title: Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors.
abstract: 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.
authors.affiliation: Mayo Clinic, Department of Internal Medicine, Division of Hematology, Rochester, MN. Electronic address: thompson.carrie@mayo.edu.
authors.forename: C A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine.
authors.forename: M E
authors.initials: ME
authors.lastname: Charlson
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
authors.forename: E
authors.initials: E
authors.lastname: Schenkein
authors.affiliation: Department of Statistical Science, Cornell University, Ithaca, NY, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Wells
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
authors.forename: R R
authors.initials: RR
authors.lastname: Furman
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
authors.forename: R
authors.initials: R
authors.lastname: Elstrom
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
authors.forename: J
authors.initials: J
authors.lastname: Ruan
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York.
authors.forename: J P
authors.initials: JP
authors.lastname: Leonard
mesh_terms: 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