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Does fear of cancer recurrence predict cancer survivors' health care use?

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Abstract

Introduction

Fear of cancer recurrence (FCR) is the most frequently cited unmet need among cancer survivors. Theoretical models of FCR suggest that patients with elevated levels of FCR will more frequently consult health care professionals for reassurance about their health. However, the relationship between FCR and health care utilization has not yet been firmly established. We examined the relationship between FCR and quantity of medications, number of emergency room (ER) visits, outpatient visits, specialist visits, allied health visits, and hospital overnight visits.

Methods

A total of 231 participants diagnosed with breast, colon, prostate, or lung cancer in the past 10 years were recruited from a cancer survivor registry. Participants were sent a survey package that included demographic and medical characteristics, a health care utilization questionnaire, and the Fear of Cancer Recurrence Inventory.

Results

A multiple regression analysis indicated that higher FCR significantly predicted greater number of outpatient visits in the past 6 months (ß = .016, F(1, 193) = 5.08, p = .025). A hierarchical multiple regression indicated that higher FCR significantly predicted greater number of ER visits in the past 6 months when controlling for relationship status and education level (F(1, 179) = 4.00, p = .047).

Conclusions

The relationship between FCR and health care use has been understudied. Results indicate that patients with elevated FCR may indeed use more health care services. We recommend that clinicians monitor health care use in patients who are struggling with FCR.

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Notes

  1. At the suggestion of one of the reviewers, we performed additional preliminary analyses to compare the impact of FCR on health care utilization by gender and by diagnosis. We performed the regression analyses described above separately for (a) women and men and (b) breast vs. prostate cancer as there were not enough participants with lung and colorectal cancer to do separate analyses for those two other diagnoses. We could not perform analyses by age group as there were only four participants under the age of 50. When comparing the results of the regression analyses by gender, we found that among female survivors, FCR predicted outpatient clinic visits (ß = .22, F(1, 94) = 4.74, p = .032) and ER visits (ß = .28, F(3, 88) = 2.71, p = .050). Among male survivors, FCR predicted only number of medication (ß = .25, F(1, 70) = 4.57, p = .036). When comparing the results of the regression analyses by diagnosis, we found that among breast cancer survivors, FCR predicted outpatient clinic visits (ß = .31, F(1, 78) = 7.99, p = .006) and ER visits (ß = .31, F(3, 73) = 2.81, p = .046). Among prostate cancer survivors, FCR predicted only outpatient clinic visits (ß = .31, F(1, 81) = 8.32, p = .005).

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Acknowledgments

This research was supported through a Research Development Grant from the University of Ottawa to Sophie Lebel. We appreciate the efforts of our volunteers on this project: Lynne Potvin, Megan Fillier, Brigitte Corran, Stephanie Robert, Rosa Leblanc, and Kristin Loeper. We extend our gratitude to the staff at Cancer Care Ontario for their invaluable help with recruitment.

Conflict of interest

The authors do not have a financial relationship with any of the organizations that sponsored the research.

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Correspondence to Sophie Lebel.

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Lebel, S., Tomei, C., Feldstain, A. et al. Does fear of cancer recurrence predict cancer survivors' health care use?. Support Care Cancer 21, 901–906 (2013). https://doi.org/10.1007/s00520-012-1685-3

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