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Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer

  • Epidemiology
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Abstract

Fear of cancer recurrence (FCR) is a common and persistent concern among breast cancer survivors. Little is known about factors associated with FCR in women with ductal carcinoma in situ (DCIS) or early invasive breast cancer (EIBC). Women with first primary DCIS, or stages I–IIA breast cancer were prospectively enrolled in a quality-of-life study and completed interviews at 4–6 weeks, 6 months, and 2 years after definitive surgical treatment. In three stepwise multivariable linear regression models, including both time-independent and time-varying variables measured at each respective interview, we identified independent correlates of mean FCR scores (range 1–6) using four items from the Concern About Recurrence Scale (CARS) at 2-year follow-up. Of 506 disease-free patients at 2-year follow-up (mean [SD] age, 58 [10] years; 81% White; 34% DCIS), the average FCR score of 2.0 was low. However, 145 (29%) reported moderate-to-high levels of FCR (scores 3.0–6.0). All three models showed that younger age, stage IIA breast cancer (vs. DCIS), lower social support, and elevated anxiety were consistently associated with higher FCR at 2-year follow-up (each P < 0.05; final models R 2 = 0.25–0.32). DCIS patients reported lower FCR than stage IIA patients (each P ≤ 0.01) but had similar FCR as stage I patients. Although mean FCR was low, 29% of DCIS and EIBC survivors reported moderate-to-high levels of FCR at 2-year follow-up. Management of anxiety, provision of social support, and patient education may help reduce FCR among DCIS and EIBC survivors, especially among younger survivors.

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Acknowledgments

This study was supported by grants from the National Cancer Institute and Breast Cancer Stamp Fund (#R01CA102777), and the National Cancer Institute Cancer Center Support Grant (#P30 CA91842) to the Alvin J. Siteman Cancer Center. We thank our patient participants, the interviewers, and the Siteman Cancer Center’s Health Behavior, Communication and Outreach Core and Biostatistics Core (Dr. Yan Yan) for data management and statistical services, and Pam Hunborg, RN, BSN, CCRC, at Saint Louis University School of Medicine. We also greatly appreciate the many physicians who helped us recruit their patients for this study, including Drs. Barbara Monsees, Jill Dietz, Julie Margenthaler, Virginia Herrmann, Timothy Eberlein, Matthew Ellis, Imran Zoberi, Marie Taylor, Michael Naughton, Antonella Rastelli, Donald Lombardi, Cynthia Ma, Loren Michel, and Rama Suresh at Washington University School of Medicine and Dr. Eddie Hsueh at Saint Louis University School of Medicine. The Beck Anxiety Inventory® and BAI® (copyright 1990, 1993 by Aaron T. Beck), are trademarks of The Psychological Corporation, a Harcourt Assessment Company. The BAI® was adapted and used by permission of the publisher, The Psychological Corporation. All rights reserved.

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Authors and Affiliations

  1. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA

    Ying Liu

  2. Division of Health Behavior Research, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Maria Pérez, Mario Schootman & Donna B. Jeffe

  3. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA

    Mario Schootman, Rebecca L. Aft, William E. Gillanders & Donna B. Jeffe

  4. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Rebecca L. Aft & William E. Gillanders

  5. John Cochran Veterans Administration Hospital, St. Louis, MO, USA

    Rebecca L. Aft

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  1. Ying Liu
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  2. Maria Pérez
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  3. Mario Schootman
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Correspondence to Ying Liu.

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Liu, Y., Pérez, M., Schootman, M. et al. Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat 130, 165–173 (2011). https://doi.org/10.1007/s10549-011-1551-x

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  • DOI: https://doi.org/10.1007/s10549-011-1551-x

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