(PS2-12) Fear of Recurrence, Perceived Risk, and Quality of Life in Rare Cancer Survivors

Abstract Text:

Background: It is well-established that many post-treatment cancer survivors struggle with fears that their cancer will recur. Such fear of recurrence (FCR) has been associated with reduced quality of life in a variety of cancer populations. However, research in this area has focused on more prevalent cancer types. Less is known about FCR and its impact on quality of life and day-to-day functioning in rare cancer survivors, for whom treatment advances are often more limited.

Method: Seventy-five post-treatment cancer survivors reporting elevated worry with a history of a rare, non-metastatic cancer were recruited to a study examining iThrive, an app-based intervention designed to reduce FCR. Rare cancers included gynecological (n= 51), pediatric (n= 3), rare melanoma and skin (n= 10), and other rare cancers (n= 11). Participants completed pre-intervention self-report measures, including items on perceived risk of recurrence and day-to-day impact, as well as the Quality of Life Patient/Cancer Survivor Version (QOL-CS), which assessed psychological, physical, social, and spiritual well-being. Cross-sectional analyses of baseline data were conducted, and qualitative data were explored using thematic analysis.

Results: Perceived risk of recurrence was significantly negatively associated with overall quality of life (r = -.36, p < .01) and specifically with psychological (r = -.42, p < .01) and physical well-being (r = -.23, p < .05), but not with social (p >.05) or spiritual well-being (p >.05). Perceived risk of recurrence was also associated with the extent to which concerns about FCR impacted their day-to-day lives (r = .56, p < .01). Thematic analysis of qualitative data revealed key themes of overwhelming and distressing emotions, constant concerns, and avoidance (of doctor’s appointments, of distressing thoughts, and of social interactions).

Discussion: Rare cancer survivors who perceived a higher likelihood of recurrence reported poorer overall quality of life, psychological and physical well-being, and greater impact on their day-to-day lives. Specifically, rare cancer survivors described constant concerns of recurrence and overwhelming, distressing thoughts, especially around the time of medical appointments. Due to these worries, they engaged in avoidance behaviors, such as not attending medical appointments, attempting to suppress negative thoughts, and withdrawing from others. These findings highlight the need for accessible, tailored interventions that address the unique daily challenges of rare cancer survivors. Research shows that CBT interventions delivered via mobile apps can effectively reduce FCR. It is imperative to further explore novel digital interventions for reducing FCR in rare cancer survivors, particularly around the time of medical appointments.