Intolerance of uncertainty, cognitive complaints, and cancer‐related distress in prostate cancer survivors

Eisenberg, Stacy; Kurita, Keiko; Taylor-Ford, Megan; Agus, David B.; Gross, Mitchell E.; Meyerowitz, Beth E.

doi:10.1002/pon.3590

Cited by 43 publications

(50 citation statements)

References 50 publications

(72 reference statements)

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“…Of note, the magnitudes of the observed relationships among these variables are nearly identical with previous literature examining intolerance of uncertainty, a variable related to cancer-related worries and fears [23]. The current study builds on Eisenberg et al’s [23] findings, as survivors in the present study were heterogeneous with respect to gender and cancer site, suggesting that these associations are generalizable to a broader range of cancer survivors. Factors accounting for survivors’ stress levels that were not evaluated in this study include unemployment/medical leave, restructured social support networks and new social support needs, and mental health concerns such as depression and anxiety [5].…”

Section: Discussionsupporting

confidence: 86%

“…This indirect effect model lends empirical support to multiple theoretical models highlighting fear of recurrence or progression as a mechanism underlying stress in cancer survivors, including uncertainty in illness theory and the cognitive-behavioral model of health anxiety [17–21]. Of note, the magnitudes of the observed relationships among these variables are nearly identical with previous literature examining intolerance of uncertainty, a variable related to cancer-related worries and fears [23]. The current study builds on Eisenberg et al’s [23] findings, as survivors in the present study were heterogeneous with respect to gender and cancer site, suggesting that these associations are generalizable to a broader range of cancer survivors.…”

Section: Discussionsupporting

confidence: 71%

“…Fardell and colleagues’ [21] recent review highlights an overall paucity of studies examining indirect pathways in these models; most quantitative support comes from bivariate correlations that are added to models in a piecemeal fashion. For instance, evidence suggests that survivors’ fear of recurrence or progression can be triggered by physiological symptoms [12, 22] on one hand and are associated with poorer psychological adjustment [23] on the other. However, to date, the indirect effect of somatic symptoms on perceived stress levels via fear of recurrence or progression has not been examined empirically.…”

Section: Introductionmentioning

confidence: 99%

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Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors

Hall

Lennes

Pirl

et al. 2016

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Purpose Many cancer survivors report experiencing somatic symptoms as well as elevated stress. Theoretical models have suggested that physical symptoms generate subjective stress via fears of recurrence or progression. To date, this indirect effect has not been established empirically. This study aimed to provide preliminary evidence as to whether fear of recurrence or progression is an intermediary between somatic symptom severity and perceived stress among heterogeneous cancer survivors. Methods Adult cancer survivors (N = 67; median 2.4 years since diagnosis; 34% male) presenting at a hospital survivorship clinic completed measures assessing somatic symptom severity (Patient Health Questionnaire-15 (PHQ-15)), perceived stress (four-item Perceived Stress Scale (PSS-4)), and fear of recurrence or progression (Assessment of Survivor Concerns (ASC)). Interrelatedness among variables was assessed using Pearson correlations. Indirect effects were modeled using 5000-iteration bootstrapping. Results Survivors endorsed a range of somatic symptom severity (29% minimal, 39% low, 18% medium, and 14% high). Somatic symptoms, perceived stress, and fear of recurrence or progression were all significantly positively correlated (rs 0.29 to 0.47). Controlling for time since diagnosis, there was a significant indirect effect of somatic symptom severity on stress via fear of recurrence or progression [B = 0.06, SE = 0.04 (95% CI 0.01–0.16)]. The model accounted for more than one third of the variance in perceived stress [R2 = 0.35, F(3,54) = 9.59, p < 0.001]. Conclusions Survivors with greater somatic symptoms tended to report higher levels of stress, due in part to elevated fears of recurrence or progression. Our findings support concerns about recurrence or progression as a mechanism underlying stress states in cancer survivors. Efforts to assist survivors with stress management should teach strategies for managing cancer-related uncertainties stemming from somatic symptoms.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors

Hall

Lennes

Pirl

et al. 2016

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“…10 Intolerance of uncertainty—a predisposing trait for anxiety marked by the tendency to perceive uncertainty as threatening 11 —perpetuates anxiety symptoms in patients with a variety of health conditions including prostate cancer. 12, 13 Men on AS may be particularly vulnerable given the monitoring-based approach to care. Interval PSA testing and prostate biopsies integral to AS could exacerbate perceptions of threat and therefore worry.…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer

et al. 2016

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Purpose Anxiety may serve as a major barrier to participation in AS. Intolerance of uncertainty—the tendency to perceive the potential for negative events as threatening—has been linked to cancer-related worry. Accordingly, we explored prospectively the relationship of intolerance of uncertainty with anxiety along with other clinical factors among men managed with AS for prostate cancer. Materials and Methods From 2011–2014, 119 men with D’Amico low-risk prostate cancer participating in active surveillance completed the HADS, MAX-PC, IUS, and IPSS surveys. We evaluated the relationship between anxiety and IUS score after adjusting for patient characteristics, cancer information, and IPSS score using bivariable and multivariable analyses. Results A number of men reported clinically significant anxiety on the generalized (n=18, 15.1%) and prostate-cancer-specific (n=17, 14.3%) scales. In bivariable analyses, men with moderate/severe urinary symptoms and higher IUS scores reported more generalized and prostate-cancer-specific anxiety than men with mild urinary symptoms and lower IUS scores, respectively (p≤0.008). Men with depressive symptoms (p=0.024) or family history of prostate cancer (p=0.006) experienced greater generalized anxiety. In multivariable analysis, IUS score was significantly associated with generalized (OR 1.22, 95% CI 1.09–1.38) and prostate-cancerspecific anxiety (OR 1.29, 95% CI 1.13–1.49) while moderate/severe urinary symptoms were associated with prostate-cancer-specific anxiety (OR 6.89, 95% CI 1.33–35.68). Conclusions Intolerance of uncertainty and urinary symptoms may promote anxiety among men on AS for prostate cancer. Patient education, management of lower urinary tract symptoms, and behavioral interventions may lessen anxiety related to uncertainty intolerance and help maintain patient engagement in AS.

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“…They often experience social and emotional sequelae of cancer and its treatment, including fear of recurrence (7,15), stress (7,16), and financial issues (17). Research is ongoing to assess how best to address these concerns.…”

Section: Introductionmentioning

confidence: 99%

Symptom burden and integrative medicine in cancer survivorship

Cutshall

Stephen

Ness

et al. 2015

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Purpose To learn the level of experience with, interest in, and desire for knowledge about integrative medicine (IM) among cancer survivors. Methods Cancer survivors attending the 2014 National Cancer Survivors Day in Rochester, Minnesota, were recruited to participate in a 1-page survey about their ongoing health concerns and symptoms, as well as their experience with, interest in, and desire for knowledge about IM. Two-sided t test was used for univariate analyses of impact of sex, time since diagnosis, and age. Results Among the 260 cancer survivors, 171 persons (female, 74%; male, 26%) completed the survey (mean age, 64.6 years). Symptoms most commonly somewhat or more bothersome were fear of recurrence (52%), stress (43%), fatigue (43%), difficulty sleeping (33%), and weight gain (31%). The most used IM resources were exercise (75%), improved nutrition and diet (66%), stress management (42%), dietary supplementation (33%), meditation (25%), and massage (22%). Older patients (age, ≥65 years) were less experienced with, interested in, and desiring of knowledge about IM techniques. Sex and time since diagnosis were not strongly predictive of most survey response categories. Conclusions Cancer survivors have adverse effects for years into survivorship. They use and express interest in various IM techniques to help manage symptoms. It is critical that oncology providers help survivors address ongoing health concerns. Education about and access to evidence-based IM techniques may have important roles in comprehensive cancer survivorship programs.

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Intolerance of uncertainty, cognitive complaints, and cancer‐related distress in prostate cancer survivors

Cited by 43 publications

References 50 publications

Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors

Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors

The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer

Symptom burden and integrative medicine in cancer survivorship

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