9ORaciGXyEGwyadmqNwBJl_r78yV65ZE=&uniplatform=NZKPT&language=CHS Niu, L., Liang, Y., & Niu, M. (2019). Factors influencing fear of cancer recurrence in patients with breast cancer: Evidence from a survey in Yancheng, China. J Obstet Gynaecol Res , 45 (7), 1319-1327. https://doi.org/10.1111/jog.13978 Yu, Z., Sun, D., & Sun, J. (2022). Social Support and Fear of Cancer Recurrence Among Chinese Breast Cancer Survivors: The Mediation Role of Illness Uncertainty. Front Psychol , 13 , 864129. https://doi.org/10.3389/fpsyg.2022.864129 Liu Jin, Lu Na, Zhang Feng-Wa, Niu Xiao Dan, Yuan Rong Jing, Li Wen Yan, Wang Ye Tong , Wang Yan Hong. (2021). Influence Factors of Cancer Recurrence Fear in Breast Cancer Patients:A Meta-analysis. Journal of Nursing(China) , 28 (14), 1-7. https://doi.org/10.16460/j.issn1008-9969.2021.14.001 Ni Ping, Chen Jingli, Liu Na. (2010). The sample size estimation in quantitative nursing research. Chinese Journal of Nursing , 45 (04), 378-380. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt4mlDuqBvW-Q4HBx2ZJF6tur5rOg__CM9juEpnJUUi8JpMUwpm_xp5xmJAiu6OIc7NhqeTFANCqkNH2SSBdrZB1erCVDQLot7DSahsP-S3V4qd0TFRmV-l_WWLbWNOOJOO07o3B5h715MH11keRnuNYU_T5YSRpP6D1MdTvI-fFU_891ixjtb_u&uniplatform=NZKPT&language=CHS Mehnert, A., Herschbach, P., Berg, P., Henrich, G., & Koch, U. (2006). [Fear of progression in breast cancer patients--validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF)]. Z Psychosom Med Psychother , 52 (3), 274-288. https://doi.org/10.13109/zptm.2006.52.3.274 (Progredienzangst bei Brustkrebspatientinnen--Validierung der Kurzform des Progredienzangstfragebogens PA-F-KF.) Wu Qiyun, Ye Zhixia , Li Li. (2015). Measurement and influencing factors of fear of cancer recurrence among cancer patients. Chinese Nursing Management , 15 (08), 1020-1023. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt7VjhBkxYI3uS3atxzHSP5nIv-UL7vooslTU5n3RqrKpK4Gh89gDO-hu8QY_rdDXOmksyuliMNN0Vu8zzCdf6rm_xWomSLZ4ZONk-4VrBgob85_5xhnU2RPZ2l-Drno7ZJo-9LT4EMQA2TJ7JhXICKq_qtJ9pD9b8LaT306tO5cHbU3KqXxA-Ll8raqNVPszeg=&uniplatform=NZKPT&language=CHS Li, B., Lin, X., Chen, S., Qian, Z., Wu, H., Liao, G., . . . Liang, G. (2024). The association between fear of progression and medical coping strategies among people living with HIV: a cross-sectional study. BMC Public Health , 24 (1), 440. https://doi.org/10.1186/s12889-024-17969-1 Kahn, Jeffrey H, Hessling, Robert M %J Journal of Social, & Psychology, Clinical. (2001). Measuring the tendency to conceal versus disclose psychological distress. 20 (1), 41-65. Min, Li Xin. (2009). Research on the Relationship between Adult Attachment,Self-disclosure and Depression of College Students Hebei Normal University]. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt4HNn3KSggjdGrnyRov9OumMWcWlBwd-TrMXJaBPGRMWRxMK7kuLMiDROat5TqVa9Wg8VqcRqP6nElSrbYIHSl7V XeX6_OHa9JILuPbRw18mvX_uzdGFL3NZmZfEBGf4cTA_W8dNx8d1VfqstuNsJAMy86a-vpX4c7x8oIvaVWL9wjKoNkS57F9cNy3YGaYRmk=&uniplatform=NZKPT&language=CHS Sherbourne, Cathy Donald, Stewart, Anita L %J Social Science, & Medicine. (1991). The MOS social support survey. 32 (6), 705-714. Huan, Li. (2012). Psychometric Measurement of the Simplified Chinese Medical Outcomes Study Social Support Survey (MOS-SSS-C) and its Application in HIV/AIDS Patients Central South University]. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt6-IPDeAIows5QYBzr9OsQE1MVCjdEDw6sjQpdUZxaRFDJpiaq9QKywdCw-pKpWQQuMz06QzjWVQFpoI1vTERGWGyMzSBPhIQL_NY1EBDKd lS7Q5m7vYjpf_YvjDp15UssPmUIVypt_ly8J0kGCQHEkjgJHjnzzjAMcplHywotQ9zV6vu7XJtAgtG0umwNO9io=&uniplatform=NZKPT&language=CHS Han, M., Chen, H., Li, J., Zheng, X., Zhang, X., Tao, L., . . . Feng, X. (2024). Correlation between symptom experience and fear of cancer recurrence in postoperative breast cancer patients undergoing chemotherapy in China: A cross-sectional study. PLoS One , 19 (9), e0308907. https://doi.org/10.1371/journal.pone.0308907 Li, Y., Fang, C., Xiong, M., Hou, H., Zhang, Y., & Zhang, C. (2024). Exploring fear of cancer recurrence and related factors among breast cancer patients: A cross-sectional study. J Adv Nurs , 80 (6), 2403-2414. https://doi.org/10.1111/jan.16009 Zhang Huifang , Lin Zihan , Li Jin ,Chen Jiejie ,Wu Wenbin ,Cui Zhenti. (2022). Latent profile analysis of fear of cancer recurrence of patients with breast cancer. Chinese Nursing Research , 36 (22), 4013-4017. https://kns.cnki.net/kcms2/article/abstract?v=_GofKS1StuT9yG1fEmwmfYK0tZ0i3V4zIZbtvXu9S2TzBy1HMnGh1Ow9c KLOWJnpssVwv1kMqEWd2hvADwxtoUvQgWtmpzIbtratC6bRmwloy_Wsns1y5dJBSD x8ckwzG5-aRYx8HFiBo0RhfcIr5s1hcnyV9wjFyOFzDWevblz2-HVZ5mDH0fmEVsOSIUbNe_IUVffSAe4=&uniplatform=NZKPT&language=CHS Mingyangjia, Tian. (2023). The Relationship between Sleep Quality and Suicidal Ideation: The Longitudinal Mediating Role of Negative Emotions and the Associated Neural Mechanisms Tianjin Normal University]. https://link.cnki.net/doi/10.27363/d.cnki.gtsfu.2023.000463 Du, X., Wang, D., Du, H., Zou, Q., & Jin, Y. (2021). The correlation between intimate relationship, self-disclosure, and adaptability among colorectal cancer enterostomy patients. Medicine (Baltimore) , 100 (19), e25904. https://doi.org/10.1097/md.0000000000025904 Mahendran, R., Liu, J., Kuparasundram, S., Simard, S., Chan, Y. H., Kua, E. H., & Griva, K. (2021). Fear of cancer recurrence among cancer survivors in Singapore. Singapore Med J , 62 (6), 305-310. https://doi.org/10.11622/smedj.2020007 Hong, S. J., Shin, N. M., & Jung, S. (2020). A predictive model of fear of cancer recurrence for patients undergoing chemotherapy. Support Care Cancer , 28 (9), 4173-4181. https://doi.org/10.1007/s00520-019-05245-7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8272695","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591661518,"identity":"6680ab76-5e97-4589-9a11-11b3f67bdf23","order_by":0,"name":"Yun Ding","email":"","orcid":"","institution":"State Key Laboratory of Oncology in South China","correspondingAuthor":false,"prefix":"","firstName":"Yun","middleName":"","lastName":"Ding","suffix":""},{"id":591661519,"identity":"4b7e23e1-e9a1-4da5-b52a-6e0627f991b2","order_by":1,"name":"Huiting Zhang","email":"","orcid":"","institution":"State Key Laboratory of Oncology in South China","correspondingAuthor":false,"prefix":"","firstName":"Huiting","middleName":"","lastName":"Zhang","suffix":""},{"id":591661520,"identity":"78c00773-f714-4f79-9812-04ad1cbe09d9","order_by":2,"name":"Huiying Qin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYDACZgY2BoYK0rWcIdEeNgbGNlLU8x3nPfaYd15d4vwZyQ8/MFTcs2tgP3sArxbJw3zpxrzbDiduuJFmLMFwpji5gScvAa8Wg8M8ZtK82w4kbpDIAbkwIZlBgseACC1zQA4jTUsDc2LDDYgWO4JaJIFaJOccO2y84cwzY4mEMwkJbDw5+LXwnT9jJvGmpk52fjswxD5UJNjzs5/Br4XhAAMDEw8Dg2MDiJPAwJBIOI6AWhh/MDDYw/j2eNSOglEwCkbBCAUAQjc/q3djUK4AAAAASUVORK5CYII=","orcid":"","institution":"State Key Laboratory of Oncology in South China","correspondingAuthor":true,"prefix":"","firstName":"Huiying","middleName":"","lastName":"Qin","suffix":""},{"id":591661521,"identity":"ab7c320b-bae6-43a7-9853-5607373f3a78","order_by":3,"name":"Lijuan Zhang","email":"","orcid":"","institution":"State Key Laboratory of Oncology in South China","correspondingAuthor":false,"prefix":"","firstName":"Lijuan","middleName":"","lastName":"Zhang","suffix":""},{"id":591661522,"identity":"fcc1a12c-7848-411d-abb0-561b23be0ac0","order_by":4,"name":"Qiaoling Zhong","email":"","orcid":"","institution":"State Key Laboratory of Oncology in South China","correspondingAuthor":false,"prefix":"","firstName":"Qiaoling","middleName":"","lastName":"Zhong","suffix":""}],"badges":[],"createdAt":"2025-12-03 17:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8272695/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8272695/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102759208,"identity":"928bb022-0e1d-4fc9-ad35-93ea146b0b3d","added_by":"auto","created_at":"2026-02-16 10:13:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50680,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFramework of Social Cognitive Theory\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8272695/v1/c25649b422e9182ad6d67697.png"},{"id":106404878,"identity":"26ceb6ae-aa4c-465a-87cb-ce6ffb560616","added_by":"auto","created_at":"2026-04-08 09:17:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1643889,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8272695/v1/aaa3dcae-70d1-4edf-b02f-acafaf823c9d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fear of cancer recurrence before treatment in newly diagnosed breast cancer patients: Identification of predictive factors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the latest data released by the International Agency for Research on Cancer, breast cancer ranks as the second most common cancer globally, following lung cancer. In 2022, approximately 2.3\u0026nbsp;million new cases of breast cancer were reported worldwide, accounting for 11.7% of all newly diagnosed malignancies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, significant advances have been made in the diagnosis and treatment of malignant tumors. However, the challenges of recurrence and metastasis remain unresolved. These remain formidable barriers that modern medicine has yet to overcome. Even patients with ductal carcinoma in situ of the breast face a recurrence risk ranging from 4% to 20% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Fear of cancer recurrence (FCR) refers to the fear, worry, and anxiety experienced by patients regarding the potential return or progression of cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This psychological state often begins at the time of cancer diagnosis and may persist for many years thereafter, affecting patients' emotional well-being and behavioral responses[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A study by Lidia et al. revealed that approximately 64.5% of breast cancer patients experience FCR prior to treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Pre-treatment FCR is likely to influence patients' treatment decisions. For example, a systematic review indicated that some Asian women opt for mastectomy due to concerns about recurrence and a desire to avoid further treatment. As a result, they may miss the opportunity for breast-conserving surgery[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A qualitative study also indicated that breast cancer survivors carrying BRCA1/2 mutations may undergo prophylactic mastectomy due to fears of recurrence[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Thus, recognizing and addressing pre-treatment FCR in breast cancer patients is essential to support optimal treatment choices.\u003c/p\u003e \u003cp\u003eHowever, current literature primarily focuses on the occurrence of FCR among breast cancer patients during or after treatment. Findings indicate that approximately half of these patients experience moderate to high levels of FCR, which negatively impacts their quality of life, psychological well-being, and treatment adherence[5; 7]. In contrast, limited research has been conducted on newly diagnosed breast cancer patients prior to treatment. Only a few studies have reported the presence of FCR during the period between diagnosis and the initiation of treatment[5; 7]. However, the severity of this fear and its associated factors remain sufficiently explored. Therefore, conducting in-depth research on FCR before treatment in newly diagnosed breast cancer patients holds significant clinical importance. Such research not only addresses a critical a gap in the existing literature but also provides a foundation for early intervention strategies.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to social cognitive theory[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], individual factors (such as age, gender, and self-disclosure) and the social-interpersonal environment (including social support or constraints) can influence patients\u0026rsquo; psychosocial adaptation by altering cognitive processing mechanisms, ultimately affecting their level of FCR (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Self-disclosure, a core concept in psychology, refers to the process by which individuals share personal and private thoughts and emotions with others [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As a positive and effective form of communication, self-disclosure has been shown to negatively predict FCR[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Several studies have demonstrated that interventions promoting self-disclosure can enhance cancer patients\u0026rsquo; communication with others, correct misconceptions regarding cancer recurrence, foster accurate illness beliefs, and ultimately reduce FCR[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, social support has been identified as an independent predictor of FCR and plays a crucial role in alleviating it [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Low levels of social support are associated with increased FCR among breast cancer patients, whereas high levels of support can encourage positive perceptions of health status and buffer the psychological distress caused by stressful events, thereby mitigating the FCR [15; 16].\u003c/p\u003e \u003cp\u003eNewly diagnosed breast cancer patients represent a unique population in which psychological factors play a pivotal role in treatment decision-making. Despite growing interest in the psychological dimensions of cancer care, no existing studies have empirically established the relationship between pre-treatment FCR and self-disclosure or social support in this specific group. Given the potential influence of psychological readiness on treatment choices, it is crucial to explore whether targeted interventions that enhance self-disclosure and strengthen social support networks can effectively reduce FCR. Such interventions may ultimately empower patients to make more informed and appropriate treatment decisions. However, further research is needed to examine these associations and assess the clinical value of early psychosocial interventions in newly diagnosed breast cancer patients.\u003c/p\u003e \u003cp\u003eTherefore, the present study aims to describe the current status of FCR prior to treatment in newly diagnosed breast cancer patients and to identify its risk factors based on social cognitive theory. The objectives of this study are as follows: (1) to explore the incidence and severity of pre-treatment FCR in newly diagnosed breast cancer patients; and (2) to identify the key risk factors contributing to pre-treatment FCR in this population, thereby providing empirical evidence to inform the development of effective intervention strategies aimed at reducing FCR levels.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized a cross-sectional design and was conducted from February to July 2023. Ethical approval was obtained from the hospital\u0026apos;s ethics committee (Approval No.B2023-700-01), and all procedures were carried out in strict accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA convenience sampling method was used to recruit breast cancer patients who sought medical care at a specialized oncology hospital in Guangdong Province, China, between February and July 2023. Inclusion criteria were as follows: (1) age \u0026ge; 18 years; (2) first-time pathological diagnosis of stage 0\u0026ndash;III breast cancer; (3) no prior breast cancer-related treatment; and (4) educational level of primary school or above. Exclusion criteria included: (1) metastatic or recurrent breast cancer; (2) history of other major organ diseases or malignancies; and (3) diagnosis of psychiatric disorders or cognitive impairment. Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eAccording to the empirical sample size calculation method based on regression analysis [17], the sample size should be 5 to 10 times the number of variables. The predictive factors included self-disclosure, social support, tumor stage, type, and a total of 23 influencing factors. Considering a 20% rate of invalid responses, the minimum sample size was calculated as \u003cimg width=\"46\" height=\"33\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e=287.5 cases. Therefore, the minimum required sample size for this study was determined to be 288 cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSociodemographic and Clinical Characteristics\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSociodemographic data collected in this study included age, sex, ethnicity, religious belief, education level, marital status, number of children, average age of the youngest child, average age of all children, educational attainment, monthly household income per capita, financial burden, place of residence, living arrangement, family relationships, occupation prior to diagnosis, and method of medical expense payment. Disease-related variables included clinical stage, tumor type, comorbidities, family history of cancer, and sleep quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe Short Form of the Fear of Progression Questionnaire\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e（\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eFoP-Q-SF\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e）\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFoP-Q-SF was developed by German scholar Mehnert et al. in 2006 by simplifying the original Fear of Progression Questionnaire, and is designed to assess the level of fear of disease progression in cancer patients[18]. In 2015, Wu Qiyun and colleagues[19] translated and culturally adapted the scale into Chinese. The FoP-Q-SF consists of 12 items, categorized into two dimensions: physical health and social/family concerns. Each item is rated on a 5-point Likert scale, with all items scored positively. The total score ranges from 12 to 60, with higher scores indicating a greater level of FCR. A total score of 34 or above suggests a high level of fear [20]. The Cronbach\u0026rsquo;s alpha coefficient of the scale in this study was 0.883, indicating good internal consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRevised Distress Disclosure Index (DDI)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe DDI was originally developed by Kahn and Hessling to assess an individual\u0026rsquo;s tendency to disclose distressing experiences [21]. In 2008, Chinese scholar Li Xinmin translated and revised the scale for use in the Chinese population to evaluate levels of self-disclosure\u0026nbsp;[22]. The revised Chinese version consists of 12 items and uses a 5-point Likert scale ranging from 1 (\u0026quot;strongly disagree\u0026quot;) to 5 (\u0026quot;strongly agree\u0026quot;). Items 2, 4, 5, 8, 9, and 10 are reverse scored. The total score ranges from 12 to 60, with higher scores indicating a greater level of self-disclosure, while lower scores reflect a higher tendency toward concealment. The Cronbach\u0026rsquo;s alpha coefficient of the scale is 0.86, indicating good internal consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSimplified Chinese Medical Outcomes Study Social Support Survey\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e（\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eMOS-SSS-CM\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e）\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMOS-SSS-CM\u0026nbsp;was originally developed by Sherbourne et al. in 1991 to assess perceived social support among patients with chronic illnesses[23]. In 2012, Li Huan adapted the scale into a simplified Chinese version (MOS-SSS-CM) for use in the Chinese population[24]. The total scale demonstrated good reliability, with a Cronbach\u0026rsquo;s alpha coefficient of 0.889 and a test-retest reliability of 0.77, indicating high internal consistency and stability. The scale contains 20 items across four dimensions: emotional/informational support, tangible support, affectionate support, and positive social interaction. Each item is rated using a 5-point Likert scale ranging from 1 to 5, based on the individual\u0026rsquo;s perceived frequency of support. The total score is converted to a 0-100 scale, with higher scores reflecting a higher level of perceived social support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor patients who met the inclusion and exclusion criteria, data collection was conducted after hospital admission and pathological diagnosis, but prior to the initiation of treatment. Upon obtaining written informed consent, a professionally trained research staff member was responsible for distributing and guiding the completion of the questionnaires. After completion, the researcher checked each questionnaire for completeness. Prior to the start of the study, this staff member received comprehensive training on research ethics, questionnaire content, completion guidelines, and communication skills with patients, ensuring effective interaction and the provision of appropriate support throughout the process.\u003c/p\u003e\n\u003cp\u003eTo ensure objectivity and the reliability of the study results, a blinded design was implemented. Specifically, the researcher responsible for questionnaire administration was not provided with information about the patients\u0026apos; treatment plans or clinical conditions during data collection, thus minimizing potential bias in the data collection process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was conducted by an independent researcher with extensive experience in clinical research and a professional background in oncology and statistics. This researcher remained blinded to participants\u0026apos; treatment groups and clinical conditions throughout the analysis process to ensure objectivity and scientific rigor. The researcher received specialized training in data analysis and was proficient in the use of relevant statistical software and methodologies for effective data interpretation.\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS version 25.0, with a significance level set at \u003cem\u003e\u0026alpha;\u003c/em\u003e = 0.05; \u003cem\u003ep\u003c/em\u003e-values less than 0.05 were considered statistically significant. Descriptive statistics were used to characterize participants\u0026apos; sociodemographic and clinical characteristics. Univariate analyses or bivariate correlations were initially conducted to identify potential factors associated with levels of FCR. Analysis of variance (ANOVA) was used to examine differences in FCR scores across various sociodemographic and clinical characteristics (e.g., education level, marital status, employment status, and household income). Pearson correlation analysis was performed to assess the relationships among self-disclosure, social support, and FCR in breast cancer patients.\u003c/p\u003e\n\u003cp\u003eVariables demonstrating statistical significance in univariate analyses were subsequently entered into a multivariate regression model. A multiple linear regression analysis was conducted to identify independent predictors of FCR. The squared correlation coefficient (\u003cem\u003eR\u0026sup2;\u003c/em\u003e) was used to indicate the proportion of variance in the dependent variable that could be explained by the independent variables. A\u0026nbsp;\u003cem\u003eP\u003c/em\u003e-value of 0.05 was considered the threshold for statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eAnalysis of Demographic Characteristics, Self-Disclosure, Social Support, Fear of Cancer Recurrence Among Newly Diagnosed Breast Cancer Patients Prior to Treatment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA total of 362 patients met the inclusion criteria and provided informed consent. As 12 patients refused to participate in the study, 350 patients finally completed the questionnaire with a loss rate of 3.31%. The descriptive data on sociodemographic and clinical characteristics as well as DDI and MOS-SSS-CM scores are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 350 breast cancer patients, aged between 25 and 77 years (mean age\u0026thinsp;=\u0026thinsp;45.39\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68), were included in the study, with 99.1% being female. The majority reported a per capita monthly household income above 5,000 RMB. Financial concerns were prevalent, with 63.7% of patients experiencing some degree of economic burden and 15.7% reporting severe financial stress. Additionally, 55.7% rated their sleep quality as average. The mean scores for self-disclosure and social support were 38.86\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31 and 70.57\u0026thinsp;\u0026plusmn;\u0026thinsp;14.04, respectively. The mean FCR score among breast cancer patients was 33.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.00, with the physical health dimension (18.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12) scoring higher than the social/family dimension (15.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66). Notably, 48.3% of patients reported experiencing fear of recurrence prior to the initiation of treatment.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalysis of Demographic Characteristics, Self-Disclosure, Social Support, and Their Correlations with Fear of Cancer Recurrence in Newly Diagnosed Breast Cancer Patients Before Treatment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe results of the ANOVA indicated that there were statistically significant differences in FCR related to age, average age of the youngest child, average age of all children, monthly per capita household income, financial burden, place of residence, family relationships, occupation before diagnosis, and sleep status (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Pearson correlation analysis revealed that both self-disclosure (\u003cem\u003er\u003c/em\u003e = -0.394, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and social support (\u003cem\u003er\u003c/em\u003e = -0.393, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) were significantly and negatively associated with fear of cancer recurrence (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of FoP-Q-SF with Sociodemographic Characteristics, Clinical Characteristics, DDI and MOS-SSS-CM(N\u0026thinsp;=\u0026thinsp;350)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN(%) and M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFop score, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(y)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.39\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.99\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoung adults(18\u0026thinsp;~\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.34\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle-aged adults(41\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.05\u0026thinsp;\u0026plusmn;\u0026thinsp;8.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlder adults(61\u0026thinsp;~\u0026thinsp;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e27.78\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.914\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e347 (99.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.192\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHan ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e338 (96.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.45\u0026thinsp;\u0026plusmn;\u0026thinsp;7.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFaith\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.596\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e330 (94.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.178\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.47\u0026thinsp;\u0026plusmn;\u0026thinsp;8.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e314 (89.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.36\u0026thinsp;\u0026plusmn;\u0026thinsp;7.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.491\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNulliparous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.68\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage age of the youngest child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.487\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e222 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.24\u0026thinsp;\u0026plusmn;\u0026thinsp;7.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage age of all children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.433\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.866\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.77\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school or technical secondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.86\u0026thinsp;\u0026plusmn;\u0026thinsp;7.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly per capita household income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.695\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.56\u0026thinsp;\u0026plusmn;\u0026thinsp;8.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3001\u0026thinsp;~\u0026thinsp;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.05\u0026thinsp;\u0026plusmn;\u0026thinsp;8.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e191(54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.47\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinancial burden\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo financial burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate financial burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223 (63.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.45\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere financial burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.368.08\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.442\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.26\u0026thinsp;\u0026plusmn;\u0026thinsp;8.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTown area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181 (51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving arrangement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.863\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.80\u0026thinsp;\u0026plusmn;\u0026thinsp;11.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e325 (92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily relationship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.963\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.02\u0026thinsp;\u0026plusmn;\u0026thinsp;7.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarmonious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e295 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation before diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.820\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e30.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.85\u0026thinsp;\u0026plusmn;\u0026thinsp;7.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e236 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.72\u0026thinsp;\u0026plusmn;\u0026thinsp;7.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of healthcare payment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.488\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-paid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e36.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e335 (95.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.72\u0026thinsp;\u0026plusmn;\u0026thinsp;7.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment-funded healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePathological staging\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.428\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.29\u0026thinsp;\u0026plusmn;\u0026thinsp;10.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.70\u0026thinsp;\u0026plusmn;\u0026thinsp;9.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTumor type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.582\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-invasive carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e313 (89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.381\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251 (71.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.70\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.599\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e283 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.56\u0026thinsp;\u0026plusmn;\u0026thinsp;7.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.91\u0026thinsp;\u0026plusmn;\u0026thinsp;8.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.399\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67(34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.04\u0026thinsp;\u0026plusmn;\u0026thinsp;8.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195(34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e30.35\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-disclosure scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.86\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.377\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial support scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.57\u0026thinsp;\u0026plusmn;\u0026thinsp;14.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.393\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ea Means comparing the Fop of different characteristics with the ANOVA test.\u003c/p\u003e \u003cp\u003eb Means Pearson correlation with FoP-Q-SF.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultiple Regression Analysis of Fear of Cancer Recurrence in Newly Diagnosed Breast Cancer Patients\u003c/h2\u003e \u003cp\u003eA standard enter method linear regression analysis was performed, with FCR set as the dependent variable. Independent variables were those found to be statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in univariate and correlation analyses, including patient age, average age of the youngest child, average age of all children, monthly per capita household income, financial burden, place of residence, family relationship, occupation before diagnosis, sleep quality, self-disclosure, and social support. A significant regression equation (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9.91, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was found, with a \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e of 0.337 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). FCR was jointly explained by age, sleep quality, household income, family relationship, financial burden, self-disclosure, and social support.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple Linear Regression Analysis of Fear of Cancer Recurrence in Breast Cancer Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE \u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e(constant)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35.34 to 46.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(y)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlder adults(61\u0026thinsp;~\u0026thinsp;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoung adults(18\u0026thinsp;~\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.86 to 10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle-aged adults(41\u0026thinsp;~\u0026thinsp;60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.87 to 7.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.38 to 4.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.39 to 5.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly per capita household income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh income(\u0026gt;5000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle income(3001\u0026thinsp;~\u0026thinsp;5000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.81 to 1.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow income(\u0026le;3000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-5.30 to -0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinancial burden\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo financial burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere financial burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.45 to 7.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate financial burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.35 to 4.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily relationship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarmonious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07 to 4.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-10.925 to 8.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-disclosure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.32 to -0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.15 to -0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eNewly diagnosed breast cancer patients represent a unique population, in which psychological factors play a critical role in treatment decision-making. To our knowledge, this study is the first to investigate the relationships between sociodemographic and clinical characteristics, self-disclosure, social support, and FCR prior to treatment, and to identify significant predictors of FCR in this population.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFear of Cancer Recurrence before Treatment in Newly Diagnosed Breast Cancer Patients\u003c/h2\u003e \u003cp\u003eThis study found that FCR was a prevalent psychological issue among newly diagnosed breast cancer patients prior to treatment, with approximately 50% experiencing clinically significant levels of fear. This proportion was lower than that reported by Han et al.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] but higher than that found by Li et al.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], suggesting heterogeneity in FCR across different patient groups. The discrepancy may be due to differences in study populations and timing of assessment. Han et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] focused on patients undergoing chemotherapy, during which FCR may be intensified by side effects and prolonged stress (including financial, occupational, and familial stressors). In contrast, the participants in this study were at the pre-treatment stage, not yet exposed to treatment-related stressors, which may explain their relatively lower FCR. Li et al.'s study[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] mainly involved postoperative patients. In our study, patients were newly diagnosed, facing difficulty accepting the diagnosis and perceiving uncertainty about future treatment, potentially contributing to high FCR. These findings highlight the importance of early psychological intervention for newly diagnosed patients.\u003c/p\u003e \u003cp\u003e \u003cb\u003eYounger Patients, Poor Sleep Quality, Low Income, and Financial Burden Exhibit Higher Levels of Fear of Cancer Recurrence\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study identified age as a significant factor influencing FCR in breast cancer patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), consistent with the findings of Zhang et al.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Younger patients tend to be more concerned with body image, and treatment-related changes such as hair loss from surgery or chemotherapy, may trigger feelings of inferiority or depression, exacerbating FCR.\u003c/p\u003e \u003cp\u003eSleep quality was also found to be an independent predictor of FCR, with poorer sleep associated with higher FCR [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A possible mechanism is that negative thoughts induced by FCR may lead to sleep disturbances, which in turn intensify psychological stress, creating a vicious cycle. Nursing staff should closely monitor sleep problems and provide pharmacological support when necessary to improve sleep, enhance psychological well-being, and ultimately reduce FCR.\u003c/p\u003e \u003cp\u003eBoth univariate and multivariate analyses in this study indicated that patients with lower household income experienced higher levels of FCR, consistent with the findings by Niu et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Possible explanations include the high cost of cancer treatment and the additional financial burden associated with recurrence. Low-income patients may also experience guilt, which can exacerbate anxiety. Notably, patients with medical insurance reported significantly lower FCR than those paying out-of-pocket. Since breast cancer patients often require adjuvant therapies after surgery, such as chemotherapy or radiotherapy, the high cost and limited reimbursement of anti-cancer drugs may increase financial stress and fear of recurrence among economically disadvantaged patients. These findings suggest that healthcare providers should consider patients\u0026rsquo; financial situations when planning treatment, offer cost-effective options, and strengthen psychological support to promote recovery. At the policy level, improving the medical insurance system and expanding coverage for major illnesses are essential to reducing patients\u0026rsquo; financial burdens. \u003cb\u003eLower Levels of Self-Disclosure Lead to Higher Levels of Fear of Cancer Recurrence\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study found a significant negative correlation between self-disclosure and FCR. Self-disclosure, typically expressed through verbal communication of one\u0026rsquo;s thoughts and emotions, serves both as a personal coping mechanism and psychological intervention strategy. It has been shown to alleviate psychological distress and improve quality of life [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Prior research supports these findings. Xu et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported that effective communication helps patients correct misconceptions about recurrence and fosters healthier beliefs, thereby reducing FCR. In a controlled trial by Chen et al.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], a self-disclosure intervention significantly increased disclosure levels, reduced negative emotions, and lowered FCR in postoperative breast cancer patients undergoing chemotherapy. Another study found that enhancing spousal self-disclosure also reduced FCR[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This may be due to the fact that individuals with higher levels of self-disclosure receive more external feedback\u0026mdash;such as encouragement, experiential guidance, or health-related information\u0026mdash;which improves their understanding of the disease and relieves emotional stress. Sharing one\u0026rsquo;s illness experience and feelings can also enhance emotional support. Therefore, clinical staff should encourage newly diagnosed patients to engage in active and meaningful communication, such as journaling or peer discussion, to express their thoughts and expectations. This practice can enhance self-disclosure, help patients cope with stress, and assist them in making informed treatment decisions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLower Levels of Social Support Are Associated with Higher Levels of Fear of Cancer Recurrence\u003c/h2\u003e \u003cp\u003eSocial support was significantly and negatively correlated with FCR, encompassing both the physical and social/family dimensions. This finding is consistent with the results of Niu et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Yu et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A meta-analysis also demonstrated that low levels of social support are associated with increased FCR in breast cancer patients, while higher levels of support promote positive health perceptions and reduce stress-related recurrence fears [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As a protective factor, social support facilitates emotional regulation through interpersonal interaction and helps alleviate symptom distress and fear of recurrence [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In the context of FCR, social support acts as a \"buffer,\" mitigating the negative psychological impact of stressful events[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Strong social support not only reduces symptom sensitivity and psychological distress, such as anxiety and depression, but also enhances mental health, decreases FCR, and improves quality of life. Furthermore, it enables patients to approach treatment and recovery with greater positivity and optimism.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. (1) Data were collected from a single tertiary cancer hospital in Guangzhou, which may limit the generalizability of the findings to other regions or healthcare settings. (2) The study captured self-disclosure, social support, and FCR at a single time point. Consequently, it lacks longitudinal data to assess how these psychological variables change over time or impact patients across different stages of treatment and disease progression.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePrior to initial treatment, 50% of newly diagnosed breast cancer patients experienced high levels of FCR. Healthcare providers should pay greater attention to FCR in younger and middle-aged patients, actively address sleep disturbances, enhance social and financial support, and encourage self-disclosure. These interventions may help alleviate FCR and foster a more positive psychological state, thereby supporting the development of more appropriate treatment strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used in this study can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was obtained from the ethics committee of Sun Yat-sen University Cancer Center (Approval No.B2023-700-01). The procedures used in this study adhere to the tenets of the Declaration of Helsinki, which emphasize respect for the dignity, autonomy, and privacy of research participants, the minimization of potential risks and the maximization of possible benefits, as well as the requirement for voluntary and informed consent prior to participation. Participants\u0026rsquo; personal data were treated with strict confidentiality, and their rights and well-being were protected throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all the participants for their contributions to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cem\u003eInternational Agency for Research on Cancer\u003c/em\u003e. Global Cancer Observatory: Cancer Today [DB/OL]. https://gco.iarc.who.int/today/en\u003c/li\u003e\n \u003cli\u003eAssociation, The Society of Breast Cancer China Anti-Cancer. (2023). Guidelines for breast cancer diagnosis and treatment by China Anti-cancer Association (2024 edition) \u003cem\u003eChina Oncology\u003c/em\u003e,\u003cem\u003e\u0026nbsp;33\u003c/em\u003e(12), 1092-1187. https://doi.org/10.19401/j.cnki.1007-3639.2023.12.004\u003c/li\u003e\n \u003cli\u003eButow, P., Sharpe, L., Thewes, B., Turner, J., Gilchrist, J., \u0026amp; Beith, J. (2018). Fear of Cancer Recurrence: A Practical Guide for Clinicians. \u003cem\u003eOncology (Williston Park)\u003c/em\u003e,\u003cem\u003e\u0026nbsp;32\u003c/em\u003e(1), 32-38.\u003c/li\u003e\n \u003cli\u003eLebel, S., Rosberger, Z., Edgar, L., \u0026amp; Devins, G. M. (2009). Emotional distress impacts fear of the future among breast cancer survivors not the reverse. \u003cem\u003eJ Cancer Surviv\u003c/em\u003e,\u003cem\u003e\u0026nbsp;3\u003c/em\u003e(2), 117-127. https://doi.org/10.1007/s11764-009-0082-5\u003c/li\u003e\n \u003cli\u003eSchapira, L., Zheng, Y., Gelber, S. I., Poorvu, P., Ruddy, K. J., Tamimi, R. M., . . . Rosenberg, S. M. (2022). Trajectories of fear of cancer recurrence in young breast cancer survivors. \u003cem\u003eCancer\u003c/em\u003e,\u003cem\u003e\u0026nbsp;128\u003c/em\u003e(2), 335-343. https://doi.org/10.1002/cncr.33921\u003c/li\u003e\n \u003cli\u003eGaleano Machuca, M. P., Cheng, S. C., Jou, T. H., \u0026amp; Cheng, C. T. (2021). Determinants of Breast-Conserving Therapy in the Asian Population: A Systematic Review. \u003cem\u003eWorld J Surg\u003c/em\u003e,\u003cem\u003e\u0026nbsp;45\u003c/em\u003e(3), 799-807. https://doi.org/10.1007/s00268-020-05814-6\u003c/li\u003e\n \u003cli\u003eSavard, J., Filion, C., Brearty, C. M., Caplette-Gingras, A., Chiquette, J., \u0026amp; Dorval, M. (2024). Fear of cancer recurrence in breast cancer survivors carrying a BRCA1/2 mutation: A qualitative study. \u003cem\u003eCancer Med\u003c/em\u003e,\u003cem\u003e\u0026nbsp;13\u003c/em\u003e(1), e6889. https://doi.org/10.1002/cam4.6889\u003c/li\u003e\n \u003cli\u003eBandura, A. (2001). Social cognitive theory: an agentic perspective. \u003cem\u003eAnnu Rev Psychol\u003c/em\u003e,\u003cem\u003e\u0026nbsp;52\u003c/em\u003e, 1-26. https://doi.org/10.1146/annurev.psych.52.1.1\u003c/li\u003e\n \u003cli\u003eMugo, C., Firdawsi, O., Wang, J., Njuguna, I. N., Wamalwa, D. C., Slyker, J. A., . . . Wagner, A. D. (2023). \u0026quot;When they are all grown, I will tell them\u0026quot;: Experience and perceptions of parental self-disclosure of HIV status to children in Nairobi, Kenya. \u003cem\u003eBMC Public Health\u003c/em\u003e,\u003cem\u003e\u0026nbsp;23\u003c/em\u003e(1), 519. https://doi.org/10.1186/s12889-023-15387-3\u003c/li\u003e\n \u003cli\u003eWang, Jingjing, \u0026amp; Zhu, Binghua. (2022). Analysis of the Influencing Factors of Postoperative Cancer Recurrence Fear in Young Female Patients with Breast Cancer. \u003cem\u003eChinese General Practice Nursing\u003c/em\u003e,\u003cem\u003e\u0026nbsp;20\u003c/em\u003e(28), 3988-3991. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2vnmDOQWKmW2uejo54aobp3mM1_9YmeDMdlr9NR7JZqj0iPYXZBFC-Vfhfwj1SlFwtWwHz2wLoJ0eSMfDhXtPlbJGKXX3pgt5WKpb34MDA9HPsRqst3VcM0okoHZ0ZaEcSLHJToRsVuPrzcQxevPbSija-kw_aeTT4UZk4QAu0Pcn4W2XGEDMDOSzxw6d_ZMDg=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eXu, W., Wang, J., \u0026amp; Schoebi, D. (2019). The role of daily couple communication in the relationship between illness representation and fear of cancer recurrence in breast cancer survivors and their spouses. \u003cem\u003ePsychooncology\u003c/em\u003e,\u003cem\u003e\u0026nbsp;28\u003c/em\u003e(6), 1301-1307. https://doi.org/10.1002/pon.5082\u003c/li\u003e\n \u003cli\u003eChen Jiao , Cheng Hong , Wei Qingfeng ,Zhong Chunxia ,Xu Yanhong ,Xia Ye ,Zhong Yan. (2022). Self-disclosure intervention for patients undergoing chemotherapy following breast cancer surgery \u003cem\u003eJournal of Nursing Science\u003c/em\u003e,\u003cem\u003e\u0026nbsp;37\u003c/em\u003e(14), 86-89. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2uBg0v4oPq6uzV3wC6TcZOkSy6F3FxOKmj9eHhsD57GOZlz8qfQUbPzOc-6APenp7GOO2_iICWpfyzp9QoLE0JF5oHlFM7C5hlO9OanvUT-th0lVajZfG7mQrBG_3mfVW8_Qy0bWRj0dWIjjhJsjs2CsJRSLAzBzbguThUdC9dbW_6uno-rEGU5AJnln60Y9os=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eZhang Xianxian , Zhang Lixia , Jia Zhihui ,Chen Yuanzun. (2019). Application and effect evaluation of marital selfdisclosure intervention on the fear of cancer recurrence in young breast cancer patients. \u003cem\u003eChinese Journal of Nursing\u003c/em\u003e,\u003cem\u003e\u0026nbsp;54\u003c/em\u003e(11), 1610-1614. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2sJvWZi26wDAbmGpWHCFBQo5akHLYa4ldYDq70Jr3cJOE62y8Q8k35HS2Fdu6rFjL-XyKL7JSP2iftnXuB_q7WCRZT8bt9pmQnjmHU4aKFpQ9v7UzgVAcZIHFbeCjjokNPz_BckeSsaAGcbQP958-iYhEQeP4DFE7U9ORaciGXyEGwyadmqNwBJl_r78yV65ZE=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eNiu, L., Liang, Y., \u0026amp; Niu, M. (2019). Factors influencing fear of cancer recurrence in patients with breast cancer: Evidence from a survey in Yancheng, China. \u003cem\u003eJ Obstet Gynaecol Res\u003c/em\u003e,\u003cem\u003e\u0026nbsp;45\u003c/em\u003e(7), 1319-1327. https://doi.org/10.1111/jog.13978\u003c/li\u003e\n \u003cli\u003eYu, Z., Sun, D., \u0026amp; Sun, J. (2022). Social Support and Fear of Cancer Recurrence Among Chinese Breast Cancer Survivors: The Mediation Role of Illness Uncertainty. \u003cem\u003eFront Psychol\u003c/em\u003e,\u003cem\u003e\u0026nbsp;13\u003c/em\u003e, 864129. https://doi.org/10.3389/fpsyg.2022.864129\u003c/li\u003e\n \u003cli\u003eLiu Jin, Lu Na, Zhang Feng-Wa, Niu Xiao Dan, Yuan Rong Jing, Li Wen Yan, Wang Ye Tong , Wang Yan Hong. (2021). Influence Factors of Cancer Recurrence Fear in Breast Cancer Patients:A Meta-analysis. \u003cem\u003eJournal of Nursing(China)\u003c/em\u003e,\u003cem\u003e\u0026nbsp;28\u003c/em\u003e(14), 1-7. https://doi.org/10.16460/j.issn1008-9969.2021.14.001\u003c/li\u003e\n \u003cli\u003eNi Ping, Chen Jingli, Liu Na. (2010). The sample size estimation in quantitative nursing research. \u003cem\u003eChinese Journal of Nursing\u003c/em\u003e,\u003cem\u003e\u0026nbsp;45\u003c/em\u003e(04), 378-380. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt4mlDuqBvW-Q4HBx2ZJF6tur5rOg__CM9juEpnJUUi8JpMUwpm_xp5xmJAiu6OIc7NhqeTFANCqkNH2SSBdrZB1erCVDQLot7DSahsP-S3V4qd0TFRmV-l_WWLbWNOOJOO07o3B5h715MH11keRnuNYU_T5YSRpP6D1MdTvI-fFU_891ixjtb_u\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eMehnert, A., Herschbach, P., Berg, P., Henrich, G., \u0026amp; Koch, U. (2006). [Fear of progression in breast cancer patients--validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF)]. \u003cem\u003eZ Psychosom Med Psychother\u003c/em\u003e,\u003cem\u003e\u0026nbsp;52\u003c/em\u003e(3), 274-288. https://doi.org/10.13109/zptm.2006.52.3.274 (Progredienzangst bei Brustkrebspatientinnen--Validierung der Kurzform des Progredienzangstfragebogens PA-F-KF.)\u003c/li\u003e\n \u003cli\u003eWu Qiyun, Ye Zhixia , Li Li. (2015). Measurement and influencing factors of fear of cancer recurrence among cancer patients. \u003cem\u003eChinese Nursing Management\u003c/em\u003e,\u003cem\u003e\u0026nbsp;15\u003c/em\u003e(08), 1020-1023. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt7VjhBkxYI3uS3atxzHSP5nIv-UL7vooslTU5n3RqrKpK4Gh89gDO-hu8QY_rdDXOmksyuliMNN0Vu8zzCdf6rm_xWomSLZ4ZONk-4VrBgob85_5xhnU2RPZ2l-Drno7ZJo-9LT4EMQA2TJ7JhXICKq_qtJ9pD9b8LaT306tO5cHbU3KqXxA-Ll8raqNVPszeg=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eLi, B., Lin, X., Chen, S., Qian, Z., Wu, H., Liao, G., . . . Liang, G. (2024). The association between fear of progression and medical coping strategies among people living with HIV: a cross-sectional study. \u003cem\u003eBMC Public Health\u003c/em\u003e,\u003cem\u003e\u0026nbsp;24\u003c/em\u003e(1), 440. https://doi.org/10.1186/s12889-024-17969-1\u003c/li\u003e\n \u003cli\u003eKahn, Jeffrey H, Hessling, Robert M %J Journal of Social, \u0026amp; Psychology, Clinical. (2001). Measuring the tendency to conceal versus disclose psychological distress.\u003cem\u003e\u0026nbsp;20\u003c/em\u003e(1), 41-65.\u003c/li\u003e\n \u003cli\u003eMin, Li Xin. (2009). \u003cem\u003eResearch on the Relationship between Adult Attachment,Self-disclosure and Depression of College Students\u003c/em\u003e Hebei Normal University]. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt4HNn3KSggjdGrnyRov9OumMWcWlBwd-TrMXJaBPGRMWRxMK7kuLMiDROat5TqVa9Wg8VqcRqP6nElSrbYIHSl7V\u003cbr\u003eXeX6_OHa9JILuPbRw18mvX_uzdGFL3NZmZfEBGf4cTA_W8dNx8d1VfqstuNsJAMy86a-vpX4c7x8oIvaVWL9wjKoNkS57F9cNy3YGaYRmk=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eSherbourne, Cathy Donald, Stewart, Anita L %J Social Science, \u0026amp; Medicine. (1991). The MOS social support survey.\u003cem\u003e\u0026nbsp;32\u003c/em\u003e(6), 705-714.\u003c/li\u003e\n \u003cli\u003eHuan, Li. (2012). \u003cem\u003ePsychometric Measurement of the Simplified Chinese Medical Outcomes Study Social Support Survey (MOS-SSS-C) and its Application in HIV/AIDS Patients\u003c/em\u003e Central South University]. https://kns.cnki.net/kcms2/article/abstract?v=7c_HF4sgkt6-IPDeAIows5QYBzr9OsQE1MVCjdEDw6sjQpdUZxaRFDJpiaq9QKywdCw-pKpWQQuMz06QzjWVQFpoI1vTERGWGyMzSBPhIQL_NY1EBDKd\u003cbr\u003elS7Q5m7vYjpf_YvjDp15UssPmUIVypt_ly8J0kGCQHEkjgJHjnzzjAMcplHywotQ9zV6vu7XJtAgtG0umwNO9io=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eHan, M., Chen, H., Li, J., Zheng, X., Zhang, X., Tao, L., . . . Feng, X. (2024). Correlation between symptom experience and fear of cancer recurrence in postoperative breast cancer patients undergoing chemotherapy in China: A cross-sectional study. \u003cem\u003ePLoS One\u003c/em\u003e,\u003cem\u003e\u0026nbsp;19\u003c/em\u003e(9), e0308907. https://doi.org/10.1371/journal.pone.0308907\u003c/li\u003e\n \u003cli\u003eLi, Y., Fang, C., Xiong, M., Hou, H., Zhang, Y., \u0026amp; Zhang, C. (2024). Exploring fear of cancer recurrence and related factors among breast cancer patients: A cross-sectional study. \u003cem\u003eJ Adv Nurs\u003c/em\u003e,\u003cem\u003e\u0026nbsp;80\u003c/em\u003e(6), 2403-2414. https://doi.org/10.1111/jan.16009\u003c/li\u003e\n \u003cli\u003eZhang Huifang , Lin Zihan , Li Jin ,Chen Jiejie ,Wu Wenbin ,Cui Zhenti. (2022). Latent profile analysis of fear of cancer recurrence of patients with breast cancer. \u003cem\u003eChinese Nursing Research\u003c/em\u003e,\u003cem\u003e\u0026nbsp;36\u003c/em\u003e(22), 4013-4017. https://kns.cnki.net/kcms2/article/abstract?v=_GofKS1StuT9yG1fEmwmfYK0tZ0i3V4zIZbtvXu9S2TzBy1HMnGh1Ow9c\u003cbr\u003eKLOWJnpssVwv1kMqEWd2hvADwxtoUvQgWtmpzIbtratC6bRmwloy_Wsns1y5dJBSD\u003cbr\u003ex8ckwzG5-aRYx8HFiBo0RhfcIr5s1hcnyV9wjFyOFzDWevblz2-HVZ5mDH0fmEVsOSIUbNe_IUVffSAe4=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n \u003cli\u003eMingyangjia, Tian. (2023). \u003cem\u003eThe Relationship between Sleep Quality and Suicidal Ideation: The Longitudinal Mediating Role of Negative Emotions and the Associated Neural Mechanisms\u003c/em\u003e Tianjin Normal University]. https://link.cnki.net/doi/10.27363/d.cnki.gtsfu.2023.000463\u003c/li\u003e\n \u003cli\u003eDu, X., Wang, D., Du, H., Zou, Q., \u0026amp; Jin, Y. (2021). The correlation between intimate relationship, self-disclosure, and adaptability among colorectal cancer enterostomy patients. \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e,\u003cem\u003e\u0026nbsp;100\u003c/em\u003e(19), e25904. https://doi.org/10.1097/md.0000000000025904\u003c/li\u003e\n \u003cli\u003eMahendran, R., Liu, J., Kuparasundram, S., Simard, S., Chan, Y. H., Kua, E. H., \u0026amp; Griva, K. (2021). Fear of cancer recurrence among cancer survivors in Singapore. \u003cem\u003eSingapore Med J\u003c/em\u003e,\u003cem\u003e\u0026nbsp;62\u003c/em\u003e(6), 305-310. https://doi.org/10.11622/smedj.2020007\u003c/li\u003e\n \u003cli\u003eHong, S. J., Shin, N. M., \u0026amp; Jung, S. (2020). A predictive model of fear of cancer recurrence for patients undergoing chemotherapy. \u003cem\u003eSupport Care Cancer\u003c/em\u003e,\u003cem\u003e\u0026nbsp;28\u003c/em\u003e(9), 4173-4181. https://doi.org/10.1007/s00520-019-05245-7\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fear of Cancer Recurrence, Breast Cancer, Self-Disclosure, Social Support","lastPublishedDoi":"10.21203/rs.3.rs-8272695/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8272695/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFear of cancer recurrence (FCR) is a common psychological disorder among cancer patients. In newly diagnosed breast cancer patients, fear and condition about recurrence often influence treatment decision-making. However, the prevalence of FCR before treatment and its key risk factors\u0026mdash;such as age, sleep quality, economic status, self-disclosure, and social support\u0026mdash;remain unclear.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo describe the prevalence and severity of FCR before treatment in newly diagnosed breast cancer patients and analyze its predicting factors, thereby providing a scientific basis for interventions to reduce such fear.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted among newly diagnosed breast cancer patients prior to treatment at a specialized oncology hospital in Guangdong Province, China, between February and July 2023. Sociodemographic data were collected, including age, gender, ethnicity, religious belief, education level, and marital status. Clinical data included pathological stage, tumor type, and family history of cancer. The Distress Disclosure Index, the Chinese version of the Medical Social Support Scale, and the short form of the Fear of Progression Questionnaire were utilized. Univariate analyses and bivariate correlations were conducted to explore relationships between variables. Multiple regression analysis was performed to identify predictors of FCR.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 350 newly diagnosed breast cancer patients were enrolled. Among participants, 48.3% experienced FCR before initiating treatment. The mean total score for FCR was 33.44\u0026thinsp;\u0026plusmn;\u0026thinsp;8.00. Age, sleep quality, financial burden, monthly household income per capita, family relationships, self-disclosure, and social support accounted for 33.7% (\u003cem\u003eR\u0026sup2;\u003c/em\u003e) of the variance in FCR.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFCR prior to treatment is common and relatively severe among newly diagnosed breast cancer patients. Healthcare professionals should encourage patients to actively enhance self-disclosure and strengthen their social support networks. These strategies may reduce pre-treatment FCR, thereby facilitating more informed and appropriate treatment decision-making. The findings of this study underscore the urgent need for early identification and management of fear of cancer recurrence (FCR) in newly diagnosed breast cancer patients. High levels of pre-treatment FCR may impair patients' psychological well-being and influence treatment decision-making, potentially leading to suboptimal treatment choices. Healthcare professionals should implement targeted interventions that promote self-disclosure and strengthen social support networks to alleviate FCR. These measures can enhance patients' psychological readiness for treatment, facilitate informed decision-making, and ultimately improve clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Fear of cancer recurrence before treatment in newly diagnosed breast cancer patients: Identification of predictive factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 10:12:08","doi":"10.21203/rs.3.rs-8272695/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"53ff5a90-3c62-45de-8bef-14a2d7d766d7","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T08:13:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 10:12:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8272695","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8272695","identity":"rs-8272695","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}