Fear of cancer recurrence and social support among Indonesian gynecological cancer survivors

Accepted 2018-06-26 INTRODUCTION Fear of cancer recurrence (FCR) is among the top concerns of cancer survivors regardless of the type of cancer (1). For the gynecological cancer (GC) survivors, recurrence is indeed a major issue due to its high recurrence rates coupled with its tendency of being asymptomatic and diagnosed at advanced stage (2). Many women with GC are aware of this fact and experience a constant fear of having cancer over time (3,4). Despite some conflicting findings of the FCR prevalence and its relations with the cancer prognosis and survival, a recent review suggests that FCR is a ubiquitous and persistent among the cancer survivors and is strongly associated with lower quality of life (QOL) (5). FCR is also poorly addressed in the survivorship care planning and care even though its incidence has been much evident (6). Many different factors can influence FCR, including sociodemographic, clinical, and psychological factors (5,7). Prior studies indicated that cultural background may account for variance of FCR (8,9). Researchers posit that different cultural groups may have distinct coping style, communication style, and social support which contribute to FCR variability (5,8). The belief such as fatalism, i.e. pessimistic view about the probability of surviving a disease, remains evident in many cultures, as shown, for example, in studies done in Turkey (10) and Portugal (11). Such belief may shape the way women perceive their experience of living with GC. In addition, a study in Iran showed how Iranian cancer patients frequently had high level of FCR mainly due to their concern about their family and children, not because of their own self-concern (12). In line with this, another study suggested what women fear the most about having their cancer back – it was the implication of their inability to perform social roles, especially their motherhood or womanhood roles, which were then associated with the poor QOL (13). These studies are among the many evidences regarding the interplays of the sociocultural dimension of FCR. Since FCR may have prominent sociocultural attributes, it deemed necessary to examine FCR in Indonesia. Indonesia, as a middle-income country in South-east Asia has a high incidence of GC, with cervical cancer being the most prevalent (14,15). The number of GC survivors is continuously increasing due to the large population and high incidence, albeit low survival (16). Cancer survivorship issues, including FCR, are mostly unexplored in Indonesia (17). Hence, there is still insufficient basis for understanding and addressing this problem. On a different note, Indonesian people hold a strong collectivist culture (18). Studies found that in Indonesia GC survivors received social, emotional, spiritual, and even financial support not only from their family or close relatives but also from their neighbors and colleagues (19,20). Whether this common social feature may influence the FCR among the GC survivors in Indonesia is yet unknown. This study was therefore conducted to assess the relationship of FCR with social support and sociodemographic characteristics of Indonesian GC survivors.