Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors.
BACKGROUND
We aimed to assess anxiety and the psychological impact of routine surveillance scans in long-term survivors of adult aggressive lymphoma.


METHODS
In this cross-sectional observational study of 70 survivors of curable adult aggressive lymphoma, we measured anxiety and the doctor-patient relationship and performed a qualitative interview (n = 30) focused on patient perception of routine follow-up imaging studies.


RESULTS
Participants were diagnosed with aggressive lymphoma a median of 4.9 years (2.4-38.0 years) before enrollment. Thirty-seven percent of patients were found to meet criteria for clinically significant anxiety, which was not associated with years since diagnosis. In multivariate analysis, history of relapse and a worse doctor-patient relationship were independently associated with higher anxiety levels. Despite representing a largely cured population, in qualitative interviews patients reported fear of recurrence as a major concern and considerable anxiety around the time of a follow-up imaging scan.


CONCLUSIONS
Routine surveillance scans exacerbate underlying anxiety symptoms and fear of recurrence in survivors of aggressive lymphoma. Strategies to minimize follow-up imaging and to improve doctor-patient communication should be prospectively evaluated to address these clinically significant issues.
Thompson
C A
CA
Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN. Electronic address: thompson.carrie@mayo.edu.
Charlson
M E
ME
Department of Internal Medicine, Division of General Internal Medicine.
Schenkein
E
E
Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
Wells
M T
MT
Department of Statistical Science, Cornell University, Ithaca, NY, USA.
Furman
R R
RR
Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
Elstrom
R
R
Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
Ruan
J
J
Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
Martin
P
P
Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
Leonard
J P
JP
Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000523:psychology*; D009367:Neoplasm Staging; D010817:Physician-Patient Relations; D011379:Prognosis; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult