Clinical Fear Of Cancer Recurrence Research Articles

Emotional Distress, Cognitive Complaints, and Care Needs among Advanced Cancer Survivors Treated with Immune Checkpoint Blockade: A Mixed-Method Study.

There is a need for a better understanding of survivorship-related issues in advanced cancer survivors treated with immune checkpoint blockade (ICB). The purpose of this study was to identify survivorship-related issues, with a focus on psychological distress, cognitive complaints, physical sequelae, impact on family dynamics, and care needs in unresectable, advanced cancer survivors treated with ICB. Semi-structured interviews and patient-reported outcome measures (PROMs) were conducted in survivors followed up at the University Hospital Brussels. We performed content analysis on the semi-structured interviews and analyzed the PROMs descriptively. 70 cancer survivors (71.4%) consented to participate between July 2022 and November 2023. Clinical fear of cancer recurrence (FCR) was present in 54.3% of the cancer survivors, and 18.6% had elevated cognitive complaints. We identified triggers related to clinically important psychological distress, such as immune-related adverse events, the progression/recurrence of disease, difficulties in adjusting to life after treatment, and co-existing life stressors, alongside persistent physical issues and unmet psychological and nutritional care needs. Our results indicate the existence of persistent psychological, physical, and cognitive issues, and support the need for routine screening for FCR. The identified triggers related to severe psychological distress can aid clinicians in timely referring the patient, thereby enhancing survivorship care.

Lived Experiences and Fear of Cancer Recurrence Among Survivors of Localized Cutaneous Melanoma.

Most of the rapid increase in cutaneous melanoma incidence in the US has been localized disease that is treated surgically and is associated with high survival rates. However, little is known about the psychological well-being of survivors in the US. To explore the lived experiences and fear of cancer recurrence among survivors of localized cutaneous melanoma. This was a qualitative and survey-based study that used semistructured interviews and the Fear of Cancer Recurrence Inventory short form (FCRI-SF) survey tool with participants recruited from an academic dermatology practice affiliated with the University of Texas, Austin. Interviews were completed via telephone or in person from August 2021 to September 2022. Each of the 9 items in the FCRI-SF was rated on a 5-point Likert scale, scored from 0 to 4, with a maximum possible score of 36 points. Data analyses were performed from February 2022 to June 2023. Semistructured interviews were analyzed for themes and subthemes associated with the lived experiences of survivors of cutaneous melanoma. The FCRI-SF scores were tabulated, with scores of 13 or greater identifying potential cases of clinically significant fear of cancer recurrence. In all, 51 participants (mean [SD] age, 49.5 [11.7] years; 34 [67%] female and 17 [33%] male) with a history of localized melanoma (stage 0-IIA) completed the interview and survey. Among them, 17 (33%) had survived a diagnosis of stage 0 melanoma, and the remainder, at least 1 invasive melanoma diagnosis (stage I-IIA). Semistructured interviews revealed several themes: (1) emotions surrounding follow-up appointments, (2) intensity of melanoma surveillance, (3) lifestyle changes regarding sun exposure, and (4) thoughts about life and death. Thirty-eight of 51 participants had an FCRI-SF score above the threshold for clinical fear of cancer recurrence. This qualitative and survey-based study found that despite having an excellent prognosis, some survivors of localized melanoma, even those who had stage 0, have high rates of fear of cancer recurrence and intense survivorship experiences that affect their psychological well-being.

Validity and screening capacity of the FCR-1r for fear of cancer recurrence in long-term colorectal cancer survivors

PurposeExisting fear of cancer recurrence (FCR) screening measures is being shortened to facilitate clinical use. This study aimed to evaluate the validity and screening capacity of a single-item FCR screening measure (FCR-1r) in long-term colorectal cancer (CRC) survivors with no recurrence and assess whether it performs as well in older as in younger survivors.MethodsAll Danish CRC survivors above 18, diagnosed and treated with curative intent between 2014 and 2018, were located through a national patient registry. A questionnaire including the FCR-1r, which measures FCR on a 0–10 visual analog scale, alongside the validated Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) as a reference standard was distributed between November 2021 and May 2023. Screening capacity and cut-offs were evaluated with a receiver-operating characteristic analysis (ROC) in older (≥ 65 years) compared to younger (< 65 years) CRC survivors. Hypotheses regarding associations with other psychological variables were tested as indicators of convergent and divergent validity.ResultsOf the CRC survivors, 2,128/4,483 (47.5%) responded; 1,654 (36.9%) questionnaires were eligible for analyses (median age 76 (range 38–98), 47% female). Of the responders, 85.2% were aged ≥ 65. Ninety-two participants (5.6%) reported FCRI-SF scores ≥ 22 indicating clinically significant FCR. A FCR-1r cut-off ≥ 5/10 had 93.5% sensitivity and 80.4% specificity for detecting clinically significant FCR (AUC = 0.93, 95% CI 0.91–0.94) in the overall sample. The discrimination ability was significantly better in older (AUC = 0.93, 95% CI 0.91–0.95) compared to younger (0.87, 95% (0.82–0.92), p = 0.04) CRC survivors. The FCR-1r demonstrated concurrent validity against the FCRI-SF (r = 0.71, p < 0.0001) and convergent validity against the short-versions of the Symptom Checklist-90-R subscales for anxiety (r = 0.38, p < 0.0001), depression (r = 0.27, p < 0.0001), and emotional distress (r = 0.37, p < 0.0001). The FCR-1r correlated weakly with employment status (r =  − 0.09, p < 0.0001) and not with marital status (r = 0.01, p = 0.66) indicating divergent validity.ConclusionsThe FCR-1r is a valid tool for FCR screening in CRC survivors with excellent ability to discriminate between clinical and non-clinical FCR, particularly in older CRC survivors.

Supportive care needs of breast cancer survivors with different levels of fear of cancer recurrence: A cross-sectional survey study

PurposeTo examine the supportive care needs of breast cancer survivors with nonclinical, subclinical, or clinical fear of cancer recurrence. MethodsIn this cross-sectional study, 385 breast cancer survivors consented and completed a set of online questionnaires. Supportive care needs were assessed by using the 34-item Supportive Care Needs Survey. Fear of cancer recurrence was assessed by using the Fear of Cancer Recurrence Inventory. ResultsOne hundred eighty-four (47.8%) participants reported nonclinical fear of cancer recurrence, 147 (38.2%) reported subclinical fear of cancer recurrence, and 54 (14.0%) reported clinical fear of cancer recurrence. Higher levels of fear of cancer recurrence were associated with higher levels of supportive care needs in five domains (β = 0.30–0.60, P < 0.001) after adjusting for places of residence, education, motherhood, and time since diagnosis. Among participants with nonclinical fears of cancer recurrence, the most common needs were in the ‘Health care system/Information’ domain (50.5%). Among participants with subclinical or clinical fear of cancer recurrence, the most common needs were in the ‘Psychological’ domain (85.7% and 96.3%, respectively). ConclusionFear of cancer recurrence was associated with supportive care needs. The most common needs among participants with subclinical or clinical fears of cancer recurrence were psychological needs.

Evaluation of the validity and screening performance of a revised single-item fear of cancer recurrence screening measure (FCR-1r).

Fear of cancer recurrence (FCR) is highly prevalent among cancer survivors, but irregularly identified in practice. Single-item FCR measures suitable for integration into broader psychosocial screening are needed. This study evaluated the validity of a revised version of the original FCR-1 (FCR-1r) and screening performance alongside the Edmonton Symptom Assessment System - Revised (ESAS-r) anxiety item. The FCR-1r was adapted from the FCR-1 and modelled on the ESAS-r. Associations between FCR-1r and FCR Inventory-Short Form (FCRI-SF) scores determined concurrent validity. Relationships of FCR-1r scores with variables related (e.g., anxiety, intrusive thoughts) and unrelated (e.g., employment/marital status) to FCR determined convergent and divergent validity respectively. A Receiver-Operating Characteristic analysis examined screening performance and cut-offs for the FCR-1r and ESAS-r anxiety item. 107 participants were recruited in two studies (Study 1, July-October 2021, n=54; Study 2: November 2021-May 2022, n=53). The FCR-1r demonstrated concurrent validity against the FCRI-SF (r=0.83, p<0.0001) and convergent validity versus the Generalised Anxiety Disorder-7 (r=0.63, p<0.0001) and Impact of Event Scale-Revised Intrusion subscale (r=0.55, p<0.0001). It did not correlate with unrelated variables (e.g., employment/marital status), indicating divergent validity. An FCR-1r cut-off ≥5/10 had 95% sensitivity and 77% specificity for detecting clinical FCR (area under the curve (AUC)=0.91, 95% CI 0.85-0.97, p<0.0001); ESAS-r anxiety cut-off ≥4 had 91% sensitivity and 82% specificity (AUC=0.87, 95% CI 0.77-0.98, p<0.0001). The FCR-1r is a valid and accurate tool for FCR screening. Further evaluation of the screening performance of the FCR-1r versus the ESAS-r anxiety item in routine care is needed.

Psychological factors associated with clinical fear of cancer recurrence in breast cancer patients in the early survivorship period.

Clinical fear of cancer recurrence (FCR) is highly prevalent among breast cancer patients and appears early in the disease trajectory. A better understanding of psychological factors associated with clinical FCR is essential to guide screening and intervention development. This cross-sectional study aimed to assess the contribution of attentional bias, intrusive thoughts, metacognitive beliefs, intolerance of uncertainty, thought suppression, and worry to clinical FCR in breast cancer patients in the early survivorship period. Seventy-four patients treated for non-metastatic breast cancer were enrolled at the end of their treatment. The FCR Inventory-Short Form (FCRI-SF) was used to discriminate between the patients with clinical versus nonclinical FCR. Attentional bias to negative and positive cancer-related and non-cancer-related emotional words was assessed with a dot-probe task. Words were presented for 17, 500, and 1500ms. Intrusive thoughts and thought suppression were assessed with the White Bear Suppression Inventory, metacognitive beliefs with the Metacognitions Questionnaire-30, intolerance of uncertainty with the Intolerance of Uncertainty Inventory-Part A, and worry with the Penn State Worry Questionnaire. According to univariate analyses, the patients with clinical FCR (FCRI-SF ≥13) significantly differed from those with nonclinical FCR in terms of intrusive thoughts (p=0.002), metacognitive beliefs (p=0.029), intolerance of uncertainty (p&lt;0.001), and worry (p&lt;0.001). Intolerance of uncertainty (odds ratio, OR=1.06; p=0.040) and worry (OR=1.09; p=0.013) remained in the final logistic regression models. All the patients showed vigilance to cancer-related words, whether with negative or positive valence, at automatic stages of processing (17ms). Intolerance of uncertainty and worry were the two psychological factors contributing directly to clinical FCR in our cross-sectional study. In addition, attentional bias did not differentiate breast cancer patients with clinical versus nonclinical FCR. Treatment approaches for clinical FCR in early survivorship care may need to integrate uncertainty and worry management intervention strategies.

Mediating effect of ill perception on the relationship between social constraints and fear of cancer recurrence among adolescent and young adult survivors who underwent hematopoietic stem cell transplantation

ObjectiveWe aimed to investigate the effect of ill perception (IP) on the relationship between social constraints (SC) and fear of cancer recurrence (FCR) among adolescent and young adult survivors who underwent hematopoietic stem cell transplantation (AYA-HSCT survivors). MethodsA total of 135 AYA-HSCT survivors were interviewed using the social constraints scale, the brief illness perception questionnaire and the fear of cancer recurrence inventory (short form). Next, the mediating effect of IP on the relationship between SC and FCR was analyzed. ResultsA total of 79.3% (107/135) of the interviewed AYA-HSCT survivors revealed that they had clinical FCR. Notably, FCR had a significant positive correlation with both SC (r ​= ​0.362, P ​< ​0.001) and IP (r ​= ​0.457, P ​< ​0.001). Moreover, IP accounted for 42.1% of the total mediating effect on the relationship between SC and FCR in AYA-HSCT survivors. ConclusionsScientific management of FCR is one of the most common and unmet needs of AYA-HSCT survivors. Results of the present study indicate that SC has a direct effect on FCR in AYA-HSCT survivors, affirming the need for families and social networks for AYA-HSCT survivors to encourage greater expression. Also, health professionals should educate survivors and their families on the importance of cancer home care. They should also empower survivors and their families with professional information, as well as practical, interpersonal, and emotional support. Our results further show that IP partially affects the relationship between SC and FCR. Therefore, the development and implementation of targeted interventions is imperative to the improvement of survivors’ IP.

Fear of cancer recurrence and disease progression in long‐term prostate cancer survivors after radical prostatectomy: A longitudinal study

Although fear of cancer recurrence (FCR) or disease progression is among the most endorsed unmet needs and concerns of cancer survivors, research on the course of FCR in long-term survivors is scarce. The objective of this study was to assess longitudinally the prevalence and predictors of FCR in long-term prostate cancer (PCa) survivors. In all, 2417 survivors from the multicenter German Familial Prostate Cancer Database completed the Fear of Progression Questionnaire-Short Form on average 7 years (T1 in 2010) after radical prostatectomy and at follow-up 9 years later (T2 in 2019). Hierarchical multivariable logistic regression was used to assess predictors of FCR at follow-up. The mean age at the initial assessment was 69.5 years (standard deviation, 5.9 years); 6.5% and 8.4% of patients reported clinical FCR at the initial assessment (T1) and at the follow-up (T2), respectively. In a multivariable analysis controlling for concurrent associations, longitudinal predictors of FCR 9 years later included a lower level of education (odds ratio [OR], 4.35; 95% confidence interval [CI], 2.33-8.33), years since radical prostatectomy (OR, 1.10; 95% CI, 1.03-1.18), biochemical recurrence (OR, 1.67; 95% CI, 1.02-2.72), no current adjuvant therapy (OR, 2.38; 95% CI, 1.19-4.76), FCR (OR, 10.75; 95% CI, 6.18-18.72), and anxiety (OR, 1.35; 95% CI, 1.06-1.72). FCR remains a burden to certain PCa survivors even many years after their diagnosis and treatment. Health care professionals should monitor for FCR and identify patients at risk to provide appropriate psychosocial care because FCR is leading to limitations in quality of life and psychological well-being.

Prevalence and correlates of psychological distress, unmet supportive care needs, and fear of cancer recurrence among haematological cancer patients during the COVID-19 pandemic.

BackgroundThe COVID-19 pandemic has had a disruptive effect on people with haematological cancers, who represent a high-risk population due to the nature of their disease and immunosuppressive treatments. We aimed to identify the psychological impacts of the COVID-19 pandemic on haematology patients and identify correlated factors to inform the development of appropriate supportive interventions.MethodsThree hundred and ninety-four respondents volunteered their participation in response to a study advertisement distributed online through established haematology groups. Participants completed a self-report online survey exploring wellbeing, psychological distress, unmet supportive care needs, and fear of cancer recurrence.ResultsAt least 1 in 3 respondents (35%) reported clinical levels of distress and nearly 1 in 3 (32%) identified at least one unmet need. Among respondents in remission (n = 134), clinical fear of cancer recurrence was reported by nearly all (95%). Unmet needs, pre-existing health conditions, younger age, financial concerns, and perceived risk of contracting COVID-19 were the dominant factors contributing to psychological distress during the pandemic. Psychological distress, lost income, perceived inadequate support from care team, perceived risk of contracting COVID-19, and being a woman were significantly associated with unmet needs. Psychological distress and concern about the impact of COVID-19 on cancer management were significantly associated with fear of cancer recurrence among respondents in remission.ConclusionResults highlight the high psychological burden and unmet needs experienced by people with haematological cancers during the COVID-19 pandemic and indicate a need for innovative solutions to rapidly identify distress and unmet needs during, and beyond, pandemic times.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-021-06369-5.

Fear of cancer recurrence among cancer survivors in Singapore.

Fear of cancer recurrence (FCR) among cancer survivors is a persistent and distressing psychosocial concern that affects recovery and quality of life. The prevalence of FCR in Singapore is unknown. This cross-sectional study was designed to examine FCR and identify factors associated with FCR in mixed-cancer survivors locally. Cancer survivors in remission (n = 404) were assessed for: FCR using the Fear of Cancer Recurrence Inventory (FCRI); emotional distress using the Hospital Anxiety and Depression Scale; and quality of life using the World Health Organization Quality of Life-BREF. Clinical and severe/pathological FCR was determined based on the severity scale of FCRI, known as FCRI-Short Form. Multivariate logistic regression was performed to examine factors associated with FCR. The mean score on the FCRI was 59.5 ± 30.4. 43.6% of cancer survivors had clinical FCR and 32.1% had severe/pathological FCR. Younger age (odds ratio [OR] 0.952, 95% confidence interval [CI] 0.911-0.995, p < 0.05), higher educational status (OR 2.55, 95% CI 1.15-5.65, p < 0.05) and higher levels of emotional distress (OR 1.17, 95% CI 1.10-1.24, p < 0.001) were significantly associated with severe/pathological levels of FCR. The present study is the first to determine levels of FCR among cancer survivors in Singapore. While the total FCR scores were similar to those of international studies, severe/pathological levels of FCR were found to be four times higher. These findings highlight a problem that is not widely recognised or acknowledged, but which deserves greater attention.

Spotlight on the Fear of Cancer Recurrence Inventory (FCRI).

Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI’s increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.

Fear of Cancer Recurrence in Patients With Localized Renal Cell Carcinoma.

Patients with cancer commonly report distress and fear of cancer recurrence (FCR) impacting quality of life and clinical outcomes. This study aims to test the association between emotional well-being and clinical characteristics of survivors with localized renal cell carcinoma (RCC). Survivors with localized RCC were invited to participate in this study through social media by the Kidney Cancer Research Alliance. Participants self-reported clinical characteristics, distress (Distress Thermometer), and FCR (Fear of Cancer Recurrence-7). Ordinal regression was used to test the association between emotional well-being and patient characteristics. A total of 412 survivors were included in this analysis. Participants were mostly female (79.4%) and well educated (58.3%), with a median age of 54 years (range, 30-80 years) and median time since diagnosis of 17.5 months. More than one half were diagnosed with stage I disease (56.1%). Most patients (62.3%) had a clear understanding of their diagnosis. A high prevalence of moderate to severe distress (67.0%) and FCR (54.9%) was reported across all survivors of RCC. Higher FCR was associated with female gender, younger age, and lack of understanding of their diagnosis (P = .001), whereas more recent diagnosis was associated with higher distress levels (P = .01). Our findings suggest that FCR is a common problem that is persistent after therapy and that certain individuals, including female and younger patients, may be at particular risk of experiencing clinically relevant FCR.

Study protocol: a randomized controlled trial comparing the efficacy of therapist guided internet-delivered cognitive therapy (TG-iConquerFear) with augmented treatment as usual in reducing fear of cancer recurrence in Danish colorectal cancer survivors

BackgroundCognitive therapy has been shown to reduce fear of cancer recurrence (FCR), mainly in breast cancer survivors. The accessibility of cognitive behavioural interventions could be further improved by Internet delivery, but self-guided interventions have shown limited efficacy. The aim of this study is to test the efficacy of a therapist guided internet-delivered intervention (TG-iConquerFear) vs. augmented treatment as usual (aTAU) in Danish colorectal cancer survivors.Methods/designA population-based randomized controlled trial (RCT) comparing TG-iConquerFear with aTAU (1:1) in n = 246 colorectal cancer survivors who suffer from clinically significant FCR (Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) ≥ 22 and semi-structured interview). Evaluation will be conducted at 2 weeks, 3 and 6 months post-treatment and between-group differences will be evaluated. Long-term effects will be evaluated after one year. Primary outcome will be post-treatment FCR (FCRI-SF). Secondary outcomes are global overall health and global quality of life (Visual Analogue Scales 0–100), bodily distress syndrome (BDS checklist), health anxiety (Whiteley-6), anxiety (SCL4-anx), depression (SCL6-dep) and sickness absence and health expenditure (register data). Explanatory outcomes include: Uncertainty in illness (Mishels uncertainty of illness scale, short form, MUIS), metacognitions (MCQ-30 negative beliefs about worry subscale), and perceived risk of cancer recurrence (Visual analogue Scale 1–100).DiscussionThis RCT will provide valuable information on the clinical and cost-effectiveness of TG-iConquerFear vs. aTAU for CRC survivors with clinical FCR, as well as explanatory variables that may act as outcome moderators or mediators.Trial registrationClinicalTrials.gov; NCT04287218, registered 25.02.2020.https://clinicaltrials.gov/ct2/results?cond=&term=NCT04287218&cntry=&state=&city=&dist=.

Identifying the key characteristics of clinical fear of cancer recurrence: An international Delphi study.

Without an agreed-upon set of characteristics that differentiate clinical from nonclinical levels of fear of cancer recurrence (FCR), it is difficult to ensure that FCR severity is appropriately measured, and that those in need of intervention are identified. The objective of this study was to establish expert consensus on the defining features of clinical FCR. A three-round Delphi was used to reach consensus on the defining features of clinical FCR. Sixty-five experts in FCR (researchers, psychologists, physicians, nurses, and allied health professionals) were recruited to suggest and rate potential features of clinical FCR. Participants who indicated they could communicate diagnoses within their clinical role were also asked to consider the application of established DSM-5 and proposed ICD-11 diagnostic criteria (Health Anxiety, Illness Anxiety Disorder, Somatic Symptom Disorder) to clinical FCR. Participants' ratings suggested that the following four features are key characteristics of clinical FCR: (a) high levels of preoccupation; (b) high levels of worry; (c) that are persistent; and (d) hypervigilance to bodily symptoms. Of participants whose professional role allowed them to diagnose mental disorders, 84% indicated it would be helpful to diagnose clinical FCR, but the use of established diagnostic criteria related to health anxiety or somatic-related disorders to clinical FCR was not supported. This suggests that participants consider clinical FCR as a presentation that is specific to cancer survivors. Clinical FCR was conceptualized as a multidimensional construct. Further research is needed to empirically validate the proposed defining features.

Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial.

Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancersurvivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS. Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6weekly 2-hour group sessions), survivorship education (SE; 6weekly 2-hour group sessions), or enhanced usual care (EUC; one30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1month after the intervention (T3), and 6months after the intervention (T4) using intent-to-treat analysis. Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P<.001) and EUC (Cohen d, 0.61; P<.01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress. Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.

Prevalence and factors associated with fear of recurrence in a mixed sample of young adults with cancer

This study examined the prevalence and factors associated with fear of cancer recurrence (FCR) in young adults (YAs). YAs diagnosed with cancer between the ages of 15 and 39 in Canada (n = 461), who were currently 19years or older, completed the Young Adults with Cancer in their Prime (YACPRIME) Study. The Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) was the primary outcome. Scores ≥ 16 on the FCRI-SF indicate problematic levels and scores ≥ 22 represent clinically significant FCR. Covariates included demographic, clinical cancer variables, and co-morbid symptom measures. Univariate and multivariate logistic regression analyses were performed to identify variables associated with FCR. Participants were predominantly female (87%) with a mean age of 32years (SD = 4.7). Problematic levels of FCR were present in 84% of YAs, and 59% met or exceeded the cutoff for clinically significant FCR. In the multivariate model, time since diagnosis of 5+ years was associated with a reduced likelihood of clinical FCR (Adjusted Odds Ratio [AOR] = 0.354; p = .004), while having a previous recurrence was related to increased likelihood (AOR = 3.468, p = .001). Other factors associated with clinical FCR in YAs were psychological distress (Mild: AOR = 2.947, p = .003; Moderate: AOR = 5.632, p < .0005; Severe: AOR = 8.877, p < .0005), and cancer-related body image dissatisfaction (AOR = 2.311, p = .004). FCR is a pervasive problem for YAs diagnosed with cancer, with previous recurrence and psychological difficulties as factors associated witha higher degree of fear. Psychosocial interventions for YAs targeting depression and anxiety should also prioritize the treatment of FCR.

Patient reported outcome measures (PROMs) in patients (pts) with locally advanced rectal cancer (LARC) managed with a watch and wait (W&amp;W) approach after a clinical complete response to chemoradiotherapy (CRT).

e15173 Background: PROMs have not been adequately studied in LARC pts who are managed with W&amp;W after a clinical complete response to CRT. The objectives of this study were to evaluate: quality of life measures, bowel function, Fear of Cancer Recurrence (FCR) and survivors’ needs, in this population. Methods: Data were collected from the Flinders Medical Centre W&amp;W prospective database. Questionnaires including Self-Administered Comorbidity (SCQ), EORTC QLQ-C30 and -CR29, EQ-5D-5L, MSKCC Bowel Function Instrument (MBFI), Low Anterior Resection Syndrome (LARS) score, Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), Cancer Survivors’ Unmet Needs (CaSUN) and Response Efficacy Score (RES) were sent via mail to eligible pts according to a Tailored Design Method. Descriptive statistical analyses were conducted. Results: Of 40 eligible pts, 21 (52.5%) responded: 15 (71%) were male, median age at diagnosis was 66 years (34-81). 5 developed local re-growth (1 had local excision and 4 had ultra-low anterior resection). Median time from end of CRT to data collection was 39.8 months (6.0-77.5). The mean SCQ score was 5.7 (SD 5.5). Mean EQ-5D-5L utility score was 0.84 (SD 0.13), mean EQ-VAS score was 81.9 (SD 12.7) and mean EORTC QLQ global health status score was 76.2 (SD 19.2). The most common symptoms were fatigue (90%), pain (67%) and flatulence (67%). In pts without a re-growth (n = 16), the mean MBFI total score was 27.9 (SD 7.7); based on LARS score: 6 (38%) had no LARS, 5 (31%) had minor LARS and 5 (31%) had major LARS. Mean FCRI-SF score was 11.8 (SD 6.1), clinical level FCR was reported by 2 (9.5%) [cut-off 22] and 4 (19%) pts [cut-off 16]. 10 (47%) reported unmet needs: the most common area was Comprehensive Cancer Care n = 9 (42%). On RES, of 20 responders, 19 (95%) believed W&amp;W was a worthwhile and effective strategy. Conclusions: The most commonly reported symptoms included fatigue, pain and flatulence. LARS was common: in the absence of surgery, LARS is due to CRT. Clinical FCR was uncommon. The majority believed W&amp;W was worthwhile and effective. Larger comparative studies are needed in this group of pts.

Fear of cancer recurrence among Chinese cancer survivors: Prevalence and associations with metacognition and neuroticism.

Fear of cancer recurrence (FCR) represents a chronic burden for many cancer survivors. We determined FCR prevalence and potential correlates, specifically metacognitive styles and neuroticism among Chinese cancer survivors with breast or colorectal cancer. This study included 285 Chinese patients with breast (N=173) and colorectal (N=112) cancers at 8-week postsurgery. Participants completed a set of baseline questionnaires evaluating FCR (Fear of Cancer Recurrence Inventory-Short Form [FCRI-SF]), metacognition (Metacognitions Questionnaire-30), and neuroticism (Eysenck Personality Questionnaire). Scores of 13 to 21 were indicative of subclinical FCR on the FCRI-SF. Scores greater than or equal to 22 indicated clinically significant levels of FCR. Fully adjusted multinomial logistic regressions identified correlates of subclinical and clinically significant FCR. Respectively, 26.0% (n=74) and 11.2% (n=32) achieved scores indicating subclinical and clinically significant FCR. Expressing significantly more positive (OR=1.21, P=.003) and negative (OR=1.19, P=.005) beliefs about worry was associated with a higher likelihood of reporting subclinical FCR. Both higher neuroticism (OR=1.28, P=.003) and more negative beliefs about worry (OR=1.19, P=0.035) were associated with an increased likelihood of experiencing clinically significant FCR. Positive and negative metacognitions may play an important role in the development of subclinical FCR. In particular, negative metacognition and neuroticism may elevate FCR from subclinical to a clinical level. The findings give insight into the identification of cancer survivors with subclinical or clinical FCR and aid the development of interventions aimed at changing metacognitive beliefs in order to manage FCR.

Utilization of health care services in cancer patients with elevated fear of cancer recurrence.

Cancer patients commonly report experiencing fear of cancer recurrence (FCR), which may lead to several negative consequences. This study aimed at examining whether clinical levels of FCR are linked to a greater use of health care services. This is a secondary analysis of a longitudinal study of 962 cancer patients on the epidemiology of cancer-related insomnia. They completed the Fear of Cancer Recurrence Inventory-Short form (FCRI-SF) and reported information on their consultations (medical, psychosocial, and complementary and alternative medicine [CAM]) and medication usage (anxiolytics/hypnotics and antidepressants) at 6 time points over an 18-month period. Results indicated that clinical FCR at baseline was associated with greater consultation rates of medical and psychosocial professionals and a greater usage of anxiolytics/hypnotics and antidepressants. No significant association was found between the FCR level and use of CAM services. While consultation rates of medical and CAM professionals and usage of antidepressants generally increased over time, consultation rates of psychosocial professionals and usage of anxiolytics/hypnotics tended to decrease. Cancer patients with clinical levels of FCR are more likely to consult health care providers and to use psychotropic medications, which may translate into significant costs for society and the patients themselves.

Cognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study

This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient’s perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.