1 Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montréal, QC, H4B 1R6, Canada. nicole.alberts@concordia.ca.
2 Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, USA.
3 Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montréal, QC, H4B 1R6, Canada.
4 Université de Montréal, Montréal, Canada.
5 Department of Rehabilitation Medicine, University of Washington, Seattle, USA.
6 Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, USA.
7 Hospital for Sick Children, Toronto, Canada.
8 Department of Medicine, University of California, San Francisco, USA.
9 Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, USA.

Purpose: Intolerance of uncertainty is central to many psychological disorders and may contribute to pain. Despite the uncertainty inherent in childhood cancer survivorship, little is known about intolerance of uncertainty in this population. This study aimed to characterize intolerance of uncertainty, its risk factors, and its associations with psychological symptoms and pain in childhood cancer survivors.

Methods: Survivors from the Childhood Cancer Survivor Study completed psychosocial measures via online survey, including the Intolerance of Uncertainty Scale-12 (score range = 12-60). Cancer and treatment variables were abstracted from medical records. Multivariable regression models with 95% confidence intervals (CI) adjusted for age and sex examined the effects of demographic, disease, treatment, pain, and psychological variables on intolerance of uncertainty.

Results: Participants included 228 adult survivors of childhood cancer (mean age = 39.6 years, 50.4% female, n = 93 chronic pain). Mean level of intolerance of uncertainty among survivors was 26.2 (SD = 10.0, 95% CI 24.9 to 27.5). Intolerance of uncertainty was associated with female sex (ß [95% CI]; 2.7 [0.2-5.3]), unemployment (5.2 [1.9-8.5]), neurologic (4.1 [0.5-7.7]) and cardiovascular (5.0 [2.2-7.8]) chronic health conditions, elevated anxiety (10.9 [8.1-13.7]), and perceived poor health status (4.5 [1.4-7.6]). Higher levels of intolerance of uncertainty were observed in survivors with chronic pain (LS mean = 29.2) compared to survivors without (LS mean = 23.5; p < 0.01).

Conclusions: Mean levels of intolerance of uncertainty in childhood cancer survivors are comparable to the general population and associated with psychological symptoms and chronic pain.

Implications for cancer survivors: Intolerance of uncertainty may be a modifiable target for transdiagnostic interventions in survivorship care.