Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Liverpool, UK.
Psychooncology. 2013 Apr;22(4):807-13. doi: 10.1002/pon.3069. Epub 2012 Mar 27.
Fear of recurrence (FoR) following head and neck cancer (HNC) treatment is a major patient concern but is infrequently discussed in outpatient settings and may cause significant detrimental effect on patient psychological well-being.
The aim of this paper is to determine longitudinal trends and predictors of significant FoR.
Prospective data collection was obtained in 189 post-treatment HNC patients with 456 clinic attendances from October 2008 to January 2011. All patients completed Patient Concerns Inventory (PCI), University of Washington Quality of Life Questionnaire version 4 and the FoR questionnaires using a combination of paper and touch-screen technology.
The prevalence of significant FoR was 35%, which was stable longitudinally. Logistic regression-delineated predictors of significant FoR were young age (<65 years), anxiety/mood and patient-reported FoR. Conventional prognostic factors including standard clinicopathological factors, treatment modality and length of follow-up did not predict significant FoR. Over time, 20% of patients reported significant FoR intermittently, whereas 30% experienced it consistently. The remaining 50% did not experience significant FoR.
Patient-related characteristics were more important than clinicopathological prognostic factors in predicting significant FoR, potentially creating a mismatch between the doctors' perception of patient's experience of FoR with what patients may experience. In the long term, FoR is expressed across a spectrum extending from 'normal' FoR to persistent significant FoR with an intermediate category of intermittent significant FoR. Those patients experiencing intermittent and consistent levels of significant FoR may benefit from psychological support. This study confirmed that self-reported screening FoR using the PCI is a valuable tool in identifying significant FoR.
头颈部癌症（HNC）治疗后对复发的恐惧（FoR）是患者主要关注的问题，但在门诊环境中很少讨论，可能会对患者的心理健康产生重大不利影响。
本文旨在确定 FoR 的纵向趋势和预测因素。
2008 年 10 月至 2011 年 1 月，前瞻性收集了 189 例 HNC 治疗后患者的资料，共进行了 456 次就诊。所有患者均完成了患者关注量表（PCI）、华盛顿大学生活质量问卷第 4 版和 FoR 问卷，使用纸质和触摸屏技术相结合的方式。
FoR 发生率为 35%，纵向来看是稳定的。逻辑回归确定的 FoR 显著预测因素是年龄较小（<65 岁）、焦虑/情绪和患者报告的 FoR。包括标准临床病理因素、治疗方式和随访时间在内的传统预后因素不能预测 FoR 显著。随着时间的推移，20%的患者间歇性报告 FoR 显著，30%的患者持续报告 FoR 显著。其余 50%的患者未经历 FoR 显著。
患者相关特征比临床病理预后因素更能预测 FoR 显著，这可能导致医生对患者 FoR 体验的看法与患者实际体验之间存在不匹配。从长远来看，FoR 表现为一个从“正常”FoR 到持续显著 FoR 的连续谱，并有间歇性显著 FoR 的中间类别。那些经历间歇性和持续显著 FoR 的患者可能会受益于心理支持。本研究证实，使用 PCI 进行自我报告的 FoR 筛查是识别显著 FoR 的一种有价值的工具。
