Adjuvant therapy and fear of cancer recurrence in bladder cancer survivors: a cross-sectional pilot study

Fear of cancer recurrence (FCR) is a prevalent and debilitating psychological burden among cancer survivors. Despite the high recurrence rates inherent to bladder cancer, FCR remains understudied in this population. This study aimed to evaluate whether receipt of adjuvant therapy following primary surgical treatment was associated with FCR severity in patients with bladder cancer. Because clinical records captured adjuvant treatment only as a single composite variable, this study was designed as a hypothesis-generating pilot investigation rather than a definitive, modality-specific test. A single-center, prospective, cross-sectional study was conducted among 79 patients with bladder cancer attending routine urological follow-up. FCR was assessed using the Fear of Cancer Recurrence Inventory – Short Form (FCRI-SF), a validated 9-item instrument with scores ranging from 0 to 36. Patients were stratified by adjuvant therapy status and compared using Mann-Whitney U tests, chi-squared tests, and multivariable linear regression adjusting for age, sex, tumor recurrence, and time since procedure. The cohort was predominantly male (89.9%) with a median age of 72 years (IQR 65–77). Overall median FCRI-SF score was 14 (IQR 9–20). Adjuvant therapy was not associated with FCR severity (median 15 vs. 12; p = 0.102), and this finding persisted on multivariable analysis (β = 2.219, p = 0.148); however, the study was underpowered to detect the observed effect size (d = 0.43); approximately 168 patients would be required for 80% power, so this null result should not be interpreted as evidence that adjuvant therapy has no effect. Documented tumor recurrence was a strong independent predictor of FCR (β = 5.009, SE = 1.546, p = 0.002), with patients who experienced recurrence reporting significantly higher composite scores than those who did not (median 17 vs. 11; Mann-Whitney U = 1088.5, p = 0.001). Female sex was also independently associated with higher FCR scores in the adjusted model (β = 4.877, p = 0.049); with only 8 female patients in the cohort, however, this estimate is imprecise and should be regarded as hypothesis-generating rather than confirmatory. After adjustment for risk-stratified clinical allocation, adjuvant therapy showed no detectable association with FCR in this cohort; because the study was underpowered for the observed effect size, this null finding should not be interpreted as proof that adjuvant therapy is psychologically neutral. FCR burden was instead driven primarily by actual tumor recurrence rather than treatment exposure; this association was statistically significant in the non-adjuvant subgroup and showed a consistent, non-significant trend in the adjuvant subgroup, likely reflecting reduced subgroup power, underscoring the need for targeted psychological screening in patients who experience disease recurrence. Given the composite classification of adjuvant therapy modalities in this dataset, these findings should be regarded as hypothesis-generating pilot data rather than a definitive assessment of treatment-specific effects.