Fear of cancer recurrence in childhood cancer survivors: A developmental perspective from infancy to young adulthood

Abstract

Aims: Fear of cancer recurrence (FCR) is among the most prevalent and distressing concerns reported by cancer survivors. While younger age is the most consistent predictor of elevated FCR, research to date has focused almost exclusively on adult cancer survivors. This is despite the fact that children with cancer are more likely to survive compared to adults, and will become regular, lifelong users of the medical system to mitigate the effects of toxic treatment. The early experience of cancer yields unique challenges and circumstances that may impact children's capacity for and experience of FCR across the developmental trajectory. The aim of this paper is to present a developmental perspective of FCR from infancy to young adulthood. Methods: Drawing on the developmental science literature and recent theoretical advancements in FCR, we outline cognitive and social factors that may influence children's capacity for and experience of FCR across the developmental trajectory. Results: First, distinct developmental groups that fall under the classification of "childhood cancer survivor," and that all require attention, are summarized. Using the structure of these groupings, we centrally provide a developmental perspective of FCR that offers a useful starting point for research in pediatric populations. Key research gaps, including the need for validated assessment tools to measure FCR in child and adolescent survivors, are highlighted. Conclusions: Consideration of the unique context of childhood is needed to guide the identification of childhood cancer survivors at risk for FCR as well as the development of effective FCR interventions for this population.

Worry about somatic symptoms as a sign of cancer recurrence: prevalence and associations with fear of recurrence and quality of life in survivors of childhood cancer

“…This stands in contrast with adult studies which have consistently reported greater fear of recurrence with declining age. Taken together, these findings suggest that those who experience cancer and/or who are survivors during adolescence and early adulthood may be a particularly vulnerable group for experiencing greater fear of recurrence 36 . There are likely multiple developmental reasons for this increased vulnerability, including a greater understanding than younger children about risk for recurrence, a perception of a longer future ahead than older adults, and age‐normative vulnerability for the development of anxiety and related mental health issues.…”

A systematic mixed studies review of fear of cancer recurrence in families and caregivers of adults diagnosed with cancer

“…Thus, the impact of interventions on caregivers' FCR remains unclear. We excluded studies of caregivers of children/adolescents with cancer, as their distinctive caregiver-care recipient relationship dynamic may differentially impact FCR [104]. Many studies focused on male caregivers of women with breast cancer, potentially limiting the generalisability of results to other caregiver populations.…”

Trajectories and risk factors for anxiety and depression in children and adolescents with cancer: A 1‐year follow‐up

“…However, based on our clinical assessment using the K‐SADS, we found that rates of anxiety disorders remain high, with 26.9% of our sample meeting the diagnostic criteria for anxiety disorders, 1 year following cancer diagnosis. The persistence of high levels of anxiety disorders, may be due to the fact that while approaching medical treatment completion, patients experience fear of cancer recurrence 25 . Another possible explanation may be the complexity that accompanies the adaptation process, of returning to daily activity routine, such as returning to school and resuming social relations with peers, 15 which may provoke anxiety.…”

“…The persistence of high levels of anxiety disorders, may be due to the fact that while approaching medical treatment completion, patients experience fear of cancer recurrence. 25 Another possible explanation may be the complexity that accompanies the adaptation process, of returning to daily activity routine, such as returning to school and resuming social relations with peers, 15 which may provoke anxiety.…”