The first section of this blog focused on the prevalence and conceptualization of Fear of Recurrence (FOR) among cancer patients.
The first section of this blog focused on the prevalence and conceptualization of Fear of Recurrence (FOR) among cancer patients. This portion of the blog will focus on the consequences of FOR, as well as provide strategies for healthcare providers to use when helping their patients.
WHAT ARE THE CONSEQUENCES OF FOR?
High levels of FOR can severely impact a survivor’s quality of life. A review by Koch et al.1 documented that moderate to high levels of FOR may result in lower all quality of life, decreased psychological well-being (due to increases in depression and anxiety), and a decreased ability to carry out the tasks of daily life. High levels of FOR are also associated with a decrease in overall health (due in part to lower adherence to follow-up recommendations, both for cancer-related and general health concerns2) and an increase in health care costs2. As a side note, a recent study found that 49% of cancer patients died from causes other than cancer3, indicating a need to emphasize the need to follow general health recommendations in addition to focusing on cancer progression and recurrence.
WHAT ARE COMMON TRIGGERS FOR FEAR OF RECURRENCE?4
HOW DO I HELP MY PATIENTS WITH HIGH LEVELS OF FOR?
It is rare to meet a cancer survivor who has no thoughts of recurrence. But in fact, some level of FOR can be beneficial, because a low level of anxiety about health can motivate people to follow recommendations regarding follow-up care, such as screenings, medications, diet, exercise, and smoking cessation.1 But survivors who have a diminished quality of life due to high levels of FOR may need help. Survivors’ oncology teams can play a crucial role in helping survivors manage their FOR. Below is a list which can be provided to survivors:
STEPS TO MANAGE FEAR OF RECURRENCE:
“Live the best you can until the very last moment, no matter what.” Karin Porter-Williamson, MD.
Helpful online resources:
ARE INTERVENTIONS HELPFUL? WHAT SHOULD THE GOALS OF INTERVENTIONS BE?
Oncology healthcare providers have been lax in referring survivors with high levels of FOR to psychosocial professionals, with only 21% of clinical providers reporting that they routinely refer survivors with high levels of FOR to treatment2. Although perhaps not widespread, interventions targeting FOR have been shown to be effective5-6. Early studies have demonstrated that cognitive behavioral therapy, supportive-experiential group therapy, and cognitive existential approaches have effective in reducing FOR, as well as improving quality of life and decreasing overall distress5-6. Patients with advanced or recurrent disease benefitted the most from the intervention5. Regardless of whether your center has a formal FOR intervention available, survivors with significant levels of FOR should be referred for psychosocial services. The goal for treatment should not be the elimination of FOR, which may not be rational or feasible, but to put FOR into a reasonable perspective within the survivor’s life, propelling the survivor to work towards overall wellness, both emotional and physical.