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Cited by 116Cancer survivorship and careChildhood Cancer Survivors' Quality of LifeCancer-related cognitive impairment studies

Fear of cancer recurrence: A qualitative systematic review and meta-synthesis of patients' experiences

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Almeida, Susana N., Elliott, Robert, Silva, Eunice R., Sales, Célia M.D.·2019·Clinical Psychology Review
DOI 10.1016/j.cpr.2018.12.001
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Abstract

Fear of cancer recurrence (FCR) is a significant issue for most cancer survivors, with nearly half of cancer survivors reporting it at moderate to high levels of intensity. We aimed to further explore the experience of having FCR from the point of view of patients by systematically reviewing qualitative studies. Following PRISMA guidelines, 87 qualitative studies were selected. All participants' quotes about FRC were extracted, then analysed using a conceptual framework based on the emotion-focused therapy theory of emotion schemes, which consist of experienced/implicit emotions, along with perceptual-situational, bodily-expressive, symbolic-conceptual and motivational-behavioral elements. According to participant descriptions, FCR was found to be an intense, difficult, multi-dimensional experience. Considering the diversity of experiences identified, it is useful to look at FCR as an emotional experience that extends along a continuum of adaptive and maladaptive responses. For some participants, FCR was described in trauma-like terms, including forms of re-experiencing, avoidance, negative thoughts and feelings, and arousal or reactivity related to cancer-related triggers or memories. Vivid metaphors expressing vulnerability and conflict also reflect the strong impact of FCR in patients' lives and can help therapists empathize with their clients.

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  • Fear of illness recurrence (FIR) has been widely studied in cancer and other chronic health conditions and is associated with greater avoidance of illness reminders, disregarding symptom changes, and social withdrawal.

    “FIR has been widely studied in cancer and other chronic health conditions and is associated with greater avoidance of illness reminders (e.g., medical appointments), disregarding symptom changes, and social withdrawal [13–16].”

    From Fear of depression recurrence among individuals with remitted depression: a qualitative interview study (2024) · cites this paper as [13]

    Section 3.10, “Action tendencies related to FCR” (page unavailable), identifies avoidance of medical examinations, disregarding bodily changes, and isolating oneself among responses described by cancer patients. The paper concerns fear of cancer recurrence; it does not establish that these patterns extend to other chronic health conditions. (LLM, conf=0.88)

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  • Fear of cancer recurrence has been associated with greater depression and anxiety symptoms, reduced quality of life, reduced engagement in social activities, and limited coping.

    “Fear of cancer recurrence has been associated with greater depression and anxiety symptoms, reduced quality of life, reduced engagement in social activities, and limited coping [13, 17, 62, 63].”

    From Fear of depression recurrence among individuals with remitted depression: a qualitative interview study (2024) · cites this paper as [13]

    The Introduction (page unavailable) says FCR can affect quality of life and emotional and social functioning, while Results §3.1 describes anxiety and depressive feelings. Results §3.10 describes isolation and avoidance, and the Discussion calls responding to FCR challenging. These passages broadly support the claimed associations, but do not specifically establish reduced participation in social activities or limited coping as general outcomes. (LLM, conf=0.84)

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  • Fear of cancer recurrence cuts across all types of cancer, with risk factors including being a woman, being younger, not having a partner, having at least one child, being socially isolated, having more and more severe physical symptoms, and having lower emotional well-being.

    “FCR seems to cut across all types of cancer, with risk factors including being a woman, being younger, not having a partner, having at least one child, being socially isolated, having more (and more severe) physical symptoms, and having lower emotional well-being (Almeida et al. 2019).”

    From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Almeida et al. 2019

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  • Positive influences of FIR in cancer have also been reported including serving as a motivator to better manage one's illness through self-care, positive coping, and symptom monitoring.

    “Positive influences of FIR in cancer have also been reported including serving as a motivator to better manage one’s illness through self-care, positive coping, and symptom monitoring [13, 19].”

    From Fear of depression recurrence among individuals with remitted depression: a qualitative interview study (2024) · cites this paper as [13]

  • FCR is a highly diverse experience, described by survivors as affecting their perceptions, emotions, body, cognitions and behaviour.

    “FCR is a highly diverse experience, described by survivors as affecting their perceptions, emotions, body, cognitions and behaviour (Almeida et al.,2019).”

    From Developing an emotion‐focused therapy model for fear of cancer recurrence: A case‐level task analysis. (2024) · cites this paper as Almeida et al.,2019

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Cites

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Research works printed but not linked: 13

  1. Berman, M. B. (2013). The Experience of Fear of Cancer Recurrence Among Early- Stage Breast Cancer Survivors (doctoral dissertation). Wright Institute Graduate School of Psychology, USA.
  2. Brandão, T. (2017). Adaptation to breast cancer: exploring the role of attachment and emotion regulation processes (doctoral dissertation). University of Porto, Portugal.
  3. Cancer Australia. (2011). The impact of fear of cancer recurrence on wellness: a systematic literature review. https://doi.org/http://dx.doi.org/10.1111/ajco.12144 · DOI
  4. Greenberg, L. S., & Paivio, S. C. (1997). Working with emotions in psychotherapy. New York: Guilford Press.
  5. Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment-by-moment process. New York: Guilford Press.
  6. Grimsbø, G. H., Finset, A., & Ruland, C. M. (2011). Left hanging in the air: experiences of living with cancer as expressed through e-mail communications with oncology nurses. Cancer Nursing, 34(2), 107-116 10p. https://doi.org/10.1097/NCC.0b013e3181eff008 · DOI
  7. Jones, W. C. (2012). Quality of life after cancer treatment: A mixed methods investigation of predictors of distress in leukemia and lymphoma survivors in Colorado (doctoral dissertation). University of Colorado, USA.
  8. Kelly, M., & Dowling, M. (2011). Patients' lived experience of myeloma. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 25(28), 38-44. https://doi.org/10.7748/ns2011.03.25.28.38.c8397 Kövecses, Z. (1990). Emotion concepts. Psycnet.Apa.Org. https://doi.org/10.1007/978- 1-4612-3312-1 · DOI
  9. Lesko, L. M. (1998). Hematopoietic Dyscrasias. In J. C. Holland (Ed.), Psycho- oncology (pp. 406-416). New York; Oxford: Oxford University Press.
  10. Raymer, D. (1993). On the fear of cancer recurrence (doctoral dissertation). University of Toronto, Canada.
  11. Sadler-Gerhardt, C. (2007). "And then what happened?": the lived experiences of breast cancer survivors and theirs stories of change and meaning (doctoral dissertation). University of Akron, USA.
  12. Scott, E. (2014). A legacy of lingering uncertainty. The experience of long-term cancer survivorship: a multiple-case study (doctoral dissertation). University of Nottingham, UK.
  13. Shachar Siman-Tov, E. (2008). The experience and the role of spirituality among women who have had breast cancer and who have completed their medical treatments (doctoral dissertation). University of Hartford, USA.

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Authors
Almeida, S. N., Elliott, R., Silva, E. R., & Sales, C. M. D.
Affiliations
  • IPO Porto (PT)
  • University of Strathclyde (GB)
  • Universidade do Porto (PT)
Corresponding author
Almeida, Susana N.
ORCID
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2019-03
Volume
68
Pages
13-24
ISSN
0272-7358 (ISSN-L)
DOI
10.1016/j.cpr.2018.12.001
OpenAlex
W2905686671
Cited by
116
References
85
Citations by year
2026: 13 · 2025: 21 · 2024: 20 · 2023: 18 · 2022: 21 · 2021: 10 · 2020: 9 · 2019: 3
FWCI
0.57
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
Funders
  • University of Chicago
  • University of Akron
  • European Oncology Nursing Society
  • Multinational Association of Supportive Care in Cancer
  • University of Hartford
  • University of Oxford
  • University of Toronto
  • European Society for Medical Oncology
  • National Cancer Institute
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords
fear of cancer recurrence, cancer survivors, patient experience, emotion-focused therapy, re-experiencing, avoidance, metaphor, vulnerability
MeSH terms
Cancer Survivors, Fear, Humans, Neoplasm Recurrence, Local, Neoplasms, Recurrence

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