Fear of Cancer Recurrence Is Highly Prevalent and Linearly Associates With Anxiety and Depression in Chinese Breast Cancer Patients

Abstract Objective: To characterize the fear of cancer recurrence (FCR) and its relationship with anxiety and depression and quality of life (QoL) among Chinese breast cancer (BC) patients in China. Methods: Patients completed the questionnaires of QLQ-C30, QLQ-BR32 and HAD to assess FCR, QoL, anxiety and depression before radiotherapy. A cross-sectional analysis was performed. Chi-square and non-parametric tests and multivariate ordinal logistic regressions (mOLR) were utilized for reference analysis. Final covariates included age, BMI, TNM, surgery, chemotherapy, pain, and sleep disturbance. Results: From July 2015 to December 2016, 463 patients were prospectively enrolled. Their age mean (range) were 47 (19 - 89) years old. In total, 327 patients (70.6%) reported having FCR ‘a little bit’ (51.2%), ‘some’ (12.1%) and ‘very much’ (7.3%) in the past week. FCR severity ordered above (incl. ‘no’) was associated with anxiety score (median 1.5, 5.0, 7.0, 8.5 and level (‘abnormal’ rate 0%, 3.4%, 12.5%, 26.5%), depression score (median 2.0, 4.0, 6.0, 6.5) and level (‘abnormal’ rate 2.2%, 3.4%, 5.4%, 17.7%) (all p<0.001). mOLR showed that compared to ‘no’, three higher levels of FCR were associated with one level increase of anxiety with OR (p) as 1.983 (0.076), 4.291 (0.001), 8.282 (<0.001) and depression with OR (p) as 1.903 (0.062), 2.262 (0.065), 4.205 (0.004), respectively. FCR severity also was inversely associated with most QoL function scores (p<0.001). Conclusions: FCR was prevalent in Chinese BC patients and linearly associated with anxiety, depression and low QoL. It seems that a single-item question for FCR is a valid surrogate tool for distress screening in this population.