Representations of cancer recurrence risk, recurrence worry, and health-protective behaviours: an elaborated, systematic review

Abstract

An expanded Common-Sense Model (CSM) contextualised to the self-regulation of cancer recurrence risk identifies risk representational attributes and recurrence worry as primary processes motivating protective behaviours in cancer survivors. A systematic review examined evidence for CSM hypotheses regarding how these processes influence diet and physical activity (PA) among survivors. A research agenda is outlined and used to evaluate the evidence base. Common databases were searched for eligible, peer-reviewed, English language reports, yielding 18 studies quantitatively testing hypothesised relationships among representations of prior cancer, recurrence risk representations, recurrence worry, and diet and PA. The findings provide promising, but mixed and limited evidence for some of the hypothesised associations of specific risk recurrence attributes with recurrence worry, and risk recurrence attributes and recurrence worry with diet and PA. Findings support the distinction of recurrence risk representations and illness representations of the prior cancer, with each showing different relationships with recurrence worry and behaviours. We discuss the status of the evidence base in relation to assessment, design, and analysis priorities and propose strategies that can yield more sensitive, rigorous tests of the CSM for cancer recurrence risk as applied to diet and PA.

Keywords: Self-regulation model; cancer recurrence beliefs; cancer recurrence worry; diet and physical activity; illness representations; risk perception.

Figure 1.

Expanded Common-Sense Model of self-regulation as contextualised to diet and physical activity for cancer survivors post-treatment for cancer (based on Cameron, 2008).

Figure 2.

The research agenda highlights primary methodological aims for advancing research on the utility of the CSM of cancer recurrence risk in predicting diet and physical activity behaviour. The status of evidence base as affected by each of the research agenda aims is determined by the number of studies from the systematic review that addressed each of the aims using the following status levels: Nil (0 studies), Minimal (1–3 studies), Very Limited (4–8 studies), Limited (9–12 studies), Moderate (12–20), and Strong (over 20 studies). While these levels are subjective and do not take into account the quality of the studies as a whole or the strength of predicted relationships, they highlight the current paucity of rigorous research testing the CSM of cancer risk recurrence in predicting diet and physical activity behaviours.

Figure 3.

Flowchart of literature search (based on PRISMA guidelines; Moher et al., 2009).