Fear of recurrence in long-term testicular cancer survivors.
OBJECTIVE
To explore fear of recurrence (FoR) in long-term testicular cancer survivors (TCSs) since FoR hardly has been examined in TCSs.


METHODS
In a cross-sectional questionnaire study, 1336 TCSs at a mean of 11.4 years (SD 4.2) after diagnosis gave information about their medical and social situation, and completed measures on mental distress, fatigue, quality of life, coping, self-esteem and neuroticism. FoR during the last week was explored with one question, with the response categories rated on a 4-point Likert scale. Nine percent of the TCSs had a structured psychiatric interview.


RESULTS
Twenty-four percent of the TCSs reported 'quite a bit' FoR and 7% reported 'very much' FoR during the last week. The FoR question showed moderate correlations (0.22-0.51) with established psychological measures. The level of FoR was significantly positively correlated with mental distress, fatigue and neuroticism and significantly negatively correlated with quality of life, self-esteem and coping. In univariate analyses, neurotoxic side effects and somatic symptoms, but not treatment modality, were significantly associated with level of FoR. In a multivariate analysis, a medium educational level, increasing levels of traumatic cancer-related stress symptoms and of neuroticism were significantly associated with rising FoR. Among those who had a psychiatric interview, the presence of at least one current mental disorder was significantly associated with FoR.


CONCLUSIONS
High levels of FoR in long-term TCSs are not uncommon. Levels of mental and somatic problems are associated with the levels of FoR. Clinical consequences of these findings for TCSs are discussed.
Skaali
Tone
T
Department of Clinical Cancer Research, The Norwegian Radiumhospital, Rikshospitalet University Hospital, Oslo, Norway. tone.skaali@radiumhospitalet.no
Fosså
Sophie D
SD
Bremnes
Roy
R
Dahl
Olav
O
Haaland
Carl Fredrik
CF
Hauge
Erik Rønneberg
ER
Klepp
Olbjørn
O
Oldenburg
Jan
J
Wist
Erik
E
Dahl
Alv A
AA
D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D003674:Defense Mechanisms; D005221:Fatigue / Q000523:psychology; D005239:Fear; D005500:Follow-Up Studies; D018237:Germinoma / Q000523:psychology* / Q000628:therapy; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D009497:Neurotic Disorders / Q000523:psychology; D010555:Personality Inventory; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D012649:Self Concept; D018239:Seminoma / Q000523:psychology* / Q000628:therapy; D012803:Sick Role; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013736:Testicular Neoplasms / Q000523:psychology* / Q000628:therapy