Associations between Fear of Cancer Recurrence and Health-Related Quality of Life, Psychological Distress, and Health Behaviors in Cancer Survivors

Background: Fear of cancer recurrence (FCR) is a prevalent psychological concern among cancer survivors, closely linked to diminished health-related quality of life (HRQoL) and increased psychological distress. However, its impact on health-related behaviors remains poorly understood. This study investigated associations between FCR, HRQoL, psychological distress, and health-related behaviors in a diverse cancer survivor population.Methods: This cross-sectional study analyzed data from 326 adult cancer survivors across diverse cancer types. FCR was assessed using four items addressing concern about recurrence, metastasis, second cancer, and follow-up and participants were classified as high FCR. HRQoL was evaluated using the EuroQol 5-Dimension Questionnaire (EQ-5D), EuroQol Visual Analogue Scale (EQ-VAS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30); psychological symptoms were measured by the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder scale (GAD-7). Health-related behaviors included recent screening, vaccination, and physical activity. Linear regression was used for continuous outcomes and logistic regression for binary outcomes, controlling for demographic and clinical covariates.Results: Participants with high FCR demonstrated significantly poorer HRQoL across multiple domains, including Global Health Status/Quality of Life (β=–10.56, 95% confidence interval 95% CI: –14.82 to –6.29, P<0.001), physical functioning (β=–7.04, P<0.001), and emotional functioning (β=–12.86, P<0.001). They also reported greater fatigue (β=11.11, P<0.001), pain (β=9.85, P<0.001), and financial difficulty (β=17.32, P<0.001). High FCR was strongly associated with depressive (PHQ-9: β=3.10, P<0.001) and anxiety symptoms (GAD-7: β=2.70, P<0.001). In contrast, no significant associations were found between FCR and health-related behaviors.Conclusions: High FCR is strongly associated with impaired HRQoL and increased psychological distress but does not translate into increased engagement in preventive health behaviors. These findings underscore the need for integrated interventions addressing both emotional and behavioral aspects of survivorship care.