Table 9.
Head and neck cancer studies reporting variations in fear of cancer recurrence measures by age.
| Author | Year | n | Location | Handling of age | H&N subsite | Treatment | FCR instrument | Study design | Findings |
|---|---|---|---|---|---|---|---|---|---|
| FCR favoring older patients | |||||||||
| Mirosevic et al. (158) | 2019 | 216 | Slovenia, Netherlands | Continuous (range 37-85 years) |
OCC, 30% OPC, 34% HPC, 8% LC, 25% CUP, 2% |
Pre treatment | CWS | Baseline data from a cross-sectional sub study of NET-QUBIC included psychiatric interviews | Younger patients reported higher FCR (β = .203, p<0.001) |
| Casswell et al. (159) | 2021 | 136 | Australia | Continuous (range 42-87 years) | All HPV+ OPC | All RT/CRT | FCRI-SF | Cross-sectional: time since treatment mean 2.97y (range 1.0-5.1y) | Younger age worse on UVA (-0.2/year increase, p=0.036) |
| Rogers et al. (160) | 2021 | 288 | United Kingdom | <55 vs 55-64 vs 65-74 vs ≥75 years | OCC, 47% OPC, 32% LC, 14% Other, 8% |
Sx alone, 40% Sx +aRT/CRT, 40% CRT/RT, 20% |
UW-QoL 5-response item | Cluster control study | Patients <65 more likely to answer more severe FCR (especially younger females <55) |
| Ghazali et al. (161) | 2013 | 189 | United Kingdom | <55 vs 55-64 vs ≥65-74 vs ≥75 years | OCC, 73% Pharyngeal, 23% |
Sx alone, 59% Sx + aRT, 32% RT/CRT, 10% |
PCI FoR questionnaire |
Prospective: post treatment (convenience sample, first appt not always patient’s actual first appointment post treatment completion). |
For first visit:
overall FoR score higher in younger patients and significant FoR in at least one item higher in younger patients Longitudinal assessment: About one-third <65 unlikely to encounter significant FoR issues compared to three-quarters of patients ≥65. |
| Kanatas et al. (162) | 2015 | 813 | United Kingdom | Continuous and <65 years | OCC, 48% OPC, 24% LC, 17% Other, 9% CUP, <1% |
Sx alone, 49% Sx +aRT, 34% CRT/RT, 14% Unknown, 3% |
HNC-PCI | Analysed patients selecting FCR item on PCI | Patients selecting FCR were 4-6 years younger; When analysis first time (n=813) PCI: Percentage ≥65y: X2 = 33.1, p< 0.001 and ≥75y: X2 = 14.4, p= 0.002 |
| Rogers et al. (163) | 2016 | 528 | United Kingdom | <55 vs 55-64 vs ≥65 years | OCC, 34% OPC, 35% LC, 20% Other, 8% |
Sx alone, 38% Sx + aRT, 40% CRT/RT, 16% Unknown, 3% |
UWQoL single item: “fear of the cancer coming back” on 5-point scale, “I have no fear of recurrence” to “I am fearful all the time that my cancer might return and I struggle with this” FoR questionnaire |
Cross-sectional: | Younger patients reported more severe levels of FoR |
| Rogers et al. (164) | 2015 | 483 | United Kingdom | <55 – 22% 55-64 – 35% 65-69 – 13% 70-74 – 14% ≥75 – 16% |
OCC, 57% OPC, 21% Other, 20% |
Sx alone, 51% Sx + aRT, 35% RT, 10% |
HNC-PCI | PCI-HN data from follow-up clinics collected from 6 different studies, not consecutive; number of responses ranged from 1-≥4 | On the PCI, being elderly correlated with fewer items being selected from the psychological, emotional and spiritual wellbeing domain; selecting fear of cancer coming back item reduced with age: 46% vs 42% vs 31% vs 26% vs 20% |
| Rylands et al. (165) | 2016 | 448 | United Kingdom | Continuous | OCC, 40% OPC, 38% LC, 22% |
Sx alone, 43% Sx + aRT, 42% CRT/RT, 15% |
FoR questionnaire | Cross-sectional | Age was inversely correlated with FoR results |
| FCR not impacted by age | |||||||||
| Rogers et al. (166) | 2010 | 191 | United Kingdom | NR | OCC, 72% OPC, 21% Other, 7% |
Sx alone, 57% Sx + aRT, 37% RT, 7% |
HNC-PCI completed at clinic attendance FoR questionnaire |
Cross-sectional: ≥ 6weeks following completion of treatment Two cohorts: PCI plus UWQoL; PCI plus UwQoL & FoR |
Non-significant trend in younger patients selecting FoR item on PCI in cohort 1 (analysis of multi-item questionnaire NR) |
| Llewellyn et al. (167) | 2008 | 55 | United Kingdom | Continuous (range 23-89) |
Subsites NR | NR | ‘Over the past month, how often have you worried about the possibility that cancer might come back?’ Response on 1-5 Likert scale (none of the time to all the time) |
Pretreatment and 6-8 month post treatment Examined longitudinal predictors of FCR in survivors of HNC using Leventhal’s CSM as a framework, |
FCR was not related to socio-demographic factors including age |
| Van Liew et al. (168) | 2014 | 138 | USA | Continuous | NR (only early vs late stage) | Sx alone, 38% RT only, 11% Combination, 42% Unknown, 9% |
FCRI | Cross-sectional | Current age and age at diagnosis were not associated with FCR |
aRT, adjuvant radiotherapy; CSM, common sense model CUP, carcinoma unknown primary; CWS, Cancer Worry Scale; FCR, fear of cancer recurrence;FCRI, Fear of Cancer Recurrence Inventory; FoR, Fear of Recurrence; HNC, Head and Neck Cancer; HPC, hypopharyngeal cancer; HPV, human papillomavirus; LC, laryngeal cancer; NR, not recorded; OCSCC, oral cavity cancer; OPC, oropharyngeal cancer; PCI, Patient Concerns Inventory RT/CRT, radiotherapy/chemoradiotherapy; SF, short form; Sx, surgery; UVA, univariate/variable analysis; UW-QoL, University of Washington Quality of Life questionnaire.