Predictors of fear of recurrence in patients one year after cancer rehabilitation: A prospective study

Background. Fear of cancer recurrence (FCR) or cancer progression is one of the most frequent distressing psychological symptoms in cancer patients. In contrast to anxiety disorders according to the ICD-10 or DSM-IV, FCR describes an emotional response to the real threat of a life-threatening illness. Elevated levels of FCR can become dysfunctional, causing considerable disruption in social functioning, and affect well-being and quality of life (QoL). We examined the prevalence and course of FCR in cancer patients during and after a rehabilitation program, and investigated associations between demographic, medical and psychosocial factors. We further aimed to identify predictors of FCR one year after cancer rehabilitation. Methods. A total of eligible N = 1281 patients (77.5% participation rate) were consecutively recruited on average 11 months post-diagnosis and assessed at the beginning (t(1)) (1148), at the end (t(2)) (1060) and 12 months after rehabilitation (t(3)) (n = 883). Participants completed validated measures assessing FCR, anxiety, depression, QoL, social support, and a range of cancer- and treatment-related characteristics. Results. At t(1) 18.1% of our sample was classified as having high levels of FCR and 66.6% showed moderate levels of FCR. Fear of recurrence decreased over time (p<0.001) (eta(2) = .095), however, at follow-up 17.2% of our sample showed high levels of FCR and 67.6% had moderate levels of FCR. Linear regression analysis (stepwise backward) including demographic, medical and psychosocial factors, revealed that lower social class, having skin cancer, colon cancer or hematological cancer, palliative treatment intention, pain and a higher number of physical symptoms, depression, lower social support and adverse social interactions predicted FCR one year after rehabilitation (R-2 adjusted = 0.34) (p<0.001). Conclusion. Our data provide evidence that elevated levels of FCR represent a continuing problem in cancer patients. The need to enhance cancer rehabilitation and survivorship programs including interventions tailored to specific problems such as FCR is emphasized.