{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T12:30:23Z","timestamp":1764333023492,"version":"3.41.2"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T00:00:00Z","timestamp":1622419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women\u2019s COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.<\/jats:p>","DOI":"10.3389\/fpsyg.2021.663310","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T04:15:19Z","timestamp":1622434519000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer"],"prefix":"10.3389","volume":"12","author":[{"given":"Mohammad H.","family":"Choobin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vida","family":"Mirabolfathi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bethany","family":"Chapman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Reza","family":"Moradi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Grunfeld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazanin","family":"Derakshan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1146\/annurev-clinpsy-050817-084903","article-title":"Cognitive effects of cancer and cancer treatments","volume":"14","author":"Ahles","year":"2018","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s13304-017-0424-1","article-title":"Breast cancer in young women: An overview.","volume":"69","author":"Anastasiadi","year":"2017","journal-title":"Updates Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1053\/j.seminoncol.2009.03.001","article-title":"Breast cancer before age 40 years.","volume":"36","author":"Anders","year":"2009","journal-title":"Semin. Oncol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.3978\/j.issn.2072-1439.2013.05.24","article-title":"Epidemiology and prognosis of breast cancer in young women.","volume":"5","author":"Assi","year":"2013","journal-title":"J. Thoracic Dis."},{"key":"B5","first-page":"21","article-title":"Relationship between rumination and depression in a sample of iranian students.","volume":"10","year":"2010","journal-title":"Stud. Educat. Psychol."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.21105\/joss.02815","article-title":"effectsize: Estimation of Effect Size Indices and Standardized Parameters.","volume":"5","author":"Ben-Shachar","year":"2020","journal-title":"J. Open Source Softw."},{"key":"B7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/0005-7967(83)90121-3","article-title":"Preliminary exploration of worry: Some characteristics and processes.","volume":"21","author":"Borkovec","year":"1983","journal-title":"Behav. Res. Therapy"},{"journal-title":"Breast Cancer Now","year":"2018","key":"B100"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1002\/pon.4715","article-title":"Predictors of anxiety and depression 2 years following treatment in uveal melanoma survivors.","volume":"27","author":"Brown","year":"2018","journal-title":"Psycho Oncol."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.582014","article-title":"COVID-19 Outbreak effects on job security and emotional functioning amongst women living with breast cancer","volume":"11","author":"Chapman","year":"2020","journal-title":"Front. Psychol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2237","DOI":"10.1002\/cncr.28737","article-title":"Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains: Comparison of Breast Cancer Survivors.","volume":"120","author":"Champion","year":"2014","journal-title":"Cancer"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/2055102919871661","article-title":"Perceived cognitive functioning and its influence on emotional vulnerability in breast cancer.","volume":"6","author":"Chapman","year":"2019","journal-title":"Health Psychol. Open"},{"key":"B12","first-page":"67","article-title":"Psychometrics Particularity of Farsi Version of Pennsylvania State Worry Questionnaire for College Students.","volume":"1","author":"Dehshiri","year":"2010","journal-title":"J. Clin. Psychol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s10549-020-05644-z","article-title":"Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. The COVID-19 pandemic breast cancer consortium.","volume":"181","author":"Dietz","year":"2020","journal-title":"Breast Cancer Res. Treat."},{"key":"B14","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1097\/SPC.0000000000000161","article-title":"Managing psychosocial issues faced by young women with breast cancer at the time of diagnosis and during active treatment.","volume":"9","author":"Fernandes-Taylor","year":"2015","journal-title":"Curr. Opin. Support. Palliat. Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3390\/jpm5030229","article-title":"Comorbidities and Quality of Life among Breast Cancer Survivors: A Prospective Study.","volume":"5","author":"Fu","year":"2015","journal-title":"J. Personaliz. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1038\/s41416-020-01182-z","article-title":"The COVID-19 pandemic and impact on breast cancer diagnoses: What happened in England in the first half of 2020.","volume":"124","author":"Gathani","year":"2021","journal-title":"Br. J. Cancer"},{"key":"B17","first-page":"152","article-title":"Effectiveness of compassion-based therapy on rumination and concern of women with breast cancer.","volume":"7","author":"Ghanavati","year":"2018","journal-title":"Health Psychol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/j.jpsychores.2008.03.005","article-title":"Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer.","volume":"65","author":"Greer","year":"2008","journal-title":"J. Psychosomat. Res."},{"key":"B19","first-page":"52","article-title":"The Effectiveness of Mindfulness Training on Reducing Rumination and Enhancing Resilience in Female Patients with Breast Cancer: A Randomized Trial.","volume":"9","author":"Heidarian","year":"2016","journal-title":"Iran J. Breast Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"10014","DOI":"10.1200\/JCO.2017.35.15_suppl.10014","article-title":"Longitudinal assessment of cancer-related cognitive impairment (CRCI) up to six-months post-chemotherapy with multiple cognitive testing methods in 943 breast cancer (BC) patients and controls.","volume":"35","author":"Janelsins","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1007\/s11606-020-05762-w","article-title":"Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19).","volume":"35","author":"Jiang","year":"2020","journal-title":"J. General Internal Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.cpr.2017.02.002","article-title":"Cognitive control interventions for depression: A systematic review of findings from training studies.","volume":"53","author":"Koster","year":"2017","journal-title":"Clin. Psychol. Rev."},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.13140\/RG.2.2.34254.82242","article-title":"Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency.","author":"Lai","year":"2020","journal-title":"medRxiv"},{"key":"B24","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.critrevonc.2011.03.001","article-title":"Comorbidity and survival after early breast cancer. A review.","volume":"81","author":"Land","year":"2012","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2015\/325715","article-title":"The Effect of Young Age in Hormone Receptor Positive Breast Cancer.","volume":"2015","author":"Lee","year":"2015","journal-title":"BioMed Res. Int."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.anr.2020.07.005","article-title":"The Relationship Among Rumination, Coping Strategies, and Subjective Well-being in Chinese Patients With Breast Cancer: A Cross-sectional study.","volume":"2020","author":"Liu","year":"2020","journal-title":"Asian Nurs. Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.clbc.2019.01.006","article-title":"The Global and Regional Survival Rate of Women With Breast Cancer: A Systematic Review and Meta-analysis.","volume":"19","author":"Maajani","year":"2019","journal-title":"Clin. Breast Cancer"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2020.102076","article-title":"Assessing the anxiety level of Iranian general population during COVID-19 outbreak.","volume":"51","author":"Moghanibashi-Mansourieh","year":"2020","journal-title":"Asian J. Psychiat."},{"key":"B29","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S1470-2045(20)30388-0","article-title":"The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.","volume":"21","author":"Maringe","year":"2020","journal-title":"Lancet Oncol."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.30476\/mejc.2018.42130","article-title":"Epidemiology and Histopathology of Breast Cancer in Iran versus Other Middle Eastern Countries.","volume":"9","author":"Nafissi","year":"2018","journal-title":"Middle East J. Cancer"},{"key":"B31","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1037\/0021-843X.109.3.504","article-title":"The role of rumination in depressive disorders and mixed anxiety\/depressive symptoms","volume":"109","author":"Nolen-Hoeksema","year":"2000","journal-title":"J. Abnormal Psychol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s10880-019-09606-6","article-title":"The Relationship Between Emotional Processing Deficits and Posttraumatic Stress Disorder Symptoms Among Breast Cancer Patients: The Mediating Role of Rumination.","volume":"27","author":"Ogi\u0144ska-Bulik","year":"2020","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076013","article-title":"Comorbid Diseases Interact with Breast Cancer to Affect Mortality in the First Year after Diagnosis\u2014A Danish Nationwide Matched Cohort Study.","volume":"8","author":"Ording","year":"2013","journal-title":"PLoS One"},{"key":"B34","doi-asserted-by":"crossref","first-page":"58","DOI":"10.54127\/WCIC8036","article-title":"The fear of COVID-19 and its role in preventive behaviors.","volume":"2","author":"Pakpour","year":"2020","journal-title":"J. Concurr. Disord."},{"key":"B35","doi-asserted-by":"publisher","first-page":"659","DOI":"10.5603\/GP.2016.0062","article-title":"Breast cancer in young women.","volume":"87","author":"Radecka","year":"2016","journal-title":"Ginekol. Polska"},{"key":"B36","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s10865-020-00192-9","article-title":"Worry and rumination in breast cancer patients: Perseveration worsens self-rated health.","volume":"44","author":"Renna","year":"2020","journal-title":"J. Behav. Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1016\/j.adro.2020.04.024","article-title":"The Effect of COVID-19 on Radiation Oncology Professionals and Patients With Cancer: From Trauma to Psychological Growth.","volume":"5","author":"Romeo","year":"2020","journal-title":"Adv. Radiat. Oncol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"S55","DOI":"10.3978\/j.issn.2072-1439.2013.06.20","article-title":"Premature menopause in young breast cancer: Effects on quality of life and treatment interventions.","volume":"5","author":"Rosenberg","year":"2013","journal-title":"J. Thorac. Dis."},{"key":"B39","doi-asserted-by":"publisher","first-page":"5349","DOI":"10.1002\/cncr.24561","article-title":"Depression as a predictor of disease progression and mortality in cancer patients: A Meta-Analysis.","volume":"115","author":"Satin","year":"2009","journal-title":"Cancer"},{"key":"B40","doi-asserted-by":"publisher","first-page":"14","DOI":"10.32768\/abc.20207114-21","article-title":"Modifications in Breast Cancer Guidelines in COVID-19 Pandemic; An Iranian Consensus.","volume":"7","author":"Shahi","year":"2020","journal-title":"Arch. Breast Cancer"},{"key":"B41","doi-asserted-by":"publisher","first-page":"5049","DOI":"10.7314\/APJCP.2015.16.12.5049","article-title":"Burden of Breast Cancer in Iranian Women is Increasing.","volume":"16","author":"Sharifian","year":"2015","journal-title":"Asian Pacific J. Cancer Prevent."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.1680","article-title":"Delay in Surgical Treatment and Survival After Breast Cancer Diagnosis in Young Women by Race\/Ethnicity.","volume":"148","author":"Smith","year":"2013","journal-title":"JAMA Surg."},{"key":"B43","doi-asserted-by":"publisher","first-page":"151","DOI":"10.21859\/ajcm.25.3.151","article-title":"Charlson Comorbidity Index as a Strong Predictor of Mortality in Patients with Chronic Hemodialysis.","volume":"25","author":"Soleymanian","year":"2018","journal-title":"Umsha"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.02033","article-title":"COVID-19 Lockdown and its adverse impact on psychological health in breast cancer","volume":"11","author":"Swainston","year":"2020","journal-title":"Front. Psychol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.1002\/pon.4727","article-title":"Training cognitive control to reduce emotional vulnerability in breast cancer.","volume":"27","author":"Swainston","year":"2018","journal-title":"Psycho Oncol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1023\/B:JOBM.0000028496.41492.34","article-title":"Is There an Association Between Rumination and Self-Reported Physical Health? A One-Year Follow-Up in a Young and an Elderly Sample.","volume":"27","author":"Thomsen","year":"2004","journal-title":"J. Behav. Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s11682-017-9728-5","article-title":"A mechanistic cohort study evaluating cognitive impairment in women treated for breast cancer.","volume":"13","author":"Vardy","year":"2019","journal-title":"Brain Imaging Behav."},{"key":"B48","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.jpainsymman.2014.08.012","article-title":"Perceived Cognitive Function in Breast Cancer Survivors: Evaluating Relationships With Objective Cognitive Performance and Other Symptoms Using the Functional Assessment of Cancer Therapy\u2014Cognitive Function Instrument.","volume":"49","author":"Von Ah","year":"2015","journal-title":"J. Pain Sympt. Manage."},{"key":"B49","doi-asserted-by":"publisher","first-page":"W32","DOI":"10.1016\/j.jpainsymman.2014.08.012","article-title":"Measuring patient self-reported cognitive function: Development of the functional assessment of cancer therapy-cognitive function instrument.","volume":"7","author":"Wagner","year":"2009","journal-title":"Support Oncol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"3186","DOI":"10.1038\/s41380-020-00865-6","article-title":"Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients.","volume":"25","author":"Wang","year":"2020","journal-title":"Mol. Psychiatry"},{"journal-title":"Coronavirus","year":"2020","key":"B51"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.663310\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T09:30:38Z","timestamp":1699090238000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.663310\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,31]]},"references-count":52,"alternative-id":["10.3389\/fpsyg.2021.663310"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2021.663310","relation":{},"ISSN":["1664-1078"],"issn-type":[{"type":"electronic","value":"1664-1078"}],"subject":[],"published":{"date-parts":[[2021,5,31]]},"article-number":"663310"}}