Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors

Abstract

Purpose Many cancer survivors report experiencing somatic symptoms as well as elevated stress. Theoretical models have suggested that physical symptoms generate subjective stress via fears of recurrence or progression. To date, this indirect effect has not been established empirically. This study aimed to provide preliminary evidence as to whether fear of recurrence or progression is an intermediary between somatic symptom severity and perceived stress among heterogeneous cancer survivors. Methods Adult cancer survivors (N = 67; median 2.4 years since diagnosis; 34% male) presenting at a hospital survivorship clinic completed measures assessing somatic symptom severity (Patient Health Questionnaire-15 (PHQ-15)), perceived stress (four-item Perceived Stress Scale (PSS-4)), and fear of recurrence or progression (Assessment of Survivor Concerns (ASC)). Interrelatedness among variables was assessed using Pearson correlations. Indirect effects were modeled using 5000-iteration bootstrapping. Results Survivors endorsed a range of somatic symptom severity (29% minimal, 39% low, 18% medium, and 14% high). Somatic symptoms, perceived stress, and fear of recurrence or progression were all significantly positively correlated (rs 0.29 to 0.47). Controlling for time since diagnosis, there was a significant indirect effect of somatic symptom severity on stress via fear of recurrence or progression [B = 0.06, SE = 0.04 (95% CI 0.01–0.16)]. The model accounted for more than one third of the variance in perceived stress [R2 = 0.35, F(3,54) = 9.59, p < 0.001]. Conclusions Survivors with greater somatic symptoms tended to report higher levels of stress, due in part to elevated fears of recurrence or progression. Our findings support concerns about recurrence or progression as a mechanism underlying stress states in cancer survivors. Efforts to assist survivors with stress management should teach strategies for managing cancer-related uncertainties stemming from somatic symptoms.

Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates

“…The impact of these newer therapies on HA appears to be an area for future research. There is consistent evidence that the presence of symptoms such as pain and fatigue predicts greater HA [33,41,45,126,142,160,226,[228][229][230][231]. There is limited evidence that time since diagnosis [35,38,41,207] or stage of cancer [4,50,159] correlates with HA.…”

Mind‐body interventions for fear of cancer recurrence: A systematic review and meta‐analysis

“…In extreme cases, catastrophic appraisals of uncertainty may lead to hopelessness, demoralization, and even suicidal ideation. Survivors' struggles with FCR are triggered by a variety of stimuli that arise throughout survivorship, including external (eg, follow‐up appointments, public health campaigns, and new diagnoses in family or friends) and internal events (eg, somatic symptoms such as fatigue, pain, and insomnia) . To manage FCR, cancer survivors may engage in maladaptive behaviors in an attempt to assert control over the unpredictability of their health .…”

“…Alternatively, avoiding follow‐up care increases the risk not just for cancer recurrence but also late effects like pain, fatigue, insomnia, osteoporosis, heart disease, and second malignancies . Several potential targets for interventions have been identified, including tolerance of uncertainty, optimism (eg, reappraisal of uncertainty as an opportunity), meaning‐making in the face of uncertainty, and clarification of ambiguity …”

“…Survivors’ struggles with FCR are triggered by a variety of stimuli that arise throughout survivorship, including external (eg, follow-up appointments, public health campaigns, and new diagnoses in family or friends) 6,9,18 and internal events (eg, somatic symptoms such as fatigue, pain, and insomnia). 19,20…”

Risk Factors Associated With Chemotherapy-Induced Nausea in the Week Before the Next Cycle and Impact of Nausea on Quality of Life Outcomes

“…In cancer patients, fear of recurrence and progression of cancer as well as physical symptoms (e.g., pain) are associated with increased stress. 50 The PSS was used to evaluate association between nonspecific stress that exceeds a person's coping abilities 39 and CIN. In the multivariate analysis, for each one-point increase in PSS score, there was a 3% decrease in odds of belonging to nausea group.…”