Fear of Cancer Recurrence in Hematopoietic Cell Transplantation Survivors

Fear of cancer recurrence (FCR) is a significant challenge faced by hematopoietic cell transplantation (HCT) survivors, yet it remains insufficiently characterized in this group, limiting the ability to develop interventions to reduce FCR. We aimed to determine the prevalence and correlates of clinically significant levels of FCR (csFCR) in a large cohort of long-term HCT survivors at a major cancer center. From July 1, 2023 through June 30, 2024, survivors who underwent HCT >1 year ago at Fred Hutch Cancer Center received an annual patient recovery questionnaire (PRQ) and FCR module that included Patient-Reported Outcomes Measurement Information System (PROMIS) instruments, the FCR Inventory-Short Form (FCRI-SF), and questions regarding adherence to healthcare maintenance and cancer screening. csFCR was defined as a score ≥16 on the FCRI-SF. We determined predictors of csFCR using logistic regression and compared PROs, healthcare maintenance, and cancer screening by presence of csFCR. Of 4514 participants, 1501 (33%) completed the PRQ and FCR module, and 513 (34%) reported csFCR. In univariate logistic regression, younger age at survey completion, shorter time from HCT, diagnosis, intermediate or high pre-HCT disease risk, current receipt of maintenance therapy, and history of post-HCT relapse were significantly associated with higher odds of csFCR. In multivariable logistic regression, younger age at survey completion, shorter time from HCT, and history of post-HCT relapse remained independently associated with higher odds of csFCR. Survivors with csFCR reported lower PROMIS physical and psychosocial function, greater anxiety before hematology/oncology appointments, and greater need for, yet reduced access to, psychological care. Rates of cancer screening did not differ significantly by presence of csFCR. HCT survivorship programs should integrate psychosocial support to address FCR and determine whether targeted interventions can mitigate FCR and improve quality of life.