Among cancer survivors, the fear of cancer recurrence (FCR) is common, affecting up to 59% of cancer survivors. Defined as fear, worry, or concern about cancer returning or progressing, FCR causes near‐daily distress or impairment among cancer survivors. Because FCR can be associated with unhealthy behaviors that negatively affect survivors’ psychological, financial, and clinical outcomes, it is essential that clinicians be aware of and screen for FCR and that patients receive appropriate treatment, when indicated.
In an interview published in Harvard Gazette, Daniel Hall, PhD, a clinical psychologist and researcher in the Health Promotion and Resiliency Intervention Research (HPRIR) Center at Mass General, discusses the fear of cancer recurrence and provides practical information for patients and clinicians on how to recognize and manage FCR. Hall comments, “When patients are left on their own to make meaning out of ambiguous symptoms, they understandably tend to frame the symptoms as a threat.”
Hall also discusses the consequences of non-recognition, including increased alcohol use, reduced physical activity, and either unscheduled, avoidance of recommended surveillance – factors that can negatively affect outcomes. In the United States, one in three women and one in two men will be diagnosed with cancer at some point in their lifetime. Despite the high prevalence of cancer in the US and high rates of FCR, we lack consistent guidelines advising clinicians on the recognition and management of FCR.
In a consensus statement published in Cancer, Hall and colleagues raise concerns about the lack of guidelines for the diagnosis and management of FCR in the United States. The most recent American Society of Clinical Oncology (ASCO) Educational Book highlights the need for early and effective intervention for FCR and details how, if left unmanaged, FCR can persist for years and increases vulnerability to anxiety and depression; however, guidelines for FCR management are not included in the 2023 ASCO update and continue to be unaddressed in other guidelines.
This report makes the following points and recommends that all cancer survivors should be screened for FCR, irrespective of recurrence risk:
- FCR can be easily and quickly identified with brief screening instruments.
- Because “scanxiety” is common before, during, and after cancer surveillance, screening should occur at multiple points along the cancer diagnosis and treatment trajectory.
- Clinicians should be aware that younger survivors often experience higher levels of FCR.
- Counterintuitively, FCR is largely independent of cancer site, stage, and time since diagnosis.
- If clinically elevated FCR persists (i.e., ≥3 months), a psychiatric diagnosis may be considered as part of either stepping up or matching a survivor to more intensive care.
Read More
Helping Patients Cope with Fear of Cancer Recurrence (Harvard Gazette)
Hall DL, Wagner LI, Lebel S, Smith AB, Bergerot CD, Park ER. Guidelines needed for the management of fear of cancer recurrence in adult survivors of cancer in the United States: A consensus statement. Cancer. 2024 Aug 15; 130(16):2739-2742.
