Skip to main content

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

Supportive Care in Cancer volume 26, pages 4207–4216 (2018)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Lebel S, Ozakinci G, Humphris G, Mutsaers B, Thewes B, Prins J, Dinkel A, Butow P (2016) From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer 24(8):3265–3268. https://doi.org/10.1007/s00520-016-3272-5

    Article  Google Scholar 

  2. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, Ozakinci G (2013) Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv 7(3):300–322

    Article  Google Scholar 

  3. Costa DSJ (2017) Screening for clinical levels of fear of cancer recurrence. Psychooncology 26:2002–2003. https://doi.org/10.1002/pon.4390

    Article  PubMed  Google Scholar 

  4. Costa DSJ, Smith AB, Fardell JE (2016) The sum of all fears: conceptual challenges with measuring fear of cancer recurrence. Support Care Cancer 24(1):1–3. https://doi.org/10.1007/s00520-015-2943-y

    Article  PubMed  Google Scholar 

  5. Sharpe L, Thewes B, Butow P (2017) Current directions in research and treatment of fear of cancer recurrence. Curr Opin Support Palliat Care Publish Ahead of Print

  6. Mutsaers B, Jones G, Rutkowski N, Tomei C, Séguin Leclair C, Petricone-Westwood D, Simard S, Lebel S (2016) When fear of cancer recurrence becomes a clinical issue: a qualitative analysis of features associated with clinical fear of cancer recurrence. Support Care Cancer 24(10):4207–4218. https://doi.org/10.1007/s00520-016-3248-5

    Article  PubMed  Google Scholar 

  7. Crist JV, Grunfeld EA (2013) Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology 22(5):978–986. https://doi.org/10.1002/pon.3114

    Article  PubMed  Google Scholar 

  8. Simard S, Savard J (2015) Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv 9(3):481–491. https://doi.org/10.1007/s11764-015-0424-4

    Article  PubMed  Google Scholar 

  9. Butow P, Kelly S, Thewes B, Hruby G, Sharpe L, Beith J (2014) Attentional bias and metacognitions in cancer survivors with high fear of cancer recurrence. Psychooncology 24:416–423. https://doi.org/10.1002/pon.3659

    Article  PubMed  Google Scholar 

  10. Custers JAE, Gielissen MFM, Janssen SHV, de Wilt JHW, Prins JB (2016) Fear of cancer recurrence in colorectal cancer survivors. Support Care Cancer 24(2):555–562. https://doi.org/10.1007/s00520-015-2808-4

    Article  Google Scholar 

  11. Fardell JE, Jones G, Smith AB, Lebel S, Thewes B, Costa D, Tiller K, Simard S, Feldstain A, Beattie S, McCallum M, Butow P (2017) Exploring the screening capacity of the fear of cancer recurrence inventory-short form for clinical levels of fear of cancer recurrence. Psychooncology 27:492–499. https://doi.org/10.1002/pon.4516

    Article  PubMed  Google Scholar 

  12. Fardell JE, Thewes B, Turner J, Gilchrist J, Sharpe L, Smith AB, Girgis A, Butow P (2016) Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv 10(4):663–673. https://doi.org/10.1007/s11764-015-0512-5

    Article  PubMed  Google Scholar 

  13. Heathcote LC, Eccleston C (2017) Pain and cancer survival: a cognitive-affective model of symptom appraisal and the uncertain threat of disease recurrence. Pain 158(7):1187–1191. https://doi.org/10.1097/j.pain.0000000000000872

    CAS  Article  PubMed  Google Scholar 

  14. Lebel S, Maheu C, Lefebvre M, Secord S, Courbasson C, Singh M, Jolicoeur L, Benea A, Harris C, Fung MFK, Rosberger Z, Catton P (2014) Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv 8(3):485–496

    Article  Google Scholar 

  15. Simonelli LE, Siegel SD, Duffy NM (2016) Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psychooncology 26:1444–1454. https://doi.org/10.1002/pon.4168

    Article  PubMed  Google Scholar 

  16. Wells A, Matthews G (1996) Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther 34(11–12):881–888

    CAS  Article  Google Scholar 

  17. Cook SA, Salmon P, Dunn G, Fisher P (2014) Measuring metacognition in cancer: validation of the metacognitions questionnaire 30 (MCQ-30). PLoS One 9(9):e107302. https://doi.org/10.1371/journal.pone.0107302

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Thewes B, Bell ML, Butow P (2013) Fear of cancer recurrence in young early-stage breast cancer survivors: the role of metacognitive style and disease-related factors. Psychooncology 22(9):2059–2063

    CAS  Article  Google Scholar 

  19. Butow P, Bell M, Smith A, Fardell J, Thewes B, Turner J, Gilchrist J, Beith J, Girgis A, Sharpe L, Shih S, Mihalopoulos C, members of the Conquer Fear Authorship Group (2013) Conquer fear: protocol of a randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. BMC Cancer 13(1):201

    Article  Google Scholar 

  20. Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, Tesson S, O’Connell R, Girgis A, Gebski VJ, Asher R, Mihalopoulos C, Bell ML, Zola KG, Beith J, Thewes B (2017) Randomized trial of ConquerFear: a novel, theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol:JCO 2017.2073.1257. https://doi.org/10.1200/JCO.2017.73.1257

    Article  Google Scholar 

  21. Simard S, Savard J (2009) Fear of cancer recurrence inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer 17(3):241–251

    Article  Google Scholar 

  22. Harrel F (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, New York

    Book  Google Scholar 

  23. Hair JFJ, Black WK, Babin BJ, Anderson RE (2014) Multivariate data analysis. Pearson Education Limited, Harlow, Essex

    Google Scholar 

  24. Pedersen AF, Rossen P, Olesen F, von der Maase H, Vedsted P (2012) Fear of recurrence and causal attributions in long-term survivors of testicular cancer. Psychooncology 21(11):1222–1228. https://doi.org/10.1002/pon.2030

    Article  PubMed  Google Scholar 

  25. Cook SA, Salmon P, Dunn G, Holcombe C, Cornford P, Fisher P (2015) The association of metacognitive beliefs with emotional distress after diagnosis of cancer. Health Psychol 34(3):207–215. https://doi.org/10.1037/hea0000096

    Article  PubMed  Google Scholar 

  26. Fergus TA, Valentiner DP, McGrath PB, Gier-Lonsway S, Jencius S (2013) The cognitive attentional syndrome: examining relations with mood and anxiety symptoms and distinctiveness from psychological inflexibility in a clinical sample. Psychiatry Res 210(1):215–219. https://doi.org/10.1016/j.psychres.2013.04.020

    Article  PubMed  Google Scholar 

  27. Wells A (2009) Metacognitive therapy for anxiety and depression. Guilford Press, New York

    Google Scholar 

  28. Tran US, Gregor B (2016) The relative efficacy of bona fide psychotherapies for post-traumatic stress disorder: a meta-analytical evaluation of randomized controlled trials. BMC Psychiatry 16(1):266. https://doi.org/10.1186/s12888-016-0979-2

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. Dieng M, Butow PN, Costa DSJ, Morton RL, Menzies SW, Mireskandari S, Tesson S, Mann GJ, Cust AE, Kasparian NA (2016) Psychoeducational intervention to reduce fear of cancer recurrence in people at high risk of developing another primary melanoma: results of a randomized controlled trial. J Clin Oncol 34(36):4405–4414. https://doi.org/10.1200/JCO.2016.68.2278

    Article  PubMed  Google Scholar 

  30. Lichtenthal WG, Corner GW, Slivjak ET, Roberts KE, Li Y, Breitbart W, Lacey S, Tuman M, DuHamel KN, Blinder VS, Beard C (2017) A pilot randomized controlled trial of cognitive bias modification to reduce fear of breast cancer recurrence. Cancer 123(8):1424–1433. https://doi.org/10.1002/cncr.30478

    Article  PubMed  PubMed Central  Google Scholar 

  31. van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J (2017) Efficacy of blended cognitive behavior therapy for high fear of recurrence in breast, prostate, and colorectal cancer survivors: the SWORD study, a randomized controlled trial. J Clin Oncol 35(19):2173–2183. https://doi.org/10.1200/JCO.2016.70.5301

    Article  PubMed  Google Scholar 

  32. Brebach R, Sharpe L, Costa DSJ, Rhodes P, Butow P Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence

  33. Gefen D, Straub D, Boudreau M-C (2000) Structural equation modeling and regression:guidelines for research practice. Commun Assoc Inf Syst 4(1)

Download references

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.

Author information

Affiliations

  1. Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia

    Allan ‘Ben’ Smith, Belinda Thewes, Joanna E. Fardell, Stephanie Tesson, Melanie L. Bell & Phyllis Butow

  2. Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

    Allan ‘Ben’ Smith, Afaf Girgis & Joseph Descallar

  3. School of Psychology, University of Sydney, Sydney, Australia

    Louise Sharpe

  4. Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands

    Belinda Thewes

  5. Mental Health Centre, Faculty of Medicine, University of Queensland, Brisbane, Australia

    Jane Turner

  6. Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Sydney, Australia

    Jemma Gilchrist

  7. Kids Cancer Centre, Sydney Children’s Hospital and School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, Australia

    Joanna E. Fardell

  8. Epidemiology & Biostatistics, University of Arizona, Tucson, AZ, USA

    Melanie L. Bell

  9. Department of Medical Oncology, Chris O’Brien Lifehouse, Missenden Rd, Camperdown, NSW, Australia

    Jane Beith

Authors
  1. Allan ‘Ben’ Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louise Sharpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Belinda Thewes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jane Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jemma Gilchrist
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joanna E. Fardell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Afaf Girgis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stephanie Tesson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joseph Descallar
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Melanie L. Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jane Beith
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Phyllis Butow
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the ConquerFear Authorship Group

  • 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
  •  & Paula Watt

Corresponding author

Correspondence to Allan ‘Ben’ Smith.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.”

Informed consent

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

Electronic supplementary material

ESM 1

(DOCX 80 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4294-y

Keywords

  • Fear of cancer recurrence
  • Cancer
  • Survivorship
  • Supportive care
  • Metacognitions
  • Post-traumatic stress