Fear of Cancer Recurrence and Its Negative Impact on Health-Related Quality of Life in Long-term Breast Cancer Survivors

Abstract

Purpose: Fear of cancer recurrence (FCR) is a common psychological issue in breast cancer (BC) survivors during early survivorship but whether the same is true among long-term survivors has yet to be empirically evaluated. This study investigated FCR level, its associated factors, and impact on quality of life (QoL) in long-term BC survivors.

Materials and methods: Participants included women diagnosed with BC between 2004 and 2010 at two tertiary hospitals. Survey was conducted in 2020. The study measured FCR with the Fear of Cancer Recurrence Inventory and other patient-reported outcomes, including depression and cancer-related QoL. Logistic regression was used to identify factors associated with FCR, and structural equation modeling was conducted to explore the impact of FCR on other outcomes.

Results: Of 333 participants, the mean age at diagnosis was 45.5, and 46% experienced FCR. Age at diagnosis ≤ 45 (adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.51 to 4.60), shorter time since diagnosis (aOR, 1.75, 95% CI, 1.08 to 2.89), and having a history of recurrence (aOR, 2.56; 95% CI, 1.16 to 5.65) was associated with more FCR. FCR was significantly associated with an increased risk of depression (β=0.471, p < 0.001) and negatively impacted emotional functioning (β=-0.531, p < 0.001). In addition, a higher FCR level may impair overall health-related QoL in long-term BC survivors (β=-0.108, p=0.021).

Conclusion: Ten years after diagnosis, long-term BC survivors still experienced a high level of FCR. Further, the negative impact of FCR on QoL and increased depression risk require an FCR screening and appropriate interventions to enhance long-term BC survivors' QoL.

Keywords: Breast cancer survivor; Depression; Fear of cancer recurrence; Quality of life; Young breast cancer.

Fig. 1

Correlations between FCRI and other factors. The brown color indicates the statistically significant negative associations. The green color indicates the statistically significant positive associations. The white color indicates non-significant associations. A darker color indicates stronger correlations. EQ-5D, EuroQol 5-Dimension Questionnaire Index; FCRI, Fear of Cancer Inventory; stage, stage at diagnosis; Time dx, time since diagnosis (in year).

Fig. 2

Path diagram of the SEM model for the associations between fear of cancer recurrence and other patient-reported outcomes. The structural model presents the effects of age at diagnosis, time since diagnosis, history of recurrence, fear of cancer recurrence, and other patient-reported outcomes. FCRI, Fear of Cancer Recurrence Inventory; QoL, quality of life; SEM, structural equation model. *p < 0.05, ***p < 0.001.