Worry about recurrence in a multi-ethnic population of breast cancer survivors and their partners

21 Background: Worry about recurrence is a significant concern for breast cancer survivors. We explored physicians‘ confidence and practices in identifying and managing worry. Methods: We surveyed a random sample of 1,500 surgeons and medical oncologists drawn from the AMA Masterfile in 2012. Physician responses to questions regarding their confidence were stratified by practice specialty and compared using the Wilcoxon rank-sum test. Correlates of use of each strategy for managing worry were modeled using multiple variable logistic regression. Results: 896 physicians (59.7%) responded: 498 surgeons and 398 medical oncologists, of whom 85.5% saw breast cancer patients. 62% reported initiating discussions regarding worry about recurrence. Overall, medical oncologists reported more confidence than surgeons in their ability to present risk information to patients, identify survivors with high levels of worry, and help patients manage their worry (p<0.001). Of note, 40.2% of physicians reported low levels of confidence managing worries surrounding recurrence. Confidence presenting risk information was significantly associated with treatment volume, which was highest with >50 cases/year. Surgeons who routinely followed breast cancer survivors for >3 years reported higher confidence; no such correlation existed among medical oncologists, but >90% of this group routinely followed patients for >3 yrs. Female physicians were significantly more likely to report being able to identify survivors with high levels of worry. Practice in an academic setting demonstrated associations with increased confidence. Use of worry management strategies varied by specialty. Medical oncologists were more likely to prescribe medication, address concerns in detail themselves, or refer to a psychologist or social worker. Longer follow-up was associated with increased likelihood of physicians addressing concerns themselves. Conclusions: A sizeable minority of physicians lack confidence in their ability to identify and manage worry in cancer survivors. Medical oncologists and surgeons differ significantly in their approach to worry management, suggesting that greater attention toward this issue in training and continuing education may be warranted.

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Provider perspectives on presenting risk information and managing worry about recurrence among breast cancer survivors

Psycho-Oncology ◽

10.1002/pon.3625 ◽

2014 ◽

Vol 24 (5) ◽

pp. 592-600 ◽

Cited By ~ 10

Author(s):

Nancy K. Janz ◽

Rebecca L. Leinberger ◽

Brian J. Zikmund-Fisher ◽

Sarah T. Hawley ◽

Kent Griffith ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Risk Information ◽

Provider Perspectives ◽

Worry About Recurrence

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Worry about Breast Cancer Recurrence: A Population-based Analysis

The American Surgeon ◽

10.1177/000313481408000716 ◽

2014 ◽

Vol 80 (7) ◽

pp. 640-645 ◽

Cited By ~ 14

Author(s):

Apoorva Tewari ◽

Anees B. Chagpar

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Radiation Therapy ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Univariate Analysis ◽

Population Based ◽

Fear Of Recurrence ◽

Worry About Recurrence

As more patients with breast cancer survive treatment, the importance of their long-term quality of life is increasing. One important concern for many survivors is fear of recurrence. To better understand worry about recurrence, we conducted a population-based statistical analysis. The National Health Interview Survey (NHIS) is the largest annual source of health information for the U.S. population. We obtained data from the 2010 survey, which asked breast cancer survivors about their fear of recurrence and quality of life. Data were analyzed using SUDAAN software. The 2010 NHIS sample represented 2,668,697 breast cancer survivors. On univariate analysis, worry about recurrence was correlated with current age ( P = 0.03) and radiation therapy ( P = 0.04). Worry was strongly associated with perceived risk of recurrence ( P < 0.01) and decreased overall quality of life ( P < 0.01) as well as lower self-reported physical ( P < 0.01) and mental ( P < 0.01) health and poor satisfaction with social activities and relationships ( P < 0.01). On multivariate analysis, worry was not independently associated with decreased quality of life ( P = 0.09). However, those who “always worried” about recurrence had a lower quality of life (odds ratio, 0.06; 95% confidence interval, 0.01 to 0.45). Worry about recurrence among breast cancer survivors is associated with age and radiation therapy and is correlated with self-reported physical health, mental health, social relationships, and overall quality of life. It is a significant predictor of decreased quality of life in those who worry the most. Screening for worry about recurrence is an important measure for the improvement of quality of life among breast cancer survivors.

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