Author(s): Dinara Kussainova, Anar Tursynbekova, Gulshara Aimbetova, Fatima Bagiyarova, Dilyara Kaidarova


DOI: 10.52711/0974-360X.2024.00049   

Address: Dinara Kussainova1, Anar Tursynbekova2, Gulshara Aimbetova3, Fatima Bagiyarova4, Dilyara Kaidarova5
1Master, Head of the Department of Psychological and Social Services, Kazakh Research Institute of Oncology and Radiology, Almaty, Kazakhstan.
2PhD in Medical Sciences The Deputy Chief Physician for Quality Control of Medical Services, Municipal State Enterprise on the Right of Economic Management of “City Clinical Hospital No. 5” of the Public Health Department of Almaty, Almaty, Kazakhstan.
3PhD in Medical Sciences, Associate Professor, Professor Department of "Public Health" Kazakh National Medical University, Almaty, st. Tolebi, 94.
4PhD in Medical Sciences, Head of Department Communication Skills, Kazakh National Medical University named after. S.D. Asfendiyarov, Almaty, Kazakhstan.
5Doctor of Medical Sciences, Professor, Academician of National Academy of Science Chairman of the Board Kazakh Research Institute of Oncology and Radiology, Kazakh Research Institute of Oncolo

Published In:   Volume - 17,      Issue - 1,     Year - 2024

The fear of cancer recurrence is defined as a mental state of anxiety or concern that cancer may return or spread. It is assumed to be the commonest unpleasant psychological disorder among cancer survivors. Breast cancer is assumed to be one of the commonest cancers in women. Also, the treatment modalities for breast cancer are strongly developed and there is an increase in the cure rate in recent years. However, surviving cancer patients are still feared of recurrence of the neoplasm. The fear of cancer recurrence affected negatively the patients' health and lowered their quality of life. Therefore, we sought to establish effective preventive strategies to improve the psychological health of patients. We searched the literature and reviewed the most recent available data from 2017 to 2023 to clarify the different factors affecting the fear of cancer recurrence in breast cancer patients.We identified different factors that increase the fear of cancer recurrence in breast cancer patients including; anxiety, chemotherapy, avoidance, intrusive thoughts, distress and exhaustion. Also, we identified other factors that decrease the fear of cancer recurrence in breast cancer patients including; younger age patients, having a good quality of time, good social support and good self-efficacy. Regarding preventive measures; our meta-analysis showed that breast cancer patients who underwent Mindfulness-Based Stress Reduction had significant improvements on the Center for Epidemiological Studies-Depression scale (P<0.0001), State-Trait Anxiety Inventory scale (P=0.0002) and perceived stress scale (P=0.0004). Also, we noticed that breast cancer patients who underwent blended cognitive behavior therapy or Smartphone problem-solving therapy had lower fear of cancer recurrence than those who received usual care. Finally, we advocate more research articles applying different modalities to overcome FCR in patients with breast cancer. Also, we recommend the use of different psychological treatments for patients with breast cancer to decrease their fear of cancer recurrence and improve their health.

Cite this article:
Dinara Kussainova, Anar Tursynbekova, Gulshara Aimbetova, Fatima Bagiyarova, Dilyara Kaidarova. Factors affecting the fear of recurrence in Breast cancer patients. Research Journal of Pharmacy and Technology. 2024; 17(1):314-2. doi: 10.52711/0974-360X.2024.00049

Dinara Kussainova, Anar Tursynbekova, Gulshara Aimbetova, Fatima Bagiyarova, Dilyara Kaidarova. Factors affecting the fear of recurrence in Breast cancer patients. Research Journal of Pharmacy and Technology. 2024; 17(1):314-2. doi: 10.52711/0974-360X.2024.00049   Available on:

1.    Waks AG, Winer EP. Breast Cancer Treatment: A Review. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
2.    Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA: a cancer journal for clinicians. 2023;73(1):17-48. doi:10.3322/caac.21763
3.    Tabár L, Dean PB, Chen TH-H, et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer. 2019; 125(4): 515-523. doi:10.1002/cncr.31840
4.    Abiodun Bnsc OF, Ohaeri Ph.D B, Ojo Ph.D IO, Babarimisa M.Sc O. Early Detection and Prevention; The Role of Breast Cancer Screening. 2023;doi:10.5281/ZENODO.7554357
5.    PınarZorba Bahçeli BK. Fear of Cancer Recurrence in Women with Breast Cancer: A Cross-Sectional Study after Mastectomy. Journal. 2022;4(3):315-320. doi:10.37990/medr.1094338
6.    Mehrabi E, Hajian S, Simbar M, Houshyari M, Zayeri F. Post-traumatic growth: a qualitative analysis of experiences regarding positive psychological changes among Iranian women with breast cancer. Electronic physician. 2015;7(5):1239-1246. doi:10.14661/1239
7.    Tran TXM, Jung S-Y, Lee E-G, et al. Fear of Cancer Recurrence and Its Negative Impact on Health-Related Quality of Life in Long-term Breast Cancer Survivors. Cancer research and treatment. 2022;54(4):1065-1073. doi:10.4143/crt.2021.835
8.    Guo H-T, Wang S-S, Zhang C-F, et al. Investigation of Factors Influencing the Fear of Cancer Recurrence in Breast Cancer Patients Using Structural Equation Modeling: A Cross-Sectional Study. International journal of clinical practice. 2022;2022:2794408-2794408. doi:10.1155/2022/2794408
9.    Levesque JV, Gerges M, Girgis A. Psychosocial Experiences, Challenges, and Coping Strategies of Chinese-Australian Women with Breast Cancer. Asia-Pacific Journal of Oncology Nursing. 2020;7(2):141-150. doi:10.4103/apjon.apjon_53_19
10.    Niu L, Liang Y, Niu M. Factors influencing fear of cancer recurrence in patients with breast cancer: Evidence from a survey in Yancheng, China. The Journal of Obstetrics and Gynaecology Research. 2019;45(7):1319-1327. doi:10.1111/jog.13978
11.    Zhang X, Sun D, Wang Z, Qin N. Triggers and Coping Strategies for Fear of Cancer Recurrence in Cancer Survivors: A Qualitative Study. Current Oncology (Toronto, Ont). 2022;29(12):9501-9510. doi:10.3390/curroncol29120746
12.    Cochrane Handbook for Systematic Reviews of Interventions. Wiley; 2019.
13.    Momenimovahed Z, Salehiniya H. Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer (Dove Medical Press). 2019;11:151-164. doi:10.2147/BCTT.S176070
14.    Britt KL, Cuzick J, Phillips K-A. Key steps for effective breast cancer prevention. Nature Reviews Cancer. 2020;20(8):417-436. doi:10.1038/s41568-020-0266-x
15.    Linnenbringer E, Geronimus AT, Davis KL, Bound J, Ellis L, Gomez SL. Associations between breast cancer subtype and neighborhood socioeconomic and racial composition among Black and White women. Breast Cancer Research and Treatment. 2020;180(2):437-447. doi:10.1007/s10549-020-05545-1
16.    Smolarz B, Nowak AZ, Romanowicz H. Breast Cancer-Epidemiology, Classification, Pathogenesis and Treatment (Review of Literature). Cancers. 2022;14(10)doi:10.3390/cancers14102569
17.    Gucalp A, Traina TA, Eisner JR, et al. Male breast cancer: a disease distinct from female breast cancer. Breast Cancer Research and Treatment. 2019;173(1):37-48. doi:10.1007/s10549-018-4921-9
18.    Zheng H-H, Du C-T, Yu C, et al. Epidemiological Investigation of Canine Mammary Tumors in Mainland China Between 2017 and 2021. Frontiers in Veterinary Science. 2022;9:843390-843390. doi:10.3389/fvets.2022.843390
19.    Hussain S, Mohapatra C. Male Breast Cancer : Signs , Symptoms, and Treatment : a Review. International Journal of Creative Research Thoughts. 2020;8(9):553-561.
20.    Zore T, Palafox M, Reue K. Sex differences in obesity, lipid metabolism, and inflammation—A role for the sex chromosomes? Molecular Metabolism. 2018;15:35-44. doi:
21.    Ji J, Yuan S, He J, Liu H, Yang L, He X. Breast-conserving therapy is associated with better survival than mastectomy in Early-stage breast cancer: A propensity score analysis. Cancer Medicine. 2022;11(7):1646-1658. doi:10.1002/cam4.4510
22.    Power EJ, Chin ML, Haq MM. Breast Cancer Incidence and Risk Reduction in the Hispanic Population. Cureus. 2018;10(2):e2235-e2235. doi:10.7759/cureus.2235
23.    Petrucelli N, Daly MB, Pal T. BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer. In: Adam MP, Everman DB, Mirzaa GM, et al, eds. 1993.
24.    Cheng TS, Ong KK, Biro FM. Adverse Effects of Early Puberty Timing in Girls and Potential Solutions. Journal of Pediatric and Adolescent Gynecology. 2022;35(5):532-535. doi:10.1016/j.jpag.2022.05.005
25.    Raglan O, Kalliala I, Markozannes G, et al. Risk factors for endometrial cancer: An umbrella review of the literature. International Journal of Cancer. 2019;145(7):1719-1730. doi:10.1002/ijc.31961
26.    Yum SK, Yum SY, Kim T. The problem of medicating women like the men: conceptual discussion of menstrual cycle-dependent psychopharmacology. Translational and clinical pharmacology. 2019;27(4):127-133. doi:10.12793/tcp.2019.27.4.127
27.    Poggio F, Tagliamento M, Pirrone C, et al. Update on the Management of Breast Cancer during Pregnancy. Cancers. 2020;12(12)doi:10.3390/cancers12123616
28.    Dunneram Y, Greenwood DC, Cade JE. Diet, menopause and the risk of ovarian, endometrial and breast cancer. The Proceedings of the Nutrition Society. 2019;78(3):438-448. doi:10.1017/S0029665118002884
29.    Łukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review. Cancers. 2021;13(17)doi:10.3390/cancers13174287
30.    Dafni U, Tsourti Z, Alatsathianos I. Breast Cancer Statistics in the European Union: Incidence and Survival across European Countries. Switzerland. 2019. p. 344-353.
31.    Kotsopoulos J, Gronwald J, McCuaig JM, et al. Breastfeeding and the risk of epithelial ovarian cancer among women with a BRCA1 or BRCA2 mutation. Gynecologic Oncology. 2020;159(3):820-826. doi:10.1016/j.ygyno.2020.09.037
32.    Lambertini M, Kroman N, Ameye L, et al. Long-term Safety of Pregnancy Following Breast Cancer According to Estrogen Receptor Status. Journal of the National Cancer Institute. 2018;110(4):426-429. doi:10.1093/jnci/djx206
33.    Alaofi RK, Nassif MO, Al-Hajeili MR. Prophylactic mastectomy for the prevention of breast cancer: Review of the literature. A Vicenna Journal of Medicine. 2018;8(3):67-77. doi:10.4103/ajm.AJM_21_18
34.    Hillers-Ziemer LE, Arendt LM. Weighing the Risk: effects of Obesity on the Mammary Gland and Breast Cancer Risk. Journal of Mammary Gland Biology and Neoplasia. 2020;25(2):115-131. doi:10.1007/s10911-020-09452-5
35.    McCarthy AM, Friebel-Klingner T, Ehsan S, et al. Relationship of established risk factors with breast cancer subtypes. Cancer Medicine. 2021;10(18):6456-6467. doi:10.1002/cam4.4158
36.    De Cicco P, Catani MV, Gasperi V, Sibilano M, Quaglietta M, Savini I. Nutrition and Breast Cancer: A Literature Review on Prevention, Treatment and Recurrence. Nutrients. 2019;11(7)doi:10.3390/nu11071514
37.    Chen KL, Madak-Erdogan Z. Estrogens and Female Liver Health. Steroids. 2018;133:38-43. doi:10.1016/j.steroids.2017.10.015
38.    McHugh RK, Weiss RD. Alcohol Use Disorder and Depressive Disorders. Alcohol Research : Current Reviews. 2019;40(1)doi:10.35946/arcr.v40.1.01
39.    Napryeyenko O, Napryeyenko N, Marazziti D, et al. Depressive Syndromes Associated with Alcohol Dependence. Clinical Neuropsychiatry. 2019;16(5-6):206-212. doi:10.36131/clinicalnpsych2019050603
40.    Friedenreich CM, Ryder-Burbidge C, McNeil J. Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. Molecular Oncology. 2021;15(3):790-800. doi:10.1002/1878-0261.12772
41.    Korde LA, Somerfield MR, Carey LA, et al. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2021;39(13):1485-1505. doi:10.1200/JCO.20.03399
42.    Abbas Z, Rehman S. An Overview of Cancer Treatment Modalities. In: Shahzad HN, ed. Neoplasm. IntechOpen; 2018:Ch. 6-Ch. 6.
43.    Alam A. Chemotherapy Treatment and Strategy Schemes: A Review. Open Access Journal of Toxicology. 2018;2(5)doi:10.19080/oajt.2018.02.555600
44.    Greenshields AL, Fernando W, Hoskin DW. The anti-malarial drug artesunate causes cell cycle arrest and apoptosis of triple-negative MDA-MB-468 and HER2-enriched SK-BR-3 breast cancer cells. Experimental and Molecular Pathology. 2019;107:10-22. doi:10.1016/j.yexmp.2019.01.006
45.    Maltsev D. A comparative study of valaciclovir, valganciclovir, and artesunate efficacy in reactivated HHV-6 and HHV-7 infections associated with chronic fatigue syndrome/myalgic encephalomyelitis. Microbiology and immunology. 2022;66(4):193-199. doi:10.1111/1348-0421.12966
46.    de Boniface J, Szulkin R, Johansson ALV. Survival After Breast Conservation vs Mastectomy Adjusted for Comorbidity and Socioeconomic Status: A Swedish National 6-Year Follow-up of 48 986 Women. JAMA surgery. 2021;156(7):628-637. doi:10.1001/jamasurg.2021.1438
47.    Siotos C, Naska A, Bello RJ, et al. Survival and Disease Recurrence Rates among Breast Cancer Patients following Mastectomy with or without Breast Reconstruction. Plastic and Reconstructive Surgery. 2019;144(2):169e-177e. doi:10.1097/PRS.0000000000005798
48.    Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet (London, England). 2011;378(9804):1707-1716. doi:10.1016/S0140-6736(11)61629-2
49.    Zhang X, Sun D, Qin N, Liu M, Jiang N, Li X. Factors Correlated With Fear of Cancer Recurrence in Cancer Survivors: A Meta-analysis. Cancer nursing. 2022;45(5):406-415. doi:10.1097/NCC.0000000000001020
50.    Sun H, Yang Y, Zhang J, et al. Fear of cancer recurrence, anxiety and depressive symptoms in adolescent and young adult cancer patients. Neuropsychiatric Disease and Treatment. 2019;15:857-865. doi:10.2147/NDT.S202432
51.    Lengacher CA, Gruss LF, Kip KE, et al. Mindfulness ‑ based stress reduction for breast cancer survivors ( MBSR ( BC )): evaluating mediators of psychological and physical outcomes in a large randomized controlled trial. Journal of Behavioral Medicine. 2021;(0123456789)doi:10.1007/s10865-021-00214-0
52.    Lengacher CA, Shelton MM, Reich RR, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). Journal of Behavioral Medicine. 2014;37(2):185-195. doi:10.1007/s10865-012-9473-6
53.    Reich RR, Lengacher CA, Alinat CB, et al. Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters. Journal of pain and symptom Management. 2017;53(1):85-95. doi:10.1016/j.jpainsymman.2016.08.005
54.    van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J. Efficacy of Blended Cognitive Behavior Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2017;35(19):2173-2183. doi:10.1200/JCO.2016.70.5301
55.    Burm R, Thewes B, Rodwell L, et al. Long-term efficacy and cost-effectiveness of blended cognitive behavior therapy for high fear of recurrence in breast, prostate and colorectal Cancer survivors: follow-up of the SWORD randomized controlled trial. BMC Cancer. 2019;19(1):462-462. doi:10.1186/s12885-019-5615-3
56.    Imai F, Momino K, Katsuki F, et al. Smartphone problem-solving therapy to reduce fear of cancer recurrence among breast cancer survivors: an open single-arm pilot study. Japanese Journal of Clinical Oncology. 2019;49(6):537-544. doi:10.1093/jjco/hyz005
57.    Akechi T, Yamaguchi T, Uchida M, et al. Smartphone Psychotherapy Reduces Fear of Cancer Recurrence Among Breast Cancer Survivors: A Fully Decentralized Randomized Controlled Clinical Trial (J-SUPPORT 1703 Study). Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2023;41(5):1069-1078. doi:10.1200/JCO.22.00699
58.    Huang H-P, He M, Wang H-Y, Zhou M. A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer (Tokyo, Japan). 2016;23(4):568-576. doi:10.1007/s12282-015-0604-0
59.    Lim E, Humphris G. The relationship between fears of cancer recurrence and patient age: A systematic review and meta-analysis. Cancer Reports. 2020;3(3):1-14. doi:10.1002/cnr2.1235
60.    Maheu C, Singh M, Tock WL, et al. Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research. Frontiers in Psychology. 2021;12(April):1-22. doi:10.3389/fpsyg.2021.644932
61.    Yang Y, Cameron J, Humphris G. The relationship between cancer patient's fear of recurrence and radiotherapy: a systematic review and meta-analysis. Psycho-Oncology. 2017;26(6):738-746. doi:10.1002/pon.4224
62.    Yang Y, Wen Y, Bedi C, Humphris G. The relationship between cancer patient's fear of recurrence and chemotherapy: A systematic review and meta-analysis. Journal of Psychosomatic Research. 2017;98:55-63. doi:10.1016/j.jpsychores.2017.05.002
63.    Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2001;9(2):112-123. doi:10.1007/s005200000206
64.    Park S, Sato Y, Takita Y, et al. Mindfulness-Based Cognitive Therapy for Psychological Distress, Fear of Cancer Recurrence, Fatigue, Spiritual Well-Being, and Quality of Life in Patients With Breast Cancer-A Randomized Controlled Trial. Journal of Pain and Symptom Management. 2020;60(2):381-389. doi:10.1016/j.jpainsymman.2020.02.017
65.    Kvillemo P, Bränström R. Experiences of a Mindfulness-Based Stress-Reduction Intervention Among Patients With Cancer. Cancer Nursing. 2011;34(1)doi:10.1097/NCC.0b013e3181e2d0df
66.    Park SY, Lim JW. Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature. BMC Cancer. 2022;22(1):1-15. doi:10.1186/s12885-021-08909-y
67.    Akechi T, Yamaguchi T, Uchida M, et al. Smartphone Psychotherapy Reduces Fear of Cancer Recurrence Among Breast Cancer Survivors: A Fully Decentralized Randomized Controlled Clinical Trial (J-SUPPORT 1703 Study). Journal of Clinical Oncology. 2022;41(5)doi:10.1200/jco.22.00699

Recomonded Articles:

Research Journal of Pharmacy and Technology (RJPT) is an international, peer-reviewed, multidisciplinary journal.... Read more >>>

RNI: CHHENG00387/33/1/2008-TC                     
DOI: 10.5958/0974-360X 

56th percentile
Powered by  Scopus

SCImago Journal & Country Rank

Recent Articles


Not Available