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Psychooncology. 2012 Nov;21(11):1222-8. doi: 10.1002/pon.2030. Epub 2011 Aug 25.

Fear of recurrence and causal attributions in long-term survivors of testicular cancer.

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The Research Unit for General Practice, Research Center for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus C, Denmark.



The purpose was to examine the prevalence of fear of recurrence (FoR) in long-term testicular cancer survivors (TCSs) and the association between FoR and causal attributions of cancer.


Testicular cancer survivors were sampled from a clinical register and were sent a questionnaire assessing FoR, depression using Beck Depression Inventory II (BDI-II), physical symptoms (ototoxicity, neuropathy, and Raynaud-like phenomena), and causal attributions of testicular cancer.


There were 316 TCSs who completed the questionnaires (response rate, 65%). The mean age was 47.6 years (standard deviation (SD) = 10.9), and the mean time since diagnosis was 12.0 years (SD = 3.0). Among the TCSs, 27.9% reported FoR. Univariate analyses revealed that FoR was associated with a BDI-II sum score of ≥19 (odds ratio (OR) = 7.07, p < 0.001) and attributing the cancer disease to psychological stress (OR = 2.57, p = 0.002). A multivariate analysis revealed associations between FoR and attributing the cancer disease to psychological stress (OR = 2.35, p = 0.010) and a BDI-II sum score ≥19 (OR = 5.82, p = 0.002).


Fear of recurrence is prevalent in long-term TCSs. The observed relationship between FoR and a psychological causal attribution is probably complex and the direction of causality may be twofold: attributing the disease to a factor that is perceived as uncontrollable in nature could induce loss of control, and high levels of FoR may increase the need to gain control over the situation by pointing out factors that could be responsible for the disease such as psychological stress.


cancer; causal attributions; fear of recurrence; long‐term survivorship; oncology

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