Factors associated with concerns about recurrence in women with breast cancer

Abstract

593 Background: The purpose of this study was to examine factors associated with concerns about disease recurrence in women with ductal carcinoma in situ (DCIS) and invasive breast cancer. Methods: Participants completed an anonymous survey instrument through the website of www.breastcancer.org , a non-profit organization. Participants provided information on diagnosis and treatment characteristics, demographics, preferences for treatment, fears of recurrence as measured by the Concerns of Recurrence Scale (Vickberg, Ann Behav Med 2003), and completed the SF-36 Mental Health Subscale. Participants were also asked if they had been told they had a “good cancer,” “good kind of cancer,” or “better cancer than others.” Bivariate and multivariate analyses examined the relationships between fears of recurrence and mental health, patient, disease, and treatment factors. Results: 331 women completed the survey instrument, 125 with DCIS and 206 with invasive breast cancer. In multivariate analysis, fear of recurrence was associated with age (β= -.24, 95% CI -.44,-.06), time since diagnosis (β= -.09, 95% CI -.16,-.02), having a mastectomy (β= -45, 95% -.83,-.08), and a diagnosis of DCIS (β= -1.00, 95% CI - 1.48,-.53). Women with DCIS who were told they had a “good cancer” had greater fear of recurrence than women with DCIS who were not told they had a good cancer (β= 1.25, 95% CI .56, 1.93). No such association in women with invasive breast cancer was found. Mental health was negatively correlated with fear of recurrence in women with DCIS (β= -0.43, 95% CI -.61,-.25). Level of education and satisfaction with the relationship with physicians were not associated with fear of recurrence. Conclusions: Older age and time since diagnosis are associated with reduced fears of recurrence. Women who have had a mastectomy also have lower fears of recurrence. Interestingly, receiving a message that one has a “good cancer” appears to be associated with increased fear of recurrence although the direction of the association cannot be determined from this study. Further research into effective and appropriate methods of informing and reassuring patients with different prognostic profiles of breast cancer is warranted. No significant financial relationships to disclose.