Abstract
-
Purpose
This study aimed to examine the level of fear of cancer recurrence (FCR) among adult breast cancer survivors and to identify factors influencing it.
-
Methods
This cross-sectional study included 104 adult breast cancer survivors who were no longer receiving active treatment. Data were collected through self-report questionnaires addressing FCR, depression, anxiety, distress, fatigue, coping with cancer, social support, subjective health status, subjective quality of life, demographic characteristics, and disease-related characteristics. Surveys were administered both face-to-face and online between March and September 2024. Data analysis was conducted using descriptive statistics, frequencies, the independent t-test, one-way analysis of variance, Pearson’s correlation, and multiple regression.
-
Results
The mean total FCR score was 78.83±25.71 (range, 0–168), reflecting a moderate level. Among participants, 22.1% scored above the cutoff for depression, 34.6% for mild anxiety, and 27.9% for severe distress. More than 70% of participants reported fatigue. Levels of coping with cancer, social support, subjective health status, and subjective quality of life were moderate or higher. Anxiety (β=.56, p<.001), fatigue (≤34) (β=.18, p=.019), and subjective quality of life (β=–.18, p=.022) significantly influenced FCR.
-
Conclusion
Ongoing assessments and tailored interventions are essential to address FCR and to promote psychological well-being in breast cancer survivors following completion of active treatment.
-
Key Words: Breast neoplasms; Cancer survivors; Fear; Psychological well-being; Recurrence
INTRODUCTION
Breast cancer is the most frequently diagnosed cancer among women worldwide and remains one of the leading causes of cancer-related death. In Korea, breast cancer accounted for 10.5% of all cancer cases in 2022 [
1]. By age distribution, the highest proportion occurred in women in their 50s (29.8%), followed closely by those in their 40s (29.0%) [
1], indicating that breast cancer is more common among middle-aged adults than older adults. In contrast to Western countries, where incidence is higher in older women, cases among younger women—particularly those in their 30s—are increasing in Korea [
2]. The 5-year relative survival rate for patients diagnosed between 2018 and 2022 was 94.3%, reflecting a steady increase [
3]. This rising survival rate highlights the need for long-term care and support as survivorship periods lengthen.
Fear of cancer recurrence (FCR) is defined as the fear or concern about the possibility of cancer recurrence or progression [
4]. Even after completing treatment, survivors may continue to experience diverse physical and psychological symptoms. FCR is one of the most prevalent unmet needs reported by survivors [
4], with prevalence estimates ranging from 49% to 82%, depending on cancer type, and with 49% to 66% experiencing moderate to severe FCR [
5]. Prior research shows that FCR is influenced by demographic and disease-related factors, with women and younger survivors reporting higher levels than men and older survivors [
6]. Among breast cancer survivors, younger women consistently report greater FCR than older women [
7]. Compared with survivors of other cancers such as endometrial cancer, leukemia, non-Hodgkin lymphoma, and prostate cancer, breast cancer survivors tend to report higher FCR [
6], suggesting that cancer type is an important determinant of severity. Younger breast cancer survivors often face heightened family and social responsibilities, which may exacerbate psychological distress and intensify FCR [
8]. Thus, healthcare providers should place special emphasis on the psychological rehabilitation of younger breast cancer survivors.
Moreover, FCR has been reported to be associated with fatigue, distress, anxiety, depression, social support, coping methods, and quality of life (QOL) in cancer survivors [
9-
11]. The relationships between FCR and the physical and psychological symptoms experienced by survivors have been demonstrated in previous studies. Depression and anxiety in cancer survivors have been found to be positively correlated with FCR [
9], and breast cancer survivors in particular have reported that higher levels of depression and anxiety are linked to increased FCR [
10]. Distress and fatigue, which are among the most common symptoms experienced by breast cancer survivors, have also been positively correlated with FCR [
10]. Social support and coping strategies may likewise be associated with FCR [
11]. For example, one study of breast cancer survivors reported that greater social support was linked to lower FCR, and that confrontation coping could contribute to reducing FCR [
11]. These findings suggest that interventions aimed at enhancing social support and strengthening coping strategies may represent effective approaches to managing FCR [
11]. FCR has also been reported to have a significant negative correlation with QOL and health-related quality of life (HRQOL) [
12]. As FCR increases, survivors experience greater uncertainty, heightened concern about the future, and more intense death anxiety, all of which contribute to declines in both physical and mental HRQOL [
4,
5]. Although many studies have identified factors associated with FCR, most investigations among breast cancer survivors have focused on only a subset of potential determinants rather than considering them comprehensively. This limitation may hinder the development of integrated interventions designed to reduce FCR in this population.
Accordingly, healthcare providers should recognize and address this concern in adult breast cancer survivors and implement appropriate interventions when needed [
6]. To establish the most effective strategies for preventing and managing FCR, such as tailored psychosocial support, education, and multifactorial interventions, further research is required to examine the influencing factors of FCR and their combined effects in a comprehensive manner. Therefore, this study aimed to assess levels of FCR, depression, anxiety, distress, fatigue, coping, and social support in adult breast cancer survivors, and to identify the factors influencing FCR, with the goal of providing foundational data for psychosocial healthcare in this population.
METHODS
1. Study Design
This study employed a cross-sectional design to identify factors influencing FCR among adult breast cancer survivors. This study was conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
2. Setting and Participants
Participants were 104 female breast cancer survivors recruited through convenience sampling. All were no longer undergoing active cancer treatment and were receiving follow-up care at the outpatient clinic of a tertiary hospital in Cheonan, Korea. The inclusion criteria were: (1) breast cancer survivors aged 19 to 64 years; (2) not currently undergoing active cancer treatment; and (3) ability to understand the study procedures and voluntarily provide written informed consent. The exclusion criteria were: (1) diagnosis of breast cancer at stage IV; (2) currently undergoing active treatment; (3) evidence of cancer recurrence or progression at the time of study enrollment; (4) diagnosis of cancer before the age of 19 years; and (5) diagnosis of psychological or psychiatric disorders.
The sample size was determined using multiple regression with seven predictors identified from prior literature (age, depression, anxiety, distress, fatigue, coping with cancer, and social support). Based on a medium effect size (Cohen’s f²=0.15), a significance level of .05, and a power of 0.80, the required sample size was calculated as 103 using G*Power version 3.1.9.7. To account for an anticipated 5% dropout rate, 108 participants were initially recruited.
Of the 108 breast cancer survivors who consented to participate, four were excluded: one did not meet the age criterion (≥65 years), and three submitted questionnaires with substantial missing data. Thus, 104 participants were included in the final analysis.
3. Measurements
The authors obtained permission from the developers to use the following instruments: the Korean version of the Fear of Cancer Recurrence Inventory (K-FCRI), the Functional Assessment of Chronic Illness Therapy–Fatigue scale (FACIT-Fatigue), the Korean version of the Cancer Coping Questionnaire (K-CCQ), and the Multidimensional Scale of Perceived Social Support (MSPSS).
The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Distress Thermometer (DT) were freely available for non-commercial use without prior permission.
1) Fear of cancer recurrence
FCR was measured using the K-FCRI, originally developed by Simard and Savard (2009) [
13] and translated into Korean by Jung et al. (2024) [
14]. This 42-item instrument is rated on a 5-point Likert scale (0=not at all/never, 1=a little, 2=somewhat, 3=a lot, 4=a great deal/all the time). Scores range from 0 to 168, with higher values indicating greater FCR. The scale comprises seven subscales: triggers (8 items), severity (9 items), psychological distress (4 items), coping strategies (9 items), functioning impairments (6 items), insight (3 items), and reassurance (3 items). Cronbach’s α was .95 in the original study [
13], .85 in Jung et al. (2024) [
14], and .94 in the present study.
2) Depression
Depression was assessed with the PHQ-9, developed by Kroenke et al. (2001) [
15] and translated into Korean by Park et al. (2010) [
16]. The PHQ-9 has shown good validity for detecting depression in cancer patients [
17]. It consists of nine items rated on a 4-point Likert scale (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day). Total scores range from 0 to 27, with higher scores reflecting greater depressive symptoms. Cutoff scores of 5, 10, 15, and 20 correspond to mild, moderate, moderately severe, and severe depression, respectively [
15]. Based on the validation studies conducted by Kroenke et al. [
15] in primary care and obstetrics-gynecology settings, a cutoff score of ≥10 was used to identify major depressive disorder. Cronbach’s α was reported as .86–.89 in the original article [
15], .81 in Park et al. (2010) [
16], and .91 in the present study.
3) Anxiety
Anxiety was assessed using the GAD-7, developed by Spitzer et al. (2006) [
18] and translated into Korean by Seo and Park (2015) [
19]. This tool has been validated for screening GAD in cancer patients [
20]. The instrument contains seven items rated on a 4-point Likert scale (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day), yielding a total score ranging from 0 to 21, with higher scores indicating greater anxiety severity. Scores of 5–9 reflect mild anxiety, 10–14 indicate moderate anxiety, and ≥15 represent severe anxiety [
18]. Cronbach’s α values were .92 in the original study [
18], .915 in Seo and Park (2015) [
19], and .94 in this study.
4) Distress
Distress was assessed using the DT, developed by the National Comprehensive Cancer Network. This tool is a visual analog scale ranging from 0 (no distress) to 10 (extreme distress). A score of 4 or below indicates mild distress, whereas a score of 4 or higher reflects severe or greater levels of distress [
21].
5) Fatigue
Fatigue was measured using the FACIT-Fatigue scale, developed by Yellen et al. (1997) [
22] and translated into Korean by Lee and Kim (2022) [
23]. This 13-item instrument was originally designed to assess fatigue associated with anemia in cancer patients. It employs a 5-point Likert scale (0=not at all, 1=a little bit, 2=somewhat, 3=quite a bit, 4=very much), producing scores ranging from 0 to 52, with higher scores indicating less fatigue. A cutoff score of 34, identified in a study of adults with sickle cell disease [
24], was used to classify clinically significant fatigue, with scores ≤34 indicating fatigue and >34 indicating its absence. Cronbach’s α values were reported as .93–.95 in the original study [
22], .93 in Lee and Kim (2022) [
23], and .95 in this study.
6) Coping with cancer
Coping with cancer was evaluated using the K-CCQ, originally developed by Moorey et al. (2003) [
25] and later translated and modified into Korean by Kim et al. (2004) [
26]. This 23-item instrument is scored on a 4-point Likert scale (1=not at all, 2=sometimes, 3=often, 4=very often), with total scores ranging from 23 to 92; higher scores indicate greater coping. The scale includes two subscales: intrapersonal coping (14 items) and interpersonal coping (9 items). Intrapersonal coping reflects self-management of cancer and comprises positive reframing (6 items), coping (5 items), and planning (3 items). Interpersonal coping reflects coping through interactions with close others. Cronbach’s α values were .82–.87 in the original article [
25], .88–.90 in Kim et al. (2004) [
26], and .93 in this study.
7) Social support
Social support was assessed using the MSPSS, developed by Zimet et al. (1988) [
27] and translated into Korean by Park et al. (2012) [
28]. Originally created for the general population, including adolescents [
27], the MSPSS has been widely applied across populations, including Korean women with breast cancer, where it demonstrated validity and reliability [
29]. This 12-item instrument is scored on a 7-point Likert scale (1=very strongly disagree to 7=very strongly agree), with total scores ranging from 12 to 84, where higher scores indicate greater perceived support. The scale consists of three subscales: family (4 items), friends (4 items), and significant other (4 items). Cronbach’s α values were .85 in the original article [
27], .90 in Park et al. (2012) [
28], and .95 in this study.
8) Subjective health status and subjective quality of life
Subjective health status and QOL were each assessed with a single item rated on a numeric scale from 1 (very bad) to 7 (very good), referring to the previous week. Higher scores indicated better health status and QOL.
9) Demographic and disease-related characteristics
Participants provided data on age, educational level, marital status (spouse), number of children, employment status, monthly family income, religion, and cancer-related information. The latter included cancer stage, time since diagnosis, duration of active treatment, type of treatment received, history of cancer progression or recurrence, and family history of cancer.
4. Data Collection
Data were collected from March to September 2024 through face-to-face surveys (n=65) and online surveys (n=39). At the outpatient clinic of a tertiary hospital, the researcher introduced the study to potential participants during follow-up visits and distributed a recruitment notice, explaining the purpose, procedures, and confidentiality measures. Those who provided informed consent were enrolled. For face-to-face participation, written consent was obtained before administering the paper-based questionnaire. For participants preferring online participation, consent was obtained verbally, and a Google survey link was sent via text message. Participants accessed the link, provided electronic consent, and completed the online questionnaire. All participants were informed of their right to refuse or withdraw at any time without consequences for their medical care.
5. Ethical Consideration
This study was approved by the Institutional Review Board (IRB) of Konyang University (IRB No. KYU-2023-11-037-001). Written informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki, and all personal information was kept confidential.
6. Data Analysis
Data were analyzed using IBM SPSS ver. 28.0 for Windows (IBM Corp., Armonk, NY, USA). Descriptive statistics and frequencies were used to summarize demographic and disease-related characteristics, as well as FCR, depression, anxiety, distress, fatigue, coping with cancer, social support, subjective health status, and subjective QOL. The independent t-test and one-way analysis of variance were conducted to examine differences in FCR levels by participant characteristics. Also, Pearson’s correlation was used to assess relationships among FCR, depression, anxiety, distress, fatigue, coping with cancer, social support, subjective health status, and subjective QOL. Finally, multiple regression analysis with a stepwise method was applied to identify factors influencing FCR.
RESULTS
1. Demographic and Disease-Related Characteristics of Participants
Table 1 summarizes participants’ characteristics. The mean age was 49.70±6.52 years, and all participants were women. A total of 68 participants (65.4%) had a high school education or lower, 88 participants (84.6%) had spouses, and 91 participants (87.5%) had children. About half of the participants (51.0%) were employed, while 49 participants (47.1%) reported a monthly family income of US dollar 3,500 or more. Approximately half of the participants identified as religious.
Forty-four participants (42.3%) were in stage I, 44 (42.3%) in stage II, and the remainder were in stage III. The average time since diagnosis was 41.82±32.00 months, and the mean duration of active treatment was 10.74±19.08 months. All participants underwent surgery for breast cancer; 93 participants (89.4%) received radiotherapy, 82 (78.8%) received hormone therapy, and 75 (72.1%) underwent chemotherapy. Only five participants (4.8%) reported cancer progression or recurrence. More than half (53.8%) indicated a family history of cancer.
2. Levels of Main Variables
Table 2 presents the levels of the main variables, including subscales and cutoff-based distributions. The mean FCR score was 78.83±25.71, indicating a moderate level. Among the seven FCR subscales, triggers, severity, and coping strategies were at moderate or higher levels. The mean depression score was 5.52±5.70, with 23 participants (22.1%) scoring ≥10, indicating moderate to severe depression. The mean anxiety score was 4.12±4.69; while 68 participants (65.4%) scored 4 or lower, 36 participants (34.6%) were classified as having anxiety, including 13 (12.5%) with moderate to severe anxiety. The mean distress score was 2.70±2.50, and 76 participants (73.1%) reported fatigue. The mean coping with cancer score was 54.63±12.76, and the mean social support score was 60.28±19.47. Among the social support subscales, family support scored higher than support from friends or significant others. The average subjective health status (4.85±1.30) and subjective QOL (5.05±1.24) were at moderate levels.
3. Differences in Fear of Cancer Recurrence Based on Participants’ Characteristics
FCR levels did not differ significantly by participants’ demographic or disease-related characteristics. Because the distributions of subgroups were severely unbalanced for marital status, presence of children, and cancer progression or recurrence, these variables were not included in the analysis.
4. Correlations between Main Variables
Table 3 shows correlations among FCR, depression, anxiety, distress, fatigue, coping with cancer, social support, subjective health status, and subjective QOL. FCR was positively correlated with depression (r=.59,
p<.001), anxiety (r=.63,
p<.001), and distress (r=.54,
p<.001). Negative correlations were found with social support (r=–.25,
p=.012), subjective health status (r=–.38,
p<.001), and subjective QOL (r=–.36,
p<.001). No significant correlations were observed between FCR and either fatigue or coping with cancer.
5. Factors Influencing Fear of Cancer Recurrence
Stepwise multiple regression analysis was conducted to identify predictors of FCR, including depression, anxiety, distress, fatigue (≤34), social support, subjective health status, and subjective QOL. Although fatigue was not significantly correlated with FCR in Pearson’s correlation analysis, a significant difference in FCR was observed between participants above and below the fatigue cutoff (t=–2.11, p=.038). Therefore, fatigue was included in the regression as a categorical variable (1=fatigue ≤34; 0=fatigue >34). Regression assumptions of normality, independence, and homogeneity of variance were verified through residual analysis. The residual scatterplot was symmetrically distributed around zero without trends, and the Q-Q plot closely approximated a straight line.
The final model explained 43.3% of the variance in FCR. Anxiety (standardized [std.] β=.56,
p<.001), fatigue ≤34 (std. β=.18,
p=.019), and subjective QOL (std. β=–.18,
p=.022) were significant predictors. Specifically, participants with higher anxiety had higher FCR, those with fatigue scores ≤34 had higher FCR than those with scores >34, and participants reporting higher subjective QOL had lower FCR (
Table 4).
DISCUSSION
This study investigated the level of FCR among Korean breast cancer survivors and identified factors associated with it. The findings demonstrated that anxiety, fatigue, and subjective QOL were significant predictors of FCR in this population.
Participants in this study reported moderate levels of FCR. A study of 93 Korean cancer survivors also found moderate FCR levels [
30], and research with early-stage breast cancer survivors in Norway reported moderate to high FCR levels [
7]. These findings align with the current results and highlight the importance of sustained attention to FCR across diverse populations. In contrast, a study conducted in a survivorship clinic at a comprehensive National Cancer Institute–designated center reported that 59.7% of participants expressed clinical needs related to FCR, but those needs were perceived as adequately met [
31]. Given such inconsistent findings, further research is warranted to clarify whether FCR levels differ according to cancer type or demographic characteristics.
Although overall depression, anxiety, and distress scores were relatively low in this study, a proportion of participants exceeded clinical cutoff thresholds, underscoring the importance of ongoing monitoring and intervention by healthcare professionals. A cohort study examining long-term psychological distress among breast cancer survivors found that, compared to women in the general population, survivors experienced higher rates of depression and anxiety for at least 10 years after diagnosis [
32]. Moreover, each one-point increase in distress score was associated with a 32% increase in the odds of identifying FCR as an unmet clinical need [
31]. Because breast cancer has relatively high survival rates compared to other cancers, psychological symptoms in long-term survivors, especially those under extended follow-up after surgery, may be underestimated or overlooked. These findings emphasize the need for healthcare providers to conduct regular assessments of psychological well-being and to identify survivors who require professional psychological support.
Anxiety was the strongest predictor of FCR in this study, consistent with prior research [
7]. A systematic review of interventions for FCR among breast cancer survivors reported that cognitive behavioral therapy (CBT), mindfulness-based interventions, acceptance and commitment therapy, and Managing Cancer and Living Meaningfully (CALM) are effective for reducing FCR [
33]. As these interventions are also effective in alleviating anxiety, they may be particularly well suited for the integrated management of both anxiety and FCR. Programs such as CBT, CALM, and structured education can incorporate coping skills and emotional regulation strategies, demonstrating potential for sustainable long-term benefits [
33]. These interventions should be considered as viable options for long-term FCR management.
Although depression and distress correlated with FCR, they were not significant predictors in this study, a finding inconsistent with some prior studies [
12]. This discrepancy may be explained by the relatively low levels of depression and distress reported by participants. Larger-scale and repeated studies are needed to clarify these relationships.
Subjective QOL was also identified as a significant factor influencing FCR. A study of long-term breast cancer survivors in Korea reported that higher FCR was associated with poorer HRQOL [
12]. Similar associations between QOL and FCR have been reported across various cancer survivor populations [
4]. Numerous interventions have been developed to improve cancer survivors’ QOL, and given its close association with FCR, long-term and continuous interventions that simultaneously target QOL enhancement and FCR reduction should be prioritized.
In this study, nearly three times as many participants reported experiencing fatigue compared to those who did not, and fatigue emerged as a significant predictor of FCR. Fatigue is among the most common and persistent symptoms in breast cancer survivors following treatment. Prior studies confirm that fatigue often persists long after treatment and can significantly impair QOL [
34]. Therefore, targeted fatigue management should be a priority in survivorship care. Rather than considering fatigue an inevitable post-treatment symptom, healthcare providers should evaluate its contributing factors and implement appropriate interventions to reduce its burden.
In this study, social support was not identified as a significant factor influencing FCR, although a significant correlation between the two variables was observed. Many previous studies have emphasized the importance of social support in managing FCR among cancer survivors, including breast cancer survivors [
11,
35]. The relatively high level of perceived social support in this study, combined with the fact that participants were exclusively adults and most had a spouse and children, may explain the inconsistent findings regarding its influence. Further research is needed to clarify the role of social support in relation to FCR.
Previous research has also reported significant associations between coping and FCR [
11]. However, this study did not identify coping as a significant factor. Although the CCQ—originally developed for general cancer patients and found to be reliable among breast cancer survivors—was used, the discrepancy may stem from differences in instruments. Therefore, future studies using coping measures specifically designed for breast cancer survivors are recommended.
This study has several limitations. First, convenience sampling was conducted at a tertiary hospital, and participants were primarily adult breast cancer survivors diagnosed at Stages I and II who underwent surgical treatment. As such, the generalizability of the findings is limited. Large-scale studies that enhance external validity, along with qualitative research exploring FCR in greater depth, are needed to strengthen the evidence base. Second, the cross-sectional design precluded examination of changes in FCR over time. Longitudinal studies are recommended to assess the trajectory of FCR after completion of active treatment and to identify its determinants among Korean breast cancer survivors. Such work would provide essential evidence for developing tailored interventions to mitigate FCR. Finally, data were collected using both paper-based and online surveys. Because responses to identical questions may vary by survey mode, caution is warranted when interpreting the findings.
CONCLUSION
This study identified factors influencing FCR in adult breast cancer survivors, providing fundamental data for the development of tailored consultations and interventions. Participants reported moderate levels of FCR, and a subset exhibited clinically significant psychological symptoms that may require professional intervention. Anxiety, fatigue, and subjective QOL were significant predictors of FCR. Healthcare providers should continue to monitor psychological symptoms, including FCR, in breast cancer survivors even after the completion of active treatment. Accurate identification of survivors requiring clinical support is crucial, as is the development of targeted nursing interventions aimed at reducing FCR and promoting psychological well-being. Interventions that consider the identified influencing factors are expected to alleviate the burden on healthcare providers while addressing the growing needs of the increasing population of adult breast cancer survivors.
-
CONFLICTS OF INTEREST
The authors declared no conflict of interest.
-
AUTHORSHIP
Study conception and/or design acquisition - KL; acquisition of data - EJP; analysis - KL; interpretation of the data - KL; and drafting or critical revision of the manuscript for important intellectual content- KL, EJP, and JOC.
-
FUNDING
This paper was supported by the Konyang University Research Fund in 2023 (No. 2023A0041).
-
ACKNOWLEDGEMENT
None.
-
DATA AVAILABILITY STATEMENT
The data can be obtained from the corresponding authors.
Table 1.Demographic and Disease-Related Characteristics (N=104)
|
Characteristics |
Categories |
M±SD (range) or n (%) |
|
Demographic characteristics |
|
|
|
Age (year) |
|
49.70±6.52 (33–64) |
|
Educational level |
≤High school |
68 (65.4) |
|
≥University |
36 (34.6) |
|
Spouse |
Yes |
88 (84.6) |
|
No |
16 (15.4) |
|
Children |
Yes |
91 (87.5) |
|
No |
13 (12.5) |
|
Employment status |
Employed |
53 (51.0) |
|
Unemployed/sick leave |
51 (49.0) |
|
Monthly family income (USD) |
<2,000 |
19 (18.3) |
|
≥2,000 to <3,500 |
36 (34.6) |
|
≥3,500 |
49 (47.1) |
|
Religion |
Yes |
52 (50.0) |
|
No |
52 (50.0) |
|
Disease-related characteristics |
|
|
|
Stages |
I |
44 (42.3) |
|
II |
44 (42.3) |
|
III |
16 (15.4) |
|
Time since diagnosis (month) |
|
41.82±32.00 (2–152) |
|
Duration of active treatment (month) |
|
10.74±19.08 (1–126) |
|
Type of treatment†
|
Operation |
104 (100) |
|
Chemotherapy |
75 (72.1) |
|
Radiotherapy |
93 (89.4) |
|
Targeted therapy |
15 (14.4) |
|
Immunotherapy |
4 (3.8) |
|
Hormone therapy |
82 (78.8) |
|
Cancer progression or recurrence |
Yes |
5 (4.8) |
|
No |
99 (95.2) |
|
Family history of cancer |
Yes |
56 (53.8) |
|
No |
48 (46.2) |
Table 2.Levels of Fear of Cancer Recurrence, Depression, Anxiety, Distress, Fatigue, Coping with Cancer, and Social Support (N=104)
|
Variables (score range) |
M±SD or n (%) |
|
Fear of cancer recurrence (0–168) |
78.83±25.71 |
|
Triggers (0–32) |
19.63±7.03 |
|
Severity (0–36) |
17.86±7.91 |
|
Psychological distress (0–16) |
6.88±4.36 |
|
Coping strategies (0–36) |
21.35±6.24 |
|
Functioning impairments (0–24) |
6.17±5.54 |
|
Insight (0–12) |
2.86±2.93 |
|
Reassurance (0–12) |
4.09±2.96 |
|
Depression (0–27) |
5.52±5.70 |
|
<10 |
81 (77.9) |
|
≥10 |
23 (22.1) |
|
Anxiety (0–21) |
4.12±4.69 |
|
≤4 |
68 (65.4) |
|
5–9 |
23 (22.1) |
|
10–14 |
9 (8.7) |
|
≥15 |
4 (3.8) |
|
Distress (0–10) |
2.70±2.50 |
|
≤4 |
75 (72.1) |
|
>4 |
29 (27.9) |
|
Fatigue (0–52) |
23.38±15.31 |
|
≤34 |
76 (73.1) |
|
≥35 |
28 (26.9) |
|
Coping with cancer (23–92) |
54.63±12.76 |
|
Intrapersonal (4–56) |
34.85±8.41 |
|
Positive reframing (6–24) |
16.75±3.90 |
|
Coping (5–20) |
11.13±3.31 |
|
Planning (3–12) |
6.97±2.34 |
|
Interpersonal (9–36) |
19.78±6.92 |
|
Social support (12–84) |
60.28±19.47 |
|
Family (0–28) |
21.60±7.08 |
|
Friends (0–28) |
19.15±7.09 |
|
Significant other (0–28) |
19.53±7.69 |
|
Subjective health status (1–7) |
4.85±1.30 |
|
Subjective QOL (1–7) |
5.05±1.24 |
Table 3.Correlations between Variables (N=104)
|
Variables |
r (p) |
|
FCR |
Depression |
Anxiety |
Distress |
Fatigue |
Coping with cancer |
Social support |
Subjective health status |
Subjective QOL |
|
FCR |
1 |
|
|
|
|
|
|
|
|
|
Depression |
.59 (<.001) |
1 |
|
|
|
|
|
|
|
|
Anxiety |
.63 (<.001) |
.81 (<.001) |
1 |
|
|
|
|
|
|
|
Distress |
.54 (<.001) |
.68 (<.001) |
.67 (<.001) |
1 |
|
|
|
|
|
|
Fatigue |
.09 (.349) |
.25 (.012) |
.21 (.034) |
.19 (.110) |
1 |
|
|
|
|
|
Coping with cancer |
.14 (.147) |
.05 (.658) |
.08 (.397) |
.07 (.499) |
.08 (.436) |
1 |
|
|
|
|
Social support |
–.25 (.012) |
–.29 (.003) |
–.41 (<.001) |
–.33 (.001) |
–.08 (.436) |
.05 (.598) |
1 |
|
|
|
Subjective health status |
–.38 (<.001) |
–.38 (<.001) |
–.39 (<.001) |
–.56 (<.001) |
–.01 (.957) |
–.02 (.836) |
.31 (.001) |
1 |
|
|
Subjective QOL |
–.36 (<.001) |
–.37 (<.001) |
–.33 (.001) |
–.55 (<.001) |
–.161 (.103) |
.01 (.902) |
.35 (<.001) |
.82 (<.001) |
1 |
Table 4.Factors Influencing Fear of Cancer Recurrence (N=104)
|
Variables |
β |
SE |
Std. β |
t (p) |
R² |
Adjusted R² |
F (p) |
|
Constant |
77.99 |
9.53 |
|
8.19 (<.001) |
.449 |
.433 |
27.18 (<.001) |
|
Anxiety |
3.04 |
0.43 |
.56 |
7.05 (<.001) |
|
|
|
|
Fatigue (≤34) |
10.22 |
4.29 |
.18 |
2.38 (.019) |
|
|
|
|
Subjective QOL |
–3.79 |
1.63 |
-.18 |
–2.33 (.022) |
|
|
|
REFERENCES
- 1. National Cancer Information Center. The cancer I want to know about > Breast cancer > Related statistics [Internet]. Goyang: National Cancer Information Center; 2025 [cited 2025 February 12]. Available from: https://www.cancer.go.kr/lay1/program/S1T211C217/cancer/view.do?cancer_seq=4757&menu_seq=4762
- 2. Kim J, Hong S, Lee JJ, Won YJ, Lee ES, Kang HS, et al. Analysis of the tumor characteristics in young age breast cancer patients using collaborative stage data of the Korea Central Cancer Registry. Breast Cancer Res Treat. 2021;187(3):785-92. https://doi.org/10.1007/s10549-021-06107-9
- 3. National Cancer Information Center. Cancer statistics [Internet]. Goyang: National Cancer Information Center; 2025 [cited 2025 February 12]. Available from: https://www.cancer.go.kr/index.do
- 4. Bergerot CD, Philip EJ, Bergerot PG, Siddiq N, Tinianov S, Lustberg M. Fear of cancer recurrence or progression: what is it and what can we do about it? Am Soc Clin Oncol Educ Book. 2022;42:18-27. https://doi.org/10.1200/edbk_100031
- 5. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300-22. https://doi.org/10.1007/s11764-013-0272-z
- 6. Luigjes-Huizer YL, Tauber NM, Humphris G, Kasparian NA, Lam WW, Lebel S, et al. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psychooncology. 2022;31(6):879-92. https://doi.org/10.1002/pon.5921
- 7. Vandraas K, Reinertsen KV, Smedsland S, Bohn S, Kiserud C, Falk RS, et al. Fear of cancer recurrence eight years after early-stage breast cancer: results from a national survey. Acta Oncol. 2023;62(6):635-41. https://doi.org/10.1080/0284186x.2023.2224052
- 8. Tong L, Wang Y, Xu D, Wu Y, Chen L. Prevalence and factors contributing to fear of recurrence in breast cancer patients and their partners: a cross-sectional study. Int J Womens Health. 2024;16:229-36. https://doi.org/10.2147/ijwh.S443681
- 9. Liu J, Peh CX, Simard S, Griva K, Mahendran R. Beyond the fear that lingers: the interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms. J Psychosom Res. 2018;111:120-6. https://doi.org/10.1016/j.jpsychores.2018.06.004
- 10. Kuswanto CN, Sharp J, Stafford L, Schofield P. Fear of cancer recurrence as a pathway from fatigue to psychological distress in mothers who are breast cancer survivors. Stress Health. 2023;39(1):197-208. https://doi.org/10.1002/smi.3180
- 11. Li Y, Fang C, Xiong M, Hou H, Zhang Y, Zhang C. Exploring fear of cancer recurrence and related factors among breast cancer patients: a cross-sectional study. J Adv Nurs. 2024;80(6):2403-14. https://doi.org/10.1111/jan.16009
- 12. Tran TX, Jung SY, Lee EG, Cho H, Kim NY, Shim S, et al. Fear of cancer recurrence and its negative impact on health-related quality of life in long-term breast cancer survivors. Cancer Res Treat. 2022;54(4):1065-73. https://doi.org/10.4143/crt.2021.835
- 13. Simard S, 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. https://doi.org/10.1007/s00520-008-0444-y
- 14. Jung W, Park J, Jeong A, Cho JH, Jeon YJ, Shin DW. Fear of cancer recurrence and its predictors among patients with non-small cell lung cancer (NSCLC). J Cancer Surviv. 2024;18(6):1782-9. https://doi.org/10.1007/s11764-023-01419-9
- 15. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
- 16. Park SJ, Choi HR, Choi JH, Kim K, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety Mood. 2010;6(2):119-24.
- 17. Hinz A, Mehnert A, Kocalevent RD, Brahler E, Forkmann T, Singer S, et al. Assessment of depression severity with the PHQ-9 in cancer patients and in the general population. BMC Psychiatry. 2016;16:22. https://doi.org/10.1186/s12888-016-0728-6
- 18. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-7. https://doi.org/10.1001/archinte.166.10.1092
- 19. Seo JG, Park SP. Validation of the Generalized Anxiety Disorder-7 (GAD-7) and GAD-2 in patients with migraine. J Headache Pain. 2015;16:97. https://doi.org/10.1186/s10194-015-0583-8
- 20. Esser P, Hartung TJ, Friedrich M, Johansen C, Wittchen HU, Faller H, et al. The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients. Psychooncology. 2018;27(6):1509-16. https://doi.org/10.1002/pon.4681
- 21. Holland JC, Andersen B, Breitbart WS, Buchmann LO, Compas B, Deshields TL, et al. Distress management. J Natl Compr Canc Netw. 2013;11(2):190-209. https://doi.org/10.6004/jnccn.2013.0027
- 22. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997;13(2):63-74. https://doi.org/10.1016/s0885-3924(96)00274-6
- 23. Lee WG, Kim HJ. Psychometric evaluation of the Korean version of the functional assessment of chronic illness therapy-fatigue. J Nurs Res. 2022;30(3):e206. https://doi.org/10.1097/jnr.0000000000000484
- 24. Cheminet G, Corbasson A, Charmettan M, Namaoui W, Khimoud D, Flamarion E, et al. Assessment of fatigue in adult patients with sickle cell disease: use of the functional assessment of chronic illness therapy-Fatigue (FACIT-fatigue) questionnaire. Br J Haematol. 2024;205(1):335-42. https://doi.org/10.1111/bjh.19568
- 25. Moorey S, Frampton M, Greer S. The Cancer Coping Questionnaire: a self-rating scale for measuring the impact of adjuvant psychological therapy on coping behaviour. Psychooncology. 2003;12(4):331-44. https://doi.org/10.1002/pon.646
- 26. Kim JN, Kwon JH, Kim SY, Yu BH, Hur JW, Kim BS, et al. Validation of Korean-Cancer Coping Questionnaire (K-CCQ). Korean J Health Psychol. 2004;9:395-414.
- 27. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30-41. https://doi.org/10.1207/s15327752jpa5201_2
- 28. Park H, Nguyen T, Park H. Validation of multidimensional scale of perceived social support in middle-aged Korean women with diabetes. Asia Pac J Soc Work Dev. 2012;22(3):202-13. https://doi.org/10.1080/02185385.2012.691719
- 29. Kim M, Yeom HE, Jung MS. Validation and psychometric properties of the multidimensional scale of perceived social support among Korean breast cancer survivors. Asia Pac J Oncol Nurs. 2022;9(4):229-35. https://doi.org/10.1016/j.apjon.2022.01.004
- 30. Park SY, Park A. Fear of cancer recurrence and associated factors among cancer survivors. Health Soc Welf Rev. 2023;43(1):282-298. https://doi.org/10.15709/hswr.2023.43.1.282
- 31. Adashek JJ, Jordan A, Redwine LS, Tyson DM, Thompson Z, Pabbathi S. Pan-cancer analysis of fear of cancer recurrence among cancer survivors. ESMO Open. 2022;7(4):100528. https://doi.org/10.1016/j.esmoop.2022.100528
- 32. Maass S, Boerman LM, Verhaak PF, Du J, de Bock GH, Berendsen AJ. Long-term psychological distress in breast cancer survivors and their matched controls: a cross-sectional study. Maturitas. 2019;130:6-12. https://doi.org/10.1016/j.maturitas.2019.09.003
- 33. Kim Y, Min HY, An HJ. Fear of cancer recurrence interventions for breast cancer survivors in the 2020s: a systematic review. J Cancer Surviv. Forthcoming 2025 Mar 25. https://doi.org/10.1007/s11764-025-01774-9
- 34. Kluthcovsky AC, Urbanetz AA. Fatigue and quality of life in breast cancer survivors: a comparative study. Rev Bras Ginecol Obstet. 2015;37(3):119-26. https://doi.org/10.1590/so100-720320150005247
- 35. Zhang X, Sun D, Qin N, Liu M, Jiang N, Li X. Factors correlated with fear of cancer recurrence in cancer survivors: a meta-analysis. Cancer Nurs. 2022;45(5):406-15. https://doi.org/10.1097/ncc.0000000000001020
E-SUBMISSION
