title: Fear of recurrence and psychological distress in head and neck cancer patients and their carers.
abstract: BACKGROUND
  Fear of recurrence (FOR) has been increasingly recognised as an issue of significant burden for most cancer patients, and has been associated with psychological morbidity and reduced quality of life. More recently, the impact of recurrence fears has been indicated in the families of cancer patients. However, there has been a lack of prospective research.
  
  
  OBJECTIVE
  To systematically examine distress and illness concerns among patient-carer dyads.
  
  
  METHODS
  A multi-centre prospective study of head and neck cancer patients and their carers (patients, n=101; carers, n=101), surveyed at two time-points following diagnosis.
  
  
  RESULTS
  Carers recorded higher recurrence concerns on average than the patient group (p<0.001). A predictive path model of patient and carer self-reports of distress and FORs was explored, with an excellent overall fit of the final model (chi(2)=15.4, df=12, p=0.22, Comparative Fit Index (CFI)=0.994, Root Mean Square Estimate of Approximation (RMSEA)=0.053).
  
  
  CONCLUSIONS
  The preliminary results establish that early fears and distress within individuals govern later reports on these same attributes, but that there is some weak evidence of influence from one attribute to another within and across individuals in the dyad. Future prospective dyadic research is warranted to ascertain the level of these fears over an extended time and their relationship to patient and carer adaptation. Intervention may be needed to reduce this disease concern to a manageable level at an early stage of the illness trajectory.
authors.affiliation: Department of Psychiatry, The University of Manchester, Manchester, UK. laura.hodges@ed.ac.uk
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Hodges
authors.forename: Gerry M
authors.initials: GM
authors.lastname: Humphris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D010039:Otorhinolaryngologic Neoplasms / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D006113:United Kingdom