title: Fear of recurrence impacts health-related quality of life and continued tobacco use in head and neck cancer survivors.
abstract: OBJECTIVE
  To examine the impact of fear of recurrence (FOR) on health-related quality of life (HRQOL) and tobacco use among head and neck cancer (HNC) survivors.
  
  
  METHODS
  A cross-sectional subset of patients (N = 138) from a large, prospective study of oncologic outcomes in HNC was assessed for FOR, in addition to the parent study's ongoing assessments of HRQOL and tobacco use. FOR was measured using the Fear of Cancer Recurrence Inventory and HNC-specific HRQOL was assessed with the Head and Neck Cancer Inventory (HNCI). Tobacco use was patient-reported as "Current," "Previous," or "Never."
  
  
  RESULTS
  After controlling for relevant clinical and demographic variables, hierarchical regression analyses revealed that higher FOR significantly predicted lower HRQOL across all HNCI domains (eating (p < .05), aesthetics (p < .01), speech (p < .01), and social disruption (p = .001)) and increased tobacco use (p < .01). A total of 60.1% of the sample expressed clinically significant levels of FOR. These patients reported lower HRQOL (eating: p < .05, aesthetics: p < .05, social disruption: p < .05) and were more likely to be using tobacco compared with patients with subclinical FOR (26.6% and 4.9%, respectively; p < .01).
  
  
  CONCLUSIONS
  Results suggest that FOR is prevalent among HNC survivors and is related to decreased HRQOL and increased tobacco use.
authors.affiliation: Department of Psychology, The University of Iowa.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Van Liew
authors.affiliation: Department of Psychology, The University of Iowa.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Christensen
authors.affiliation: Department of Psychology, The University of Iowa.
authors.forename: M Bryant
authors.initials: MB
authors.lastname: Howren
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics.
authors.forename: Lucy
authors.initials: L
authors.lastname: Hynds Karnell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics.
authors.forename: Gerry F
authors.initials: GF
authors.lastname: Funk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006258:Head and Neck Neoplasms / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D064424:Tobacco Use / Q000523:psychology*; D055815:Young Adult