Fear of Cancer Recurrence

Fear of cancer recurrence (FCR) is broadly defined as “fear, worry or concern relating to the possibility that cancer will come back or progress.” Some degree of FCR is almost universal among cancer survivors, and management of FCR is frequently reported as an unmet need. Conceptualization and measurement of FCR remain challenging, as consensus regarding its multidimensional nature and clinical presentation is yet to be established. Accordingly, estimated prevalence rates of “clinical FCR” vary widely. Research suggests that if left untreated FCR remains stable over time, and that those who are younger, have greater symptom burden, and experience greater psychological distress are likely to experience more FCR. In contrast, medical (diagnosis staging, treatment, etc.) and other demographic variables do not appear to be strongly associated with FCR levels, making identification of FCR in clinical practice difficult. Brief FCR screening measures have been developed, but further work validating clinical cut-offs is needed. Those who experience a high level of FCR have poorer quality of life and experience difficulties moving on with their life after cancer diagnosis and treatment. A growing number of interventions have demonstrated efficacy in addressing FCR in recent years, with those using contemporary cognitive-behavioral therapy approaches focused on how patients relate to their thoughts, rather than on changing the contents of thoughts, shown to be most effective. Priorities for future research include development of treatment models, such as stepped care, that address the varying levels of FCR in cancer survivors and use interventions of varying intensity to efficiently address FCR.