Fear of Recurrence Grows Over Time in People Who Are Younger at Diagnosis

Fear of recurrence tends to grow over the first year and 6 months after breast cancer surgery in younger women, according to a recent study. The study was held in Belgium and published in Psycho-Oncology.

Background

As breast cancer treatments have gotten better at treating the disease, more people are living longer with a history of diagnosis and treatment. Following treatment, people experience a range of emotions, both positive and negative. Positive feelings can include a greater appreciation for life. Negative feelings may include sadness and fear of recurrence, or fear that the cancer will return.

Fear of recurrence does not follow a specific timeline. Earlier research shows that fear of recurrence may be stable or lessen as time goes by, depending on the type of cancer, form of treatment, and timing of the study. Age, experiencing physical symptoms and optimism have been found to affect fear of recurrence the most.

This fear can have a powerful impact on emotional and psychological well-being. Quality of life can be affected when fear of recurrence is not addressed. Researchers on this study surveyed women living with a history of breast cancer to see how factors like age and optimism influence fear of recurrence over time.

Design

The study included 267 women between the ages of 20 and 80 who had recently been diagnosed with breast cancer. The women were asked to take part in the study while admitted to a hospital in Belgium for breast surgery. All surgeries took place 5 to 10 days after breast cancer diagnosis.

Participants completed several surveys during the study. The Concerns About Recurrence Scale measures the level of fear of recurrence. The Life Orientation Test — Revised measures dispositional optimism, or how positive a person tends to feel about the future. Participants also shared information on their age, marital status and level of education. The CARS and LOT-R were completed after surgery, but before leaving the hospital. Participants completed the CARS survey again at 6 months and 18 months after surgery.

Results

All participants experienced fear of recurrence during the first 6 months after surgery. After 6 months, older women reported less fear of recurrence than they had in earlier surveys. But fear of recurrence worsened in younger women 6 months after surgery. Fear of recurrence was still growing in younger women at 18 months, showing more fear than they had right after surgery and at 6 months.

Researchers suggested this finding could be due to participants feeling relief immediately after surgery. As time passes, people again focus on the future. Younger women may have more worries for the future than older women.

Looking at the results from the LOT-R survey, which measured participant’s outlook on the future, the researchers found that optimistic participants experienced lower levels of fear of recurrence than those who were less optimistic. Optimism can influence how people cope with illness. Optimistic individuals are more likely to accept illness early and find positive ways to cope. They are also less likely to develop habits that get in the way of coping, such as worrying. Researchers suggest future studies look at possible ways doctors can help people who struggle with fear of recurrence, and the role setting realistic expectations may play in that effort.

Limitations

This study had several limitations. Participants completed the first survey while recovering from surgery. Scores may have differed if participants completed the CARS one week before or after surgery. The researchers used an abbreviated CARS survey to make it easier for participants recovering from surgery. This study was observational and it is possible that other factors could have affected the results.

What This Means for You

If you were diagnosed at a young age, or if you tend to expect the worst, fears about cancer returning in the future may stick around or even worsen as you go through and finish treatment. That’s OK. Fear of recurrence is a completely normal emotional reaction to cancer treatment.

Each person has different triggers that will bring out this fear. Be patient with yourself as you identify your triggers, as it will take time to develop strategies to cope in a healthy and effective way. Look in our Guide to Understanding Your Emotions and Guide to Understanding Fear of Recurrence for more information and tips.

To receive the support you need, you will need to be honest with your providers, your loved ones and yourself. Young women and their partners can reduce fear through talking about cancer-related concerns. You may also consider speaking with a mental health provider to help navigate difficult conversations. You can also call the Breast Cancer Helpline to talk to someone who understands.

Starreveld, DEJ, Markovitz, SE, van Breukelen, G, Peters, ML. The course of fear of cancer recurrence: Different patterns by age in breast cancer survivors. Psycho-Oncology. July 20, 2017; 27(1): 295-301. DOI: 10.1002/pon.4505.