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Peer-reviewedCC BY 4.0Journal of Cancer Survivorship

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

  • Katrine Ingeman1
  • Johanne D. Lyhne2
  • Per Fink1,3
  • Allan “Ben” Smith4,5
  • Lisbeth Frostholm1,3
  • Tina Birgitte Wisbech Carstensen1,3
5 affiliations
  1. 1Department of Functional Disorders, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, Aarhus N, 8200 Denmark
  2. 2Department of Clinical Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100 Denmark
  3. 3Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, Aarhus N, 8200 Denmark
  4. 4The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, NSW Australia
  5. 5South West Sydney Clinical Campuses, Faculty of Medicine and Health, University of New South Wales (UNSW Sydney), Liverpool, Australia
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Abstract

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.

Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s11764-026-02058-6.

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Cite

BibTeXRIS
BibTeX
@article{ingeman2026overlap,
  title = {{Overlap and distinction between fear of cancer recurrence and health anxiety in long-term colorectal cancer survivors}},
  author = {Katrine Ingeman and Johanne D. Lyhne and Per Fink and Allan “Ben” Smith and Lisbeth Frostholm and Tina Birgitte Wisbech Carstensen},
  journal = {Journal of Cancer Survivorship},
  year = {2026},
  month = jun,
  doi = {10.1007/s11764-026-02058-6},
  url = {https://doi.org/10.1007/s11764-026-02058-6},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Overlap and distinction between fear of cancer recurrence and health anxiety in long-term colorectal cancer survivors
AU  - Katrine Ingeman
AU  - Johanne D. Lyhne
AU  - Per Fink
AU  - Allan “Ben” Smith
AU  - Lisbeth Frostholm
AU  - Tina Birgitte Wisbech Carstensen
PY  - 2026
DA  - 2026/06/18
JO  - Journal of Cancer Survivorship
DO  - 10.1007/s11764-026-02058-6
UR  - https://doi.org/10.1007/s11764-026-02058-6
AB  - 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.  Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s11764-026-02058-6.
SN  - 1932-2259
SN  - 1932-2267
ER  -