Fear of Cancer Recurrence and Psychological Symptom Burden in Breast Cancer Survivors Without Evidence of Active Disease: A Cross-Sectional Real-World Study

Abstract

Objective: This study assessed the prevalence of fear of cancer recurrence (FCR) and its clinical, treatment-related, and psychological correlates in breast cancer survivors without active disease. Materials and Methods: This cross-sectional study included 200 breast cancer survivors after curative treatment. FCR was assessed using the Fear of Cancer Recurrence Inventory–Short Form (FCRI-SF), with scores ≥ 13 indicating clinically significant FCR. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Depression (HADS-D) scores ≥ 8 indicated clinically significant symptoms. Associations with FCR were analyzed using logistic regression, with HADS-A and HADS-D evaluated in separate multivariable models because of their potential overlap. Results: The mean age was 55.6 ± 9.5 years; clinically significant FCR, anxiety, and depression occurred in 38.0%, 32.5%, and 38.0%, respectively. In univariable analysis, younger age, stage III disease, mastectomy, chemotherapy history, and high HADS-A and HADS-D were associated with FCR. In the HADS-A model, chemotherapy history (adjusted OR: 5.841; p = 0.006) and high HADS-A (adjusted OR: 7.828; p < 0.001) were independently associated with FCR, whereas increasing age was protective (adjusted OR: 0.855; p < 0.001). In the HADS-D model, mastectomy (adjusted OR: 6.265; p = 0.002), chemotherapy history (adjusted OR: 6.941; p = 0.001), and high HADS-D (adjusted OR: 14.343; p < 0.001) were independently associated with FCR, whereas increasing age was protective (adjusted OR: 0.836; p < 0.001). Conclusions: FCR is a major psychosocial concern among breast cancer survivors, particularly in younger patients, those with chemotherapy history, and those with greater psychological symptom burden. The association with mastectomy should also be considered, particularly in patients with depressive symptoms.