Digest Commentator: Breanna Lane, B.A. (Hons), Department of Psychology, Faculty of Science, Memorial University of Newfoundland

Digest Editor: Mary Ann O'Brien, Ph.D., Department of Family and Community Medicine, University of Toronto

Digest Commentary

Fear of cancer recurrence (FCR) is one of the most prevalence, high priority and lasting psychosocial implications of a cancer diagnosis. Researchers have begun to examine the cognitive mechanisms that perpetuate FCR. Exploration of avoidance and cognitive appraisal as moderating factors for FCR and functioning has been unsuccessful. Rumination plays a disruptive role in cognitive functioning and emotional distress associated with anxiety and depression, and therefore may provide insight into the development of psychological illness for individuals with cancer. Liu et al. reported data from a cross-sectional study that examined potential interactions between FCR and rumination in relation to self-reported symptoms of anxiety and depression.

Of the 927 approached to participate in the study, 388 eligible adults diagnosed with cancer were recruited following service utilization at the National University Cancer Institute Singapore. Eligible participants could understand English or Mandarin, were currently in remission, and completed treatment at least one year ago. Participants had a mean age of 55.6y(SD = 11.6y), 80.2% identified as female, and 70.7% reported being diagnosed with Stage I/II cancer. Participants completed a series of outcome measures including the Fear of Cancer Recurrence Inventory (FCRI), Ruminative Response Scale (RRS), and the Hospital Anxiety and Depression Scale (HADS). The FCRI severity scale, which has been validated independently as the FCRI Short Form, was also used in subsequent analysis.

An interaction between FCR and rumination was associated with depression symptoms. When rumination was high in individuals with high FCR, rumination was associated with more severe depression symptoms compared to those with high FCR and low rumination. Independent of rumination, a significant relationship between high FCR and more severe depression symptoms remained. These relationships suggest that individuals with high FCR may ruminate or fixate on cancer fears, which contribute to low mood, negative thoughts, and distress. Using anxiety as the outcome the interaction between FCR and rumination was not replicated; individually FCR and rumination were associated with anxiety. Body-checking is a frequent behavioural reaction to FCR which can perpetuate fears and compulsive checking, and therefore it is possible that FCR could contribute to anxiety without individuals engaging in rumination. Finally, the significant association between rumination and anxiety suggests that anxious thoughts and feelings can create a cognitive cycle that contributes to anxiety symptoms. The cross-sectional design and symptom self-report limits the ability to determine causal factors contributing to mental health symptoms. However, overall, this study provides crucial insights into the relationships between essential psychological concerns often experienced by cancer survivors and illustrates the potential implications of maladaptive cognitive coping styles.

Why I liked this article:

With the development of novel treatments to target psychological symptoms associated with coping with cancer, greater insight into the mechanisms of change is essential for enhancing the efficacy and effectiveness of interventions. Individuals with high FCR and maladaptive coping strategies, like rumination, may be particularly vulnerable for developing severe symptoms of depression. Therefore, this study provides preliminary evidence for the use of interventions that disrupt rumination and teach alternative skills to assist with positive coping and reduce the risk for the development of psychopathology.

Liu, J., Peh, C.-X., Simard, S., Griva, K. &  Mahendran R. (2018). Beyond the fear that lingers: The interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms. Journal of Psychosomatic Research, 111, 120-126. DOI: https://doi.org/10.1016/j.jpsychores.2018.06.004.

Journal of Psychosomatic Research website: https://www.journals.elsevier.com/journal-of-psychosomatic-research

Author Website: http://nusmedicine.nus.edu.sg/pcm/faculty-staff/expert-team-physicians-psychologist/rathi-mahendran/