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Background <p>Fear of cancer recurrence (FCR) is a prevalent psychological concern among cancer patients, negatively affecting their emotional well-being, treatment adherence, and overall quality of life. Psychological variables such as cognitive flexibility and coping strategies may play a significant role in the development and intensity of FCR.</p> Aim <p>This study aimed to investigate the fear of cancer recurrence in cancer patients and assess its relationship with cognitive flexibility and coping strategies.</p> Methods <p>A cross-sectional study was conducted on 300 cancer patients with different cancer types and stages referred to five hospitals in Mashhad, Iran, from March to October 2024. Participants were included in the study through stratified random sampling method. Data were collected using the Fear of Cancer Recurrence Inventory (FCRI), Cognitive Flexibility Inventory (CFI), and Brief COPE questionnaire. Statistical analysis was performed using STATA-17, including multiple linear regression with bootstrapped estimates to assess relationships, controlling for age, sex, and education.</p> Results <p>Of the 300 invited patients, 275 completed the questionnaires (response rate: 93.3%). The mean FCR score was 103.72 ± 28.19, indicating a relatively high level of fear. Regression analysis revealed that the alternatives subscale of cognitive flexibility (i.e., the ability to consider alternative interpretations and solutions) was negatively associated with FCR (Coefficient: -0.904; CI95% [-1.618 to -0.191]; P-value: 0.013). Similarly, problem-focused coping strategies showed a significant inverse relationship (Coefficient: -0.909; CI95% [-1.583 to -0.235]; P-value: 0.008), whereas emotion-focused strategies were positively correlated with higher FCR (Coefficient: 1.75; CI95% [0.878 to 2.628]; P-value &lt; 0.000).</p> Conclusion <p>The Alternatives subscale of cognitive flexibility, as well as problem-focused and emotion-focused coping strategies, play independent and significant roles in modulating fear of recurrence among cancer patients. Interventions aimed at enhancing cognitive flexibility and promoting adaptive coping strategies may help reduce FCR and improve psychological well-being.</p>

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Fear of cancer recurrence and assessing its relationship with cognitive flexibility and coping strategies: a cross-sectional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Razieh Talebi,
  • Elahe Ramezanzade Tabriz,
  • Seyed Nima Nateghi

摘要

Background

Fear of cancer recurrence (FCR) is a prevalent psychological concern among cancer patients, negatively affecting their emotional well-being, treatment adherence, and overall quality of life. Psychological variables such as cognitive flexibility and coping strategies may play a significant role in the development and intensity of FCR.

Aim

This study aimed to investigate the fear of cancer recurrence in cancer patients and assess its relationship with cognitive flexibility and coping strategies.

Methods

A cross-sectional study was conducted on 300 cancer patients with different cancer types and stages referred to five hospitals in Mashhad, Iran, from March to October 2024. Participants were included in the study through stratified random sampling method. Data were collected using the Fear of Cancer Recurrence Inventory (FCRI), Cognitive Flexibility Inventory (CFI), and Brief COPE questionnaire. Statistical analysis was performed using STATA-17, including multiple linear regression with bootstrapped estimates to assess relationships, controlling for age, sex, and education.

Results

Of the 300 invited patients, 275 completed the questionnaires (response rate: 93.3%). The mean FCR score was 103.72 ± 28.19, indicating a relatively high level of fear. Regression analysis revealed that the alternatives subscale of cognitive flexibility (i.e., the ability to consider alternative interpretations and solutions) was negatively associated with FCR (Coefficient: -0.904; CI95% [-1.618 to -0.191]; P-value: 0.013). Similarly, problem-focused coping strategies showed a significant inverse relationship (Coefficient: -0.909; CI95% [-1.583 to -0.235]; P-value: 0.008), whereas emotion-focused strategies were positively correlated with higher FCR (Coefficient: 1.75; CI95% [0.878 to 2.628]; P-value < 0.000).

Conclusion

The Alternatives subscale of cognitive flexibility, as well as problem-focused and emotion-focused coping strategies, play independent and significant roles in modulating fear of recurrence among cancer patients. Interventions aimed at enhancing cognitive flexibility and promoting adaptive coping strategies may help reduce FCR and improve psychological well-being.