title: Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors.
abstract: Many cancer survivors report experiencing somatic symptoms as well as elevated stress. Theoretical models have suggested that physical symptoms generate subjective stress via fears of recurrence or progression. To date, this indirect effect has not been established empirically. This study aimed to provide preliminary evidence as to whether fear of recurrence or progression is an intermediary between somatic symptom severity and perceived stress among heterogeneous cancer survivors.
  
  
  
  Adult cancer survivors (N = 67; median 2.4 years since diagnosis; 34% male) presenting at a hospital survivorship clinic completed measures assessing somatic symptom severity (Patient Health Questionnaire-15 (PHQ-15)), perceived stress (four-item Perceived Stress Scale (PSS-4)), and fear of recurrence or progression (Assessment of Survivor Concerns (ASC)). Interrelatedness among variables was assessed using Pearson correlations. Indirect effects were modeled using 5000-iteration bootstrapping.
  
  
  
  Survivors endorsed a range of somatic symptom severity (29% minimal, 39% low, 18% medium, and 14% high). Somatic symptoms, perceived stress, and fear of recurrence or progression were all significantly positively correlated (rs 0.29 to 0.47). Controlling for time since diagnosis, there was a significant indirect effect of somatic symptom severity on stress via fear of recurrence or progression [B = 0.06, SE = 0.04 (95% CI 0.01-0.16)]. The model accounted for more than one third of the variance in perceived stress [R2= 0.35, F(3,54) = 9.59, p < 0.001].
  
  
  
  Survivors with greater somatic symptoms tended to report higher levels of stress, due in part to elevated fears of recurrence or progression. Our findings support concerns about recurrence or progression as a mechanism underlying stress states in cancer survivors. Efforts to assist survivors with stress management should teach strategies for managing cancer-related uncertainties stemming from somatic symptoms.
authors.affiliation: Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA. dhall7@mgh.harvard.edu.|Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA. dhall7@mgh.harvard.edu.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Hall
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.
authors.forename: Inga T
authors.initials: IT
authors.lastname: Lennes
authors.affiliation: Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.|Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Friedman
authors.affiliation: Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.|Massachusetts General Hospital Cancer Center, Boston, MA, USA.|Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
mesh_terms: D018450:Disease Progression; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology / Q000523:psychology*; D009369:Neoplasms / Q000503:physiopathology / Q000523:psychology*; D010465:Perception; D013315:Stress, Psychological / Q000523:psychology*; D017741:Survivors
keywords: Cancer; Fear of recurrence; Oncology; Stress; Survivorship; Symptoms