The Burden of Worry: Fear of Cancer Recurrence Across Bladder Cancer Survivorship Phases-A Cross-Sectional Analysis

Objective: To characterize the distribution of FCR severity across survivorship time intervals in bladder cancer survivors. Methods: A cross-sectional study of 79 patients utilized the validated 9-item FCR Inventory-Short Form (FCRI-SF) to assess overall FCR severity. Primary analysis employed Spearman's correlation coefficient to evaluate the relationship between time elapsed since the first procedure and total FCR scores. Patients were stratified into four temporal groups (<1, 1-2, 2-5, and >5 years). Inter-group variability in FCR scores was assessed using Levene's test for equality of variances. Subgroup analyses compared FCR scores across clinical subgroups, including tumor grade and smoking history, using the Mann-Whitney U test. Multivariate logistic regression identified independent predictors of clinically significant FCR (total score ≥13). Results: Median patient age was 72.0 years (IQR 66.0-78.0), with a median of 24.0 months post-diagnosis. Clinically significant FCR (score ≥13) was prevalent in 55.7% of the cohort. Spearman correlation analysis revealed no significant relationship between months elapsed and FCR severity (rho = 0.068, p = 0.552). Patients in the 12-24 month window exhibited the highest variability (Levene's test, p = 0.058), representing a period of clinical divergence. High-Grade disease and smoking cessation motivated by diagnosis were associated with higher FCR scores. In the multivariate logistic regression model, history of tumor recurrence was the sole independent predictor of clinically significant FCR (aOR 3.28, 95% CI 1.11-9.68, p = 0.031), whereas age and gender were not significantly associated. Conclusions: FCR severity did not demonstrate a significant association with time elapsed since diagnosis in this cross-sectional sample. The 1-2 year interval demonstrated greater inter-individual variability in FCR scores. Findings highlight the need for long-term, structured survivorship support, particularly targeting the 12-24 month post-diagnosis window.