Relationships between fear of cancer recurrence, anxiety and worry, and health behaviors and health service use: a systematic review

PURPOSE: Fear of cancer recurrence is highly prevalent among adult survivors of cancer. The role of fear of recurrence in the emotional distress of survivors of cancer, as well as health behaviors that may directly affect their health, remains unclear. To advance oncology practice, this study sought to examine the extent to which fear of recurrence stemming from physical symptoms accounts for emotional distress in a large sample of adult survivors of cancer and to extend the model to explain postdiagnosis self-reported health behavior change. METHODS: In 2016, 258 survivors of cancer at an academic hospital completed a survey of psychosocial needs. Items assessed physical symptoms (checklist), fear of cancer recurrence (Assessment of Survivor Concerns), emotional distress (anxiety and depressed mood), and health behaviors (current alcohol use, physical activity, diet, and sunscreen use, as well as changes after cancer diagnosis) informed by National Comprehensive Cancer Network survivorship guidelines. Indirect effects regression models accounting for relevant covariates (age and treatment history) used 5,000-iteration bootstrapping. RESULTS: Higher fear of cancer recurrence was associated with greater number of physical symptoms ( P < .001), greater emotional distress ( P < .05), lower moderate or vigorous physical activity ( P < .05), higher sunscreen use ( P < .05), and postdiagnosis increases in alcohol use ( P < .01) and reductions in physical activity ( P < .01). Fear of cancer recurrence models accounted for almost half of the variance in distress of survivors of cancer ( R2 = 0.44, P < .001) and, to a lesser yet significant extent, changes in alcohol consumption ( R2 = 0.09, P < .001) and physical activity ( R2 = 0.06, P = .003). CONCLUSION: Fear of cancer recurrence plays a central role in the emotional distress and key health behaviors of survivors of cancer. These findings support fear of cancer recurrence as a potential target for emotional health and health behavior change interventions.

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A Systematic Review of Fear of Cancer Recurrence Among Indigenous and Minority Peoples

Frontiers in Psychology ◽

10.3389/fpsyg.2021.621850 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kate Anderson ◽

Allan ‘Ben' Smith ◽

Abbey Diaz ◽

Joanne Shaw ◽

Phyllis Butow ◽

...

Keyword(s):

Systematic Review ◽

Cancer Survivors ◽

Lived Experience ◽

Cancer Recurrence ◽

Fear Of Cancer Recurrence ◽

Bibliographic Databases ◽

Minority Populations ◽

Cancer Knowledge ◽

Adult Cancer Survivors ◽

Fear Of Cancer

While cancer survivors commonly experience fear and anxiety, a substantial minority experience an enduring and debilitating fear that their cancer will return; a condition commonly referred to as fear of cancer recurrence (FCR). Despite recent advances in this area, little is known about FCR among people from Indigenous or other ethnic and racial minority populations. Given the high prevalence and poor outcomes of cancer among people from these populations, a robust understanding of FCR among people from these groups is critical. The current review identified and aggregated existing literature on FCR amongst adult cancer survivors from Indigenous and minority populations. The protocol of this review was registered with PROSPERO in July 2020 (Registration number: CRD42020161655). A systematic search of bibliographic databases was conducted for relevant articles published from 1997 to November 2019. Data from eligible articles were extracted and appraised for quality by two independent reviewers. Nineteen articles from four countries (United States of America, Canada, Australia and the United Kingdom) met the inclusion criteria, including 14 quantitative, 4 qualitative and 1 mixed-methods study. Only one article reported on an Indigenous population. Few studies reported on FCR prevalence (n = 3) or severity (n = 9). While the variation in tools used to measure FCR hindered a robust estimate of severity, results suggested some differences in FCR severity between minority and dominant populations, although these may have been due to study metholodological differences. Few factors were reported as being associated with FCR in minorities across multiple studies. The qualitative synthesis found five themes associated with the lived experience of FCR: (i) variations in the lived experience of FCR; (ii) spirituality and worldview impacting on FCR; (iii) the importance of staying positive; (iv) complexities around support; and (v) increasing cancer knowledge. The findings of this review highlight differences in FCR across cultures and contexts, which reinforces the need for culturally-specific approaches to this condition. The dearth of research in this area is of concern given the significant burden of cancer in these populations. A deeper understanding of this condition among Indigenous and minority populations is critical to developing and delivering appropriate and effective psychosocial care for cancer survivors from these groups. Systematic Review Registration: identifier [CRD42020161655].

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Systematic review of interventions by non-mental health specialists for managing fear of cancer recurrence in adult cancer survivors

Supportive Care in Cancer ◽

10.1007/s00520-019-04979-8 ◽

2019 ◽

Vol 27 (11) ◽

pp. 4055-4067 ◽

Cited By ~ 5

Author(s):

Jia (Jenny) Liu ◽

Phyllis Butow ◽

Jane Beith

Keyword(s):

Mental Health ◽

Systematic Review ◽

Cancer Survivors ◽

Cancer Recurrence ◽

Fear Of Cancer Recurrence ◽

Adult Cancer Survivors ◽

Fear Of Cancer

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Patterns of health service use and child abuse or neglect in young childhood: a systematic review

Archives of Disease in Childhood ◽

10.1136/adc.2011.212563.220 ◽

2011 ◽

Vol 96 (Supplement 1) ◽

pp. A94-A95

Author(s):

J. Woodman ◽

M. Brandon ◽

D. Glaser ◽

R. Gilbert

Keyword(s):

Systematic Review ◽

Child Abuse ◽

Health Service ◽

Service Use ◽

Health Service Use

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Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies

Journal of Cancer Survivorship ◽

10.1007/s11764-013-0272-z ◽

2013 ◽

Vol 7 (3) ◽

pp. 300-322 ◽

Cited By ~ 406

Author(s):

Sébastien Simard ◽

Belinda Thewes ◽

Gerry Humphris ◽

Mélanie Dixon ◽

Ceara Hayden ◽

...

Keyword(s):

Systematic Review ◽

Cancer Survivors ◽

Cancer Recurrence ◽

Fear Of Cancer Recurrence ◽

Quantitative Studies ◽

Adult Cancer Survivors ◽

Fear Of Cancer

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Health service use among adults with cerebral palsy: a mixed‐methods systematic review

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.15097 ◽

2021 ◽

Author(s):

Manjula Manikandan ◽

Claire Kerr ◽

Grace Lavelle ◽

Michael Walsh ◽

Aisling Walsh ◽

...

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Mixed Methods ◽

Health Service ◽

Service Use ◽

Health Service Use

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The Relationship Between Fears of Cancer Recurrence and Patient Gender: A Systematic Review and Meta-Analysis

Frontiers in Psychology ◽

10.3389/fpsyg.2021.640866 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chuan Pang ◽

Gerry Humphris

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cancer Recurrence ◽

Fear Of Cancer Recurrence ◽

Cancer Type ◽

Publication Type ◽

Cancer Types ◽

Meta Regression ◽

Fear Of Cancer ◽

The Relationship

Background: A significant concern for patients treated for cancer is fear of cancer recurrence (FCR). Although a common experience, some patients report high levels of FCR that are difficult to manage and result in over vigilant checking and high use of health services. There has been speculation about the relationship of FCR with gender with mixed reports from several systematic reviews.Aims: To determine the association of FCR with gender in previous reported studies and investigate the strength of this relationship with various moderators including year of publication, type of cancer and measurement attributes of self-reported FCR instruments.Methods: A systematic review was conducted with searches of the literature from the MEDLINE, PubMed, Embase, and PsycINFO databases following PRISMA guidelines. All the included papers were divided into two groups, namely: “pure” that comprise only of patients with cancer types that both men and women can contract and “mixed” that report on patients with a variety of cancer types. The association between gender and FCR level was assessed by meta-analysis. A meta-regression was performed to investigate the moderating effects of factors including: the year of publication, cancer type, mean age of the sample and the length of the FCR scale measurement. This review was registered with PROSPERO, ID: CRD42020184812.Results: Finally, 29 studies were included. The N size of pooled participants was 33,339. The meta-analysis showed females to have an overall higher level of FCR than males (ES = 0.30; 95% CI, 0.23, 0.36). The meta-regression of moderating or control variables found little, if any, systematic variation in effect-sizes.Conclusion: This systematic review has clarified a potentially confused pattern of previous results in understanding the relationship between gender and FCR. Women report higher levels of FCR than men and this feature is one that clinicians and researchers can factor into their practice and future studies. The effect size is moderate, hence there is ample variation in FCR level, independent of gender, that requires further investigation.

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