Understanding the Fear of Recurrence in Cancer Survivors

Fear of cancer recurrence (FCR) is characterized as fear, worry, or concern relating to the possibility that primary cancer or subsequent malignancy can return or progress to other parts of the body. FCR is prevalent among survivors of adult-onset cancer (cancer that occurs at the age of 18 to 49).

Fear of Cancer Recurrence in Cancer Survivors

FCR among adult-onset cancer is well characterized when compared to FCR in adult survivors of childhood cancer who are at an increased risk of developing secondary cancers (6 times higher than the general population).

Attentiveness towards pain and associated anxiety is an adaptive quality in survivors because they have a high chance of recurrence of cancer and subsequent secondary cancers.

Clinically significant levels of FCR (CS-FCR) are associated with negative effects in adult-onset cancer survivors. It includes anxiety, depression, poor quality of life and increased healthcare use.

Common FCR risk factors in this population include younger current age, physical symptoms (eg, fatigue, pain), female sex, metastatic diagnosis, and treatment factors (eg, chemotherapy).

The role of chronic pain (3 months or more), is neglected even though acute pain is included in FCR models. Pain can act as a cancer-related sign, that can induce FCR related thoughts and anxiety. Repeated exposure to chronic pain can increase the occurrence of FCR.

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Factors That Increases FCR in Cancer Survivors

Researchers aimed to distinguish the prevalence and risk factors of CS-FCR in adult survivors of childhood cancer. The association between FCR, chronic pain and fear of the unknown were examined.

FCR was tested with the 9 factors Fear of Cancer Recurrence Inventory–Short Form (FCRI-SF), which defined recurrence as the possibility that cancer could return to the same place or another part of the body.

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They identified that approximately 1in 3 adult survivors of childhood cancer experienced FCR where psychological treatment were indicated.

It was revealed that FCR childhood cancer survivors had no significant association with age, cancer type or prior recurrence/secondary cancer.

Unemployment was associated with increased clinically significant FCR, which shows that anxiety and physical limitation can affect survivors. Increased anxiety and depression are related to increased CS-FCR, which can be misinterpreted due to presence of chronic neurological conditions.

Surgical procedure which involves limb removal leads to physical disability and can increase the chances of FCR because they develop inferior thoughts.

Fear of unknown partially influenced the anxiety-FCR relationship, but anxiety and depression were more influential.

Effective psychological treatments, including cognitive-behavioral therapy and acceptance and commitment therapy, can help reduce FCR, highlighting the need to address psychological factors in managing FCR in survivors.

Reference:

1. Fear of Cancer Recurrence in Adult Survivors of Childhood Cancer - (https:jamanetwork.com/journals/jamanetworkopen/fullarticle/2824358)

Source-Medindia