Sophie Lebel1, Christine Maheu2, Christina Tomei1, Lori J Bernstein3, Christine Courbasson4, Sarah Ferguson5, Cheryl Harris6,7, Lynne Jolicoeur7, Monique Lefebvre7, Linda Muraca8, Agnihotram V Ramanakumar9, Mina Singh10, Julia Parrott1, Danielle Figueiredo1. 1. School of Psychology, University of Ottawa, Ottawa, Ontario, Canada. 2. Ingram School of Nursing, McGill University, Montreal, Quebec, Canada. 3. Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada. 4. Cognitive Behavioural, Dialectic Behavioural, and Humanistic Therapy Centre, Toronto, Ontario, Canada. 5. Division of Gynecologic Oncology, Princess Margaret Cancer Centre and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. 6. The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 7. The Ottawa Hospital, Ottawa, Ontario, Canada. 8. Mount Sinai Hospital, Toronto, Ontario, Canada. 9. Research Institute-McGill University Health Center, Montreal, Quebec, Canada. 10. School of Nursing, York University, Toronto, Ontario, Canada.
Abstract
OBJECTIVE:Fear of cancer recurrence (FCR) is defined as "fear, worry, or concern about cancer returning or progressing". To date, only the seminal model proposed by Lee-Jones and colleagues has been partially validated, so additional model testing is critical to inform intervention efforts. The purpose of this study is to examine the validity of a blended model of FCR that integrates Leventhal's Common Sense Model, Mishel's Uncertainty in Illness Theory, and cognitive theories of worry. METHODS:Participants (n = 106) were women diagnosed with stageI to III breast or gynecological cancer who were enrolled in a Randomized Controlled Trial of a group cognitive-existential intervention for FCR. We report data from standardized questionnaires (Fear of Cancer Recurrence Inventory-Severity and Triggers subscales; Illness Uncertainty Scale; perceived risk of recurrence; Intolerance of Uncertainty Scale; Why do people Worry about Health questionnaire; Reassurance-seeking Behaviors subscale of the Health Anxiety Questionnaire, and the Reassurance Questionnaire) that participants completed before randomization. Path analyses were used to test the model. RESULTS: Following the addition of four paths, the model showed an excellent fit (χ2 = 13.39, P = 0.20; comparative fit index = 0.99; root mean square error of approximation = 0.06). Triggers, perceived risk of recurrence, and illness uncertainty predicted FCR. FCR was associated with maladaptive coping. Positive beliefs about worrying and intolerance of uncertainty did not predict FCR but led to more maladaptive coping. CONCLUSIONS: These results provide support for a blended FCR model.
RCT Entities:
OBJECTIVE: Fear of cancer recurrence (FCR) is defined as "fear, worry, or concern about cancer returning or progressing". To date, only the seminal model proposed by Lee-Jones and colleagues has been partially validated, so additional model testing is critical to inform intervention efforts. The purpose of this study is to examine the validity of a blended model of FCR that integrates Leventhal's Common Sense Model, Mishel's Uncertainty in Illness Theory, and cognitive theories of worry. METHODS:Participants (n = 106) were women diagnosed with stage I to III breast or gynecological cancer who were enrolled in a Randomized Controlled Trial of a group cognitive-existential intervention for FCR. We report data from standardized questionnaires (Fear of Cancer Recurrence Inventory-Severity and Triggers subscales; Illness Uncertainty Scale; perceived risk of recurrence; Intolerance of Uncertainty Scale; Why do people Worry about Health questionnaire; Reassurance-seeking Behaviors subscale of the Health Anxiety Questionnaire, and the Reassurance Questionnaire) that participants completed before randomization. Path analyses were used to test the model. RESULTS: Following the addition of four paths, the model showed an excellent fit (χ2 = 13.39, P = 0.20; comparative fit index = 0.99; root mean square error of approximation = 0.06). Triggers, perceived risk of recurrence, and illness uncertainty predicted FCR. FCR was associated with maladaptive coping. Positive beliefs about worrying and intolerance of uncertainty did not predict FCR but led to more maladaptive coping. CONCLUSIONS: These results provide support for a blended FCR model.
Keywords:
breast cancer; cancer; coping; fear of cancer recurrence; gynecological cancer; illness uncertainty; model testing; oncology; path analyses; worry
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