title: Trajectories of fear of recurrence in women with breast cancer.
abstract: OBJECTIVE
  Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery.
  
  
  METHODS
  Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months.
  
  
  RESULTS
  From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time.
  
  
  CONCLUSIONS
  These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.
authors.affiliation: School of Medicine, University of California, San Francisco, CA, USA, laura.dunn@ucsf.edu.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dunn
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Langford
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.forename: Molly B
authors.initials: MB
authors.lastname: Berman
authors.forename: Dianne M
authors.initials: DM
authors.lastname: Shumay
authors.forename: Kord
authors.initials: K
authors.lastname: Kober
authors.forename: John D
authors.initials: JD
authors.lastname: Merriman
authors.forename: Claudia
authors.initials: C
authors.lastname: West
authors.forename: John M
authors.initials: JM
authors.lastname: Neuhaus
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000223:Adaptation, Psychological; D001008:Anxiety Disorders / Q000209:etiology / Q000523:psychology; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D005239:Fear / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D011184:Postoperative Period; D011788:Quality of Life; D017741:Survivors / Q000523:psychology*