Fear of cancer recurrence and quality of life among survivors of pancreatic and periampullary neoplasms.

Abstract

289 Background: Fear of Cancer Recurrence (FCR) is well documented among survivors of breast, colon and prostate cancer. Incurable recurrence is common following resection of pancreatic and periampullary neoplasms. The incidence and significance of FCR in this population is unknown. We hypothesized that FCR represents an important source of psychosocial distress following resection of pancreatic neoplasms. Methods: We conducted a cross-sectional study of patients with non-recurrent pancreatic ductal (PDAC), periampullary adenocarcinoma or pancreatic neuroendocrine tumor (PNET) treated with potentially curative surgery 1991–2011. We assessed 7 discrete dimensions of FCR using the Fear of Recurrence Inventory (FCRI) and evaluated quality of life (QOL) and psychosocial distress using the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire and Hospital Anxiety and Depression Scale. Participants completed these validated instruments by mail. Results: 188 (53%) of 355 eligible patients completed at least one instrument, a median of 49 months (range, 6–222 months) following potentially curative resection. Participants included 73 (39%) patients with PDAC, 55 (29%) with periampullary adenocarcinoma, and 60 (32%) with PNET. The median FCR severity score was higher than a previously established cutoff for clinical significance in 55%, 51% and 63% of patients with PDAC, periampullary adenocarcinoma and PNET, respectively. Older age, male gender, periampullary adenocarcinoma, negative lymph nodes, and longer interval since operation were clinical factors associated with lower total FCR score (all p<0.05). In multivariate analysis, only age (p=0.01) and gender (p=0.03) were independently associated with severity of FCR. A higher total FCR score was significantly associated with higher anxiety (r=0.64), depression (r=0.41) and lower QOL (r =−0.53), all p<0.001. Conclusions: Fear of cancer recurrence is pervasive following resection of pancreatic neoplasms, regardless of survivors’ histopathologic diagnosis, disease severity, or time since resection. Given its association with anxiety, depression and lower QOL, FCR represents a critical therapeutic target.