Fear of recurrence among uninsured and underrepresented prostate cancer survivors of the Men's Health Study.

Abstract

e17157 Background: The California Department of Public Health has funded the IMPACT program since 2001 to support low-income, uninsured, or underinsured Californians with biopsy-proven prostate cancer (PCa). Patient-reported outcomes (PROs) were assessed in participants of the UCLA Men’s Health Study(MHS). Despite efforts to reduce the uninsured population, millions in the U.S. remain without insurance. Fear of recurrence(FCR) is a major concern for PCa survivors. Although previous studies have explored factors linked to FCR, little is known about its prevalence and determinants among underrepresented, uninsured PCa survivors. Objective: This study investigates the prevalence of FCR among underrepresented PCa survivors in the MHS who underwent radical prostatectomy (RP), radiotherapy (RT), or active surveillance (AS), and explores clinical, demographic, PROs, and psychological factors associated with FCR. Methods: This retrospective cross-sectional study included MHS participants from July 2001 to April 2007 who completed the Fear of Recurrence Scale (FoRS) at baseline. High FCR was defined as a score ≤14. Psychological stress at diagnosis was measured using the SF-12v2 Mental Composite Score and emotional well-being domain. Demographics, clinical data, and PROs—including health-related and prostate-specific quality of life, self-efficacy in physician interactions, social functioning, and symptom distress—were analyzed. Results: The cohort included 150 PCa patients treated with RP (n=42), RT (n=39), AS (n=11), or androgen deprivation therapy (ADT) with RT (n=58).High FCR was reported by 28% (n=42) of participants, with similar rates across treatment modalities (RP=33%, RT+ADT=27%, RT=28%, AS=27%). Patients with high FCR had significantly lower scores in mental health composite (mean: 41.6 vs. 48.2; P<0.01), emotional well-being (51.2 vs. 61.7; P=0.01), emotional limitations (64.0 vs. 79.0; P<0.01), energy (50.6 vs. 63.1; P=0.02), and social functioning (61.3 vs. 76.2; P=0.01) compared to those with low FCR. High FCR was strongly associated with treatment regret (95.2% vs. 28.7%, P<0.01). Clinical and demographic characteristics, physical health composite scores, and prostate-specific quality of life were not associated with high FCR. Conclusions: One-third of underrepresented PCa survivors reported high FCR, regardless of treatment modality. Surprisingly, patients with poorer prognostic factors, such as advanced clinical T stage and high biopsy grade group, exhibited similar FCR levels to those with better prognostic indicators, suggesting limited health literacy may hinder understanding of disease severity. High FCR was associated with significant psychological and emotional distress, highlighting the need for targeted interventions and supportive care strategies to reduce FCR and improve quality of life in this underserved population.