Trajectories of fear of recurrence in women with breast cancer

Abstract

Purpose: Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery.

Methods: Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months.

Results: From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time.

Conclusions: These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.

Fig. 1

Trajectories of fear of cancer recurrence (FCR) scores for (a) the unconditional model, and (b) a random selection of 10 patients’ FCR scores over the course of the 6-month study

Fig. 2

Trajectories of fear of cancer recurrence (FCR) scores by (a) living circumstances, (b) changes in spiritual life (c) state anxiety at enrollment, (d) difficulty coping as a result of treatment/disease, (e) distress due to the initial diagnosis, (f) distress of the illness to family, (g) overall physical health, and (h) FCR scores at enrollment. For the continuous variables, higher/lower differences were calculated based on 1 standard deviation above/below the mean score