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The role of metacognition and its indirect effect through cognitive attentional syndrome on fear of cancer recurrence trajectories: A longitudinal study
Author(s) -
Ng Danielle W. L.,
Foo ChiChung,
Ng Simon S. M.,
Kwong Ava,
Suen Dacita,
Chan Miranda,
Or Amy,
Chun Oi Kwan,
Fielding Brenna F. S.,
Lam Wendy W. T.
Publication year - 2020
Publication title -
psycho‐oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.41
H-Index - 137
eISSN - 1099-1611
pISSN - 1057-9249
DOI - 10.1002/pon.5234
Subject(s) - worry , psychology , metacognition , cognition , confidence interval , multinomial logistic regression , clinical psychology , developmental psychology , medicine , anxiety , psychiatry , machine learning , computer science
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.