Fear of cancer recurrence is associated with higher primary care use after cancer treatment: a survey-administrative health data linkage study.
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PURPOSE: To examine the association between fear of cancer recurrence (FCR) and healthcare utilization after completing cancer treatment. METHODS: A population-based survey to examine survivors' experiences and needs after completing cancer treatment was administered by the provincial cancer registry as part of a national study. Respondents included Nova Scotian survivors of breast, melanoma, colorectal, prostate, hematologic, and young adult cancers who were 1-3 years post-treatment. FCR was assessed using a single item that captured presence and severity. Survey responses were linked to cancer registry, physicians' claims, hospitalization, and ambulatory care data. The data linkage provided four years of healthcare utilization data for each cancer survivor, beginning 1 year after their cancer diagnosis. The final study cohort were cancer survivors who responded to the survey, had their data linked, completed the FCR survey items, and were alive and cancer-free during the 4-year follow-up period (n = 823). The data were analyzed descriptively and using regression models for count data analysis. RESULTS: Thirty-eight percent of respondents reported FCR. Younger respondents reported higher levels of FCR compared to older respondents: for example, 66.1% of respondents age 18-54 years reported FCR whereas 24.4% of respondents age 75 years and older reported FCR. More females than males reported FCR. Upon adjusted analyses, FCR was associated with 22% higher primary care use after cancer treatment (incidence rate ratio = 1.22, 95% confidence interval = 1.19-1.25, p < 0.0001). No differences were found for specialist visits between those with FCR and those with no FCR (p = 0.366). CONCLUSION: FCR is a highly prevalent ongoing effect for those who complete cancer treatment. Cancer survivors who reported FCR visited their primary care providers more during follow-up care than those without FCR.