The role of metacognition and its indirect effect through cognitive attentional syndrome on fear of cancer recurrence trajectories: A longitudinal study

Abstract

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. K E Y W O R D Sattentional bias, avoidance, fear of cancer recurrence trajectory, intrusive thoughts, meta-cognition

Psychological distress during the 2019 Coronavirus Disease (COVID‐19) pandemic among cancer survivors and healthy controls

“…To test if attentional bias assessed by an experimental paradigm was associated with distress levels during the pandemic, we recontacted the participants from two previous studies of attentional bias among Hong Kong Chinese cancer patients and matched healthy women 3,4 : a cross-sectional study that had recruited 140 women with breast cancer 3 and 150 healthy women (unpublished), and a longitudinal study that had followed 270 patients with breast or colorectal cancer for 12 months, which assessed attentional bias at baseline. 4 Two modified dot-probe tasks involving visually presented word stimuli were employed to assess attentional bias. 3,4 The present study recruited participants from the original studies who had completed the dot-probe tasks and agreed to be re- Reaction times in the dot-probe tasks were extracted from the previous datasets.…”

“…4 Two modified dot-probe tasks involving visually presented word stimuli were employed to assess attentional bias. 3,4 The present study recruited participants from the original studies who had completed the dot-probe tasks and agreed to be re- Reaction times in the dot-probe tasks were extracted from the previous datasets. 3,4 A positive bias score represents a tendency to attend towards target stimuli (vigilance); whereas a negative bias score represents a tendency to direct attention away from target stimuli (avoidance).…”

“…3,4 The present study recruited participants from the original studies who had completed the dot-probe tasks and agreed to be re- Reaction times in the dot-probe tasks were extracted from the previous datasets. 3,4 A positive bias score represents a tendency to attend towards target stimuli (vigilance); whereas a negative bias score represents a tendency to direct attention away from target stimuli (avoidance). 8 The parameters of dot-probe tasks are described in details in the original studies.…”

“…8 The parameters of dot-probe tasks are described in details in the original studies. 3,4 3 | DATA ANALYSIS Risk perception (self-perceived likelihood of contracting COVID-19) (Evens/likely: 25% cancer, 95%CIs = 15%, 35% vs 22% control, 95%CIs = 10%, 34%), perceived likelihood of being seriously ill (Likely/certain: 60% cancer, 95%CIs = 48%, 71% vs 73% control, 95% CIs = 60%, 86%) or death (Likely/certain: 58% cancer, 95%CIs = 47%, 70% vs 73% control, 95%CIs = 60%, 86%) from COVID-19 for cancer patients, worry about developing COVID-19 (Not-at-all: 36% cancer, 95%CIs = 25%, 47% vs 42% control, 95%CIs = 28%, 57%) and perceived self-efficacy in preventing against COVID-19 (Yes: 76% cancer, 95%CIs = 67%, 86% vs 91% control, 95%CIs = 83%, 99%) did not differ significantly by health status.…”

Spotlight on the Fear of Cancer Recurrence Inventory (FCRI)

“…41 Standard deviations ranged from 3.4 to 8.3 with an average of 6.5. Sample sizes ranged from 38 42 to 1984 13 and mean time since diagnosis varied from 2.2 months 42 to 8.9 years. 30 As seen in Table 1, the aggregated, weighted mean FCRI-SF score was 15.8 (95% CI: 14.5-17.1), which is above the lowest proposed cut-off (≥13) for clinical FCR.…”