Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

The role of intolerance of uncertainty and negative metacognitive beliefs in fear of cancer recurrence in Chinese cancer survivors (126162)

Danielle Wing Lam Ng 1 2 , Ceci Guo 1 2 , Rachel Ng 1 2 , Richard Fielding 1 2 , Wendy Wing Tak Lam 1 2
  1. LKS Faculty of Medicine, School of Public Health, Centre for Psycho-Oncology Research and Training, The University of Hong Kong , Hong Kong
  2. LKS Faculty of Medicine, Jockey Club Institute of Cancer Care, The University of Hong Kong , Hong Kong

Objectives/Purpose: Fear of cancer recurrence (FCR) is a major unmet need among survivors, with unclear cognitive determinants. This study examined relationships among FCR, negative metacognition, intolerance of uncertainty (IU), and cognitive attentional syndrome (CAS) in Chinese cancer survivors.

Sample and Setting: We recruited 384 Cantonese- or Mandarin-speaking cancer patients with curable, non-metastatic diseases who had completed surgery and post-adjuvant therapy within the past 18 months through local oncology clinics and online platforms.

Procedures: Participants completed questionnaires at baseline (T1), 3 (T2), 6 (T3), and 12 (T4) months. FCR was measured with the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF; scores 13–21 indicate subclinical FCR and >21 clinical FCR). Additional measures included negative metacognition (MCQ-30), IU (IUS-12), and CAS-maladaptive coping (CAS-1). Only baseline data were analyzed using multinomial regression.

Results: Compared to low-FCR patients (30%; 116/384), those with subclinical (50%; 190/384) and clinical FCR (20%; 78/384) had significantly higher negative metacognition (subclinical: OR=1.29, 95% CI 1.12–1.48; clinical: OR=1.50, 95% CI 1.27–1.78), enhanced IU (subclinical: OR=1.09, 95% CI 1.03–1.15; clinical: OR=1.10, 95% CI 1.03–1.18), and greater use of maladaptive coping (subclinical: OR=1.08, 95% CI 1.03–1.13; clinical: OR=1.11, 95% CI 1.05–1.17), alongside a reduced need to control thoughts (Subclinical: OR=0.86, 95% CI 0.76–0.96; Clinical: OR=0.86, 95% CI 0.74–0.99). Maladaptive coping partially mediated the effects of metacognition (β=0.072, 95% CI 0.051–0.10) and IU (β=0.093, 95% CI 0.064–0.13) on FCR.

Conclusion and Clinical Implications: Negative metacognition and heightened IU significantly contributed to FCR among Chinese cancer survivors, with the mediation effect underscoring the critical role of coping in the cognitive architecture of FCR. These findings support targeted cognitive-behavioral interventions aimed at modifying metacognitive beliefs, enhancing tolerance for uncertainty and reinforcing adaptive coping, a promising avenue for reducing FCR.

Funding: General Research Fund of the Research Grant Council of Hong Kong (Project No. 17613221).