Skip to main content
SpringerLink
Log in

Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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 [R 2 = 0.35, F(3,54) = 9.59, p < 0.001].

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Berger AM, Gerber LH, Mayer DK (2012) Cancer-related fatigue: implications for breast cancer survivors. Cancer 118(S8):2261–2269

    Article  PubMed  Google Scholar 

  2. Stasi R, Abriani L, Beccaglia P, Terzoli E, Amadori S (2003) Cancer-related fatigue: evolving concepts in evaluation and treatment. Cancer 98(9):1786–1801

    Article  PubMed  Google Scholar 

  3. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367(9522):1618–1625

    Article  PubMed  Google Scholar 

  4. Bloom JR, Stewart SL, Chang S, Banks PJ (2004) Then and now: quality of life of young breast cancer survivors. Psychooncology 13(3):147–160

    Article  PubMed  Google Scholar 

  5. Stanton AL, Rowland JH, Ganz PA (2015) Life after diagnosis and treatment of cancer in adulthood: contributions from psychosocial oncology research. Am Psychol 70(2):159–174

    Article  PubMed  Google Scholar 

  6. Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36(1):13–34

    Article  PubMed  Google Scholar 

  7. Traeger L, Greer JA, Fernandez-Robles C, Temel JS, Pirl WF (2012) Evidence-based treatment of anxiety in patients with cancer. J Clin Oncol 30(11):1197–1205

    Article  PubMed  Google Scholar 

  8. Simard S, Savard J, Ivers H (2010) Fear of cancer recurrence: specific profiles and nature of intrusive thoughts. J Cancer Surviv 4(4):361–371

    Article  PubMed  Google Scholar 

  9. Crist JV, Grunfeld EA (2013) Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology 22(5):978–986

    Article  PubMed  Google Scholar 

  10. Savard J, Ivers H (2013) The evolution of fear of cancer recurrence during the cancer care trajectory and its relationship with cancer characteristics. J Psychosom Res 74(4):354–360

    Article  PubMed  Google Scholar 

  11. Thewes B et al (2012) Fear of cancer recurrence: a systematic literature review of self-report measures. Psycho-Oncology 21(6):571–587

    Article  PubMed  Google Scholar 

  12. Gil KM, Mishel M, Belyea M, Germino LS, Porter L, LaNey IC, Stewart J (2004) Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum 31(3):633–639

    Article  Google Scholar 

  13. McGinty HL, Small BJ, Laronga C, Jacobsen PB (2016) Predictors and patterns of fear of cancer recurrence in breast cancer survivors. Health Psychol 35(1):1–9

    Article  PubMed  Google Scholar 

  14. Hilton BA (1988) The phenomenon of uncertainty in women with breast cancer. Issues Ment Health Nurs 9(3):217–238

    Article  CAS  PubMed  Google Scholar 

  15. Mckinley ED (2000) Under toad days: surviving the uncertainty of cancer recurrence. Ann Intern Med 133(6):479–480

    Article  CAS  PubMed  Google Scholar 

  16. Nelson JP (1996) Struggling to gain meaning: living with the uncertainty of breast cancer. ANS Adv Nurs Sci 18(3):59–76

    Article  CAS  PubMed  Google Scholar 

  17. Mishel MH (1990) Reconceptualization of the uncertainty in illness theory. Image J Nurs Sch 22(4):256–262

    Article  CAS  PubMed  Google Scholar 

  18. Salkovskis PM, Warwick HM (1986) Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behav Res Ther 24(5):597–602

    Article  CAS  PubMed  Google Scholar 

  19. van de Wal MA, Gielissen MF, Servaes P, Knoop H, Speckens AE, Prins JB (2015) Study protocol of the SWORD-study: a randomized controlled trial comparing combined online and face-to-face cognitive behaviour therapy versus treatment as usual in managing fear of cancer recurrence. BMC Psychol 3(1):12

    Article  PubMed  PubMed Central  Google Scholar 

  20. Warwick HM (1989) A cognitive-behavioural approach to hypochondriasis and health anxiety. J Psychosom Res 33(6):705–711

    Article  CAS  PubMed  Google Scholar 

  21. Fardell JE et al (2016) Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv:1–11

  22. Dow KH (1995) A review of late effects of cancer in women. Semin Oncol Nurs 11(2):128–136

    Article  CAS  PubMed  Google Scholar 

  23. Eisenberg SA, Kurita K, Taylor-Ford M, Agus DB, Gross ME, Meyerowitz BE (2015) Intolerance of uncertainty, cognitive complaints, and cancer-related distress in prostate cancer survivors. Psychooncology 24(2):228–235

    Article  PubMed  Google Scholar 

  24. Sporn NJ, Smith KB, Pirl WF, Lennes IT, Hyland KA, Park ER (2015) Sexual health communication between cancer survivors and providers: how frequently does it occur and which providers are preferred? Psychooncology 24(9):1167–1173

    Article  PubMed  Google Scholar 

  25. Kroenke K, Spitzer RL, Williams JB (2002) The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 64(2):258–266

    Article  PubMed  Google Scholar 

  26. Kroenke K et al (2010) Somatic symptoms in patients with cancer experiencing pain or depression: prevalence, disability, and health care use. Arch Intern Med 170(18):1686–1694

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gotay CC, Pagano IS (2007) Assessment of Survivor Concerns (ASC): a newly proposed brief questionnaire. Health Qual Life Outcomes 5(1):15

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396

    Article  CAS  PubMed  Google Scholar 

  29. Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40(3):879–891

    Article  PubMed  Google Scholar 

  30. Hayes AF (2009) Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr 76(4):408–420

    Article  Google Scholar 

  31. Simmons JP, Nelson LD, Simonsohn U (2011) False-positive psychology undisclosed flexibility in data collection and analysis allows presenting anything as significant. Psychol Sci:0956797611417632

  32. Bennett MI, Rayment C, Hjermstaf M, Aass N, Caraceni A, Kaasa S (2012) Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain 153(2):359–365

    Article  PubMed  Google Scholar 

  33. Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12(S1):4–10

    Article  PubMed  Google Scholar 

  34. Koch L et al (2013) Fear of recurrence and disease progression in long-term (≥ 5 years) cancer survivors—a systematic review of quantitative studies. Psycho-Oncology 22(1):1–11

    Article  CAS  PubMed  Google Scholar 

  35. Cohen S (1988) Perceived stress in a probability sample of the United States

  36. Cohen S, Herbert TB (1996) Health psychology: psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annu Rev Psychol 47(1):113–142

    Article  CAS  PubMed  Google Scholar 

  37. Glaser R, Kiecolt-Glaser JK (2014) Handbook of human stress and immunity. Academic Press

  38. Antoni MH et al (2006) The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer 6(3):240–248

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B (2006) Cancer-related worries and psychological distress among older adult, long-term cancer survivors. Psychooncology 15(4):306–320

    Article  PubMed  Google Scholar 

  40. Gil KM, Mishel MH, Belyea M, Germino B, Porter LS, Clayton M (2006) Benefits of the uncertainty management intervention for African American and white older breast cancer survivors: 20-month outcomes. Int J Behav Med 13(4):286–294

    Article  PubMed  Google Scholar 

  41. Mishel MH et al (2005) Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psycho-Oncology 14(11):962–978

    Article  PubMed  Google Scholar 

  42. Lebel S et al (2014) Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv 8(3):485–496

    Article  PubMed  Google Scholar 

  43. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, Widen RH, Fitzgerald SG, Shelton MM, Barta M, Goodman M, Cox CE, Kip KE (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology 18(12):1261–1272

    Article  PubMed  Google Scholar 

  44. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, Jacobsen PB, Shelton MM, Le N, Budhrani P, Goodman M, Kip KE (2011) Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs 29(2):107–117

    Article  PubMed  Google Scholar 

  45. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, Paterson C, Ramesar S, Budhrani P, Carranza I, Lucas J, Jacobsen PB, Goodman MJ, Kip KE (2014) Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trail (RCT). J Behav Med 37(2):185–195

    Article  PubMed  Google Scholar 

  46. Kim Y, Carver CS, Spillers RL, Love-Ghaffari M, Kaw CK (2012) Dyadic effects of fear of recurrence on the quality of life of cancer survivors and their caregivers. Qual Life Res 21(3):517–525

    Article  PubMed  Google Scholar 

  47. Fan G (2007) Symptom clusters in cancer patients: a review of the literature. Curr Oncol 14(5):173–179

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge the patients who participated in this study.

Author information

Authors and Affiliations

  1. Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA

    Daniel L. Hall & Elyse R. Park

  2. Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA

    Daniel L. Hall

  3. Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Inga T. Lennes, Emily R. Friedman & Elyse R. Park

  4. Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA

    William F. Pirl

  5. Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA

    Emily R. Friedman & Elyse R. Park

Authors
  1. Daniel L. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inga T. Lennes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William F. Pirl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emily R. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elyse R. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel L. Hall.

Ethics declarations

Funding source

This study was supported by internal funds from the Massachusetts General Hospital Cancer Center. DLH was supported by an Institutional National Research Service Award (T32AT000051) from the National Center for Complementary and Integrative Health at the National Institutes of Health. ERP was supported by a midcareer investigator award (NCI K24CA197382) from the National Cancer Institute.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hall, D.L., Lennes, I.T., Pirl, W.F. et al. Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors. Support Care Cancer 25, 1401–1407 (2017). https://doi.org/10.1007/s00520-016-3533-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3533-3

Keywords

Search

Navigation