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

• Published in: Supportive care in cancer 2021-12, Vol.29 (12), p.7647-7657
• Main Authors: Heidkamp, Paula, Breidenbach, Clara, Hiltrop, Kati, Kowalski, Christoph, Enders, Anna, Pfaff, Holger, Weltermann, Birgitta, Geiser, Franziska, Ernstmann, Nicole
• Format: Article
• Language: English
• Subjects: Analysis; Anxiety; Breast; Breast cancer; Breast Neoplasms - therapy; Cancer; Cancer Survivors; Chemotherapy; Fear; Fear & phobias; Female; Health psychology; Humans; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - epidemiology; Nursing; Nursing Research; Oncology; Oncology, Experimental; Original; Original Article; Pain Medicine; Rehabilitation Medicine; Relapse; Surveys; Survivor
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-021-06329-z

Objective This 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. Methods A 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. Results Respondents 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 (χ 2 (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). Conclusions The 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.