Social support and fear of cancer recurrence in breast cancer patients: the mediating role of illness perception and maladaptive cognitive emotion regulation strategies

This study aimed to examine the mediating role of illness perception and maladaptive cognitive emotion regulation strategies in the relationship between social support and fear of cancer recurrence (FCR). This multi-center cross-sectional study recruited 857 female breast cancer patients from four tertiary hospitals in Jilin and Shanxi Provinces, China (mean age = 47.18 ± 9.86; within five years after surgery). Participants completed the Social Support Rating Scale, the Brief Illness Perception Questionnaire, the 16-item maladaptive cognitive emotion regulation strategy composite from the Cognitive Emotion Regulation Questionnaire (self-blame, rumination, catastrophizing, and other-blame), and the Fear of Cancer Recurrence Inventory–Short Form. Chain mediation was tested using PROCESS Model 6 with 5,000 bias-corrected bootstrap samples, adjusting for age and relevant clinical covariates. FCR was positively correlated with illness perception and maladaptive cognitive emotion regulation strategies, and negatively correlated with social support. Social support was negatively related to illness perception and maladaptive cognitive emotion regulation strategies. Chain mediation analysis indicated that illness perception and maladaptive cognitive emotion regulation strategies jointly mediated the association between social support and FCR, with a total indirect effect of b = − 0.153 (48.88% of the total effect). Significant specific paths included mediation via illness perception (b = − 0.070; 22.36%), via maladaptive cognitive emotion regulation strategies (b = − 0.066; 21.09%), and the sequential pathway through illness perception and maladaptive cognitive emotion regulation strategies (b = − 0.017; 5.43%), all with 95% CIs excluding zero. Higher social support was associated with lower FCR partly through less threatening illness perceptions and lower use of maladaptive cognitive emotion regulation strategies. Given the cross-sectional design, these findings should be interpreted as theory-informed associations rather than causal evidence. Clinical practice implicationsHealthcare providers should strengthen patients' perception of available support systems and consider interventions targeting illness perception and maladaptive cognitive emotion regulation strategies. Structured education and personalized communication may reduce exaggerated threat appraisals and enhance perceived controllability. Cognitive-behavioral or mindfulness-based interventions may address self-blame, rumination, catastrophizing, and other-blame by fostering attentional refocusing, decentering, and values-based coping.