Untangling the Relationship Between Fear of Cancer Recurrence and Health Behaviours: A Nationwide Trajectory and Theoretical Study of Cancer Survivors
Creators: name: Séguin Leclair, Caroline
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2019
Subjects: cancer
fear of cancer recurrence
physical activity
fruit and vegetables

description: Recognized as one of the most prevalent and persistent concerns in cancer survivors, fear of cancer recurrence (FCR) is defined as the "fear, worry, or concern relating to the possibility that cancer will come back or progress" (Lebel et al., 2016). Higher FCR severity leads to poor mental health, impaired functioning and reduced quality of life. It is well established that health behaviours can help reduce the risk of cancer recurrence in cancer survivors, but little is known about their relationship with FCR. The overall thesis objectives were: 1) to identify subgroups of cancer survivors by FCR severity and corresponding patient characteristics; 2) to explore the relationship between FCR and health behaviours (physical activity and fruit and vegetable intake) over time; and 3) to further examine the relationship between FCR severity subgroups and health behaviours using the Common-Sense Model (CSM). Data analyses were conducted on 2337 survivors of ten cancer sites who completed the American Cancer Society’s Studies of Cancer Survivorship-I survey at three time points (M =1.3, 2.2, and 8.8 years post-diagnosis). In study 1, group-based trajectory analyses revealed three FCR severity groups: low, moderate, and high. FCR significantly decreased from early to long-term survivorship and remained distinct for each group. Subsequently, repeated measures analysis of variance revealed that patient characteristics prevalent in the high FCR group were being female, of younger age, Hispanic ethnicity, having more advanced cancer stage (II-III) and Non-Hodgkin lymphoma. Across FCR groups, only a minority of survivors adhered to the recommended physical activity and fruit and vegetable intake. Survivors in the high FCR group reported significantly fewer of these health behaviours than other survivors. In study 2, cross-sectional path analyses were conducted to examine the relationship between FCR and health behaviours using the CSM framework across the FCR severity groups. Results indicated good-fitting models for the low, moderate, and high FCR groups. Engaging in physical activity and fruit and vegetable intake did not influence FCR in most participants. Yet, in the low FCR group, survivors reporting more health behaviours had lower FCR severity. In the low and moderate FCR groups, health behaviours were related to control over health and self-efficacy to manage health, suggesting that cancer survivors use health behaviours to manage illness outcomes. For survivors in the high FCR group, results suggest that self-efficacy to manage health is a better predictor of FCR than engaging in physical activity and fruit and vegetable intake In conclusion, most cancer survivors fail to meet the recommended physical activity and fruit and vegetable intake throughout cancer survivorship, with survivors in the high FCR group being at greater risk of engaging in fewer health behaviours. Health behaviours appear unrelated to FCR severity for most cancer survivors, except for survivors with low FCR, who might be experiencing less FCR when engaging in more health behaviours. Findings suggests that clinical interventions should be tailored by FCR severity groups and that health behaviour research among cancer survivors should account for FCR severity groups. Further investigations are required to assess cancer survivors’ perceived usefulness of health behaviours to manage the risk of cancer recurrence by FCR severity group