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Fear of Cancer Recurrence

Overview

 

Fear of cancer recurrence (FCR) is a common unmet need of cancer survivors and a challenge that individuals in remission face, impacting quality of life and IADL participation. A 2022 study found that FCR was more likely to impact young breast cancer survivors. While fears sometimes improve over time, there are instances where anxiety associated with FCR requires more intense medical intervention. 

​Matthew Cordova, Clinical Psychologist Ph.D. -   Palo Alto University
 

Overview

  • Clinicians should validate concerns regarding fear of cancer recurrence, and normalize fear as a shared experience among cancer survivors 

  • There is a societal pressure to stay positive. This pressure inadvertently sends a message that worry = negativity.

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Clinical Interactions

  • Individuals may try to suppress negative thoughts, finding that the fear then consumes their thoughts.  (see advice for addressing negative thought patterns in the video “Addressing FCR”

  • Individuals may fear cancer recurrence out of trauma from their treatment experience, making them averse to going through treatment again. Allied health professionals should involve themselves in the cancer treatment process to reduce trauma (can be done through non-pharmacological pain management approaches: breathing, imagery, muscle, relaxation, mindfulness, strategies, exercises, and biofeedback)

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Click below to learn more from Matthew Cordova​

 Professional Insights

Catherine Benedict, PhD - Clinical Assistant Professor at Stanford University School of Medicine 

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Overview

  • Individuals challenged fear of cancer recurrence may benefit from anxiety management strategies: strategies. Examples vary from breathing techniques and mindfulness techniques to exercise. 

Clinical Interactions

  • Anxiety strategies are about future orientation and are intended to reorient the individual to be present in the moment, all about future orientation, so how do we reorient to be in the present moment. How do you employ those strategies and practice them both in times of high anxiety, but also as just as normal practice to sort of lower the baseline.So, yeah, so a combination of education. And you know, learning new skills

  • Clinicians should inform women that the cancer journey extends beyond the completion of treatment, and be prepared to help patients navigate these lasting emotional and physical impacts 

  • Benedict tells patients the most challenging part emotionally is at the end of treatment and transitioning into survivorship because this is where the processing about the cancer journey begins and uncertainty about the future lies

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Click below to learn more from Catherine Benedict  

Dr. Lidia Shapira, Stefania Falvo OTR/L, Ceddeth Richardson OTR/L

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Overview

  • Fear can improve with time; the majority of individuals move forward without fear impacting their activities of daily living

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Clinical Interactions

  • Clinicians can help individuals return to meaningful roles/activities (or finding new meaningful occupations)

  • Clinicians should acknowledge fear of cancer recurrence and avoid triggering anxiety in individuals.

  • Clinicians can initiate the conversation by reassuring individuals that fear is a shared experience among cancer survivors

  • Differentiating between general worry and Fear of Cancer Recurrence (FCR): take into consideration whether this is the person’s first round of treatment or if they are experiencing a tumor regrowth. A detailed occupational profile, including questions about how life has changed, will help therapists understand how the FCR is impacting daily life 

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Click below to learn more from Dr. Shapira

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Click below to learn more from Stefania Falvo

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Click below to learn more from Ceddeth Richardson

OT Insights

  • Allied health professionals should involve themselves in the cancer treatment process to reduce trauma

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  • Clinicians should validate concerns regarding fear of cancer recurrence, and normalize fear as a shared experience among cancer survivors 

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  • Seek out a support system to distract from current fears  

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  • Acknowledge the fear cancer survivors face regarding cancer recurrence and avoid provoking anxiety through language choice that may heighten fear  

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  • Provide opportunities for individuals to discuss their fears and normalize the experience

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  • Assist individuals in finding an activity of meaning they can still participate in - this can distract from current fears they are experiencing  

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  • Individuals challenged fear of cancer recurrence may benefit from anxiety management strategies: strategies. Examples vary from breathing techniques and mindfulness techniques to exercise.​ 

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  • Clinicians should inform women that the cancer journey extends beyond the completion of treatment, and be prepared to help patients navigate these lasting emotional and physical impacts 

References:

Schapira L;Zheng Y;Gelber SI;Poorvu P;Ruddy KJ;Tamimi     RM;Peppercorn J;Come             SE;Borges VF;Partridge AH;Rosenberg SM; (n.d.). Trajectories of fear of cancer recurrence in Young Breast Cancer Survivors. Cancer. https://pubmed.ncbi.nlm.nih.gov/34614212/ 

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