Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Vicky Phares, Ph.D.

Co-Major Professor

Paul B. Jacobsen, Ph.D.

Committee Member

J. Kevin Thompson, Ph.D.

Committee Member

Diana Rancourt, Ph.D.

Committee Member

Jamie Goldenberg, Ph.D.

Committee Member

Brent Small, Ph.D.


psycho-oncology, fear of cancer recurrence, quality of life, colorectal cancer


Fear of cancer recurrence (FCR) is regarded as one of the most common and distressing issues affecting cancer survivors. Observational studies have identified several modifiable characteristics associated with FCR. However, many of the findings are based on post-hoc analyses and come from studies in which FCR was not identified as a primary outcome. This study sought to overcome these limitations by using a model comprised of cognitive, behavioral, and social characteristics as a framework for examining modifiable characteristics associated with FCR. A sample of 120 patients who had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months was recruited during routine outpatient visits or by mail for participation in the study. Medical record reviews were conducted to assess clinical variables, and participants filled out a standard demographic questionnaire as well as self-report measures of characteristics resistant to modification (perceived risk of recurrence, neuroticism, conscientiousness), cognitive modifiable characteristics (self-efficacy, positive beliefs about worry, negative beliefs about worry, misinterpretation of symptoms, intolerance of uncertainty and rumination), behavioral modifiable characteristics (reassurance seeking and health-related reassurance seeking), and social modifiable characteristics (social support and social constraints). As hypothesized, results demonstrated that modifiable characteristics (i.e., self efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking and social constraints) were associated with FCR (all p’s < .05). Multivariable regression analyses demonstrated that modifiable characteristics accounted for 13% of the variance in FCR beyond that accounted for by non-modifiable characteristics (p < .001), with self-efficacy, rumination and health-related reassurance seeking accounting for unique variance in FCR. This study has identified several modifiable characteristics that should be considered as targets for interventions seeking to reduce FCR among cancer survivors.