A Structural Model Explaining the Effect of Cognitive Emotion Regulation on the Fear of Cancer Recurrence in Breast Cancer Survivors: the Mediating Roles of Illness Perception and Psychological Well-being

Abstract

Background: Fear of cancer recurrence (FCR) in cancer patients, including those with breast cancer is a special and highly conscious experience having bearing on emotional, cognitive and behavioral domains. This study examines the effect of cognitive emotion regulation on FCR with the mediation of illness perception and psychological well-being in breast cancer survivors in a structural model. Methods: The population of this study included all women with breast cancer who were referred to Cancer Institute of Iran for their regular checkups in the spring and summer of 2022. 300 patients were recruited based on convenience sampling. They completed the validated questionnaires online for FCR, cognitive emotion regulation, illness perception and psychological well-being. Data were analyzed by using Pearson's correlation coefficient and structural equation modeling analysis. Results: The findings indicated the model did fit the data. In addition to the direct effect of adaptive and maladaptive strategies of cognitive emotion regulation on FCR, the indirect effect of adaptive strategies on FCR through psychological well-being (β=0.148, p=0.001) and illness perception (β=0.233, p=0.001) was negative and significant. Furthermore, the indirect effect of maladaptive strategies on FCR through psychological well-being (β=0.109, p=0.001) and illness perception (β=0.212, p=0.001) was positive and significant. Therefore Psychological well-being and illness perception negatively and significantly mediated the effect of adaptive strategies on FCR and positively and significantly mediated the effect of maladaptive strategies on FCR. Conclusion: Patients who possess adaptive strategies of cognitive emotion regulation, less-threatening perception of illness and higher psychological well-being were exposed less to FCR. Psychological interventions for strengthening these factors in breast cancer survivors are suggested.