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

Figures & data

Table 1. Characteristics of the study sample of long-term breast cancer survivors, according to the presence of moderate/high fear of cancer recurrence or not* (n = 1311).

	All BCSs		High FCR		No high FCR
	n	%	n	%	n	%
	1311	100	737	56.2	574	43.8
Demographic and somatic health variables
Age at survey, years, mean (SD)	59.8	8.7	58.5	8.7	61.5	8.3
Living with partner	960	73.2	542	73.5	418	72.8
Education >12 y	676	51.6	378	51.3	298	51.9
Somatic co-morbidity
1-2 conditions	712	54.3	401	54.4	311	54.2
≥ 3 conditions	309	23.6	180	24.4	129	22.5
Clinical variables
Stage 1	589	44.9	298	40.4	291	50.7
Stage 2	472	36.0	281	38.1	191	33.3
Stage 3	102	7.8	68	9.2	34	5.9
Systemic treatment burden
No systemic treatment	234	17.8	101	13.7	133	23.2
Endocrine (E) treatment only	166	12.7	83	11.3	83	14.5
Chemotherapy (C) only	220	16.8	124	16.8	96	16.7
C + E therapy	679	51.8	421	57.1	258	44.9
Surgical treatment
Breast conserving	775	59.1	408	55.4	367	63.9
Mastectomy	536	40.9	329	44.6	207	36.1
Radiation therapy	1055	80.5	584	79.2	471	82.1
Late effects
Cognitive dysfunction^a	565	43.1	367	49.8	198	34.5
Fatigue^b	538	41.0	358	48.6	180	31.4
Pain^c	607	46.3	390	52.9	217	37.8
Sleep disturbances^d	444	33.9	301	40.8	143	24.9
Arm problems^e	414	31.6	278	37.7	136	23.7
Breast problems^e	305	23.3	206	28.0	99	17.2
Mental distres
Anxiety^f	94	7.2	81	11.0	13	2.3
Depression^g	240	18.3	184	25.0	56	9.8

BCSs: breast cancer survivors; FCR: fear of cancer recurrence; *moderate/high FCR: an ASC sum score of ≥ 6, or a single score on one of the items of ≥ 3; BCSs: breast cancer survivors; SD: standard deviation. ^adefined as EORTC QLQ-C30 score above below 75, ^bdefined as EORTC QLQ-C30 score above 39, ^cdefined as a EORTC QLQ-C30 score above 25, ^ddefined as a EORTC QLQ-C30 score above 50, ^edefined as 3 (quite a bit) or 4 (very much) for at least one of the items within each scale of BR-23, ^fdefined as a sum score ≥ 10 on the General Anxiety Disorder 7-item scale, ^gdefined as a sum score ≥ 10 on the Patient Health Questionnaire -9.

Table 2. Assessment of Survivor Concerns (ASC) including sub scales for cancer worry and health worry with response alternatives among long term breast cancer survivors (n = 1311)*.

ASC items	Sub scale	Not at all (1)	A little bit (2)	Somewhat (3)	Very much (4)
I worry about:		n (%)	n (%)	n (%)	n (%)
1. Future medical tests?	Cancer worry	629 (48.0)	515 (39.3)	119 (9.1)	48 (3.7)
2. Another cancer illness?	Cancer worry	287 (21.9)	673 (51.3)	225 (17.2)	126 (9.6)
3. Disease recurrence?	Cancer worry	244 (18.6)	662 (50.5)	264 (20.1)	141 (10.8)
4. Dying?*	Health worry	561 (42.8)	520 (39.7)	143 (10.9)	83 (6.3)
5. General health?*	Health worry	237 (18.1)	689 (52.6)	259 (19.8)	122 (9.3)

*missing = 4 for item 4 and 5.

Table 3. Univariable and hierarchical multivariable logistic regression analyses assessing associations between age, cancer treatment, somatic late effects and mental distress and moderate/high fear of cancer recurrence as dependent variable (n = 1215).

	Univariable analysis			Multivariable analysis, block 1			Multivariable analysis, block 1-2			Multivariable analysis, block 1-3
	OR	95% CI	P	OR	95% CI	P	OR	95% CI	P	OR	95% CI	P
Block 1
Age (years)	0.96	0.95–0.97	<.001	0.96	0.95–0.98	<.001	0.97	0.95–0.98	<.001	0.97	0.96–0.99	<.001
Endocrine (E) therapy*	1.32	0.88–1.96	0.18	1.42	0.93–2.16	0.11	1.39	0.91–2.14	0.13	1.34	0.87–2.07	0.18
Chemotherapy (C)*	1.70	1.17–2.47	0.01	1.36	0.91–2.03	0.13	1.31	0.87–1.97	0.20	1.28	0.85–1.93	0.24
C + E therapy*	2.15	1.59–2.91	<.001	1.59	1.15–2.20	0.01	1.42	1.02–1.99	0.04	1.40	1.00–1.96	0.05
Block 2
Cognitive dysfunction^a	1.89	1.51–2.37	<.001				1.06	0.79–1.42	0.72	0.98	0.73–1.33	0.91
Fatigue^b	2.08	1.66–2.61	<.001				1.16	0.84–1.61	0.36	1.08	0.78–1.51	0.64
Pain^c	1.86	1.49–2.32	<.001				1.29	0.97–1.73	0.08	1.27	0.95–1.71	0.11
Sleep disturbances^d	2.09	1.64–2.66	<.001				1.58	1.18–2.10	<0.001	1.44	1.08–1.94	0.01
Arm problems^e	1.97	1.54–2.52	<.001				1.28	0.95–1.73	0.10	1.23	0.91–1.65	0.19
Breast problems^e	1.91	1.45–2.50	<.001				1.23	0.9–1.70	0.20	1.18	0.86–1.63	0.31
Block 3
Anxiety^f	5.30	2.92–9.63	<.001							2.67	1.38–5.19	<0.01
Depression^g	3.08	2.23–4.25	<.001							1.45	0.97–2.16	0.07

CI: confidence interval; OR: odds ratio; P: p-value, significant associations highlighted in bold; *reference: no systemic treatment. ^adefined as EORTC QLQ-C30 score above below 75, ^b defined as EORTC QLQ-C30 score above 39, ^cdefined as a EORTC QLQ-C30 score above 25, ^ddefined as a EORTC QLQ-C30 score above 50, ^edefined as 3 (quite a bit) or 4 (very much) for at least one of the items within each scale of BR-23 ^fdefined as a sum score ≥ 10 on the General Anxiety Disorder 7-item scale, ^gdefined as a sum score ≥ 10 on the Patient Health Questionnaire -9.

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.