Fear of cancer recurrence: testing a cognitive formulation across time in women with ovarian cancer

Background: Lee-Jones and colleagues (1997) have proposed a comprehensive cognitive model of fear of cancer recurrence (FCR), however little research has utilized or fully tested this conceptual model. Additionally, the cross-sectional nature of most studies limits our understanding of the trajectory of FCR over time, and longitudinal research is greatly needed. Method: Patients completed assessment measures at baseline (Time 1) and three months post-baseline (Time 2). The three aims of this study were to (1) test the cognitive model of FCR within an ovarian cancer population; (2) examine model stability; and (3) test the predictive validity of the model. Results: An exploratory factor analysis (EFA) suggested a more parsimonious four-factor model relative to Lee-Jones et al.’s suggested model. Using the results of the EFA, structural equation modeling (SEM) was used to analyze the data-driven model, with findings revealing excellent model fit at Time 1,  2 (60, N=283) = 130.48, p< .001,  2 /df = 1.84, CFI = 0.95, RMSEA = .06, SRMR = .06. This same model was examined at Time 2, with findings revealing acceptable model fit;  2 (60, N=201) = 121.15, p < .001,  2 /df = 2.02, CFI =0.93, RMSEA = .07, SRMR = .07, thus confirming that configural invariance was met. Tests of predictive validity indicated that using the components of FCR at Time 1 to predict consequences at Time 2 resulted in adequate model fit, 2 (84, N=283) = 167.17, p < .001, CFI =0.94, RMSEA = .06, SRMR = .07,  2 /df = 1.99; however, the regression paths from the emotional experience and cognitive appraisals were not significant predictors of behavioural responses at Time 2. Discussion: Findings demonstrated that the emotional experience of FCR may be far more complex for ovarian cancer patients than previously suggested which has important treatment implications. The current study is the first to evaluate the relative stability of the components of a data-driven model of FCR, with results revealing that the majority of ovarian cancer patients experience FCR, which is stable across a three-month period. Findings suggest that screening for FCR would be beneficial across the cancer experience.