Cancer recurrence is a foremost concern of patients and their caregivers.1 Fear of recurrence can negatively affect quality of life, and approximately 7% of patients develop severe and disabling fear that includes constant intrusive thoughts and misinterpretation of mild and unrelated symptoms. It is important that clinicians discuss the fear of recurrence with their patients, which can be initiated by direct questions or through the use of a short questionnaire tool.

It is also important that clinicians discuss the risk of recurrence with the patient as this information can reduce the fear of recurrence among patients. Clinicians should discuss recurrence rates, signs and symptoms of recurrence, practices that can reduce the risk of recurrence, and the rationale behind follow-up or surveillance schedules.

Recurrence Rates

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Recurrence rates vary widely between cancer types, and within cancer types according to stage, histology, genetic factors, patient-related factors, and treatments. Many estimates of recurrence rates do not take into account newer treatment options, which is important to consider, particularly when new anticancer therapies are being continuously approved for multiple cancer types. Recurrence rates, therefore, should be viewed as estimates that can vary between individuals. A summary of estimated recurrence rates for select cancers are listed in Table 1.

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Cancers with High Recurrence Rates

Some cancers are difficult to treat and have high rates of recurrence. Glioblastoma, for example, recurs in nearly all patients, despite treatment.2 The rate of recurrence among patients with ovarian cancer is also high at 85%.3 Soft tissue sarcomas recur in approximately 50% of patients after adjuvant chemotherapy, and for most patients who are diagnosed in late stages, the rate of recurrence approaches 100%.4 Similarly, approximately 50% of patients with bladder cancer develop recurrence after cystectomy, and 36% to 46% of patients who undergo surgery with curative intent develop a recurrence of pancreatic cancer, despite adjuvant chemotherapy.5-7

For hematologic malignancies, the non-Hodgkin lymphoma subtype diffuse large B-cell lymphoma (DLBCL) recurs in 30% to 40% of patients and peripheral T-cell lymphoma (PTCL) in 75% of patients after primary treatment.8,9

Cancers with Low Recurrence Rates

Some cancers, particularly when treated in earlier stages, have low recurrence rates. Patients with estrogen receptor–positive breast cancer after initial treatment and during maintenance therapy experienced a recurrence rate of 5% to 9%.10 Recurrence of kidney cancer develops in approximately 13% of patients, and local recurrence of early-stage osteosarcoma is about 11% to 12%.11,12

Hodgkin lymphoma has a high cure rate with primary treatment with multiagent chemotherapy, with a recurrence rate of 10% to 13%.13 For patients who relapse, the recurrence rate after second-line therapy is 20% to 50%.14 Low-risk childhood acute myeloid leukemia demonstrates low recurrence rates beginning at 9%.15

Table 1. Recurrence Estimates of Selected Cancers

Cancer Type Recurrence Rate
Bladder5 50% after cystectomy
Breast10,16

30% overall

5% to 9% with letrozole or placebo during median 10.6 years
Colorectal17 17% after curative surgical resection with microscopically clear margins
Glioblastoma2 Nearly 100%
Head and neck, stage IV18

After intensified, split-course, hyperfractionated multiagent chemoradiotherapy:

17%, locoregional

22%, distant
Hodgkin lymphoma13,14

10% to 13% after primary treatment

20% to 50% after second-line treatment
Kidney11,19

13%

49% after complete response to tyrosine kinase inhibitor therapy
Leukemia, childhood ALL20 15% to 20%
Leukemia, childhood AML15 9% to 29%, depending on risk
Lymphoma, DLBCL8 30% to 40%
Lymphoma, PTCL9 75%
Melanoma21

15% to 41%, depending on stage

87%, metastatic disease
NSCLC22,23

26% after curative surgery

27% after chemoradiotherapy for locally advanced disease
Osteosarcoma12

11%-12% local recurrence

5%-45% metastasis
Ovarian3 85%
Pancreas6,7

36% within 1 year after curative surgery

38% local recurrence after adjuvant chemotherapy

46% distant metastasis after adjuvant chemotherapy
Prostate24

After prostatectomy at 10 years:

24% low-risk disease

40% intermediate-risk disease

48% high-risk disease
Soft tissue sarcoma4

50% after adjuvant chemotherapy

Nearly 100% for advanced disease
Thyroid25,26

Up to 30% for differentiated thyroid carcinoma

8%-14% after surgery for medullary thyroid carcinoma

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; DLBCL, diffuse large B-cell lymphoma; PTCL, peripheral T-cell lymphoma; NSCLC, non-small cell lung cancer.

Correction: This article was updated on 4/18/19 to correct the recurrence rate for DLBCL.

References

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  17. Pugh SA, Shinkins B, Fuller A, et al. Site and stage of colorectal cancer influence the likelihood and distribution of disease recurrence and postrecurrence survival: data from the FACS randomized controlled trial. Ann Surg. 2016;263:1143-1147. doi: 10.1097/sla.0000000000001351
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Fact Sheet General Oncology