Fear of recurrence as a triage strategy to identify testicular cancer survivors in need of psychological interventions

Background: Testicular cancer survivors (TCS) can experience long-term psychological sequel. Physicians are poorly trained to inquire about psychological problems and there is a limited availability of mental health practitioners. Clinicians need a strategy to help them identify those TCS who will profit the most from a psychological intervention. Fear of recurrence (FOR) does not disappear over time and might be an indicator of functional impairment. Our aim was to evaluate FOR as a strategy to identify TCS in need of a psycho-oncologic intervention. Methods: FOR (defined as score ³13) was evaluated in our TCS cohort with the Spanish version of the Cancer Worry Scale (CWS), Quality of Life (QoL) and anxiety were assessed with: EORTC QoL Questionnaire (QLQ-C-30), testicular specific QoL Questionnaire QLQ-TC26, Trait-State Anxiety Inventory (STAI). The associations of clinical and demographic characteristics, diminished QoL and higher levels of anxiety with FOR were identified via multiple logistic regression analysis. Results: A total of 40 TCS were included. Their median age was 28 (±7.3) yo, median DFS was 19 mo. FOR was found in 37.5% (n = 15). In the univariate analysis, FOR was not significantly associated with any clinical variables such as disease burden, provided treatment, or time on surveillance. FOR was associated with poor QoL; global health status (p= .04), functional scales (p= .004), symptom scales (p= .035), and increased state anxiety (p = 0.001) and trait anxiety (p= 0.008). In the multivariate analysis, state anxiety (p= .01) and low QoL as functional scale (p = .002) were independently associated with a clinically significant level of FOR. © 2018 by American Society of Clinical Oncology