Fear of cancer recurrence eight years after early-stage breast cancer – results from a national survey

Abstract

Background

Fear of cancer recurrence (FCR) in breast cancer survivors (BCSs) is common, associated with reduced quality of life and effective interventions exist. There are knowledge gaps concerning FCR among long-term, early-stage BCSs and its associations with other late effects. Within a national cohort, we explored these knowledge gaps, with the ultimate aim of improved care for BCSs experiencing long-term FCR.

Methods

In this cross-sectional study, all BCSs aged 20–65 years with early-stage breast cancer in 2011–2012 (n = 2803), were identified by the Cancer Registry of Norway in 2019 and mailed a survey including the Assessment of Survivor Concerns used to measure FCR. Factors associated with moderate/high FCR (defined as a sum score of ≥ 6 of a possible range 3–12, or a single score on one of the items of ≥ 3) were explored using a three-block regression analyses including relevant sociodemographic-, health- and cancer-related variables.

Results

In total, 1311 BCSs were included (47%). Median age at survey was 60 years. Fifty-six % reported moderate-to-high FCR, associated with younger age (OR 0.96, 95% CI 0.95–0.97) and receiving chemo- and endocrine therapy (OR 1.59, 95% CI 1.15–2.20). After adding late effects into the model, FCR remained significantly associated with these variables, in addition to sleep disturbances (OR 1.58, 95% CI 1.18–2.10). In the final block, adding mental distress, FCR remained significantly associated with younger age (OR 0.97, 95% CI 0.96–0.99), receiving chemo- and endocrine therapy (OR 1.14, 95% CI 1.00–1.97), sleep disturbances (OR 1.44, 95% CI 1.08–1.94) and anxiety (OR 2.67, 95% CI 1.38–5.19).

Conclusions

FCR was prevalent eight years after early-stage breast cancer. Being younger, receiving intensive treatment, experiencing sleep disturbances and/or anxiety were associated with moderate/high FCR. Addressing FCR should be part of standard follow-up care of long-term BCSs.

Keywords:

• Fear of cancer recurrence
• breast cancer
• long-term survivorship
• late effects after breast cancer

Author contributions

Study concept and design: KVR and KV; acquisition of data: KVR, KV; statistical analysis: SS, SB, KV, RSF, HCL, KVR; interpretation of data: KV, KVR, SB, HCL, RSF, SS, CK. drafting of the paper: KV; critical revision of the paper for important intellectual content: KV, KVR, SB, HCL, RSF, SS, CK.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, KV. All data are available at the National Advisory Unit for Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, the Radium Hospital, Oslo, Norway. The data are not publicly available due to restrictions e.g. their containing information that could compromise the privacy of research participants.

Additional information

Funding

This study was funded by the Pink Ribbon Movement and Norwegian Breast Cancer Society through Grant No. 197255.