title: Towards an evidence-based model of fear of cancer recurrence for breast cancer survivors.
abstract: In order to understand the multidimensional mechanism of fear of cancer recurrence (FCR) and to identify potential targets for interventions, it is important to empirically test the theoretical model of FCR. This study aims at assessing the validity of Lee-Jones et al.'s FCR model.
  
  
  
  A total of 1205 breast cancer survivors were invited to participate in this study. Participants received a questionnaire booklet including questionnaires on demographics and psychosocial variables including FCR. Data analysis consisted of the estimation of direct and indirect effects in mediator models.
  
  
  
  A total of 460 women (38 %) participated in the study. Median age was 55.8 years (range 32-87). Indirect effects of external and internal cues via FCR were found for all mediation models with limited planning for the future (R2= .28) and body checking (R2= .11-.15) as behavioral response variables, with the largest effects for limited planning for the future. A direct relation was found between feeling sick and seeking professional advice, not mediated by FCR.
  
  
  
  In the first tested models of FCR, all internal and external cues were associated with higher FCR. In the models with limited planning for the future and body checking as behavioral response, an indirect effect of cues via FCR was found supporting the theoretical model of Lee-Jones et al.
  
  
  
  An evidence-based model of FCR may facilitate the development of appropriate interventions to manage FCR in breast cancer survivors.
authors.affiliation: Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Jose.Custers@radboudumc.nl.
authors.forename: José A E
authors.initials: JA
authors.lastname: Custers
authors.affiliation: Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marieke F M
authors.initials: MF
authors.lastname: Gielissen
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.affiliation: Department of Internal Medicine, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Aafke
authors.initials: A
authors.lastname: Honkoop
authors.affiliation: Department of Oncology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands.
authors.forename: Tineke J
authors.initials: TJ
authors.lastname: Smilde
authors.affiliation: Department of Internal Medicine, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
authors.forename: Dick-Johan
authors.initials: DJ
authors.lastname: van Spronsen
authors.affiliation: Department of Social Sciences, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors.forename: William
authors.initials: W
authors.lastname: van der Veld
authors.affiliation: Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.|The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.affiliation: Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Prins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
keywords: Breast cancer; Fear of cancer recurrence; Oncology; Psychology