Rapid Fire Presentations 2025 National Cancer Survivorship Conference

How do coping differ among Chinese cancer survivors with non-clinical, subclinical, and clinically-significant fear of cancer recurrence? A qualitative study (#18)

Danielle Wing Lam Ng 1 , Lucia Wang 1 , Richard Fielding 2 , Ava Kwong 3 , Dominic Chi-chung Foo 3 , Wing Lok Chan 4 , Simon Ng 5 , Julia Wei Chun Tang 1 , Wendy Wing Tak Lam 1
  1. LKS Faculty of Medicine, School of Public Health, Centre for Psycho-Oncology Research and Training, The University of Hong Kong , Hong Kong
  2. LKS Faculty of Medicine, Jockey Club Institute of Cancer Care, The University of Hong Kong , Hong Kong
  3. LKS Faculty of Medicine, School of Clinical Medicine, Department of Surgery, The University of Hong Kong , Hong Kong
  4. LKS Faculty of Medicine, School of Clinical Medicine, Department of Clinical Oncology, The University of Hong Kong , Hong Kong
  5. Faculty of Medicine, Department of Surgery, The Chinese University of Hong Kong , Hong Kong

Objectives: One in ten cancer survivors experienced clinically-significant levels of fear of cancer recurrence (FCR). Qualitative differences in coping with FCR among cancer survivors may explain why FCR, initially a normal response, was elevated for this subset of affected survivors. This study aimed to identify coping strategies used to manage FCR among Chinese cancer survivors and compare coping strategies between those with nonclinical, subclinical, and clinically-significant FCR.

Methods: This qualitative study involved individual semi-structured interviews with 52 Cantonese- or Mandarin-speaking Chinese cancer survivors. Participants were selected based on their FCR status as indicative of FCRI-SF < 13 as nonclinical, 13-21 as subclinical, or > 21 as clinically-significant levels. All interviews were audio-recorded, transcribed, and analysed using a grounded theory approach.

Results: A sense of demoralisation stood out as the distinct construct of clinical levels of FCR. Those with clinically-significant FCR viewed the illness as a constant threat, leading to feelings of hopelessness and helplessness. Maladaptive thought suppression, biased processing of somatic cues, and excessive reassurance seeking were common in response to illness demand, such as uncertainty and a perceived high risk of recurrence. This subgroup of survivors received poor support from family and friends. In contrast, those with non-clinical/subclinical FCR perceived the illness as a temporary challenge that they could manage in a supportive environment and were able to detach from worry. Non-clinical FCR survivors utilised adaptive, active coping strategies to cope with FCR/the illness.

Conclusion: Thought suppression, excessive threat monitoring behaviour, intolerance of uncertainty, and social constraint were the risk factors of clinically-significant FCR. Early therapeutic intervention interrupting maladaptive information processing and enhancing psychological flexibility may be beneficial in preventing progression of FCR to a clinical level.