PERCEIVED RISK OF CANCER RECURRENCE, TRUST AND QUALITY OF LIFE AMONG CANCER SURVIVORS

Purpose: The Institute of Medicine has identified quality of life (QOL) concerns among cancer survivors as essential components of survivorship care. Perceived risk of a hazard can be associated with mental and physical health outcomes (e.g., worry, mortality). However, little is known about the association between perceived risk of cancer recurrence among cancer survivors and QOL more generally. This study is the first to examine whether perceived risk of recurrence is related to QOL among cancer survivors. Trust, an important factor in acceptance of risk and in mental QOL, was investigated as a possible moderator.

Methods: Data were collected in 2003-2004 for the Assessment of Patients’ Experience of Cancer Care (APECC) study. APECC was a population-based, nationally representative, cross-sectional survey of individuals diagnosed with leukemia, colorectal, or bladder cancer within the previous 2-5 years. Of the 1572 survivors who were mailed the survey, 774 returned it and 579 completed all of the items necessary for these analyses. Data were analyzed using three GLMs. The outcome variables were the Mental (MCS) and the Physical (PCS) components of the SF-36 Health Survey and the CES-D scale for depression. Perceived risk of cancer recurrence, trust in the physician, and the interaction of perceived risk and trust were the predictors. Several demographic, communication, and disease status variables were included as covariates.

Results: Higher perceived risk was associated with worse scores on the MCS (p<.001), the PCS (p<.001), and the CES-D (p<.001). Higher trust was associated with better scores on the MCS (p<.001), but not the PCS (p=.85) or CES-D (p=.17). The association between perceived risk and MCS was much stronger among survivors in the bottom 3 quartiles of trust than among survivors in the top quartile (p<.001). Trust did not moderate the relationship between perceived risk and PCS scores (p=.17) or perceived risk and CES-D scores (p=.24).

Conclusions: This study extends the risk perception literature to QOL among cancer survivors. It found that perceived risk can be inversely associated with a variety of QOL measures, but that some of these relationships may be attenuated by very high levels of trust in the follow-up care physician. Improving the physician-patient relationship might improve psychological QOL among survivors, but the directionality and causality of these relationships should be elucidated.