Anxiety, Depression, and Fear of Cancer Recurrence in Head and Neck Cancer

Abstract

Objective: Patients with head and neck cancer (HNC) report some of the highest levels of psychological distress amid managing their disease as well as debilitating and disfiguring treatment side effects. Fear of cancer recurrence (FCR) is a top unmet need and concern of patients with HNC. Prior research suggests elevated symptoms of anxiety and depression are potential antecedents to FCR, but findings have been limited in HNC populations. The aim of the present study was to examine early level and change in symptoms of anxiety and depression in relation to later change in FCR among patients with HNC. Methods: The study is a secondary analysis of data collected from 2011-2014 through the Head and Neck 5000 Study in the United Kingdom. A sample of 4891 patients completed self-report longitudinal assessments of anxiety and depression symptoms at baseline, 4, and 12 months and FCR at 4 and 12 months. Results: Utilizing multiple indicator latent change score modeling, results revealed baseline anxiety and increases in anxiety from baseline to 4 months were both positively associated with increases in FCR from 4 to 12 months. Neither baseline depression nor change in depression from baseline to 4 months were significantly associated with FCR change. Conclusions: Findings indicate that early level and increases in symptoms of anxiety were markers of increased FCR in patients with HNC. Future research may consider anxiety as a unique antecedent and maintaining factor of FCR and targeting anxiety early in the cancer trajectory may have downstream effects on FCR development. Public significance statements: This study examined change in fear of cancer recurrence (FCR) as a function of early level and change in symptoms of anxiety and depression in the year after head and neck cancer diagnosis. Results indicated that early level and increases in anxiety but not depression were associated with later increases in FCR. Identifying patients with clinically elevated anxiety and ensuring early intervention may mitigate possible downstream development of FCR.