Bracing for the worst? Real-time scanxiety and uncertainty management during cancer surveillance.

Abstract

Objectives: "Scanxiety" is a common and distressing experience that can negatively impact quality of life after completing cancer treatment, yet little research has investigated risk factors for scanxiety as it emerges in real time. This study used an ecological momentary assessment design to examine how uncertainty management strategies predict the experience of "scanxiety," operationalized via self-reported fear of cancer recurrence (FCR) in the days before, on, and after a routine surveillance scan or test.

Method: Adolescent and young adult survivors of childhood cancer (N = 55, M_age = 17.31 years, M = 2.90 years off treatment) self-reported how they manage uncertainty surrounding surveillance scans, including strategies of bracing for the worst, hoping for the best, and remaining optimistic. Daily FCR was captured via a smartphone app for 11 days surrounding a surveillance scan.

Results: In the days before the scan, bracing for bad news predicted greater overall fear of recurrence and a sharper increase in daily fear of recurrence. Bracing also predicted greater fear of recurrence on the day of the scan and a steeper decrease in fear of recurrence after receiving reassuring scan results. Findings held while controlling for baseline fear of recurrence. Hope and optimism did not predict daily fear of recurrence.

Conclusion: Adolescent and young adult cancer survivors who brace for bad news may experience worse FCR while awaiting surveillance scans, yet this fear largely resolves following good news. Positive uncertainty management strategies (hope and optimism) do not appear to buffer against scanxiety. Findings can inform scanxiety intervention development. (PsycInfo Database Record (c) 2025 APA, all rights reserved).