Anxiety in the context of cancer: A systematic review and development of an integrated model

•Theoretical models of cancer-anxiety have mainly considered Fear of Recurrence.•Minimal attention has been given to mortality awareness in models of cancer-anxiety.•The cancer context often involves ongoing threat, uncertainty and lack of control.•A model of cancer-related anxiety relevant to all cancer stages is proposed.•The integrated model includes pre-existing, cognitive, coping and contextual factors.

Anxiety is common in the context of cancer, but there are few theoretical models that apply to people with cancer across the trajectory of their illness. The aims of this review are to identify existing theories and to propose an integrated model of cancer-related anxiety. Using a systematic literature search of Medline, Premedline and PsycINFO databases, we identified nine theoretical models of anxiety in the context of cancer. We reviewed these for psychological concepts that fell under five themes: pre-existing schema, the inherent nature of cancer, cognitive factors, coping responses and contextual factors. From these themes, we integrated concepts from different models to develop a theoretical framework to explain the development and maintenance of anxiety in the context of cancer. The resulting model suggests that pre-existing schema, past experiences of cancer, an intolerance of uncertainty and meta-cognitive beliefs about worry interact with the inherent nature of cancer to produce overwhelming distress. The distress activates cognitive processes characterized by vigilance, worry and rumination. Attempts to cope by re-establishing control, and a pattern of vigilance to cancer-related cues and/or avoidance reinforce anxiety, in the context of a range of systemic factors that can either buffer against or worsen the anxiety.

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