title: Social-cognitive processes associated with fear of recurrence among women newly diagnosed with gynecological cancers.
abstract: OBJECTIVE
  This cross sectional study aimed to characterize fears of recurrence among women newly diagnosed with gynecologic cancer. The study also evaluated models predicting the impact of recurrence fears on psychological distress through social and cognitive variables.
  
  
  METHODS
  Women (N=150) who participated in a randomized clinical trial comparing a coping and communication intervention to a supportive counseling intervention to usual care completed baseline surveys that were utilized for the study. The survey included the Concerns about Recurrence Scale (CARS), Beck Depression Inventory (BDI), Impact of Event Scale (IES), and measures of social (holding back from sharing concerns and negative responses from family and friends) and cognitive (positive reappraisal, efficacy appraisal, and self-esteem appraisal) variables. Medical data was obtained via medical chart review.
  
  
  RESULTS
  Moderate-to-high levels of recurrence fears were reported by 47% of the women. Younger age (p<.01) and functional impairment (p<.01) correlated with greater recurrence fears. A social-cognitive model of fear of recurrence and psychological distress was supported. Mediation analyses indicated, that as a set, the social and cognitive variables mediated the association between fear of recurrence and both depression and cancer-specific distress. Holding back and self-esteem showed the strongest mediating effects.
  
  
  CONCLUSIONS
  Fears of recurrence are prevalent among women newly diagnosed with gynecologic cancer. Social and cognitive factors play a role in women's adaptation to fears and impact overall psychological adjustment. These factors may be appropriate targets for intervention.
authors.affiliation: The Cancer Institute of New Jersey, USA. Electronic address: myerssb@umdnj.edu.
authors.forename: Shannon B
authors.initials: SB
authors.lastname: Myers
authors.affiliation: The Cancer Institute of New Jersey, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Manne
authors.affiliation: Memorial Sloan Kettering Cancer Center, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
authors.affiliation: Memorial Sloan Kettering Cancer Center, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Ozga
authors.affiliation: Michigan State University, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kashy
authors.affiliation: Hospital of the University of Pennsylvania, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rubin
authors.affiliation: Fox Chase Cancer Center, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Heckman
authors.affiliation: Thomas Jefferson University, USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Rosenblum
authors.affiliation: Fox Chase Cancer Center, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Morgan
authors.affiliation: The Cancer Institute of New Jersey, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Graff
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003071:Cognition; D003863:Depression / Q000209:etiology; D005239:Fear; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*