Fear of Cancer Recurrence in Breast Cancer: A Moderated Serial Mediation Analysis of a Prospective International Study

Objective: Women dealing with breast cancer (BC) face many challenges, one of which is the fear of cancer recurrence (FCR). This study examined whether disease severity predicts FCR 6 months after cancer diagnosis through psychological distress and whether cognitive-emotion regulation moderates this effect. Method: The study sample included 656 women from Italy (27.5%), Finland (31.9%), Israel (19.8%), and Portugal (20.8%) diagnosed with Stages I-III of BC. Participants' age ranged between 40 and 70 years (M = 54.92, SD = 8.22). Participants were tracked following BC diagnosis and at 3 and 6 months follow-up. Participants filled out self-report questionnaires, including the FCR inventory-short form, the Hospital Anxiety and Depression Scale, and the cognitive-emotion regulation questionnaire along with medical-social-demographic data. Results: Greater disease severity at baseline indicated by higher cancer stage predicted greater psychological distress, which in turn predicted greater psychological distress at 3 months. The latter predicted greater FCR at 6 months. This serial mediation model was moderated by negative cognitive-emotion regulation. The mediating effect of disease severity on FCR through psychological distress was significant only in women with mean or higher levels of negative cognitive-emotion regulation. Conclusion: This study suggests that facilitating psychological well-being and effective cognitive-emotion regulation in the early stages after a cancer diagnosis may protect women from FCR. Objetivo: Las mujeres que padecen cáncer de mama (BC, por sus siglas en inglés) enfrentan muchos desafíos, uno de los cuales es el miedo a la recurrencia del cáncer (FCR, por sus siglas en inglés). Este estudio examinó si la gravedad de la enfermedad predice la FCR seis meses después del diagnóstico de cáncer a través de la angustia psicológica y si la regulación cognitivo-emocional modera este efecto. Método: La muestra del estudio incluyó a 656 mujeres de Italia (27.5%), Finlandia (31.9%), Israel (19.8%) y Portugal (20.8%) diagnosticadas con estadios I a III de BC. La edad de los participantes osciló entre 40 and 70 años (M = 54.92, SD = 8.22). Se realizó un seguimiento de los participantes después del diagnóstico de BC y a los tres y seis meses de seguimiento. Los participantes completaron cuestionarios de autoinforme, incluido el Inventario de Miedo a la Recurrencia del Cáncer-forma corta, la Escala de Ansiedad y Depresión Hospitalaria y el Cuesti