Study: Breast Cancer Survivors' Fear of Cancer Returning Linked to Genomic Test Results, Psychological Factors

A new study led by researchers at NYU Rory Meyers College of Nursing found that breast cancer survivors with a higher risk of cancer recurrence based on genomic testing may experience greater fear of their cancer returning. However, psychological factors such as anxiety are the best predictors of survivors’ fear of their cancer recurring.

“Although genomic test results were associated with fear of cancer recurrence, our findings highlight that distressing, but treatable, psychological factors fuel cancer survivors’ fear of recurrence,” said lead study author Maurade Gormley, PhD, RN, an assistant professor and faculty fellow at NYU Meyers, in a press release.

More than half of breast cancer survivors experience moderate to severe levels of fear of cancer recurrence, compared with approximately 70% of younger breast cancer survivors, according to the study authors.

The Oncotype Dx® test is a genomic test that is used to predict the likelihood of cancer recurring in women with early-stage hormone receptor-positive breast cancer. The test analyzes breast cancer cells after surgery or biopsy to predict the 10-year risk of recurrence, creating a “recurrence score” that is divided into 3 risk categories: low, intermediate, and high.

Additionally, it can be used to plan breast cancer treatment, including whether a patient will benefit from chemotherapy in addition to hormone therapy.

“We wanted to address the question of whether women with a history of breast cancer have greater fear of recurrence when they are told they are at high risk from genomic testing,” Gormley said in the press release.

The study authors examined 110 breast cancer survivors to explore associations between the genomic test’s recurrence score and its relationship to a range of factors: fear of cancer recurrence, distress, anxiety, depression, health-related quality of life, including pain and fatigue, and perceived risk of cancer recurring and spreading. They also measured women’s beliefs about their illness, including their emotional response to it, perceived consequences of cancer on their lives, whether they believe they have control over their illness, and whether they perceive their cancer to be chronic, according to the study.

The researchers found that breast cancer survivors with high recurrence scores reported higher overall fear and greater perceived consequences of their cancer compared to those with low recurrence scores. In addition, a greater fear of cancer recurrence was associated with higher distress, anxiety, depression, lower quality of life, and certain beliefs about their cancer, including worse perceived consequences and greater emotional response to illness.

Further analyses revealed that the best predictors of whether someone was at high risk for fear of cancer recurrence were actually modifiable factors (anxiety, greater emotional response to cancer, and perceived consequences of illness) and not unchangeable factors such as genomic test results and age, which explained 58% of the variance in fear of cancer recurrence, according to the study authors.

“These findings are important because they illustrate that an individual’s understanding of and response to their illness may explain who is at greatest risk for developing fear of cancer recurrence,” Gormley said in the press release. “This could pave the way for developing targeted support—for instance, mental health interventions like cognitive behavioral skills—to address maladaptive beliefs about illness that occur among many breast cancer survivors.”

REFERENCE

Breast cancer survivors’ fear of cancer returning linked to genomic test results, psychological factors. NYU. Published April 6, 2021. Accessed April 8, 2021. https://www.nyu.edu/about/news-publications/news/2021/april/breast-cancer-fear-of-recurrence.html