Overlap and distinction between fear of cancer recurrence and health anxiety in long-term colorectal cancer survivors

BACKGROUND: Fear of cancer recurrence (FCR) and health anxiety (HA) share central features such as illness-related worries and hypervigilance toward bodily sensations, yet the conceptual boundaries between them remain debated. The present study investigated psychological clinical characteristics and treatment outcomes in people with FCR and HA. METHODS: Data were drawn from a national cohort and a randomized controlled trial evaluating a therapist-guided internet-delivered intervention for FCR (TG-iConquerFear). Participants (≥ 5 years post-diagnosis of colorectal cancer, no recurrence) completed pre-intervention assessments of HA and FCR severity, along with self-report measures of FCR, illness worries, and psychological distress. RESULTS: Among 298 interviewed participants, 38 met the criteria for clinical FCR only, 44 for both clinical FCR and HA, and 5 for HA only. Participants with comorbid HA more frequently reported illness worries predating cancer diagnosis (44%) compared to participants with FCR only (5.3%). For participants with FCR only, 42.1% reported worries limited to colorectal cancer, while this was the case for only 2.3% of participants with both FCR and HA. The latter group also had higher levels of depression (P = 0.005), anxiety (P < 0.001), and emotional distress (P = 0.005). Based on descriptive data, individuals with FCR only appeared to show a larger reduction in FCR symptoms following TG-iConquerFear than those with comorbid HA. CONCLUSION: FCR and HA are distinct, yet highly overlapping conditions among long-term colorectal cancer survivors. Comorbid HA is associated with more severe emotional distress. IMPLICATIONS FOR CANCER SURVIVORS: Survivors will benefit from destigmatization of HA and correct distinction between FCR and HA to receive effective intervention.