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Does fear of cancer recurrence predict cancer survivors' health care use?

Supportive Care in Cancer volume 21, pages 901–906 (2013)Cite this article

Abstract

Introduction

Fear of cancer recurrence (FCR) is the most frequently cited unmet need among cancer survivors. Theoretical models of FCR suggest that patients with elevated levels of FCR will more frequently consult health care professionals for reassurance about their health. However, the relationship between FCR and health care utilization has not yet been firmly established. We examined the relationship between FCR and quantity of medications, number of emergency room (ER) visits, outpatient visits, specialist visits, allied health visits, and hospital overnight visits.

Methods

A total of 231 participants diagnosed with breast, colon, prostate, or lung cancer in the past 10 years were recruited from a cancer survivor registry. Participants were sent a survey package that included demographic and medical characteristics, a health care utilization questionnaire, and the Fear of Cancer Recurrence Inventory.

Results

A multiple regression analysis indicated that higher FCR significantly predicted greater number of outpatient visits in the past 6 months (ß = .016, F(1, 193) = 5.08, p = .025). A hierarchical multiple regression indicated that higher FCR significantly predicted greater number of ER visits in the past 6 months when controlling for relationship status and education level (F(1, 179) = 4.00, p = .047).

Conclusions

The relationship between FCR and health care use has been understudied. Results indicate that patients with elevated FCR may indeed use more health care services. We recommend that clinicians monitor health care use in patients who are struggling with FCR.

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References

  1. Baker F, Denniston M, Smith T, West MM (2005) Adult cancer survivors: how are they faring? Cancer 104(S11):2565–2576

    PubMed  Article  Google Scholar 

  2. Simard S, Savard J (2009) Fear of cancer recurrence inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer 17(3):241–251

    PubMed  Article  Google Scholar 

  3. Lebel S, Rosberger Z, Edgar L, Devins GM (2007) Comparison of four common stressors across the breast cancer trajectory. J Psychosom Res 63(3):225–232

    PubMed  Article  Google Scholar 

  4. Llewellyn CD, Weinman J, McGurk M, Humphris G (2008) Can we predict which head and neck cancer survivors develop fears of recurrence. J Psychosom Res 65(6):525–532

    PubMed  Article  Google Scholar 

  5. Vickberg SM (2003) The concerns about recurrence scale (CARS): a systematic measure of women's fears about the possibility of breast cancer recurrence. Annals Behav Med 25(1):16–24

    Article  Google Scholar 

  6. Barsky AJ, Ettner SL, Horsky J, Bates DW (2001) Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care 39(7):705–715

    PubMed  Article  CAS  Google Scholar 

  7. Lee-Jones C, Humphris G, Dixon R, Hatcher MB (1997) Fear of cancer recurrence: a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psycho-Oncol 6(2):95–105

    Article  CAS  Google Scholar 

  8. Easterling DV, Leventhal H (1989) Contribution of concrete cognition to emotion: neutral symptoms as elicitors of worry about cancer. J Appl Psychol 74:787–796

    PubMed  Article  CAS  Google Scholar 

  9. Glynne-Jones R, Chait I, Thomas F (1997) When and how to discharge cancer survivors in long term remission from follow-up: the effectiveness of a contract. Clin Oncol 9:25–29

    Article  CAS  Google Scholar 

  10. Maszczakiewicz E, Jolicoeur L, Lebel S, Lefevbre M (2009) Fear of recurrence and its effects on patient satisfaction with follow-up after primary therapy for endometrial cancer. Annual Meeting of the Canadian Association of Psychosocial Oncology, Vancouver, Canada, April 1–4, 2009

  11. Thomas SF, Glynne-Jones R, Chait I, Marks DF (1997) Anxiety in long term cancer survivors influences the acceptability of planned discharge from follow-up. Psycho-Oncol 6:190–197

    Article  CAS  Google Scholar 

  12. Thewes B, Butow P, Bell ML, Beith J, Stuart-Harris R, Grossi M, Capp A, Dalley D, the FCR Study Advisory Committee (2011) Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours. Support Care Cancer. doi:10.1007/s00520-011-1371-x

  13. Knobf MT (2011) Clinical updated: psychosocial responses in breast cancer survivors. Semin Oncol Nurs 27(3):e1–e14

    PubMed  Article  Google Scholar 

  14. Simard S, Savard J (2008) Screening and psychiatric comorbidity of clinical fear of cancer recurrence. Paper presented at the 4th Canadian Breast Cancer Research Alliance Reasons for Hope Scientific Conference, Vancouver, Canada

  15. Schultz KR (2011). A Randomized Multicentre Study Comparing G-CSF Mobilized Peripheral Blood and G-CSF Stimulated Bone Marrow in Patients Undergoing Matched Sibling Transplantation for Hematologic Malignancies [Grant 5R01CA108752-05 proposal to the National Institutes of Health (NIH)]

  16. Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA (2000) Gender differences in the utilization of health care services. J Fam Prac 49(2):147–152

    CAS  Google Scholar 

  17. Frostholm L, Fink P, Chistensen KS, Toft T, Oernboel E, Olesen F, Weinman J (2005) The patients' illness perceptions and the use of primary health care. Psychosom Med 67:997–1005

    PubMed  Article  Google Scholar 

  18. Stark D, Kiely M, Smith A, Morley S, Selby P, House A (2004) Reassurance and the anxious cancer patient. Br J Cancer 91:893–899

    PubMed  CAS  Google Scholar 

  19. Rosen NO, Knauper B, Di Dio P, Morrison E, Tabing R, Feldstain A, Amsel R, Mayrand MH, Franco EL, Rosberger Z (2010) The impact of an intolerance of uncertainty on anxiety after receiving an informational intervention about HPV: a randomized controlled study. Psychol Health 25(6):651–668

    PubMed  Article  Google Scholar 

  20. Heins MJ, Korevaar JC, Rijken PM, Schellevis FG (2012) For which health problems do cancer survivors visit their general practitioner? Eur J Cancer. doi:10.1016/j.ejca.2012.07.011 [Epub ahead of print]

  21. Bergman J, Gore JL, Saigal CS, Kwan L, Litwin MS (2009) Partnership and outcomes in men with prostate cancer. Cancer 115(20):4688–4694

    PubMed  Article  Google Scholar 

  22. Herschbach P, Berg P, Waadt S, Durana G, Engst-Hastreiter U et al (2010) Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother Psychosom 79(1):31–38

    PubMed  Article  Google Scholar 

  23. Humphris G, Ozakinci G (2008) The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer. Br J Health Psychol 13:223–230

    PubMed  Article  Google Scholar 

  24. Mishel MH, Germino BB, Gil KM, Belyea M, Laney IC, Stewart J et al (2005) Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psycho-Oncol 14(11):962–978

    Article  Google Scholar 

  25. Sabariego C, Brach M, Herschbach P, Berg P, Stucki G (2011) Cost-effectiveness of cognitive behavioral group therapy for dysfunctional fear of progression in cancer patients. Eur J Health Econ 12:489–497

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

This research was supported through a Research Development Grant from the University of Ottawa to Sophie Lebel. We appreciate the efforts of our volunteers on this project: Lynne Potvin, Megan Fillier, Brigitte Corran, Stephanie Robert, Rosa Leblanc, and Kristin Loeper. We extend our gratitude to the staff at Cancer Care Ontario for their invaluable help with recruitment.

Conflict of interest

The authors do not have a financial relationship with any of the organizations that sponsored the research.

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Affiliations

  1. School of Psychology, University of Ottawa, 136 Jean Jacques Lussier, Room 4016, Ottawa, Ontario, Canada, K1N6N5

    Sophie Lebel, Christina Tomei, Andrea Feldstain, Sara Beattie & Megan McCallum

Authors
  1. Sophie Lebel
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  2. Christina Tomei
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  3. Andrea Feldstain
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  4. Sara Beattie
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  5. Megan McCallum
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Correspondence to Sophie Lebel.

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Lebel, S., Tomei, C., Feldstain, A. et al. Does fear of cancer recurrence predict cancer survivors' health care use?. Support Care Cancer 21, 901–906 (2013). https://doi.org/10.1007/s00520-012-1685-3

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  • DOI: https://doi.org/10.1007/s00520-012-1685-3

Keywords

  • Fear of cancer recurrence
  • Cancer survivors
  • Health care use