Fear of Cancer Recurrence in Patients Undergoing Definitive Treatment for Prostate Cancer: Results From CaPSURE

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Abstract
Purpose: Contemporary cancer treatments have resulted in patients living longer but with the risk of disease recurrence. Studies suggest that fear of recurrence is a significant burden. We described fear of cancer recurrence in patients with prostate cancer undergoing treatment with radical prostatectomy (RP), radiation (XRT) or brachytherapy (BT). Materials and Methods: A total of 519 patients (326 RP, 53 XRT, 140 BT) were identified from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor), a national longitudinal registry of men with prostate cancer. To be included in the study patients had to complete at least 1 pretreatment and 2 posttreatment health related quality of life questionnaires and have complete clinical information. Fear of cancer recurrence was assessed with a validated 5-item scale, and was described at baseline and up to 2 years after treatment. Multivariate linear regression was performed to determine significant predictors of fear of cancer recurrence. Results: Men receiving XRT were older and had worse clinical disease characteristics than patients treated with RP or BT. For all groups fear of cancer recurrence was more severe before treatment and improved after treatment but did not change substantially in the 2 years thereafter. Regression revealed that only general health and mental health were important predictors of fear of cancer recurrence. No other general or disease specific health related quality of life domains or clinical characteristics contributed appreciable explanatory power. Conclusions: Fear of prostate cancer recurrence imposes a substantial burden in patients before and after treatment. Understanding the fear of cancer recurrence associated with different treatments can help physicians better counsel patients and promote psychological well-being.