Measuring Justifiable Fear

While more systematic research may be required, studies to date indicate that survivors are more vulnerable to FOCR if they are younger in age. These fears also have been linked to physical symptoms, such as fatigue or treatment-related side effects, as well as psychological symptoms such as anxiety or depression, according to the review of 130 studies published in the Journal of Cancer Survivorship.1

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Screening methodologies range from just a few questions to longer formats. One recent study involving 318 cancer patients at Massachusetts General Hospital, Boston, took a FOCR snapshot with a single item of feedback. The patients, who had a curable cancer and had either already or nearly wrapped up treatment, were asked to respond on a 4-point scale to this statement: “I worry about my cancer coming back.” Overall, 53% of the participants reported notable levels of FOCR, and those individuals were more likely to be female and aged younger than 70 years.4

There also appears to be a negative interaction between physical and mental maladies, as outlined in a study published in 2017 in Supportive Care in Cancer.5 Through a series of assessments with 67 adult cancer survivors, researchers found that physical symptoms appeared to amplify survivors’ fear of recurrence.

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“What the model suggested to us was that pain, fatigue, GI symptoms might be triggering these fears in cancer survivors,” said Daniel Hall, PhD, a clinical health psychologist involved with the study and a postdoctoral fellow at Harvard Medical School. “And that level of fear of recurrence, in return, is associated with greater stress.”

That amplified stress might further aggravate an individual’s physical symptoms, Dr Hall added. “This suggests to us that stress management for cancer survivors might be more effective if it also addresses fear of recurrence.”