The role of anxiety in predicting change of fear of cancer recurrence in people with head and neck cancer: a latent change model

Background/Purpose: The fear of cancer recurrence (FCR) literature is expanding. However, the dynamic changes in this major patient concern recovering from initial diagnosis and treatment are poorly documented. This study utilises an extensive data set of people who have been recruited into the Head and Neck 5000 (HN5000) study. The aim of this study was to determine the predictive utility of changes in anxiety and depression in the early stages following diagnosis and treatment for FCR change during the initial phase of survivorship. Methods: The HN5000 study recruited 5111 people with a new diagnosis of head and neck cancer (HNC) in the UK over the period: 1st April 2011 and 31st December 2014. A questionnaire consisting of the Hospital Anxiety and Depression Scale was sent to patients at diagnosis and at 4 and 12 months. The 4 item Fear of Cancer Recurrence Scale (FCR4) was given at the latter two stages. A latent change model predicted FCR change (4-12 months) by the change in anxiety and depression levels (diagnosis4 months). Control variables were included e.g. initial levels of anxiety and depression, patient age and gender. Analyses were conducted using full-information maximum likelihood estimation (MPlus). Results: Change of anxiety (Beta=0.17, p<.02) but not depression (Beta=0.06, p=.30) predicted change in 4 to 12 months FCR. Conclusions and implications: Early changes in anxiety have a reliable effect on FCR change during the early survivorship phase. The clinical team need to be sensitive to managing anxiety soon after diagnosis to prevent FCR increase.