Fear of Recurrence
This, of course, is what it is all about. When we are initially diagnosed with breast cancer, we are sad and anxious, but generally recognize that we are not going to die quickly from the disease. Although there are some women who are diagnosed with advanced/metastatic/Stage IV breast cancer, most, blessedly are not. Instead, we endure a long treatment of surgery, maybe radiation, maybe chemotherapy, maybe hormonal therapy, and then we finish. And try to resume our normal lives, gradually recognizing that everything has changed. Even those women with "excellent" prognoses know that no one gets a promise.
As time passes, most women find that the anxiety about recurrence diminishes a bit also. It flairs a few days before medical visits or an annual mammogram or MRI or upon hearing of someone else's bad news. It flairs big time if we experience a worrisome sympton: a lingering cough, pain that might be bone pain but probably isn't, a headache that persists. Doctors generally suggest the Two Week Rule: if something lasts longer than two weeks, call about it. Otherwise, forget it; most things don't last that long. Obviously this does not apply to major emergent symptoms like chest pain or a severe headache (that probably don't mean cancer, but might mean some other serious thing). I often reassure women that a breast cancer diagnosis turns us all into hypochondriacs as we become very body focused and aware of every twinge.
Background: Increasing proportions of patients diagnosed with cancer will become long-term
survivors (!5 years post-diagnosis). However, survivors may continue to experience negative
effects of cancer and/or treatment, including fear of recurrence (FoR). This review aims to provide
an overview of current knowledge on FoR, including determinants and consequences in long-term
cancer survivors, and to outline methodological and conceptual challenges that should be
addressed in future research.
Methods: Multiple databases including PUBMED, EMBASE, and PsycINFO were searched
to identify relevant articles. Seventeen articles were included. Data were extracted by two
reviewers and summarized following a systematic scheme.
Results: Even years after initial diagnosis, cancer survivors suffer from FoR. Most studies
report low or moderate mean FoR scores, suggesting that FoR is experienced in modest intensity
by most survivors. Studies including long-term and short-term survivors indicate no significant
change of FoR over time. Lower level of education, lower level of optimism, and being
Hispanic or White/Caucasian were found to be associated with higher levels of FoR. Signi!cant
negative associations were reported between FoR and quality of life as well as psychosocial wellbeing
All but three studies were conducted in the USA. General cut-offs for severity/clinical signi
!cance have not been defined yet.
Conclusions: FoR at modest intensity is experienced by most long-term cancer survivors. Future
studies should address determinants and consequences of FoR in more detail. Validated
instruments providing cut-offs for severity/clinical signi!cance of FoR should be developed and
utilized. Ef!cient interventions should be implemented to reduce detrimental effects of FoR.