Fear of cancer recurrence (FCR) is a major concern for patients who have received curative treatment for cancer. We aimed to: (a) define the incidence and severity of FCR; and (b) identify factors associated with FCR in a cohort of patients who attended the Sydney Survivorship Clinic at Concord Hospital.
Data from a prospectively collected RedCap database were used to perform a cross-sectional study. Survivors of breast cancer (BC) or colorectal cancer (CRC) attending an initial visit to the survivorship clinic were included. All patients were formally assessed by a clinical psychologist for presence of FCR. Quality of life (QoL) was measured by the Functional Assessment of Cancer Therapy-General (FACT-G) and QoL/symptoms by Patient’s Disease and Treatment Assessment (PDTA) Form and Distress Screening Tool. Clinical and QoL variables were evaluated for associations with FCR. Factors independently associated with FCR were identified using logistic regression.
Overall, 254 survivors (146 BC, 108 CRC) were included. In total, 160 survivors (63%) had FCR diagnosed by psychology assessment; 44/78 (56%) rated moderate-severe FCR. The rate of FCR was significantly lower in CRC survivors (55/108, 51%) than BC (105/146, 72%) (OR 0.41, 95%CI 0.24-0.68, p=0.001). On univariable analysis, factors associated with FCR included younger age (p<0.001), BC compared with CRC (p=0.001), higher distress score (p=0.004), insomnia (p=0.006), anxiety (p<0.001), depression (p<0.001), irritability (p=0.028), lower emotional wellbeing (p=0.003), and lower overall wellbeing (p=0.002). FCR was significantly associated with lower physical (p=0.007) and emotional subscales (p<0.001) on the FACT-G. On multivariable analysis, younger age (p=0.003) and lower FACT-G emotional subscale score (p=0.016) were independently associated with FCR.
FCR is an important problem for cancer survivors. There were high rates of FCR amongst BC and CRC survivors with the majority being moderate-severe. FCR was independently predicted by younger age and poorer emotional wellbeing.