Assessing the relationship between fear of cancer recurrence and health care utilization in early-stage breast cancer survivors

Purpose: The purpose of this study was to determine whether fear of cancer recurrence (FCR) is associated with greater health care utilization (HCU) in early-stage breast cancer survivors. Methods: Three hundred early-stage breast cancer survivors diagnosed within the past 7 years reported on FCR as well as calls and visits to oncology providers and primary care providers during the preceding 3 months. Participants also reported on use of mental health services and psychotropic medications since diagnosis. Structural equation modeling was used to create a latent FCR factor and evaluate this factor as a predictor of various HCU outcomes controlling for age at diagnosis, years since diagnosis, generalized anxiety, objective risk of recurrence, and number of comorbidities. Results: FCR predicted more visits to both oncology providers (RR = 1.53, p =.002) and primary care providers (RR = 1.31, p =.013), as well as more phone calls to oncology providers (RR = 2.08, p =.007). FCR was not a significant predictor of phone calls to primary care providers (RR = 1.39, p =.054), utilization of mental health treatment (OR = 1.27, p =.362), or use of psychotropic medications (OR = 1.37, p =.178). Conclusions: FCR was associated with increases in some types of HCU, which may reflect excessive medical reassurance-seeking and lead to unnecessary medical costs. Implications for Cancer Survivors: FCR is a serious concern that warrants greater attention to reduce distress-related health care utilization. Utilization of mental health services to address FCR may represent higher-value health care.