Relations between recurrence risk perceptions and fear of cancer recurrence in breast cancer survivors

Abstract

Purpose This study aimed to: (1) determine the accuracy of Dutch breast cancer survivors’ estimations of the locoregional recurrence risk (LRR); (2) examine which variables influence (the accuracy of) risk estimations, and risk appraisals; and (3) investigate the influence of the objective LRR risk (estimated using the INFLUENCE-nomogram), risk estimations and risk appraisals on fear of cancer recurrence (FCR). Findings of this study will inform clinicians on risk communication and can improve communication about FCR. Methods In a cross-sectional survey among 258 breast cancer survivors, women’s recurrence risk estimations (in odds) and risk appraisals (in high/low), FCR, demographics and illness perceptions, about one year after surgery were measured and compared to the objective risk for LRRs estimated using the INFLUENCE-nomogram. Results Half of the women (54%) accurately estimated their LRR risk, 34% underestimated and 13% overestimated their risk. Risk estimations and risk appraisals were only moderately positively correlated (r = 0.58). Higher risk appraisals were associated with radiotherapy (r = 0.18) and having weaker cure beliefs (r = − 0.19). Younger age was associated with overestimation of risk (r = − 0.23). Recurrence risk estimations and risk appraisals were associated with more FCR (r = 0.29, r = 0.39). In regression, only risk appraisal contributed significantly to FCR. Conclusion Although women were fairly accurate in recurrence risk estimations, it remains difficult to predict over- or underestimation. Recurrence risk estimations and risk appraisal are two different concepts which are both associated with FCR and should therefore be addressed in patient-provider communication.

Is de-escalation of treatment by omission of radiotherapy associated with fear of cancer recurrence in women with early breast cancer? An exploratory study

“…For instance, stronger beliefs about personal control over BC are related to fewer worries about whether cancer has been cured [ 21 ] and ideas about the chronicity, consequences, and emotional representation of BC have been associated with FCR [ 22 ]. Perceived risk of recurrence and appraisal of that risk are a key part of illness representations and are also associated with FCR [ 22 , 23 ]. Future studies would benefit from including these variables.…”

Associations between empirically proportionate and disproportionate fears of cancer recurrence and anxiety and depression in uveal melanoma survivors: Five‐year prospective study

“…FCR is not completely veridical to objective risk (Ankersmid et al, 2022). Instead, it can conceptually be seen to exist on a spectrum of proportionality (Pradhan et al, 2021).…”

“…An implication of this focus on subjectivity is that fears based on falsehoods carry similar implications to those based on truths. Empirically, disproportionately high FCR can be demonstrated by studies showing high rates of FCR in cancers where the population risk of recurrence is low (e.g., Ankersmid et al, 2022;Bell et al, 2017;Maguire et al, 2018;Magnani et al, 2022;Smith et al, 2018). In one of these studies, disproportionately high fear is associated with poorer quality of life (Maguire et al, 2018).…”

“…Experimental manipulations emphasizing objectively presented threats have powerful effects on both perceptions of the likelihoods of negative events and emotional arousal, whereas manipulations that do not emphasize evidence are less likely to do this because they primarily influence perceptions of threat severity (Elsey & Kindt, 2021;Klemm et al, 2019). In terms of cancer, FCR and anxiety and depression are greater in cancers objectively known to carry a higher recurrence risk (Ankersmid et al, 2022;Brown et al, 2021;Gormley et al, 2021;Savard & Ivers, 2013). However, there is little evidence to suggest that FCR is more likely to develop into anxiety and depression in those who know that they are objectively at greater recurrence or progression risk.…”