Department of Psychology, Concordia University, Montréal, Québec, Canada.
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
JAMA Netw Open. 2024 Oct 1;7(10):e2436144. doi: 10.1001/jamanetworkopen.2024.36144.
Fear of cancer recurrence is common among survivors of adult-onset cancer and associated with increased distress, functional impairment, and health care utilization. However, little is known about the prevalence and risk factors of fear of cancer recurrence among adult survivors of childhood cancer who are also at high risk for subsequent malignant neoplasms.
To characterize the prevalence of and risk factors for clinically significant fear of cancer recurrence in adult survivors of childhood cancer.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional investigation included participants recruited from the Childhood Cancer Survivor Study, a retrospective cohort study of long-term childhood cancer survivors treated at 31 institutions between 1970 and 1999 across North America. Participants were recruited and completed psychosocial measures via online survey between October 2018 and April 2019. Cancer and treatment-related variables were abstracted from medical records. Data were analyzed from May 2023 to July 2024.
Clinically significant fear of cancer recurrence was assessed via the Fear of Cancer Recurrence Inventory-Short Form. Poisson regression models estimated prevalence ratios (PRs) with 95% CIs adjusted for age and sex to examine the associations of demographic, disease, treatment, and psychosocial variables with fear of cancer recurrence.
The final sample included 229 adult survivors of childhood cancer (115 female [50.2%]; mean [SD] age, 39.6 [9.9] years; mean [SD] time since diagnosis, 31.7 [8.4] years). Among survivors, 38 (16.6%; 95% CI, 11.6%-21.6%) reported clinically significant fear of cancer recurrence, and an additional 36 (15.7%) reported high fear of cancer recurrence. Clinically significant fear of cancer recurrence was associated with unemployment (PR, 2.5; 95% CI, 1.3-4.8), presence of neurologic chronic health conditions (PR, 3.3; 95% CI, 1.8-6.1), treatment with pelvic radiation (PR, 2.9; 95% CI, 1.5-5.6), and amputation or limb sparing surgery (PR, 2.4; 95% CI, 1.2-4.9). Higher risk of clinically significant fear of cancer recurrence was also associated with having either elevated anxiety or depression (PR, 2.6; 95% CI, 1.2-5.9), having both elevated (PR, 3.2; 95% CI, 1.2-8.4), and perceived poor health status (PR, 3.0; 95% CI, 3.1-9.7).
Decades following treatment, one-third of childhood cancer survivors in this study reported elevated fear their cancer will recur or a subsequent malignant neoplasm will develop. Findings suggest that fear of cancer recurrence should be routinely screened, and clinically significant symptoms intervened upon as a part of survivorship care.
癌症复发恐惧是成年癌症幸存者常见的问题，并与增加的痛苦、功能障碍和医疗保健利用有关。然而，对于在儿童期癌症后也有很高风险发生后续恶性肿瘤的成年幸存者中，癌症复发恐惧的流行率和风险因素知之甚少。
描述儿童期癌症成年幸存者中临床显著的癌症复发恐惧的流行率和风险因素。
设计、地点和参与者：这是一项横断面调查，参与者来自北美 31 个机构的 31 个机构的儿童癌症幸存者研究，这是一项对 1970 年至 1999 年期间治疗的长期儿童癌症幸存者进行的回顾性队列研究。参与者通过在线调查于 2018 年 10 月至 2019 年 4 月期间招募并完成心理社会措施。癌症和治疗相关变量从病历中提取。数据分析于 2023 年 5 月至 2024 年 7 月进行。
临床显著的癌症复发恐惧通过癌症复发恐惧量表-短表进行评估。泊松回归模型估计了调整年龄和性别后的患病率比 (PR)，以 95%CI 来评估人口统计学、疾病、治疗和心理社会变量与癌症复发恐惧的关联。
最终样本包括 229 名儿童期癌症成年幸存者（115 名女性 [50.2%]；平均 [标准差] 年龄，39.6 [9.9] 岁；平均 [标准差] 诊断后时间，31.7 [8.4] 年）。在幸存者中，38 名（16.6%；95%CI，11.6%-21.6%）报告了临床显著的癌症复发恐惧，另有 36 名（15.7%）报告了高度的癌症复发恐惧。临床显著的癌症复发恐惧与失业（PR，2.5；95%CI，1.3-4.8）、存在神经慢性健康状况（PR，3.3；95%CI，1.8-6.1）、接受盆腔放射治疗（PR，2.9；95%CI，1.5-5.6）和截肢或肢体保留手术（PR，2.4；95%CI，1.2-4.9）有关。较高的临床显著癌症复发恐惧风险还与焦虑或抑郁升高有关（PR，2.6；95%CI，1.2-5.9）、焦虑和抑郁均升高（PR，3.2；95%CI，1.2-8.4）和感知健康状况较差有关（PR，3.0；95%CI，3.1-9.7）。
在治疗后几十年，本研究中三分之一的儿童期癌症幸存者报告说，他们的癌症复发或随后发生恶性肿瘤的恐惧增加。研究结果表明，应该常规筛查癌症复发恐惧，并且对临床显著的症状进行干预，作为生存护理的一部分。
