Individual courses and determinants of fear of cancer recurrence in long-term breast cancer survivors with and without recurrence

Paula Heidkamp,Anna Enders,Christoph Kowalski,Clara Breidenbach,Nicole Ernstmann,Birgitta Weltermann,Kati Hiltrop,Franziska Geiser,Holger Pfaff

doi:10.1007/s00520-021-06329-z

Abstract

ObjectiveThis study investigated the prevalence, individual courses, and determinants of fear of cancer recurrence (FoR) in long-term breast cancer survivors (BCSs) with and without recurrence.MethodsA total of 184 breast cancer survivors were surveyed at four measurement time points: during hospitalization (T1), 10 weeks (T2), 40 weeks (T3), and 5–6 years (T4) after hospital discharge. Descriptive statistics, chi-square tests, and logistic regression were performed.ResultsRespondents were females and 57 years old, on average. At T1, T3, and T4, 54.8%, 31.6%, and 29.7% of BCSs, respectively, were classified as having dysfunctional levels of FoR. Dysfunctional FoR decreased from T1 to T3 (χ2(1) = 17.11, p = 0.000; N = 163) and remained stable afterwards. Eight subgroups of individual courses of FoR over time could be described: (1) constant functional FoR; (2) constant dysfunctional FoR; (3) improving from dysfunctional to functional FoR from T1 to T3; (4) improving from dysfunctional to functional FoR from T3 to T4; (5) worsening from functional to dysfunctional FoR from T1 to T3; (6) worsening from functional to dysfunctional FoR from T3 to T4; (7) dysfunctional FoR at T1 and T4, and functional FoR in between; and (8) functional FoR at T1 and T4, and dysfunctional FoR in between. Logistic regression analysis revealed that being divorced/widowed, showing high levels of fatigue, being treated by chemotherapy, and having low confidence in treatment were associated with dysfunctional FoR 5 to 6 years after diagnosis (Nagelkerkes’ Pseudo-R2 = 0.648).ConclusionsThe findings reveal that FoR is a significant issue in long-term BCSs and has the potential to become a persistent psychological strain. We emphasize the need for increased awareness of FoR among BCSs and the need for support programs.

Highlights

Even years after diagnosis and active treatment, cancer survivors suffer from their disease in multiple ways and report lower levels of quality of life compared to the non-affected population [1, 2]
For a better understanding of individual experiences of fear of cancer recurrence (FoR) in the long term, it should be considered whether breast cancer survivors (BCSs) have a recurrence over the course of the disease or not
The sample consisted of 184 female breast cancer survivors

Summary

Introduction

Even years after diagnosis and active treatment, cancer survivors suffer from their disease in multiple ways and report lower levels of quality of life compared to the non-affected population [1, 2]. The first studies that investigated group-based trajectories of FoR in cancer patients identified three patterns: constant low FoR over time, constant high FoR over time, and decreasing FoR over time [12, 13] As these studies focused on the first year of the cancer, generalization to long-term cancer survivors is limited. For a better understanding of individual experiences of FoR in the long term, it should be considered whether breast cancer survivors (BCSs) have a recurrence over the course of the disease or not Previous studies found both positive associations between having a recurrence and FoR and no significant relationship between these variables [5, 9]

Methods

Discussion

Conclusion