Fear of recurrence and cancer screening adherence among cancer survivors: A HINTS-SEER 2021 study

Background: Fear of cancer recurrence is among the most common unmet survivorship needs, and adherence to recommended cancer screening guidelines remains critical, as nearly one in five new cancers diagnosed in the US occurs among individuals with a prior cancer history. Using data from a representative sample of US adults with a history of cancer, this study aims to identify sociodemographic, clinical, and psychosocial predictors of fear of cancer recurrence and to examine its association with adherence to cervical, breast, and colorectal cancer screening guidelines. Methods: Data from the 2021 Health Information National Trends Survey-Surveillance, Epidemiology, and End Results (HINTS-SEER) pilot project (N=1,234) were analyzed. Screening adherence was defined according to guideline-recommended timeframes from the U.S. Preventive Services Task Force and the American Cancer Society. Survey-weighted linear regression models were used to identify factors associated with fear of cancer recurrence. Survey-weighted logistic regression was conducted to evaluate the association between fear of cancer recurrence and adherence to cervical, breast, and colorectal cancer screening. Models were adjusted for age, sex (as appropriate), stage at diagnosis, marital status, education, race/ethnicity, insurance status, treatment status, SEER registry, patient-centered communication, self-efficacy, cancer prevention beliefs, psychological distress, smoking, alcohol use, and physical activity. Results: The most common cancers were breast (24%), male reproductive (23%), gastrointestinal (11%), and skin (10%), with 70% diagnosed at localized stage. About 12%, 27%, 31%, 22%, and 9% of cancer survivors reported being “not at all”, “slightly”, “somewhat”, “moderately”, and “extremely” worried about cancer recurrence, respectively. Among participants meeting guideline-based eligibility criteria, 76%, 82%, and 96% were adherent to cervical, breast, and colorectal cancer screening, respectively. In multivariable linear regression, greater fear of cancer recurrence was associated with currently receiving cancer treatment (beta=0.92, p<0.0001 ), lower self-efficacy (beta=0.19, p=0.0004 ), and higher psychological distress (beta=0.05, p=0.017 ). In multivariable logistic regression greater fear of cancer recurrence was associated with higher odds of breast cancer screening adherence (OR 1.88, 95%CI 1.07-3.31, p=0.028 ), but not cervical or colorectal screening. Conclusions: A large proportion of cancer survivors reported some degree of fear of recurrence. Fear of cancer recurrence was associated with treatment status, psychological distress, and perceived self-efficacy and was linked to breast cancer screening adherence. Further research is needed to determine how fear of recurrence can be appropriately addressed within survivorship care to support guideline-concordant screening.