{"entity":{"id":"rejuv-mind-fear-of-recurrence","kind":"technology","name":"Fear that the cancer will come back: how common it is, and when it stops being ordinary worry","aka":[],"tldr":"Almost everyone who finishes cancer treatment thinks about it coming back, and for about one in five the thought is severe enough to be worth treating. Pooling 9,311 people from 46 studies in 13 countries, 58.8 per cent scored 13 or more on a 36-point questionnaire, 45.1 per cent scored 16 or more and 19.2 per cent reached 22, the clinical threshold.","summary":"The individual participant data meta-analysis is the best single source of numbers. Researchers asked for raw data from 87 studies that had used the short form of the Fear of Cancer Recurrence Inventory, received it from 46, and analysed 9,311 respondents from 13 countries. On that nine-item questionnaire, scored from 0 to 36, 58.8 per cent of respondents scored 13 or more, 45.1 per cent scored 16 or more and 19.2 per cent scored 22 or more. Fear decreased with age, women reported more of it than men, and it was found \"across cancer types and continents and for all time periods since cancer diagnosis\". The authors' opening sentence is the reason this record exists: \"Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors.\"\n\nWhere the thresholds come from. A 2019 study tested the short form against two reference standards. In the first, 167 cancer survivors taking part in the Australian ConquerFear trial were rated by clinicians after a biopsychosocial interview as having non-clinical, subclinical or clinical fear; clinicians rated 43 per cent as clinical. In the second, 40 Canadian survivors were classified using a semi-structured clinical interview designed for this purpose, and 25 per cent met criteria. In both samples the receiver operating characteristic analysis pointed to the same place: \"a cut-off ≥22 on the FCRI-SF identified cancer survivors with clinical levels of FCR with adequate sensitivity and specificity\", which the authors note is higher than the cut-off used before. That matters in both directions. A score of 13 is common and not in itself a disorder; a score of 22 is the point at which a trained interviewer tends to agree that something is wrong.\n\nWhat separates ordinary worry from the clinical form is not the subject of the thought but what it does. The inventory scores severity separately from triggers, from psychological distress, from coping and from how far the fear interferes with functioning, and the randomised trials report those subscales separately. The practical markers are preoccupation that intrudes on ordinary days rather than clustering around appointments, checking the body or seeking reassurance repeatedly, avoiding appointments or scans altogether, and difficulty making plans because the future feels provisional. A person who feels a jolt of fear before a scan and then gets on with the week is describing the ordinary version.\n\nThe course. The 2013 systematic review of 130 papers found that survivors reported \"low to moderate level of FCR but considered it as one of the top greatest concerns and the most frequently endorsed unmet need\", and, in a sentence that contradicts what patients are usually told, that \"FCR remains stable over the survivorship trajectory\". It does not reliably fade with time. Higher fear went with younger age, with the presence and severity of physical symptoms, with psychological distress and with lower quality of life. The same review found that carers reported higher fear than the patients themselves.\n\nWhat is not known. There is no national prevalence estimate for the United Kingdom, no routine measurement of this in any health service OnCo could find, and no agreed point in the pathway at which anyone is asked. The 2013 review's own conclusion was that the field \"has expanded somewhat haphazardly over the last 20 years\" and that consensus definitions and well-validated measures were still needed. A reader who recognises themselves in this record will usually have to raise it first.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Cancer_survivor","links":[{"label":"What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis (Psychooncology 2022)","url":"https://doi.org/10.1002/pon.5921"},{"label":"Exploring the screening capacity of the Fear of Cancer Recurrence Inventory-Short Form for clinical levels of fear of cancer recurrence (Psychooncology 2019)","url":"https://doi.org/10.1002/pon.4516"},{"label":"Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies (J Cancer Surviv 2013)","url":"https://doi.org/10.1007/s11764-013-0272-z"},{"label":"Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update (JCO 2023)","url":"https://doi.org/10.1200/JCO.23.00293"}],"tags":["rejuvenation","survivorship","evidence:moderate","psychosocial"],"related":["lymphoma-living-scanxiety-and-surveillance","idea-moon-survivor-lifelong-care-model"],"cancers":["breast-hr-positive","colorectal","prostate","melanoma","hodgkin-lymphoma","testicular"],"sections":["rejuvenation","supportive-care"],"technologies":["rejuv-mind-fear-of-recurrence-treatment","rejuv-mind-scan-anxiety","rejuv-mind-anxiety-after-cancer","rejuv-mind-distress-screening","psycho-oncology","survivorship-care-plan"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["relapse-recurrence","late-recurrence","quality-of-life","late-effects"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Contemporary cognitive models treat persistent fear of recurrence as a problem of process rather than content: the thought that the cancer may return is accurate, and what makes it disabling is the attention paid to bodily sensations, the beliefs a person holds about whether worrying is useful or uncontrollable, and the checking and avoidance that stop those beliefs from being tested. That is why the trial interventions that worked train attention and target metacognitive beliefs rather than argue with the reader about the odds.","strengths":["A validated nine-item measure with a cut-off tested against clinician interviews in two countries","Pooled individual participant data from 9,311 people rather than a single cohort","The distinction between common fear and the clinical form is measurable, so it can be acted on"],"limitations":["Fear does not reliably decline with time since diagnosis","No health service OnCo could find measures this routinely","Carers are affected at least as much as patients and are almost never asked"]},"route":"/technologies/rejuv-mind-fear-of-recurrence/","neighbours":{"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"late-recurrence","kind":"term","name":"Late recurrence","route":"/terms/late-recurrence/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"},{"id":"relapse-recurrence","kind":"term","name":"Recurrence and relapse","route":"/terms/relapse-recurrence/"},{"id":"rejuv-history-ncsi-england","kind":"term","name":"The National Cancer Survivorship Initiative in England, and the Recovery Package","route":"/terms/rejuv-history-ncsi-england/"},{"id":"lymphoma-living-scanxiety-and-surveillance","kind":"term","name":"The surveillance schedule, and the evidence that routine scans do not find relapse first","route":"/terms/lymphoma-living-scanxiety-and-surveillance/"}],"idea":[{"id":"idea-rejuv-core-outcome-set-for-late-effects","kind":"idea","name":"Agree what to measure, so the next systematic review can pool rather than narrate","route":"/ideas/idea-rejuv-core-outcome-set-for-late-effects/"},{"id":"idea-moon-survivor-lifelong-care-model","kind":"idea","name":"Risk-stratified lifelong care for tens of millions of survivors, automated and shared with primary care","route":"/ideas/idea-moon-survivor-lifelong-care-model/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","route":"/cancers/testicular/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-mind-anxiety-after-cancer","kind":"technology","name":"Anxiety after cancer, in survivors and in their partners","route":"/technologies/rejuv-mind-anxiety-after-cancer/"},{"id":"rejuv-mind-scan-anxiety","kind":"technology","name":"Anxiety around scans, and what the evidence says about how often to scan","route":"/technologies/rejuv-mind-scan-anxiety/"},{"id":"rejuv-measure-eortc-qlq-c30","kind":"technology","name":"EORTC QLQ-C30: the questionnaire most cancer trials use","route":"/technologies/rejuv-measure-eortc-qlq-c30/"},{"id":"rejuv-measure-fear-of-recurrence-inventory","kind":"technology","name":"Measuring fear of recurrence: the FCRI and its cut-off","route":"/technologies/rejuv-measure-fear-of-recurrence-inventory/"},{"id":"psycho-oncology","kind":"technology","name":"Psycho-oncology and distress screening","route":"/technologies/psycho-oncology/"},{"id":"rejuv-mind-distress-screening","kind":"technology","name":"Screening for distress: what the thermometer can and cannot do","route":"/technologies/rejuv-mind-distress-screening/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"rejuv-life-carers","kind":"technology","name":"The carer's own recovery: what is known about the person who is not the patient","route":"/technologies/rejuv-life-carers/"},{"id":"rejuv-mind-fear-of-recurrence-treatment","kind":"technology","name":"Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available","route":"/technologies/rejuv-mind-fear-of-recurrence-treatment/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"rejuv-agenda-no-agreed-outcome-measures","kind":"bottleneck","name":"The field cannot pool its own studies, because it has not agreed what to measure","route":"/bottlenecks/rejuv-agenda-no-agreed-outcome-measures/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"roadmap":[{"id":"rejuvenation-roadmap","kind":"roadmap","name":"Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it","route":"/roadmaps/rejuvenation-roadmap/"}]}}