The Relationship Between Fear of Cancer Recurrence and Health Behaviors: A Nationwide Longitudinal Study of Cancer Survivors

Objective: The goal of this study was to examine fear of cancer recurrence (FCR) and 2 health behaviors, physical activity and fruit and vegetable intake, from early to long-term survivorship in a large cohort of mixed cancer survivors. Method: Group-based trajectory analyses and repeated measures analysis of variance were conducted on data collected in the American Cancer Society's Studies of Cancer Survivorship-I. Two thousand three hundred thirty-seven survivors of 10 cancers completed the survey at 3 time points (M = 1.3, 2.2, and 8.8 years postdiagnosis). Results: The current study found 3 FCR trajectories clustering cancer survivors by FCR severity: low (33.6%), moderate (58.1%), and high (8.3%). FCR significantly decreased over time and remained distinct for each trajectory group. Patient characteristics prevalent in the high FCR group were being female, of younger age, Hispanic ethnicity, having advanced cancer stage (II to III) and non-Hodgkin lymphoma, and low adherence to physical activity and fruit and vegetable intake recommendations. The high FCR group also reported significantly fewer of these health behaviors compared with the other groups, albeit the effect size was small. Conclusions: Across the survivorship trajectory, FCR severity decreased but remained distinct for the 3 trajectory groups. Future investigations should inquire about the specific needs of each FCR group to subsequently develop targeted interventions. A weak association between FCR and health behaviors was found, with individuals in the high FCR group reporting less health behaviors. Future research should assess the direction of this relationship over time to inform intervention targets within this subgroup.