Healthcare use and fear of recurrence in adult cancer survivors at 2.5years after a cancer diagnosis: a nationwide register study in Denmark.

Abstract

To investigate the association between fear of cancer recurrence (FCR) and healthcare use in general practice among cancer survivors. We linked nationwide register data to survey data on FCR in cancer survivors at 2.5years after a cancer diagnosis. Multiple regression models were used to analyse the association between high FCR level and quartiles of healthcare use at 18-30months before the cancer diagnosis (habitual healthcare use) and between high FCR level and healthcare use at 18-30months after the cancer diagnosis (survivorship healthcare use). We included 1538 cancer survivors in the study. High habitual healthcare use was associated with a high level of FCR (odds ratio = 2.07 (95% confidence interval (CI): 1.36-3.15)) for the 4th quartile of healthcare use compared to the 1st quartile. A high FCR score was also associated with higher healthcare use during cancer survivorship (incidence rate ratio (IRR) = 1.26 (95% CI: 1.14-1.40)). This association remained statistically significant when adjusting for habitual healthcare use (IRR = 1.20 (95% CI: 1.09-1.33)). High healthcare use before the cancer diagnosis was associated with high FCR during survivorship. This indicates that FCR is partly explained by a general (pre-diagnostic) health concern. High FCR predicted high healthcare use during cancer survivorship, even when adjusting for habitual healthcare use. Our results suggest that FCR in cancer survivors is triggered by a general high level of health concern, and the cancer diagnosis may further exacerbate this concern.