Worry and the Formation of Cognitive Representations of Illness in Individuals Undergoing Surgery for Suspected Lung Cancer

Rebecca H. Lehto, PhD, RN, OCN; Bernadine Cimprich, PhD, RN, FAAN

Disclosures

Cancer Nurs. 2009;32(1):2-10. 

In This Article

Abstract and Introduction

Abstract

Worry involving repetitive thoughts about threats and concerns is prevalent when confronted with a life-threatening illness such as cancer. Worry may contribute to the formation of negative cognitive representations of illness that can have a detrimental effect on behavioral and adaptive outcomes. The study examined for the first time (a) the relationship between worry and early formation of cognitive representations of illness in individuals with suspected lung cancer over the presurgical and postsurgical period and (b) associations between worry and anxiety, sex, age, and educational level. Correlational statistical analyses were used to assess worry and cognitive representations in 42 individuals before lung surgery and again 3 weeks postsurgery. Higher worry was significantly related to more threatening content in multiple illness domains. Repeated-measures analysis of variance using high- and low-worry strata showed significant interactions between worry and time on certain illness domains indicating that high worry was associated with increased threat and negative contents in cognitive representations of illness over time. Multiple regression analyses showed that trait anxiety was the only significant predictor of worry in a regression model including age, sex, education, and anxiety before surgery. Findings suggest that higher worry at time of diagnosis is associated with the development of negative and more threatening contents in cognitive representations of illness in individuals with suspected lung cancer.

Introduction

Lung cancer is the leading cause of cancer mortality in both men and women in the United States and is currently the second most common cancer.[1] Although enormous strides have been made in cancer management, including in early-stage lung cancer,[2] an unexpected cancer diagnosis and its treatment remain a stressful and serious personal threat. When dealing with a life-threatening illness such as lung cancer, worry can become a major and sustained problem.[3,4] Worry involves recurring involuntary aversive thoughts that focus on perceived threats and concerns.[5] Such worry may have a profound effect on the shaping of cognitive representations of illness, internalized knowledge structures built by perceptions that subsequently guide behavioral responses and adaptive outcomes.[6,7] Little research, however, has examined the possible impact of worry on the formation of cognitive representations of illness in the early postdiagnostic period. The purpose of this study was to examine relationships between worry and the early formation of cognitive representations of illness in individuals newly diagnosed with suspected lung cancer over the presurgical and postsurgical interval. A second purpose was to examine associations between worry and selected variables such as anxiety, sex, age, and education level.

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