Greater Fear Of Cancer Recurrence Research Articles

Fear of cancer recurrence and change in hair cortisol concentrations in partners of breast cancer survivors.

Partners of breast cancer (BC) survivors report high rates of psychological distress including fear of cancer recurrence (FCR). Research suggests that partners may have poorer physical health outcomes than the general population, but little research has examined the physiological biomarkers by which distress may impact partner health outcomes. The current study examined the associations between FCR and changes in hair cortisol among BC partners. Male partners (N = 73) of early-stage BC survivors provided hair samples during two visits, one after completion of survivors' adjuvant treatment (T1) and again 6 months later (T2). Two subscales from the Fear of Cancer Recurrence Inventory and one subscale from the Concerns about Recurrence Scale comprised a latent FCR factor at T1. A latent change score model was used to examine change in cortisol as a function of FCR. Partners were on average 59.65 years of age (SD = 10.53) and non-Hispanic White (83%). Latent FCR at T1 was positively associated (b = 0.08, SE = 0.03, p = .004, standardized β = .45) with change in latent hair cortisol from T1 to T2. Results indicated that greater FCR was associated with increases in hair cortisol in the months following adjuvant treatment. This is one of the first studies to examine the physiological correlates of FCR that may impact health outcomes in BC partners. Findings highlight the need for further research into the relationship between FCR and its physiological consequences. Interventions to address partner FCR are needed and may aid in improving downstream physical health outcomes.

Fear of Cancer Recurrence among Aboriginal and Torres Strait Islander Women Diagnosed with Breast Cancer.

Little is known about the fear of cancer recurrence (FCR) severity, coping strategies, or quality of life impacts for Indigenous populations. This mixed-methods study aimed to (1) quantify FCR levels among Indigenous Australian (i.e., Aboriginal and Torres Strait Islander) breast cancer survivors and (2) qualitatively explore experiences of FCR and the coping strategies used. Nineteen participants completed the Fear of Cancer Recurrence Inventory (FCRI); ten also completed a semi-structured interview. Interview transcripts were thematically analysed. Average FCR levels (Mean FCRI Total Score = 71.0, SD = 29.8) were higher than in previous studies of Australian breast cancer survivors, and 79% of participants reported sub-clinical or greater FCR (FCRI-Short Form ≥ 13/36). Qualitative themes revealed the pervasiveness of FCR, its impact on family, and exacerbation by experience/family history of comorbid health issues. Cultural identity, family, and a resilient mindset aided coping skills. Greater communication with healthcare providers about FCR and culturally safe and appropriate FCR care were desired. This study is the first to assess FCR among Aboriginal and Torres Strait Islander breast cancer survivors, extending the limited literature on FCR in Indigenous populations. Results suggest FCR is a significant issue in this population and will inform the development of culturally appropriate interventions to aid coping and improve quality of life.

Pursuing germline genome sequencing to reduce illness uncertainty may involve additional uncertainties for cancer patients: A mixed-methods study.

Cancer-related illness uncertainty has been associated with poorer psychological outcomes for patients. While some cancer patients believe obtaining genomic information will reduce their illness uncertainty, the complexity of genomics has the potential to compound illness uncertainty. The aim of this mixed-methods study was to investigate uncertainty in patients with a cancer of likely heritable origin immediately following their decision to have germline genome sequencing. Participant (N=348) negative attitudes toward uncertainty were associated with higher satisfaction with decision to have germline genome sequencing and greater fear of cancer recurrence. Thematic analysis of semi-structured interviews with a subset of participant (N=20) revealed the following four themes: (a) germline genome sequencing to reduce illness uncertainty; (b) germline genome sequencing to reduce uncertainty related to relatives' risk; (c) uncertainty generated by germline genome sequencing; and (d) resilience and coping with uncertainty. This study demonstrated the complexity of uncertainty in germline genome sequencing in cancer patients. These results provide genomic healthcare professionals with important information about cancer patient's motivation to pursue germline genome sequencing, the specific uncertainties generated by germline genome sequencing, and how cancer patients cope with uncertainty.

Worry about somatic symptoms as a sign of cancer recurrence: prevalence and associations with fear of recurrence and quality of life in survivors of childhood cancer.

Somatic symptoms (e.g., pain, fatigue) are common after childhood cancer and are associated with greater fear of cancer recurrence and poorer health-related quality of life (HRQoL). Qualitative studies indicate that survivors of childhood cancer (SCCs) worry about somatic symptoms as indicating cancer recurrence, which could in part explain associations between symptoms and poorer psychosocial outcomes. However, the prevalence, characteristics, and impact of symptom worry has not been quantitatively studied. SCCs (N=111; 52% female; Mage at study=17.67 years, range=8-25 years; Mage at diagnosis=6.70 years) across a variety of diagnoses were recruited from a pediatric cancer center in Canada and completed self-report measures of symptom worry, symptom frequency, general anxiety, fear of cancer recurrence, and HRQoL. A majority (62%) of SCCs worried about at least one symptom as a sign of recurrence. Pain was the most worrisome symptom, but SCCs also reported worrying about symptoms that are rarely associated with cancer recurrence such as hunger, dizziness, and feeling cold. Symptom worry was more strongly associated with fear of cancer recurrence than the mere frequency of those symptoms, and this relationship held while controlling for treatment factors and general anxiety. Symptom worry and frequency each explained unique variance in HRQoL. Worry about somatic symptoms as a sign of cancer recurrence is common and may be impactful after childhood cancer. Excessive worry about somatic symptoms could be an important target to reduce fear of recurrence and increase HRQoL in SCCs.

Fear of cancer recurrence promotes cancer screening behaviors among family caregivers of cancer survivors.

Fear of cancer recurrence (FCR) has been associated with cancer screening behaviors among cancer survivors, but to the authors' knowledge, the question of whether the same is true for caregivers is unknown. The current study investigated the extent to which FCR among caregivers predicted their cancer screening behaviors years after their relatives' cancer diagnosis. A total of 813 caregivers (67% of whom were female, mean age of 56years, and 92% non-Hispanic white) completed surveys 2years (T1) and 8years (T2) after their patients' cancer diagnosis. FCR, anxiety (Profile of Mood States-Short Form [POMS-SF]), and general mental health (Medical Outcomes Study 36-Item Short-Form Health Survey [MOS SF-36]) were reported at T1; caregivers' engagement in screening for colorectal, breast, and prostate cancers because of the patients' diagnoses were reported at T2. Caregivers were found to engage in cancer screening at rates similar to those of the national average. Controlling for covariates, hierarchical logistic regression modeling for each type of cancer screening demonstrated that greater FCR was linearly related to a higher likelihood of undergoing colorectal cancer screening (odds ratio [OR], 1.15) and maintaining prostate cancer screening (OR, 1.34), but a lower likelihood of maintaining breast cancer screening in an age-appropriate manner (OR, 0.27). Examining curvilinear effects demonstrated that moderate levels of FCR were associated with a higher likelihood of maintaining age-appropriate colorectal cancer screening (OR, 1.48). The overall FCR among caregivers uniquely promotes their engagement in cancer screening behaviors. The role of caregivers' FCR in other types of cancer preventive behaviors and ways to channel FCR concerns into promoting healthy lifestyle behaviors should be investigated.

Factors associated with the use of diet and the use of exercise for prostate cancer by long-term survivors.

To assess the use of diet and the use of exercise for prostate cancer (and/or its treatments' side effects) by long-term survivors and whether such use is associated with selected socio-demographic, clinical, health-related quality-of-life (HRQOL) and psychological factors. Population-based cohort study in New South Wales, Australia of prostate cancer survivors aged <70 years at diagnosis and who returned a 10-year follow-up questionnaire. Validated instruments assessed patient's HRQOL and psychological well-being. Poisson regression was used to estimate adjusted relative proportions (RRs) of prostate cancer survivor groups who were currently eating differently ('using diet') or exercise differently ('using exercise') to help with their prostate cancer. 996 (61.0% of 1634) participants completed the 10-year questionnaire of whom 118 (11.8%; 95%CI[9.8-13.9]) were using diet and 78 (7.8%; 95%CI[6.2-9.5]) were using exercise to help with their prostate cancer. Men were more likely to use diet or use exercise for prostate cancer if they were younger (p-trend = 0.020 for diet, p-trend = 0.045 for exercise), more educated (p-trend<0.001, p-trend = 0.011), support group participants (p-nominal<0.001, p-nominal = 0.005), had higher Gleason score at diagnosis (p-trend<0.001, p-trend = 0.002) and had knowledge of cancer spread (p-nominal = 0.002, p-nominal = 0.001). Use of diet was also associated with receipt of androgen deprivation therapy (RR = 1.59; 95%CI[1.04-2.45]), a greater fear of cancer recurrence (p-trend = 0.010), cognitive avoidance (p-trend = 0.025) and greater perceived control of cancer course (p-trend = 0.014). Use of exercise was also associated with receipt of prostatectomy (RR = 2.02; 95%CI[1.12-3.63]), receipt of androgen deprivation therapy (RR = 2.20; 95%CI[1.34-3.61]) and less satisfaction with medical treatments (p-trend = 0.044). Few long-term prostate cancer survivors use diet or exercise to help with their prostate cancer. Survivors may benefit from counselling on the scientific evidence supporting healthy eating and regular exercise for improving quality-of-life and cancer-related outcomes.

Emotional adjustment among parents of adolescents and young adults with cancer: the influence of social constraints on cognitive processing and fear of recurrence.

Parents of adolescents and young adults (AYAs) with cancer experience distress comparable to other caregiver populations, but remain understudied. This study tested the social cognitive processing model of emotional adjustment to cancer. We hypothesized that social constraints on emotional disclosure would inhibit cognitive processing and be related to greater fear of cancer recurrence (FCR), potentially negativelyinfluencing psychological adjustment. Data were collected through an online cross-sectional survey study of 66 parents of AYAs with cancer (aged 15-39) and analyzed using bootstrapping techniques for ordinary least squares regression. One-third of the parents reported moderate to severe depressive symptoms. Serial mediation analyses indicated that greater social constraints were related topoorer cognitive processing and higher FCR, and, ultimately, greater depressive symptoms. Alternative models were tested and were not significant. Future psychosocial interventions for parents of AYAs with cancer should include improving cancer-related communication between parents and their social network.

Do Future Limitation Perspective in Cancer Patients Predict Fear of Cancer Recurrence, Mental Distress, and the Ventromedial Prefrontal Cortex Activity?

Life-threatening diseases (e.g., cancer) affect people’s future time perspective (FTP) and affect their mental health. When one’s lifetime is perceived as running out, the individual possesses a future limitation perspective (FLP), which is one of factors in FTP. In this study, we explored the structural relationship between FLP, fear of cancer recurrence (FCR), mental health status (MHS), and brain activity in patients with cancer. Cancer patients were divided into two groups using the FTP scale and Feelings About Life Scale: a strong FLP group (S-FLP) and a weak FLP group (W-FLP). For these groups, we measured cancer patients’ MHS using the Symptom Checklist (SCL-90) and FCR using the Cancer Acceptance Scale; brain activity was measured using resting-state functional magnetic resonance imaging (rs-fMRI). Behavioral results showed that the S-FLP group had higher mental symptoms and FCR scores than did the W-FLP group. Neuroimaging results revealed that spontaneous brain activity in the ventromedial prefrontal cortex (vmPFC) was stronger in the W-FLP group than in the S-FLP group. Moreover, brain activity in the vmPFC negatively correlated with FLP, FCR, and SCL-90 scores only in the S-FLP group, and the model constructed further indicated that FCR and SCL-90 scores fully mediated the relationship between FLP and vmPFC activities. These findings suggested that a strong FLP might lead to mental disorders and greater FCR, which might change the spontaneous activity of the vmPFC in cancer patients.

Long-term results of a phase II randomized controlled trial (RCT) of a psychological intervention (Conquer Fear) to reduce clinical levels of fear of cancer recurrence in breast, colorectal, and melanoma cancer survivors.

LBA10000 Background: Up to 70% of cancer survivors report clinically significant fear of cancer recurrence (FCR). This parallel RCT evaluated the impact of a psychological intervention, Conquer Fear (CF), on FCR in cancer survivors. Methods: Participants were disease-free stage I-III breast, colorectal or melanoma cancer survivors, 2 months to 5 years post-treatment, who scored above the clinical cut-off (≥13) on the FCR Inventory (FCRI) severity subscale. CF included 5 sessions incorporating attention training, detached mindfulness, challenging unhelpful metacognitions, values clarification and psycho-education. Participants were randomised to the intervention ( n= 121) or a relaxation training (RT) control arm ( n= 101) (target n= 260). The primary end-point was reduction in FCR (FCRI total) immediately after intervention completion. Follow-up assessments occurred immediately, 3- and 6-months post-treatment. Data analysis was by intention to treat. The differences in change in FCR from baseline between CF and RT and secondary outcomes were tested using independent t-tests. A difference of 14.5 points in FCR was considered clinically significant. Long-term changes in FCR and secondary outcomes were evaluated using linear regression models fitted with generalized estimating equations (GEE), adjusted for baseline FCR. Results: Reduction in FCR between baseline and immediately post-treatment was significantly more in CF participants compared to RT. (Difference in change (95% CI): -10.5 (-16.1, -4.9); p &lt; 0.001). Greater FCR reductions were also observed amongst CF participants at 3 months (-7.6 (-13.9, -1.4), p = 0.02) and 6 months (-7.8 (-14.2, -1.4), p = 0.02) compared with RT. The pattern of change in outcomes over time was consistent between treatment groups as no significant linear trends in treatment effects over time were observed. Conclusions: Conquer Fear is a theoretically-grounded intervention to reduce FCR and its associated psychological morbidity which leads to significantly greater reductions in FCR in the first 6 months following treatment than relaxation training. Clinical trial information: ACTRN12612000404820.

Exploring characteristics, predictors, and consequences of fear of cancer recurrence among Asian-American breast cancer survivors.

To address the fear of cancer recurrence (FCR) research gap, we used prospective data to explore FCR predictors and FCR associations with health-related quality of life among Asian-American breast cancer survivors (BCS). A total of 208 diverse Asian-American BCS completed T1 survey, and 137 completed T2 survey after 1year. Fear of cancer recurrence scores (range=0-4) were 2.01 at T1 and 1.99 at T2 reflecting low-to-moderate FCR. Scores of FCR were stable over the 1-year period (t(126)=.144, P=.886). Multiple regression analyses showed that Chinese women reported lower FCR both at T1 (t(193)=-2.92, P=.004) and T2 (t(128)=-2.56, P=.012) compared to other Asian women. Also, more positive health care experience at T1 predicted lower FCR at T2 (β=-.18, P=.041). Controlling for other covariates, greater FCR at T1 predicted poorer outcomes 1year later including lower physical (β=-.31, P<.001), emotional (β=-.37, P<.001) and functional (β=-.16, P=.044) well-being and health-related quality of life specific to breast cancer at T2 (β=-.31, P<.001). We found substantial consistencies and some divergences between our findings with Asian-American BCS and the existing literature. This prospective investigation reveals new information suggesting that Asian-American subgroup variation exists and health care system factors may influence FCR. Thus, FCR studies should consider Asian subgroupings, cultural aspects, ie, level of acculturation and health care system factors including provider-patient communication and treatment setting. Future research may benefit from contextualizing FCR within a broader distress framework to advance the science and practice of patient-centered and whole-person care.

Changes in sexual roles and quality of life for gay men after prostate cancer: challenges for sexual health providers.

Gay men with prostate cancer (GMPCa) may have differential health-related quality of life (HRQOL) and sexual health outcomes than heterosexual men with prostate cancer (PCa), but existing information is based on clinical experience and small studies. Our goals were to: (i) describe HRQOL and examine changes in sexual functioning and bother; (ii) explore the psychosocial aspects of sexual health after PCa; and (iii) examine whether there were significant differences on HRQOL and sexual behavior between GMPCa and published norms. A convenience sample of GMPCa completed validated disease-specific and general measures of HRQOL, ejaculatory function and bother, fear of cancer recurrence, and satisfaction with prostate cancer care. Measures of self-efficacy for PCa management, illness intrusiveness, and disclosure of sexual orientation were also completed. Where possible, scores were compared against published norms. Main outcome measures were self-reported sexual functioning and bother on the Expanded Prostate Cancer Index. Compared with norms, GMPCa reported significantly worse functioning and more severe bother scores on urinary, bowel, hormonal symptom scales (Ps < 0.015-0.0001), worse mental health functioning (P < 0.0001), greater fear of cancer recurrence (P < 0.0001), and were more dissatisfied with their PCa medical care. However, GMPCa reported better sexual functioning scores (P < 0.002) compared with norms. Many of the observed differences met criteria for clinical significance. Physical functioning HRQOL and sexual bother scores were similar to that of published samples. GMPCa tended to be more "out" about their sexual orientation than other samples of gay men. GMPCa reported substantial changes in sexual functioning after PCa treatment. They also reported significantly worse disease-specific and general HRQOL, fear of recurrence, and were less satisfied with their medical care than other published PCa samples. Sexual health providers must have an awareness of the unique functional and HRQOL differences between gay and heterosexual men with PCa.

The evolution of fear of cancer recurrence during the cancer care trajectory and its relationship with cancer characteristics

ObjectiveThis population-based longitudinal study assessed the prevalence, incidence and evolution of fear of cancer recurrence (FCR) and its relationship with some cancer characteristics in a large sample of patients with mixed cancer sites over an 18-month period. MethodsA total of 962 patients scheduled to undergo surgery for cancer completed the severity subscale of the Fear of Cancer Recurrence Inventory at the peri-operative period and 2, 6, 10, 14, and 18months later. ResultsResults indicated that FCR levels were highest at baseline, significantly decreased at the 2-month evaluation and then remained stable throughout the remainder of the study. Between 44.0% and 56.1% of the patients reported a clinical level of FCR during the study, with the highest proportion found at baseline. A relationship was obtained between greater FCR and some indices of poorer prognosis (i.e., diagnosis of head and neck cancer, more advanced cancer, cancer recurrence), as well as with the administration of adjuvant treatment, particularly chemotherapy. Patients with clinical FCR at baseline continued to display clinical levels at all subsequent time points. The incidence rate of clinical levels of FCR was 51.7% overall. ConclusionFCR is a highly prevalent and persistent condition. More efforts should be devoted to developing effective treatments for patients with clinical levels of FCR. Early interventions appear particularly relevant in order to prevent the problem from becoming chronic, although patients' acceptability and the efficacy of this approach remain to be demonstrated.

Relationship of threat appraisal with coping appraisal to fear of cancer recurrence in breast cancer survivors

Prior research suggests that fear of cancer recurrence (FOR) is very common among cancer survivors. This study examined the extent to which the interaction of threat appraisal and coping appraisal accounted for differences in FOR in cancer patients who recently completed treatment. It was hypothesized that greater FOR would be related to a combination of high threat appraisal and low coping appraisal. A sample of 155 early stage breast cancer patients (mean age = 59 years) who completed surgery, chemotherapy, and/or radiotherapy between 6 and 24 months previously (mean = 12 months) completed measures of FOR, threat appraisal (perceived risk and severity of a potential cancer recurrence), and coping appraisal (perceived response efficacy and self-efficacy to perform diet and exercise recommendations to reduce recurrence risk). Basic demographic and clinical information were also collected. Threat appraisal accounted for 30% of the variance in FOR (p<0.001) while coping appraisal accounted for 0% (p = 0.64). After accounting for these variables and relevant covariates, the interaction of threat appraisal and coping appraisal explained 2% of the remaining variance in FOR (p = 0.04). As hypothesized, survivors who reported high threat appraisal and low coping appraisal had the highest FOR. Future research should focus on examining these relationships longitudinally and further assess coping appraisal and how it impacts cancer recurrence fears.

Impact of radical prostatectomy positive surgical margins on fear of cancer recurrence: Results from CaPSURE™

Purpose Fear of cancer recurrence (FCR) is a significant source of distress in men with prostate cancer and could affect clinical decision-making, especially in those with positive margins following radical prostatectomy (RP). We examined the influence of positive surgical margin status on fear of cancer recurrence in men undergoing radical prostatectomy. Methods Five hundred eight-four men underwent RP from 1999 to 2002 in CaPSURE™, a prospective, longitudinal, national cohort. All men had both baseline and follow-up assessment of FCR using a validated Kornblith scale. Statistical analysis included χ 2 test, Wald test, and linear as well as repeated measures ANOVA mixed model. Results One hundred sixty (27%) men had positive surgical margins. Baseline FCR and clinical variables did not differ based on margin status. Men with positive margins experienced greater FCR after RP than negative margins (OR, 1.94, 95% CI, 1.22–3.07). Men who had received adjuvant therapy experienced greater FCR (OR, 2.78, 95% CI, 1.21–6.39). Repeated measures analysis showed greater FCR over time (14-month mean follow-up, range 2–31 months) for positive vs. negative margins ( P = 0.02). This difference in fear widened over time. There were no significant differences in health-related quality of life scores based on margin status. Conclusion Positive surgical margin status is associated with greater fear of cancer recurrence, a difference not alleviated by adjuvant therapy use. Men with positive margins remain more fearful over the course of several years compared with those with negative margins. Clinicians should be aware of the potential stressful impact of positive surgical margins.

The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment.

Given the marked individual variability in psychological adjustment in response to breast cancer, it is important to specify factors contributing to adaptive survivorship. This longitudinal study of 70 women with Stage I or II breast cancer tested the ability of situation-specific coping strategies and a more stable attribute, hope, to predict adjustment prospectively from the point shortly following diagnosis through the first year. Consonant with previous studies, coping through active acceptance at diagnosis predicted more positive adjustment across time, and avoidance-oriented coping predicted greater fear of cancer recurrence, over and above participant age and initial status on dependent variables. The hypothesis that coping through turning to religion would be more effective for less hopeful women was supported, and mixed support emerged for the hypothesis that approach-oriented coping strategies would yield greater adaptational benefits for women high in hope. Findings suggest that risk and protective factors for adjustment across the first year of survivorship can be identified even prior to definitive surgery for breast cancer, particularly when both dispositional characteristics such as hope and situation-specific coping strategies are considered.