Trajectories of fear of cancer recurrence in young breast cancer survivors

Abstract

Background Fear of cancer recurrence (FCR) is more intense in younger women. Because FCR is a powerful determinant of quality of life, identifying those at risk for persistently elevated FCR can inform timing of interventions. Methods A total of 965 women with stage 0 to stage III breast cancer enrolled in the Young Women's Breast Cancer Study, a prospective cohort of women diagnosed with breast cancer at age ≤40 years, completed the 3‐item Lasry Fear of Recurrence Index. Group‐based trajectory modeling was used to classify distinct FCR patterns from baseline through 5 years post‐diagnosis. Multinomial logistic regression was used to identify patient, disease, and treatment characteristics associated with each trajectory. Results Five FCR trajectories were identified with the majority of participants having moderate (33.1%) or high FCR (27.6%) that improved over time. A total of 6.9% participants had moderate FCR that worsened, whereas 21.7% had high FCR at baseline that remained high throughout. In the fully adjusted multinomial model, stages II and III (vs stage I) were associated with lower odds (of being in the high/stable trajectory). White (vs non‐White) were associated with higher odds of being in a trajectory that improved over time. Conclusions Although FCR improves over time for many young women with breast cancer, approximately one‐third had FCR that was severe and did not improve or worsened over 5 years after diagnosis. Ongoing monitoring is warranted, with early referral to mental health professionals indicated for those at highest risk for unresolved FCR. Lay Summary Fear of recurrence is common among young women with breast cancer. The authors followed a large cohort of young women diagnosed with breast cancer when they were 40 years of age and younger, and found 5 distinct trajectories that show moderate and severe fears do not always improve over time and may require targeted mental health intervention.

Trajectories of quality of life in breast cancer survivors during the first year after treatment: a longitudinal study

“…In particular, unlike the moderate and high QOL groups, the consistently low QOL group showed significantly decreased QOL scores six months after treatment (T3). In addition, some breast cancer patients feel vulnerable in terms of physical, psychological, social, and spiritual aspects throughout the lengthy recovery process, even after completing medical treatment [ 2 ]. Considering that the QOL one year after the end of primary treatment is essential in determining the QOL as a breast cancer survivor, strategies are needed to periodically identify QOL for high-risk groups using a standardized questionnaire during this period [ 30 ].…”

“…This is similar to a previous study that followed up 126 breast cancer patients before chemotherapy to 12 months after chemotherapy completion [ 30 ] and reported that the higher the psychological distress, such as depression and anxiety, the lower the QOL. Breast cancer patients may experience anxiety about health, misunderstanding of physical symptoms, anxiety, uncertainty about cancer recurrence, depression, and fatigue after treatment is completed [ 2 , 31 ]. Psychological distress has a direct impact on the patient's ability to return to life or return to work [ 32 ], as well as negligent self-management to prevent recurrence [ 31 ].…”

“…Breast cancer is increasing worldwide, ranking second among cancers occurring in women in Korea [ 1 ]. However, the survival rate of breast cancer patients has been increasing with the development of screening and adjuvant therapies in the past few decades [ 2 ]. Moreover, while the incidence of breast cancer is high in women aged 50 or older in foreign countries, in Korea, breast cancer is diagnosed most frequently in women in their 40 s (39.9%), which means that these women live for a longer time as breast cancer survivors after the completion of treatment [ 1 ].…”

Fear of Cancer Recurrence 7 Scale Tamil Translation and Validation among Breast Cancer Survivors in India

“…While considering the median of FCR, it was found that around half of the BCSv experienced more FCR during their survivorship period, which is similar to the studies by Schapira et al . [ 15 ] where it was reported that the majority of the population had reported moderate to high FCR, however, which was fluctuating over a while.…”

Social Support and Fear of Cancer Recurrence Among Chinese Breast Cancer Survivors: The Mediation Role of Illness Uncertainty

“…Fear of cancer recurrence is defined as the “fear, worry, or concern about cancer returning or progressing ( Lebel et al, 2016 ).” In a study of 240 breast cancer survivors in China, a total of 159 breast cancer survivors (76.81%) were found to have experienced high levels of FCR, characterized by lower functional and overall health than survivors with a low FCR ( Peng et al, 2019 ). According to Schapira et al’s (2022) study of breast cancer survivors’ FCR trajectories confirmed that although some breast cancer survivors’ FCR improves over time, approximately one-third of breast cancer survivors’ FCR remains severe, even within 5 years of diagnosis. Cancer survivors experiencing FCR primarily present with hypervigilance to changes in physical symptoms and may lead to increased healthcare utilization, resulting in increased personal financial burden and waste of public healthcare resources ( Vachon et al, 2021 ).…”