{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:36:24Z","timestamp":1781760984786,"version":"3.54.5"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,12,23]],"date-time":"2019-12-23T00:00:00Z","timestamp":1577059200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100002920","name":"Research Grants Council, University Grants Committee","doi-asserted-by":"publisher","award":["17607315"],"award-info":[{"award-number":["17607315"]}],"id":[{"id":"10.13039\/501100002920","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This longitudinal study mapped distinct trajectories of fear of cancer recurrence (FCR) over 12\u2009months among patients with breast (BC) or colorectal (CRC) cancer, and examined if metacognition, indirectly via attentional bias, intrusive thoughts and avoidance (hallmarks of cognitive attentional syndrome; CAS) predicted FCR trajectory membership.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two hundred and seventy BC (n = 163) or CRC (n = 107) patients were assessed at 8\u2010weeks, 3\u2010, 6\u2010, and 12\u2010months postsurgery on a measure of FCR (FCRI\u2010SF). Metacognition (MCQ\u201030), Intrusive and Avoidant Thoughts (CIES\u2010R) and attentional bias (dot\u2010probe tasks) were assessed at baseline. Latent growth mixture modeling identified FCR trajectories. Fully\u2010adjusted Multinomial Logistic Regression identified whether direct and indirect effects of metacognition through CAS determined FCR trajectory membership.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three distinct FCR trajectories were identified, namely, low\u2010stable (62.4%), high\u2010stable (29.2%), and recovery (8.3%). Negative beliefs about worry, cognitive confidence, and age predicted FCR trajectories (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> (6) = 38.31, <jats:italic>P<\/jats:italic>&lt;.001). Compared with Low\u2010stable group, Recovery FCR patients held greater Negative beliefs about worry (OR = 1.13, <jats:italic>P<\/jats:italic> = .035) and High\u2010stable FCR patients reported poorer Cognitive confidence (OR = 1.12, <jats:italic>P<\/jats:italic> = .004). The effect of Negative beliefs about worry was partially mediated by avoidance (<jats:italic>\u03b2<\/jats:italic> = .06, 95% CIs 0.03\u20100.12) and fully mediated by intrusive thoughts (<jats:italic>\u03b2<\/jats:italic> = .14, 95% CIs 0.08\u20100.20). Attentional bias did not predict FCR trajectories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>While most patients experienced low level of FCR, 3 in 10 persistently worried about cancer returning over the first 12\u2010months postsurgery. Modifying metacognitive knowledge to interrupt maladaptive cognitive processing including intrusion and avoidance may be an effective therapeutic intervention for patients at risk of persistent FCR.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pon.5234","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T06:41:01Z","timestamp":1572417661000},"page":"271-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["The role of metacognition and its indirect effect through cognitive attentional syndrome on fear of cancer recurrence trajectories: A longitudinal study"],"prefix":"10.1002","volume":"29","author":[{"given":"Danielle W. L.","family":"Ng","sequence":"first","affiliation":[{"name":"Centre for Psycho\u2010Oncological Research and Training, Division of Behavioural Sciences, School of Public Health The University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8849-6597","authenticated-orcid":false,"given":"Chi\u2010Chung","family":"Foo","sequence":"additional","affiliation":[{"name":"Department of Surgery The University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon S. 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