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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

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Abstract

Purpose

Despite the prevalence of fear of cancer recurrence (FCR), understanding of factors underlying clinically significant FCR is limited. This study examined factors associated with greater FCR morbidity, according to a cognitive processing model, in cancer survivors who screened positively for clinically significant FCR seeking psychological treatment through the ConquerFear trial.

Methods

Participants had completed treatment for breast, colorectal or melanoma cancer 2 months to 5 years previously and scored ≥ 13/36 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Hierarchical regression analyses examined associations between demographic, medical and psychological variables, namely metacognitions (MCQ-30), post-traumatic stress symptoms (IES-R) and FCR (FCRI total score).

Results

Two hundred and ten (95%) of the 222 cancer survivors who consented to the ConquerFear trial completed the baseline questionnaire. Participants were predominantly (89%) breast cancer survivors. The final regression model accounted for 68% of the variance in FCR (demographic and medical variables 13%, metacognitions 26%, post-traumatic stress symptoms 28%). Negative metacognitive beliefs about worry and intrusive post-traumatic stress symptoms were significant individual correlates of FCR, but negative beliefs about worry did not significantly moderate the impact of intrusions on FCR morbidity.

Conclusions

Results provide partial support for the cognitive processing model of FCR. Psychological factors were found to play an important role in FCR morbidity after controlling for demographic/medical factors. More intrusive thoughts and negative beliefs about worry were strong independent predictors of FCR morbidity. Cancer survivors with clinically significant FCR may benefit from assessment for intrusive thoughts and metacognitions and delivery of trauma- and/or metacognitive-based interventions accordingly.

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Acknowledgments

The ConquerFear Authorship Group includes Lisa Beatty, Barbara Bennett, Rachel Brebach, Christina Brock, Sue Butler, Donna Byrne, Sinead Day, Justine Diggens, Amanda Fairclough, Therese Faulkner, Maria Ftanou, Maree Grier, Geraldine Hill, Tessa Jones, Laura Kirsten, Sue McConaghey, Sarah McKinnon, Catherine Mihalopoulos, Shab Mireskandari, Toni Musiello, James Penhale, Annabel Pollard, Anita Rangganadhan, Marita Scealy, Mary Scott, Sophy Shih, Mey Teoh, Kerry Tiller and Paula Watt.

Funding

This project was co-funded by beyondblue, the National Breast Cancer Foundation and Cancer Australia. Ben Smith and Afaf Girgis are funded through a Cancer Institute NSW grant. Phyllis Butow is the recipient of an NHMRC Senior Principal Research Fellowship.

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Correspondence to Allan ‘Ben’ Smith.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

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Informed consent was obtained from all individual participants included in the study.

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Smith, A.‘., 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 26, 4207–4216 (2018). https://doi.org/10.1007/s00520-018-4294-y

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