Fear of Cancer Recurrence or Progression: What Is It and What Can We Do About It?

Abstract

Patients with cancer face a trajectory marked by emotional and physical distress that can be associated with both diagnosis and treatment. Fear of cancer recurrence or progression has been considered one of the most common unmet needs reported by patients diagnosed with both localized and metastatic disease. Fear of cancer recurrence or progression has been defined as the “fear, worry, or concern relating to the possibility that cancer will come back or progress.” Often overlooked by health care teams, fear of cancer recurrence or progression has been associated with impaired quality of life and psychosocial adjustment, elevated emotional distress, and a range of physical symptoms. Several interventions for fear of cancer recurrence or progression are currently under investigation. Early recognition, support, and validation of feelings associated with fear of cancer recurrence or progression, and appropriate referrals to psychosocial oncology, can be beneficial for many patients. Assessing patients early in their cancer trajectory, and at important milestones, including a change in therapies, at the end of active treatment, and during follow-up visits, can help identify individuals at risk and help individuals engage in supportive programs.

Evaluation of the validity and screening performance of a revised single‐item fear of cancer recurrence screening measure (FCR‐1r)

“…10,11 Apart from younger age, female gender, and experience of physical/psychological symptoms, there are few demographic and clinical variables reliably associated with FCR to guide identification in clinical practice. 2,4,12 Most health professionals are not trained to assess or manage FCR, leading to infrequent referral to psychosocial staff and considerable difficulties helping patients manage FCR in clinical health professionals. 13 The 9-item FCRI-SF 14 is the most widely validated and used FCR screening tool in research.…”

“…Cancer survivors may be reluctant to raise FCR, for fear of seeming ungrateful and damaging the doctor‐patient relationship by questioning the efficacy of their treatment 10,11 . Apart from younger age, female gender, and experience of physical/psychological symptoms, there are few demographic and clinical variables reliably associated with FCR to guide identification in clinical practice 2,4,12 . Most health professionals are not trained to assess or manage FCR, leading to infrequent referral to psychosocial staff and considerable difficulties helping patients manage FCR in clinical health professionals 13 …”

The COMFORT trial: a randomised control trial comparing group-based COMpassion-FOcussed therapy and breathing pattern ReTraining with treatment as usual on the psychological functioning of patients diagnosed with cancer recurrence during COVID

“…A cancer diagnosis may create a state of mental anguish that is sometimes more punishing than the physical presence of the disease itself [2]. Fear of recurrence (FoR) is a well-documented, distressing consequence of cancer [3][4][5]. A diagnosis of recurrent or metastatic disease is regularly associated with reduced psychological well-being, the recovery from which is often slower than after the initial diagnosis [6].…”

The COMFORT Trial: A randomised control trial comparing group-based COMpassion FOcused Therapy and breathing pattern ReTraining with Treatment As Usual on the psychological functioning of patients diagnosed with cancer recurrence during COVID.

“…A cancer diagnosis may create a state of mental anguish that is sometimes more punishing than the physical presence of the disease itself [2]. Fear of recurrence (FoR) is a well-documented, distressing consequence of cancer [3][4][5]. A diagnosis of recurrent or metastatic disease is regularly associated with reduced psychological wellbeing, the recovery from which is often slower than after the initial diagnosis [6].…”