Factors Associated With Fear of Cancer Recurrence in Family Caregivers of Cancer Survivors: A Systematic Review

Abstract

Objective: Fear of cancer recurrence (FCR) is a significant concern for family caregivers of cancer survivors and is associated with many adverse outcomes, including increased emotional distress and poorer quality of life. Although several theoretical models have been proposed to account for FCR in cancer survivors, their applicability to caregivers is unknown. The aim of this review was to identify clinical, demographic and psychological factors that are associated with, and predict, FCR in caregivers of cancer survivors.Method: AMED, CINAHL, Medline, PsycINFO, and Scopus were systematically searched for relevant studies reporting quantitative data on factors associated with FCR or similar constructs (e.g., worry or anxiety about cancer recurrence) in family caregivers of adult cancer survivors. Included studies were assessed for methodological quality using a standardized checklist adapted from the Agency for Healthcare Research and Quality.Results: Sixteen studies, half of which were cross-sectional, were included and summarized narratively. Non-modifiable factors, including age (n = 6) and treatment modality (n = 4), were found to be associated with increased FCR. Significant positive associations were also reported between illness perceptions and FCR (n = 3). However, there was heterogeneity across included studies with regards to factors examined and most were conducted in the USA. There were also several methodological limitations to the included studies.Conclusions: Research examining FCR in caregivers of cancer survivors has predominantly focused on demographic and clinical factors. Given the paucity of research exploring the psychological mechanisms underpinning FCR, future research should investigate theoretical underpinnings of FCR in caregivers of cancer survivors to support the development of psychological interventions for this population.Systematic Review Registration: PROSPERO, identifier [CRD42019119729].

A qualitative exploration of fear of cancer recurrence in caregivers

“…Contrary to prior literature, 9,32 we found that many participants were in a constant state of planning and preparation for the "worstcase scenario" (i.e., the death of the patient). It is possible that this hypervigilant behavioural preparation was an attempt to compensate for a caregiver's sense of being cognitively and emotionally unprepared for the loss of the patient.…”

“…Meta‐analytic evidence suggests that 46% of caregivers experience FCR at levels that would be considered clinically significant in patient populations 8 . Three recent systematic reviews further suggest that caregivers experience FCR at levels equal to or higher than those they care for 8–10 . Smith and colleagues 10 proposed that, like distress, 11 there is a bidirectional relationship between patient and caregiver FCR.…”

“…than those they care for. [8][9][10] Smith and colleagues 10 proposed that, like distress, 11 there is a bidirectional relationship between patient and caregiver FCR. Hence, caregiver FCR may reduce both patient and caregiver QoL and exacerbate poorer patient health outcomes by reinforcing patient concerns or compromising the caregiver's ability to provide support.…”

Fear of progression and its associated factors in parents of children undergoing cancer treatment: A cross‐sectional study

“…Fear of progression (FoP), or fear of recurrence or relapse, is defined as the “fear that the illness will progress with all its biopsychosocial consequences, or that it will recur” 3 . FoP has been extensively studied in the past decades in both, adult cancer patients and their caregivers 4,5 ; however, little is known regarding the FoP among parents of children undergoing cancer treatment 6 …”

“…2 Fear of progression (FoP), or fear of recurrence or relapse, is defined as the "fear that the illness will progress with all its biopsychosocial consequences, or that it will recur". 3 FoP has been extensively studied in the past decades in both, adult cancer patients and their caregivers 4,5 ; however, little is known regarding the FoP among parents of children undergoing cancer treatment. 6 Dysfunctional levels of FoP have been observed in 48.3%-61.9% of parents of childhood cancer patients 6,7 ; this proportion is considerably higher than that in adult cancer patients and their partners.…”