The relationship between fear of cancer recurrence and health behaviors: A nationwide longitudinal study of cancer survivors.
Abstract
OBJECTIVE: The goal of this study was to examine fear of cancer recurrence (FCR) and 2 health behaviors, physical activity and fruit and vegetable intake, from early to long-term survivorship in a large cohort of mixed cancer survivors. METHOD: Group-based trajectory analyses and repeated measures analysis of variance were conducted on data collected in the American Cancer Society's Studies of Cancer Survivorship-I. Two thousand three hundred thirty-seven survivors of 10 cancers completed the survey at 3 time points (M = 1.3, 2.2, and 8.8 years postdiagnosis). RESULTS: The current study found 3 FCR trajectories clustering cancer survivors by FCR severity: low (33.6%), moderate (58.1%), and high (8.3%). FCR significantly decreased over time and remained distinct for each trajectory group. Patient characteristics prevalent in the high FCR group were being female, of younger age, Hispanic ethnicity, having advanced cancer stage (II to III) and non-Hodgkin lymphoma, and low adherence to physical activity and fruit and vegetable intake recommendations. The high FCR group also reported significantly fewer of these health behaviors compared with the other groups, albeit the effect size was small. CONCLUSIONS: Across the survivorship trajectory, FCR severity decreased but remained distinct for the 3 trajectory groups. Future investigations should inquire about the specific needs of each FCR group to subsequently develop targeted interventions. A weak association between FCR and health behaviors was found, with individuals in the high FCR group reporting less health behaviors. Future research should assess the direction of this relationship over time to inform intervention targets within this subgroup. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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FIR in cancer is associated with lower mood, greater depression and anxiety, reduced quality of life, and lower engagement in health behaviours.
“FIR in cancer is associated with lower mood, greater depression and anxiety, reduced quality of life, and lower engagement in health behaviours [17–20].”
From Fear of depression recurrence among individuals with remitted depression: a qualitative interview study (2024) · cites this paper as [18]
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“Several studies have reported that females experience higher FCR than men (Wagner et al., 2018; Götze et al., 2019; Leclair et al., 2019), while others have not found any significant association between gender and FCR (Mullens et al.”
BackgroundMeissner, V. H., Olze, L., Schiele, S., Ankerst, D. P., Jahnen, M., Gschwend, J. E., Herkommer, K., & Dinkel, A. (2021) · Cancer · doi:10.1002/cncr.33836 · Cited by 58 · see citing works
Calidad de Vida: a systematic review of quality of life in Latino cancer survivors in the USA
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“The clinical relevance of FCR expands beyond psychosocial functioning, with recent work showing associations between FCR and cancer surveillance (self-checking) behavior [8], health care utilization [9], sleep [10], and other health behaviors [11].”
BackgroundLi, Y., Fang, C., Xiong, M., Hou, H. B., Zhang, Y., & Zhang, C. (2023) · Journal of Advanced Nursing · doi:10.1111/jan.16009 · Cited by 54 · see citing works
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“Some studies have reported that women experience higher levels of fear of recurrence than men [9,11], while others have found greater concern among men, especially for specific types of cancer [12,13], or no significant association between gender and fear of recurrence at all [14].”
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“levels, coping difficulties, poor health behaviors, advanced cancer, and experiencing distress in relation to the illness.(4,5,7) While some FCR is considered a normal and even adaptive response to a cancer diagnosis (e.”
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“In a study examining group‐based trajectories of FCR in over 2300 cancer survivors, those with the highest FCR had low levels of physical activity.(39) Our eligibility criteria requiring elevated FCR may have resulted in a sample of breast cancer survivors with a lower like-”
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“In a previous study in cancer survivors, health behaviors differed according to the time of diagnosis, physical symptoms, and fear of recurrence [14, 15].”
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Aguiar‐Ibáñez, R., Mbous, Y. P. V., Sharma, S., Chawla, E., & Pawar, D. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1575813 · Cited by 12 · see citing works
“Of the included studies reporting FCR, three studies did not explicitly specify the recurrence status of patients (38, 117, 119), and one study stated that, while patients did not have recurrence at the time of the survey, recurrence status during the follow-up period was not recorded (120).”
Influentialvan Helmondt, S. J., Lodder, P., van Woezik, R., de Vries, J., & van der Lee, M. L. (2023) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac078 · Cited by 10 · see citing works
“From the studies about FCR classes and trajectories in FCR, only two reported follow-up periods above 24 months: 5 years (a prospective cohort of women diagnosed with breast cancer at age ≤40 years) and 9 years (a national prospective longitudinal study from the American Cancer Society’s Study of Cancer Survivors-I) […”
BackgroundButow, P. N., Müller, F., Napier, C. E., Bartley, N., Ballinger, M. L., Biesecker, B. B., Juraskova, I., Meiser, B., Schlub, T. E., Thomas, D. M., et al. (2021) · Psycho-Oncology · doi:10.1002/pon.5764 · Cited by 9 · see citing works
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“The inclusion criteria for survivors were as follows: (1) being 15–39 years old; (2) ability to speak Mandarin and read Chinese questionnaires; (3) having underwent HSCT within 5 years as at the commencement of the survey (5-year survival rates for cancer are generally associated with a good prognosis)30 and; (4) havi…”
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“Even so, a pattern exists between high FoR and diminished engagement in health behaviors, such as physical activities like walking or running (40).”
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“Based on a previous trajectory analysis, 38 we classified as high FCR individuals with scores > 6.”
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“In addition, cancer survivors with a high FCR a reported significantly fewer health behaviors (Séguin Leclair et al., 2019).”
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Fear of cancer recurrence in patients undergoing germline genome sequencing
Bartley, N., Davies, G., Butow, P. N., Napier, C. E., Schlub, T. E., Ballinger, M. L., Thomas, D. M., Juraskova, I., Meiser, B., & Best, M. C. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06311-9 · Cited by 2 · see citing works
“While a systematic review found little evidence to suggest an association between FCR and time since diagnosis [1], more recent longitudinal studies have shown that patient FCR declines over time [22, 23].”
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“Findings of the current study run counter to those of Seguin Leclair et al. 52 who explored relationships between fear of cancer recurrence (FCR) and health behaviors.”
ResultShin, J., Shin, D. W., Lee, J., Hwang, J., Lee, J. E., Cho, B., & Song, Y. (2021) · Research Square · doi:10.21203/rs.3.rs-378423/v1 · Cited by 1 · see citing works
Todea, D., Luca, A., & Podina, I. R. (2024) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-024-00567-w
“This is consistent with previous studies showing that long-term survivors may have adapted to their survivorship status over time, resulting in lower levels of FCR (Götze et al., 2019; Podina et al., 2023b; Séguin Leclair et al. 2019).”
Gumuchian, S. T., Boyle, A., Kennedy, G., Wong, S. F., & Ellenbogen, M. A. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2500981
“…having fears of illness recurrence have been associated with increased anxiety and depression, reduced quality of life, greater hypervigilance to symptom changes, and lower engagement in health behaviours (Almeida et al., 2019; Liu et al., 2018; Séguin Leclair et al., 2019; Sharpe et al., 2022).”
Seo-Hee, C. H. O. I., Kim, Y., & Choe, Y. (2025) · Daehan imsang geon-gang jeungjin hakoeji/Daehan imsang geon'gang jeungjin haghoeji · doi:10.15384/kjhp.2025.00122
“Finally, longitudinal research is needed to clarify how changes in FCR relate to health behaviors and whether individuals with persistently high FCR respond better to tailored interventions, providing more nuanced survivorship strategies [33,34].”
Kanser Nüks Korkusu ve Kişilik Özellikleri Arasındaki İlişki: Bir Sistematik Derleme Çalışması
Yastıbaş, C., & Erdem, B. (2025) · OSMANGAZİ JOURNAL OF MEDICINE · doi:10.20515/otd.1722713
Gumuchian, S. T., Boyle, A., Hazel, L., & Ellenbogen, M. A. (2024) · Figshare · doi:10.6084/m9.figshare.25264468
Gumuchian, S. T., Boyle, A., Hazel, L., & Ellenbogen, M. A. (2024) · Figshare · doi:10.6084/m9.figshare.25264376
Integrative approaches to anxiety
Addington, E. L. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-30194-0.00034-5
Park, S., & Shim, E. (2026) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2026.112639 · Cited by 1 · see citing works
白国福, Gong, X., Huang, C., & Zhuang, Y. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1893298
“…of recurrence can exacerbate a patient’s psychological stress response, creating a vicious cycle that intensifies psychological distress (23), while also inducing high-risk behaviors such as unhealthy eating and disrupted sleep patterns (24), further increasing the likelihood of disease recurrence.”
Wheeler, C., & O'Rourke, N. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-11180-1 · Cited by 1 · see citing works
- Authors
- Séguin Leclair, C., Lebel, S., & Westmaas, J. L.
- Affiliations
- University of Ottawa (CA)
- Venue
- Health Psychology
- Published
- 2019-07
- Volume
- 38
- Issue
- 7
- Pages
- 596-605
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- OpenAlex
- W2946381091
- Cited by
- 61
- References
- 0
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 13 · 2023: 10 · 2022: 12 · 2021: 11 · 2020: 4
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- 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 › Oncology › Global Cancer Incidence and Screening
- Keywords
- fear of cancer recurrence, cancer survivors, health behavior, physical activity, fruit and vegetable intake, non-Hodgkin lymphoma, tumor stage, Hispanic origin, survivorship, targeted interventions
- MeSH terms
- Cancer Survivors, Adult, Aged, Fear, Female, Fruit, Humans, Longitudinal Studies, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Prospective Studies, Surveys and Questionnaires, United States, Vegetables, Health Behavior, Exercise, Prevalence
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