Abdominal Symptoms Track Closely With Fear of Recurrence in CRC

Seven years after diagnosis, what pulls a colorectal cancer survivor back toward worry about relapse can be something as ordinary as bloating. In a study including nearly 5500 recurrence-free Danish survivors, severe abdominal symptoms and tiredness were strongly associated with clinical fear of cancer recurrence (FCR), a pattern the researchers described as a modifiable target for follow-up care.¹

Fear of Recurrence Ranks Among the Most Common Unmet Survivor Needs

Fear of cancer recurrence is widely described as the most common unmet need in cancer survivorship. An individual participant data meta-analysis drawing on 46 studies, with 9311 respondents in the main analysis, found that 19.2% scored at or above 22 on the short form of the Fear of Cancer Recurrence Inventory, the cutoff commonly used to flag clinically significant fear, with higher scores reported by women and by younger survivors.²

That evidence base drew on mixed cancer populations and said little about which disease-specific symptoms feed the fear. Colorectal cancer survivors carry a distinctive long-term symptom burden that includes bowel dysfunction, abdominal discomfort, and fatigue, and many of those sensations overlap with the warning signs patients are told to watch for. Whether those symptoms were associated with fear of recurrence had not been tested in a large population-based sample of long-term survivors.¹

Nationwide Danish Survey of Recurrence-Free Colorectal Cancer Survivors

The cross-sectional study used Danish clinical registries to identify 9638 people diagnosed with colorectal cancer between 2014 and 2018 who remained free of recurrence. Electronic questionnaires were distributed from May 2023 through May 2024, and 5480 people responded, a rate of 56.9%.

Respondents had a mean age of 73 years (range, 30-99), and 42.1% were women. Two-thirds had colon cancer and one-third had rectal cancer, 93.9% had nonmetastatic disease at diagnosis, and the mean time since diagnosis was 7.2 years. Fear of recurrence was measured with the Fear of Cancer Recurrence Inventory short form, physical symptoms with the Bodily Distress Syndrome checklist, and psychological symptoms with validated scales. Logistic regression models were adjusted for demographic confounders.

Bloating, Pain, and Tiredness Marked Clinical Fear of Recurrence

Clinical fear of recurrence, defined as a score of 22 or higher, was reported by 5.3% of survivors, or 288 of the 5435 who completed the measure. Another 28.6% (n = 1555) fell into the subclinical range of 13 to 21, and 66.1% (n = 3592) scored below that.

Severe abdominal bloating, tension, or heaviness carried the strongest physical association with clinical fear (adjusted OR [aOR], 10.0; 95% CI, 6.1-16.3), followed by severe abdominal pain (aOR, 8.7; 95% CI, 4.8-15.8) and severe tiredness (aOR, 7.1; 95% CI, 4.1-12.1). Psychological symptoms were associated more strongly still. Health anxiety showed an adjusted OR of 19.7 (95% CI, 13.5%-28.6%), anxiety an adjusted OR of 11.2 (95% CI, 6.4%-19.6%), and depression an adjusted OR of 5.5 (95% CI, 2.6%-11.9%).

“Addressing cancer-specific physical symptoms may be a promising strategy for reducing FCR,” the authors wrote.

Most Survivors With Clinical Fear Wanted Treatment for It

Among the 288 survivors with clinical fear of recurrence, 215 (74.7%) said they were interested in treatment for it, with higher interest among men and among those who had received chemotherapy. The authors cautioned that the response rate leaves room for selection bias, that missing patient-reported outcome data were interpreted conservatively as an absence of symptoms, and that cases rested on self-report rather than diagnostic interviews. Because the design was cross-sectional, it cannot establish whether symptoms provoke fear, fear amplifies symptom reporting, or both operate together.

The practical implication for clinicians and payers designing survivorship programs is that persistent abdominal complaints and fatigue in a long-term survivor may warrant attention as psychological signals as well as physical ones. A brief question about worry during routine follow-up would identify a group that is small, identifiable from symptoms already being reported, and, by its own account, willing to accept help.

References

1. Lyhne JD, Jensen LH, Fink P, Timm S, Frostholm L, Smith AB. Fear of cancer recurrence in long-term colorectal cancer survivors: a nationwide cross-sectional study. J Cancer Surviv. 2026;20(4):1431-1442. doi:10.1007/s11764-025-01746-z
2. Luigjes-Huizer YL, Tauber NM, Humphris G, et al. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psychooncology. 2022;31(6):879-892. doi:10.1002/pon.5921