Alex Pizzo, MSc, and colleagues conducted a novel, cross-sectional study of North American adults who survived childhood cancer to characterize the prevalence of and risk factors for clinically significant fear of cancer recurrence in adult survivors of childhood cancer. The study included 229 survivors, who had a mean age at diagnosis of 7.9 years and at study completion of 39.6 years. Of those, 9.2% experienced a recurrence of their primary cancer, 7.4% had been diagnosed with a subsequent malignant neoplasm, and 41% reported experiencing chronic pain.
Fear of cancer recurrence was reported at a severity likely to affect their functioning by about one-third of participants, including 38 (16.6%) who detailed clinically significant fear of cancer recurrence. Risk factors associated with clinically significant fear of cancer recurrence included female sex, unemployment, completion of some college or an undergraduate degree, neurologic conditions, history of pelvic radiation or limb-sparing or amputation surgery, elevated depression and/or anxiety, and poor or fair health status. Intolerance of uncertainty was identified as a partial mediator of the association between fear of cancer recurrence and anxiety. Treatment in the form of psychological interventions has been proven effective in reducing fear of cancer recurrence in survivors of adult-onset cancer and may be similarly beneficial for childhood cancer survivors.
High level
Fear of cancer recurrence has a substantial psychological and functional burden and should be routinely assessed as part of a comprehensive care approach for long-term survivors. Cognitive behavioral therapy and acceptance and commitment therapy, as well as mind-body interventions, are effective psychological interventions for people with fear of cancer recurrence that should be incorporated into care models.
Ground level
Psychological intervention is recommended for people with clinically significant or high fear of cancer recurrence. The authors recommend routine monitoring of fear of cancer recurrence for long-term survivors using the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), which was used in this study, and newly developed single-item screeners for rapid administration and interpretation within clinical settings.