A systematic review of fear of cancer recurrence related healthcare use and intervention cost‐effectiveness

Abstract

Objective Fear of cancer recurrence (FCR) is a common and burdensome psychological condition affecting cancer survivors. This systematic review aims to synthesise current evidence regarding: (1) FCR‐related healthcare usage and costs and (2) the cost‐effectiveness of FCR treatments. Methods We searched MEDLINE, CINAHL, Cochrane and other electronic databases using MeSH headings and keywords for cancer, FCR and costs from their inception to September 2019. Identified studies were screened for eligibility. Original, peer‐reviewed journal articles reporting quantitative data from samples of adults treated for cancer written in English were included. Quality was appraised using the Drummond checklist for economic evaluations or the relevant Joanna Briggs Institute Critical Appraisal Tool. Results Data from 11 studies were extracted and synthesised. Seven studies addressed the costs of FCR and suggested an increase in the use of primary and secondary healthcare. Four studies addressed the cost‐effectiveness of different FCR treatments and suggest that some treatments may cost‐effectively reduce FCR and improve quality of life. Reviewed treatments had an incremental cost‐effectiveness ratio between AU$3,233 and AU$152,050 per quality‐adjusted life year gained when adjusted to 2019 Australian dollars. All studies were of sufficient quality to be synthesised in this review. Conclusions FCR appears to be associated with greater use of certain healthcare resources, and FCR may be treated cost‐effectively. Thus, appropriate FCR treatments may not only reduce the individual burden, but also the strain on the healthcare system. Further high‐quality research is needed to confirm this and ensure the future implementation of efficient and sustainable FCR treatments.

What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta‐analysis

“…[7][8][9][10][11][12] A 2019 Delphi study conceptualized four features as key characteristics of clinical FCR: "(a) high levels of preoccupation; (b) high levels of worry; (c) that are persistent; and (d) hypervigilance to bodily symptoms". 13 It is important to address FCR, because FCR may also lead to increased healthcare costs 14 and for most patients, it does not decrease over time without intervention. 3,7,11,15,16 Furthermore, several effective interventions to treat FCR have been developed.…”

Juggling cancer and life in survivorship: The role of general practitioners

“…Clinically significant FCR is characterised by high levels of worry or preoccupation, and hypervigilance to bodily symptoms that persists for three months or more. 17 FCR has been linked with greater physical symptoms and greater use of primary care, 4,18 thus frequent unscheduled GP visits by cancer survivors in response to symptoms may indicate underlying FCR. 4 FCR is not consistently related to clinical variables such as disease stage, treatment type or time post-treatment, and it typically will remain stable or become more severe over time without clinical assessment and intervention.…”

Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors

“…11,12 As a result of reassurance seeking, clinically significant levels of FCR are typically associated with increased health-care costs. 13,14 In addition to the costs, higher levels of FCR have consistently been associated with increased depressive, anxiety and post-traumatic stress symptoms, [15][16][17] as well as the experience of psychiatric disorders. 3 Since clinical levels of FCR do not appear to dissipate over time, individuals often require specialized psychological support and intervention to manage symptoms of FCR.…”

“… 11 , 12 As a result of reassurance seeking, clinically significant levels of FCR are typically associated with increased health-care costs. 13 , 14 …”