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 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.
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|
5% to 9% with letrozole or placebo during median 10.6 years
|Colorectal17||17% after curative surgical resection with microscopically clear margins|
|Head and neck, stage IV18||After intensified, split-course, hyperfractionated multiagent chemoradiotherapy:
|Hodgkin lymphoma13,14||10% to 13% after primary treatment
20% to 50% after second-line treatment
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%|
|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
|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.
- Butow P, Sharpe L, Thewes B, Turner J, Gilchrist J, Beith J. Fear of cancer recurrence: a practical guide for clinicians. Oncology (Williston Park). 2018;32:32-38.
- Nabors LB, Portnow J, Baehring J, et al. Central Nervous System Cancers, Version 1.2018. NCCN Clinical Practice Guidelines in Oncology. March 20, 2018.
- Corrado G, Salutari V, Palluzzi E, Distefano MG, Scambia G, Ferrandina G. Optimizing treatment in recurrent epithelial ovarian cancer. Expert Rev Anticancer Ther. 2017;17:1147-1158. doi: 10.1080/14737140.2017.1398088
- Casali PG. Adjuvant chemotherapy for soft tissue sarcoma. Am Soc Clin Oncol Educ Book. 2015;e629-e633. doi: 10.14694/EdBook_AM.2015.35.e629
- Flaig TW, Spiess PE, Agarwal N, et al. Bladder Cancer, Version 5.2018. NCCN Clinical Practice Guidelines in Oncology. July 3, 2018.
- Nishio K, Kimura K, Amano R, et al. Preoperative predictors for early recurrence of resectable pancreatic cancer. World J Surg Oncol. 2017;15:16. doi: 10.1186/s12957-016-1078-z
- Fischer R, Breidert M, Keck T, Makowiec F, Lohrmann C, Harder J. Early recurrence of pancreatic cancer after resection and during adjuvant chemotherapy. Saudi J Gastroenterol. 2012;18:118-121. doi: 10.4103/1319-3767.93815
- Li S, Young KH, Medeiros LJ. Diffuse large B-cell lymphoma. Pathology. 2018;50:74-87. doi: 10.1016/j.pathol.2017.09.006
- Chihara D, Fanale MA, Miranda RN, et al. The survival outcome of patients with relapsed/refractory peripheral T-cell lymphoma-not otherwise specified and angioimmunoblastic T-cell lymphoma. Br J Haematol. 2017;176:750-758. doi: 10.1111/bjh.14477
- Goss PE, Ingle JN, Pritchard KI, et al. Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med. 2016;375:209-219. doi: 10.1056/NEJMoa1604700
- Brookman-May SD, May M, Shariat SF, et al. Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma–results from a comprehensive multi-centre database (CORONA/SATURN-Project). BJU Int. 2013;112:909-916. doi: 10.1111/bju.12246
- Cipriano C, Griffin AM, Ferguson PC, Wunder JS. Developing an evidence-based followup schedule for bone sarcomas based on local recurrence and metastatic progression. Clin Orthop Relat Res. 2017;475:830-838. doi: 10.1007/s11999-016-4941-x
- Townsend W, Linch D. Hodgkin’s lymphoma in adults. Lancet. 2012;380:836-847. doi: 10.1016/S0140-6736(12)60035-X
- Glimelius I, Diepstra A. Novel treatment concepts in Hodgkin lymphoma. J Internal Med. 2016;281:247-260. doi: 10.1111/joim.12582
- Alexander TB, Wang L, Inaba H, et al. Decreased relapsed rate and treatment-related mortality contribute to improved outcomes for pediatric acute myeloid leukemia on successive clinical trials. Cancer. 2017;123:3791-3798. doi: 10.1002/cncr.30791
- Colleoni M, Sun Z, Price KN, et al. Annual hazard rates of recurrence for breast cancer during 24 years of follow-up: results from the International Breast Cancer Study Group Trials I to V. J Clin Oncol. 2016;34:927-935. doi: 10.1200/JCO.2015.62.3504
- 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
- Brockstein B, Haraf DJ, Rademaker AW, et al. Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience. Ann Oncol. 2004;15:1179-1186. doi: 10.1093/annonc/mdh308
- Santini D, Santoni M, Conti A, et al. Risk of recurrence and conditional survival in complete responders treated with TKIs plus or less locoregional therapies for metastatic renal cell carcinoma. Oncotarget. 2016;7:33381-33390. doi: 10.18632/oncotarget.8302
- Hunger SP, Mullighan CG. Acute lymphoblastic leukemia in children. N Engl J Med. 2015;373:1541-1552. doi: 10.1056/NEJMra1400972
- Rockberg J, Amelio JM, Taylor A, Jörgensen L, Ragnhammar P, Hansson J. Epidemiology of cutaneous melanoma in Sweden—Stage-specific survival and rate of recurrence. Int J Cancer. 2016;139:2722-2729. doi: 10.1002/ijc.30407
- Maurizi G, D’Andrilli A, Ciccone AM, et al. Margin distance does not influence recurrence and survival after wedge resection for lung cancer. Ann Thorac Surg. 2015;100:918-924. doi: 10.1016/j.athoracsur.2015.04.064
- Ochiai S, Nomoto Y, Watanabe Y, et al. The impact of epidermal growth factor receptor mutations on patterns of disease recurrence after chemoradiotherapy for locally advanced non–small cell lung cancer: a literature review and pooled analysis. J Radiation Res. 2016;57:449-459. doi: 10.1093/jrr/rrw075
- Kurbegovic S, Berg KD, Thomsen FB, et al. The risk of biochemical recurrence for intermediate-risk prostate cancer after radical prostatectomy. Scand J Urol. 2017;51:450-456. doi: 10.1080/21681805.2017.1356369
- Haddad RI, Nasr C, Bischoff L, et al. Thyroid Carcinoma, Version 1.2018. NCCN Clinical Practice Guidelines in Oncology. May 22, 2018.
- Momin S, Chute D, Burkey B, Sscharpf J. Prognostic variables affecting primary treatment outcome for medullary thyroid cancer. Endocr Pract. 2017;23:1053-1058. doi: 10.4158/EP161684.OR