Survivorship care plans and fear of recurrence in patients with breast cancer (BC).
Authors: Weiss Marisa C. , Chino Junzo P. , Thom Bridgette , Meske Sam , Ganz Patricia A. , Chino Fumiko 
Published: July 2024

e13790

Background: A survivorship care plan (SCP) is recommended for all patients after curative treatment for cancer. It typically includes guidance on the type and interval of follow-up care as well as education on treatment received and potential long-term side effects. Fear of recurrence is a common unmet need reported by cancer survivors and is associated with higher depression and lower social functioning. It is unknown if SCPs are associated with reduced fear of recurrence. Methods: Between 7/2023-8/2023, active patients and survivors were recruited from Breastcancer.org and consented to participate in an anonymous online survey in English or Spanish. Eligibility included: US resident, age ≥18, and diagnosed with BC within the past 10 years. Survey assessed engagement in and satisfaction with survivorship care, receipt of a written SCP, and fear of recurrence (via the validated 9 question FCRI-SF, scored 0-36, higher scores indicate greater fear of recurrence) in patients with non-metastatic BC. Multivariate analysis (MVA) assessed relationship of SCP and FCRI-SF score ≥22 (indicating a clinically significant level of fear) after controlling for gender, age, race, ethnicity, and education. Results: Of 997 who completed the survey, 340 (34.1%) had completed all curative treatment and thus queried on receipt of SCP and fear of recurrence. Of this cohort, 97.4% identified as women, 78.8% White, 6.2% Black, and 3.3% Hispanic. Median age was 63 (interquartile range IQR 54-70) and median time since diagnosis 2.5 years (IQR 1.4-5.2). 76.2% had a college degree. Most were satisfied with their survivorship care (median score 4: scale: 1-very unsatisfied to 5-very satisfied). Less than a quarter (21.8%) had access to a cancer survivorship program at their facility; 60.0% did not; and 18.2% did not know. Of the 74 respondents who had access to a program, 56.8% used its services. 32.1% participants reported receiving a written SCP, 18.5% did not remember; almost half (49.4%) reported they did not receive one. Of those that received a SCP, most reported it was explained well to them (median score 4; scale: 1-poor to 5-excellent), and that they had “excellent” comprehension of the plan (median score 5). Median fear of recurrence score was 20 (IQR 14-25); 43.2% had a score ≥22, indicating a clinically significant level of fear. On MVA, patients who were older (OR 0.98, 95%CI 0.96-1.00, p=0.019) and who had received a SCP (OR 0.54, 95%CI 0.33-.88, p=0.013) were less likely to have clinically significant fear. Conclusions: Although overall satisfaction with survivorship care was high, less than one-third of surveyed BC survivors reported receiving a written SCP. Receipt of a SCP was associated with clinically significantly lower fear of recurrence. Future research should focus on provider barriers to SCP implementation, patient barriers to survivorship program use, and explore the role of SCP in mitigating psychosocial distress in diverse samples.