Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
OtherPractice

Assessing and managing patient fear of cancer recurrence

Brittany Mutsaers, Nicole Rutkowski, Georden Jones, Jani Lamarche and Sophie Lebel
Canadian Family Physician September 2020, 66 (9) 672-673;
Brittany Mutsaers
PhD candidate in clinical psychology at the University of Ottawa in Ontario.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nicole Rutkowski
PhD candidate in clinical psychology at the University of Ottawa in Ontario.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Georden Jones
PhD candidate in clinical psychology at the University of Ottawa in Ontario.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jani Lamarche
PhD candidate in clinical psychology at the University of Ottawa in Ontario.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sophie Lebel
Professor in the School of Psychology at the University of Ottawa.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • CFPlus
  • eLetters
  • Info & Metrics
  • PDF
Loading

Low-risk cancer survivors are increasingly being discharged back to primary care after completing active cancer treatment in tertiary care settings (eg, cancer centres), shifting the responsibility of managing their complex follow-up care needs to primary care providers.1 The purpose of this article is to provide recommendations on assessing and managing fear of cancer recurrence (FCR), one of the highest reported unmet needs of cancer survivors.2

Clinically significant FCR

Fear of cancer recurrence has been defined as “fear, worry or concern relating to the possibility that cancer will come back or progress.”3 Given that recurrence is a very real possibility, FCR is a normative reaction affecting most cancer survivors to some degree.2 The severity of FCR can be conceptualized on a continuum, from transient fears (often occurring in conjunction with upcoming medical tests or results, anniversary of diagnosis, etc) to more substantial levels of fear that are difficult to control and might interfere with daily functioning and overall well-being.3 A recent study of experts in the field of FCR identified the following key features of clinically significant FCR: high levels of preoccupation or worry, worry that is persistent, and hypervigilance or hypersensitivity to bodily symptoms, where any of these features last for at least 3 months.4 Other important aspects include functional impairment and maladaptive coping strategies such as excessively seeking reassurance from medical professionals, excessive body checking, or avoiding medical appointments.5 Additionally, clinically significant FCR is linked to more health care use2; however, a number of empirically supported interventions have been developed to treat FCR.6

Screening and assessing for FCR

One of the most commonly used measures of FCR is the Fear of Cancer Recurrence Inventory (FCRI).7 The short form of this measure (FCRI-SF), consisting of 9 items, has been used as a tool to screen for clinical levels of FCR and is available for download at CFPlus.* Each item is rated on a scale from 0 (not at all or never) to 4 (a great deal or several), where higher scores indicate greater FCR severity, with a maximum score of 36.7 When calculating the score, item 5 is reverse coded. The recommended cutoff score for clinical levels of FCR is 22 or greater.8 However, a score of 16 or greater indicates high FCR and requires further assessment and discussion.9 The differences in cutoff scores in the literature are largely attributable to differences in methodology. These include the limited number of studies, small sample sizes, and, until recently,4 a lack of agreement on what constitutes clinical FCR. Research in this area is ongoing.8 Further to the FCRI, a conversation assessing the persistence of worries, preoccupations, and hypervigilance or hypersensitivity to bodily symptoms related to FCR is warranted (Table 1).4,10 Referrals can be made for psychosocial support contingent on the extent that the patient’s FCR is reported as problematic for the patient or is interfering with the patient’s ability to engage in daily life.

View this table:
  • View inline
  • View popup
Table 1.

Assessing clinically significant levels of FCR

Managing FCR

Low to moderate severity (0 to 15 on the FCRI-SF).

Because FCR is a common experience for cancer survivors, normalizing this experience for patients in a supportive and empathetic way is recommended. This could include discussion around the frequency with which survivors report FCR and common triggers of FCR (eg, hearing of someone being diagnosed with cancer, aches and pains, reminders of cancer experience in general).10 Uncertainty is inherent to FCR; therefore, providing information to cancer survivors and their caregivers on signs and symptoms of cancer recurrence, frequency of surveillance tests, and what to expect in cancer-related follow-up care, etc, can be helpful.5

If maladaptive coping strategies are present, introducing more adaptive coping approaches such as engaging in enjoyed activities, meditation, yoga, physical activity, journaling about FCR, and talking to supportive friends and family about their fears can help decrease the severity of FCR among patients.5

High and clinically significant severity (16 to 21 and ≥ 22 on the FCRI-SF, respectively).

For cancer survivors experiencing high (score of 16 to 21 on the FCRI-SF) and clinically significant (score of ≥ 22 on the FCRI-SF) levels of FCR, referral to allied health care professionals working in psychosocial cancer care might be appropriate. Psychotherapists can provide cognitive-behavioural approaches to address clinical FCR. Such interventions are empirically supported in group, online, and individual formats.6 Additional online resources on FCR (available at CFPlus*) can be shared with cancer survivors who present with high FCR.

Conclusion

Experiencing some level of FCR is inevitable in cancer survivors, who will present most commonly in primary care settings for their follow-up health needs. Primary care providers have a key role in managing the unmet needs of cancer survivors and are able to provide effective care for survivors experiencing low to moderate levels of FCR. They are also uniquely positioned to connect those who experience clinical levels of FCR with other providers in the community to ensure they receive appropriate psychosocial intervention.

Notes

We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations. Praxis articles can be submitted online at http://mc.manuscriptcentral.com/cfp or through the CFP website (www.cfp.ca) under “Authors and Reviewers.”

Footnotes

  • ↵* The Fear of Cancer Recurrence Inventory–Short Form and additional online resources on FCR are available at www.cfp.ca. Go to the full text of the article online and click on the CFPlus tab.

  • Competing interests

    None declared

  • This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.

  • This article has been peer reviewed.

  • Cet article se trouve aussi en français à la page 674.

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Cancer Journey Survivorship Expert Panel,
    2. Howell D,
    3. Hack TF,
    4. Oliver TK,
    5. Chulak T,
    6. Mayo S,
    7. et al
    . Survivorship services for adult cancer populations: a pan-Canadian guideline. Curr Oncol 2011;18(6):e265-81.
    OpenUrlPubMed
  2. 2.↵
    1. Simard S,
    2. Thewes B,
    3. Humphris G,
    4. Dixon M,
    5. Hayden C,
    6. Mireskandari S,
    7. et al
    . Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv 2013;7(3):300-22. Epub 2013 Mar 10.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Lebel S,
    2. Ozakinci G,
    3. Humphris G,
    4. Mutsaers B,
    5. Thewes B,
    6. Prins J,
    7. et al
    . From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer 2016;24(8):3265-8. Epub 2016 May 12.
    OpenUrl
  4. 4.↵
    1. Mutsaers B,
    2. Butow P,
    3. Dinkel A,
    4. Humphris G,
    5. Maheu C,
    6. Ozakinci G,
    7. et al
    . Identifying the key characteristics of clinical fear of cancer recurrence: an international Delphi study. Psychooncology 2020;29(2):430-6. Epub 2019 Nov 25.
    OpenUrl
  5. 5.↵
    1. Lebel S,
    2. Maheu C,
    3. Lefebvre M,
    4. Secord S,
    5. Courbasson C,
    6. Singh M,
    7. et al
    . Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv 2014;8(3):485-96. Epub 2014 Apr 23.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Tauber NM,
    2. O’Toole MS,
    3. Dinkel A,
    4. Galica J,
    5. Humphris G,
    6. Lebel S,
    7. et al
    . Effect of psychological intervention on fear of cancer recurrence: a systematic review and meta-analysis. J Clin Oncol 2019;37(31):2899-915. Epub 2019 Sep 18.
    OpenUrl
  7. 7.↵
    1. Simard S,
    2. Savard J
    . Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer 2009;17(3):241-51. Epub 2008 Apr 15.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Fardell JE,
    2. Jones G,
    3. Smith AB,
    4. Lebel S,
    5. Thewes B,
    6. Costa D,
    7. et al
    . Exploring the screening capacity of the Fear of Cancer Recurrence Inventory–Short Form for clinical levels of fear of cancer recurrence. Psychooncology 2018;27(2):492-9. Epub 2017 Aug 18.
    OpenUrl
  9. 9.↵
    1. Simard S,
    2. Savard J
    . Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv 2015;9(3):481-91. Epub 2015 Jan 21.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Mutsaers B,
    2. Jones G,
    3. Rutkowski N,
    4. Tomei C,
    5. Séguin Leclair C,
    6. Petricone-Westwood D,
    7. et al
    . When fear of cancer recurrence becomes a clinical issue: a qualitative analysis of features associated with clinical fear of cancer recurrence. Support Care Cancer 2016;24(10):4207-18. Epub 2016 May 12.
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Family Physician: 66 (9)
Canadian Family Physician
Vol. 66, Issue 9
1 Sep 2020
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Assessing and managing patient fear of cancer recurrence
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Assessing and managing patient fear of cancer recurrence
Brittany Mutsaers, Nicole Rutkowski, Georden Jones, Jani Lamarche, Sophie Lebel
Canadian Family Physician Sep 2020, 66 (9) 672-673;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Assessing and managing patient fear of cancer recurrence
Brittany Mutsaers, Nicole Rutkowski, Georden Jones, Jani Lamarche, Sophie Lebel
Canadian Family Physician Sep 2020, 66 (9) 672-673;
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Clinically significant FCR
    • Screening and assessing for FCR
    • Managing FCR
    • Conclusion
    • Notes
    • Footnotes
    • References
  • Figures & Data
  • CFPlus
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • Évaluer et gérer la peur des patients d’une récidive du cancer
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Practice

  • Determining if and how older patients can safely stay at home with additional services
  • Managing type 2 diabetes in primary care during COVID-19
  • Effectiveness of dermoscopy in skin cancer diagnosis
Show more Practice

Praxis

  • Aide à la décision d’utiliser ou non les gliflozines pour l’insuffisance cardiaque avec fraction d’éjection supérieure à 40 %, à l’intention des patients
  • Patient decision aid for flozins in heart failure and ejection fraction greater than 40%
  • Examens et traitements à reconsidérer en médecine du sport et de l’exercice pédiatrique
Show more Praxis

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2023 by The College of Family Physicians of Canada

Powered by HighWire