The purpose of this study was to determine whether fear of cancer recurrence (FCR) is associated with greater health care utilization (HCU) in early-stage breast cancer survivors.
Three hundred early-stage breast cancer survivors diagnosed within the past 7 years reported on FCR as well as calls and visits to oncology providers and primary care providers during the preceding 3 months. Participants also reported on use of mental health services and psychotropic medications since diagnosis. Structural equation modeling was used to create a latent FCR factor and evaluate this factor as a predictor of various HCU outcomes controlling for age at diagnosis, years since diagnosis, generalized anxiety, objective risk of recurrence, and number of comorbidities.
FCR predicted more visits to both oncology providers (RR = 1.53, p = .002) and primary care providers (RR = 1.31, p = .013), as well as more phone calls to oncology providers (RR = 2.08, p = .007). FCR was not a significant predictor of phone calls to primary care providers (RR = 1.39, p = .054), utilization of mental health treatment (OR = 1.27, p = .362), or use of psychotropic medications (OR = 1.37, p = .178).
FCR was associated with increases in some types of HCU, which may reflect excessive medical reassurance-seeking and lead to unnecessary medical costs.
Implications for Cancer Survivors
FCR is a serious concern that warrants greater attention to reduce distress-related health care utilization. Utilization of mental health services to address FCR may represent higher-value health care.
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The FCRI Severity subscale has been used in previous research as an indicator of clinically-significant FCR; when items are scaled from 0-4 and summed, a score of 13 or greater is indicative of clinical levels of FCR . To facilitate comparisons to past work, we provide descriptive information about FCR scores based on these clinical guidelines: In the present sample, mean FCRI Severity score was 14.97 (SD = 7.77). Over half of patients (53.9% in the present sample scored 13 or greater on the FCRI Severity subscale and would therefore be considered to have clinical levels of FCR.
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This study was funded partially by a grant from the National Cancer Institute (R21 CA171921) and funds from the University of Delaware.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Amy K. Otto is now located at Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
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Otto, A.K., Soriano, E.C., Siegel, S.D. et al. Assessing the relationship between fear of cancer recurrence and health care utilization in early-stage breast cancer survivors. J Cancer Surviv 12, 775–785 (2018). https://doi.org/10.1007/s11764-018-0714-8
- Fear of recurrence
- Health care utilization
- Breast cancer
- Survivorship concerns
- Medical reassurance-seeking
- Health anxiety