نبذة مختصرة : Objective: This longitudinal study mapped distinct trajectories of fear of cancer recurrence (FCR) over 12 months among patients with breast (BC) or colorectal (CRC) cancer, and examined if metacognition, indirectly via attentional bias, intrusive thoughts and avoidance (hallmarks of cognitive attentional syndrome; CAS) predicted FCR trajectory membership.
Methods: Two hundred and seventy BC (n = 163) or CRC (n = 107) patients were assessed at 8-weeks, 3-, 6-, and 12-months postsurgery on a measure of FCR (FCRI-SF). Metacognition (MCQ-30), Intrusive and Avoidant Thoughts (CIES-R) and attentional bias (dot-probe tasks) were assessed at baseline. Latent growth mixture modeling identified FCR trajectories. Fully-adjusted Multinomial Logistic Regression identified whether direct and indirect effects of metacognition through CAS determined FCR trajectory membership.
Results: Three distinct FCR trajectories were identified, namely, low-stable (62.4%), high-stable (29.2%), and recovery (8.3%). Negative beliefs about worry, cognitive confidence, and age predicted FCR trajectories (χ 2 (6) = 38.31, P<.001). Compared with Low-stable group, Recovery FCR patients held greater Negative beliefs about worry (OR = 1.13, P = .035) and High-stable FCR patients reported poorer Cognitive confidence (OR = 1.12, P = .004). The effect of Negative beliefs about worry was partially mediated by avoidance (β = .06, 95% CIs 0.03-0.12) and fully mediated by intrusive thoughts (β = .14, 95% CIs 0.08-0.20). Attentional bias did not predict FCR trajectories.
Conclusions: While most patients experienced low level of FCR, 3 in 10 persistently worried about cancer returning over the first 12-months postsurgery. Modifying metacognitive knowledge to interrupt maladaptive cognitive processing including intrusion and avoidance may be an effective therapeutic intervention for patients at risk of persistent FCR.
(© 2019 John Wiley & Sons, Ltd.)
References: Simard S, Thewes B, Humphris G, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300-322.
McGinty HL, Small BJ, Laronga C, Jacobsen PB. Predictors and patterns of fear of cancer recurrence in breast cancer survivors. Health Psychol. 2016;35(1):1-9.
Dunn L, Langford D, Paul S, et al. Trajectories of fear of recurrence in women with breast cancer. Support Care Cancer. 2015;23(7):2033-2043.
Manne SL, Myers-Virtue S, Kissane D, et al. Group-based trajectory modeling of fear of disease recurrence among women recently diagnosed with gynecological cancers. Psycho-Oncol. 2017;26(11):1799-1809.
Fardell JE, Thewes B, Turner J, et al. Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv. 2016;10(4):663-673.
Flavell JH. Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. Am Psychol. 1979;34(10):906.
Wong W-S, Fielding R. Suppression of emotion expression mediates the effects of negative affect on pain catastrophizing: a cross-sectional analysis. Clin J Pain. 2013;29(10):865-872.
Thewes B, Bell M, Butow P. Fear of cancer recurrence in young early-stage breast cancer survivors: the role of metacognitive style and disease-related factors. Psycho-Oncol. 2013;22(9):2059-2063.
Butow P, Kelly S, Thewes B, Hruby G, Sharpe L, Beith J. Attentional bias and metacognitions in cancer survivors with high fear of cancer recurrence. Psycho-Oncol. 2015;24(4):416-423.
Smith AB, Sharpe L, Thewes B, et al. Medical, demographic and psychological correlates of fear of cancer recurrence (FCR) morbidity in breast, colorectal and melanoma cancer survivors with probable clinically significant FCR seeking psychological treatment through the ConquerFear study. Support Care Cancer. 2018;1-10.
Ng DWL, Kwong A, Suen D, et al. Fear of cancer recurrence among Chinese cancer survivors: Prevalence and associations with metacognition and neuroticism. Psycho-Oncol. 2019;28:1243-1251.
Glinder JG, Beckjord E, Kaiser CR, Compas BE. Psychological adjustment to breast cancer: Automatic and controlled responses to stress. Health Psychol. 2007;22(3):337-359.
Chan MW, Ho SM, Tedeschi RG, Leung CW. The valence of attentional bias and cancer-related rumination in posttraumatic stress and posttraumatic growth among women with breast cancer. Psycho-Oncol. 2011;20(5):544-552.
Lam WW, Ng D, Wong S, Lee T, Kwong A, Fielding R. The role of cognitive bias in relation to persistent distress among women diagnosed with breast cancer. Psycho-Oncol. 2018;27:983-989.
Custers JAE, Becker ES, Gielissen MF, Van Laarhoven HW, Rinck M, Prins JB. Selective attention and fear of cancer recurrence in breast cancer survivors. Ann Behav Med. 2015;49(1):66-73.
Simard S, Savard J. Fear of cancer recurrence inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer. 2009;17(3):241-251.
Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv. 2015;9(3):481-491.
Cook SA, Salmon P, Dunn G, Fisher P. Measuring metacognition in cancer: Validation of the metacognitions questionnaire 30 (MCQ-30). PLoS ONE. 2014;9(9):e107302.
Lam WW, Law CC, Fu YT, Wong KH, Chang VT, Fielding R. New insights in symptom assessment: the Chinese versions of the Memorial Symptom Assessment Scale Short Form (MSAS-SF) and the Condensed MSAS (CMSAS). J Pain Symptom Manage. 2008;36(6):584-595.
MacLeod C, Mathews A, Tata P. Attentional bias in emotional disorders. J Abnorm Psychol. 1986;95(1):15.
Wu KK, Chan K. The development of the Chinese version of Impact of Event Scale-Revised (CIES-R). Soc Psychiatry Psychiatr Epidemiol. 2003;38(2):94-98.
Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41(3):209-218.
Muthén LK, Muthén BO. Mplus User's Guide. 5th ed. Los Angeles: CA; 2007.
Geiser C. Data analysis with Mplus: Guilford press; 2012.
Curran PJ, Obeidat K, Losardo D. Twelve frequently asked questions about growth curve modeling. J Cogn Dev. 2010;11(2):121-136.
Jung T, Wickrama KA. An introduction to latent class growth analysis and growth mixture modeling. Soc Personal Psychol Compass. 2008;2(1):302-317.
Lam WW, Bonanno GA, Mancini AD, et al. Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psycho-Oncol. 2010;19(10):1044-1051.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173.
Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. New York: The Guliford Press; 2018.
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879-891.
Fardell JE, Jones G, Smith AB, et al. Exploring the screening capacity of the Fear of cancer recurrence inventory-short form for clinical levels of fear of cancer recurrence. Psycho-Oncol. 2018;27(2):492-499.
Cook SA, Salmon P, Dunn G, et al. A prospective study of the association of metacognitive beliefs and processes with persistent emotional distress after diagnosis of cancer. Cognit Ther Res. 2015;39(1):51-60.
Yılmaz AE, Gençöz T, Wells A. The temporal precedence of metacognition in the development of anxiety and depression symptoms in the context of life-stress: A prospective study. J Anxiety Disord. 2011;25(3):389-396.
Dekker J, Braamse A, Schuurhuizen C, et al. Distress in patients with cancer - on the need to distinguish between adaptive and maladaptive emotional responses. Acta Oncol. 2017;56(7):1026-1029.
Wells A. Emotional disorders and metacognition: Innovative cognitive therapy. John Wiley & Sons; 2000.
Skaali T, Fosså SD, Bremnes R, et al. Fear of recurrence in long-term testicular cancer survivors. Psycho-Oncol. 2009;18(6):580-588.
Llewellyn CD, Weinman J, McGurk M, Humphris G. Can we predict which head and neck cancer survivors develop fears of recurrence? J Psychosom Res. 2008;65(6):525-532.
Wells A. Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley & Sons; 2013.
Koch L, Jansen L, Brenner H, Arndt V. Fear of recurrence and disease progression in long-term (≥ 5 years) cancer survivors-a systematic review of quantitative studies. Psycho-Oncology. 2013;22(1):1-11.
Butow P, Turner J, Gilchrist J, et al. Randomized trial of ConquerFear: a novel, theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066-4077.
Processing Request
No Comments.