Aims: Fear of cancer recurrence (FCR) is increasingly recognised as a prevalent and debilitating challenge of cancer survivorship, particularly in younger survivors. Gaining a better understanding of the factors that contribute to high levels of FCR is an important step in the development of treatment approaches. Maladaptive metacognitions have been shown to be important to the development of a range of emotional disorders, but have not previously been explored in the context of fear of cancer recurrence.

Methods: This cross-sectional study included young women diagnosed with early stage breast cancer at least one year prior to study entry. Participants completed a web-based questionnaire which included the Fear of Cancer Recurrence Inventory (FCRI) and the Brief Metacognitions Questionnaire (MCQ-30).

Results: 218 women with a mean age of 39 years at diagnosis participated. All measures of metacognitive style were moderately correlated with FCRI scores (r= 0.31- 0.49) and statistically significantly associated with FCRI in both unadjusted and adjusted models. Overall metacognitive style, in combination with disease and demographic factors explained 36% of the variance in FCR scores.  A change in the MCQ total score of 13 points (1 s.d.) would result in a clinically important change in FCR.

Conclusions: Metacognition appears to play an important role in FCR. Treatments which focus on changing unhelpful metacognitions may prove a useful approach for treating clinical FCR in cancer survivors.