Longitudinal Trends Relating to Fear of Recurrence Amongst Head and Neck Cancer Survivors

Poster Abstract (P2-84) Abstracts of the IPOS 13th World Congress of Psycho-Oncology, 16–20 October 2011, Antalya, Turkey BACKGROUND: Fear of recurrence (FOR) following head and neck cancer (HNC) treatment is one of the most significant patient concerns and is associated with psychological distress but this concern/need is infrequently met in the outpatient setting. There is limited evidence suggesting FOR does not diminish with time and clinical characteristics are ineffectual as predictors of FOR. The aim of this study was to evaluate long-term FOR trends by routine screening in outpatient clinics. METHOD: Prospective data collection from 197 HNC patients attending 81 routine follow-up clinics occurred from October 2008 to January 2011. All patients completed the Patient’s Concerns Inventory (PCI), a holistic, self-reported screening tool for unmet needs/concerns and University of Washington Quality of Life Questionnaire, version 4. Those who indicated FOR on PCI also completed the FOR questionnaire, where scoring ‘a lot’ or ‘all the time’ for questions 1–6 and a response of 7–10 (10-point scale) for question 7 were deemed as having ‘significant’ FOR. Statistical analysis was performed to determine correlations and individual agreement. Interventions for FOR were obtained from case-notes. RESULTS: 462 sets of questionnaires were obtained from 197 patients. FOR was inconsistently highlighted in those with sequential PCI data of up to 5 visits. Significant FOR was reported by 11-27% (questions 1-6) and by 18% (question 7). Longitudinal FOR data was obtained in 65% (123/197) and 35% who had two and three sequential visits, respectively. Significant FOR reported in 22%, 27% and 24% of cases over sequential visits. There was less stability of agreement at individual level. Younger patients were more likely to report significant FOR. Onward referrals for psychological support were made in those with significant FOR. CONCLUSIONS: Significant FOR is prevalent in HNC survivors attending routine follow-up clinics. Longitudinal data suggests that FOR is stable with time in this cohort although the individual FOR experience may fluctuate. Younger age is a risk for significant FOR. The PCI is a useful tool to broach FOR in the outpatient clinic as addressing this item of concern, allowing clinicians to initiate the process of identifying those with significant FOR so that appropriate and timely supportive care and psychological intervention can be provided. RESEARCH IMPLICATIONS: Previous studies have established the value of PCI in screening for FOR in routine HNC clinics and that a high proportion of patients experience significant FOR. Our study suggests significant FOR is stable with time. Utilization of PCI-FOR combination can trigger need for intervention in those at risk. Further work is required to establish the supposition that addressing FOR in clinic has resulted in meeting the patients and their carers need on this issue. CLINICAL IMPLICATIONS: The need to address FOR has gained expression through PCI. Multidisciplinary team approach in HNC is the current standard of care. However, psychological support is not always party to this set-up in some centres. The PCI also allows patients to identify professionals they would like to talk to, and the list includes the psychologist and emotional support therapist. Therefore, PCI empowers patients to take charge of their cancer care, including the supportive care needs.