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. 2022 Jan 15;128(2):335-343.
doi: 10.1002/cncr.33921. Epub 2021 Oct 6.

Trajectories of fear of cancer recurrence in young breast cancer survivors

Lidia Schapira  1 , Yue Zheng  2 , Shari I Gelber  2 , Philip Poorvu  2 , Kathryn J Ruddy  3 , Rulla M Tamimi  4 , Jeffrey Peppercorn  5 , Steven E Come  6 , Virginia F Borges  7 , Ann H Partridge  2 , Shoshana M Rosenberg  2   4
Affiliations

Trajectories of fear of cancer recurrence in young breast cancer survivors

Lidia Schapira et al. Cancer. .

Erratum in

Abstract

Background: Fear of cancer recurrence (FCR) is more intense in younger women. Because FCR is a powerful determinant of quality of life, identifying those at risk for persistently elevated FCR can inform timing of interventions.

Methods: A total of 965 women with stage 0 to stage III breast cancer enrolled in the Young Women's Breast Cancer Study, a prospective cohort of women diagnosed with breast cancer at age ≤40 years, completed the 3-item Lasry Fear of Recurrence Index. Group-based trajectory modeling was used to classify distinct FCR patterns from baseline through 5 years post-diagnosis. Multinomial logistic regression was used to identify patient, disease, and treatment characteristics associated with each trajectory.

Results: Five FCR trajectories were identified with the majority of participants having moderate (33.1%) or high FCR (27.6%) that improved over time. A total of 6.9% participants had moderate FCR that worsened, whereas 21.7% had high FCR at baseline that remained high throughout. In the fully adjusted multinomial model, stages II and III (vs stage I) were associated with lower odds (of being in the high/stable trajectory). White (vs non-White) were associated with higher odds of being in a trajectory that improved over time.

Conclusions: Although FCR improves over time for many young women with breast cancer, approximately one-third had FCR that was severe and did not improve or worsened over 5 years after diagnosis. Ongoing monitoring is warranted, with early referral to mental health professionals indicated for those at highest risk for unresolved FCR.

Lay summary: Fear of recurrence is common among young women with breast cancer. The authors followed a large cohort of young women diagnosed with breast cancer when they were 40 years of age and younger, and found 5 distinct trajectories that show moderate and severe fears do not always improve over time and may require targeted mental health intervention.

Keywords: anxiety; breast cancer; cancer survivors; fear of cancer recurrence; quality of life.

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Conflict of interest statement

Conflicts of Interest:

Lidia Schapira – Blue Note Therapeutics, Rubedo

Jeffrey M. Peppercorn - GlaxosmithKline: Employee and Stock (spouse), Pfizer: Research funding (self, to my institution), Athenex: consulting (self), Abbott Laboratories: consulting (self)

Figures

Figure 1.
Figure 1.
Prevalence of concerns about recurrence over time. A) Prevalence of current concern about health – Baseline through 5 years. B) Prevalence of current concern about cancer returning: Baseline through 5 years. C) Prevalence of perceived family concern about cancer returning: Baseline through 5 years.
Figure 1.
Figure 1.
Prevalence of concerns about recurrence over time. A) Prevalence of current concern about health – Baseline through 5 years. B) Prevalence of current concern about cancer returning: Baseline through 5 years. C) Prevalence of perceived family concern about cancer returning: Baseline through 5 years.
Figure 1.
Figure 1.
Prevalence of concerns about recurrence over time. A) Prevalence of current concern about health – Baseline through 5 years. B) Prevalence of current concern about cancer returning: Baseline through 5 years. C) Prevalence of perceived family concern about cancer returning: Baseline through 5 years.
Figure 2.
Figure 2.
Fear of Cancer Recurrence trajectories over 5 years of follow-up Higher scores indicate more greater fear of recurrence. Solid lines: Parameter estimates of trajectory model; dashed lines: 95% confidence interval for estimated trajectory membership probabilities; legend percentages: weighted by APP.
Figure 3.
Figure 3.
Distribution of baseline HADS anxiety scores among FCR trajectories FCR: fear of cancer recurrence; HADS: Hospital Anxiety and Depression Scale
See this image and copyright information in PMC

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