Factors Correlated With Fear of Cancer Recurrence in Cancer Survivors: A Meta-analysis
Abstract
Background: Fear of cancer recurrence (FCR) is one of the most common and aversive psychological phenomena among cancer survivors. Understanding the independent and potentially modifiable risk factors that contribute toward FCR seen in cancer survivors would inform future interventional trials aimed at reducing this risk. Objective: The aim of this study was to provide an evidence synthesis of factors correlated with FCR to inform the development of preventive interventions. Methods: A literature search was performed of the PsycINFO, EMBASE, and MEDLINE (PubMed) databases. Reports published from inception to 2020 focusing on the correlates of FCR with physical, psychological, and social factors were identified. Authors assessed the studies’ risk of bias in accordance with the Standard Quality Assessment Criteria for Quantitative Studies (QualSyst criteria) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After extracting data and assessing the quality of the included studies, meta-analysis was conducted using RevMan 5.3 software. Results: Thirty-four articles were included in this study with a total sample of more than 13 000 cancer patients. Fear of cancer recurrence was positively correlated with anxiety, depression, avoidance, chemotherapy, distress, intrusive thoughts, fatigue, rumination, and neuroticism. It was negatively correlated with optimism, age, social support, quality of life, time since diagnosis, well-being, and self-efficacy. Conclusions: We identified 16 factors that are correlated with FCR, 9 positively correlated with FCR and 7 negatively correlated with FCR. Implications for Practice: The findings of this study provide direction for the development of precise interventions for FCR in cancer survivors and lay the foundation for the further construction of an FCR-related nursing theoretical framework.
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FCR has been found to be related to depression and anxiety.
“FCR has also been found to be related to depression and anxiety [19–21].”
From Fear of cancer recurrence in breast cancer survivors carrying a BRCA1 or 2 genetic mutation : a cross-sectional study (2024) · cites this paper as [19]
Evidence shows that mindfulness-based interventions reduce fear of cancer recurrence and rumination.
“evidence showing MBIs reduce FCR and rumination.68,69”
From Mindfulness and Psychosocial Symptoms in People with Cancer: Testing Rumination and Experiential Avoidance as Mediators, and Sex as a Moderator. (2025) · cites this paper as [69]
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“WARPS scores were lower for participants with a longer time since diagnosis, consistent with the small effect found across studies [39].”
Latent profile analysis of fear of progression in Chinese hematologic malignancy survivors
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“25,26 29 However, a recent study found a higher prevalence of anxiety and depression in endometrial cancer survivors compared with the general population.”
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Effectiveness of Cognitive Behavioral Therapy on Fear of Cancer Recurrence in Breast Cancer
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“Previous studies have shown that a significant proportion of patients who have completed cancer treatment report that managing the fear of cancer recurrence (FCR) is one of their key psychological problems [3,4].”
BackgroundMaas, A., Maurice-Stam, H., Feijen, L. E. A. M., Teepen, J. C., van der Aa-van Delden, A. M., Streefkerk, N., van Dulmen-den Broeder, E., Tissing, W. J. E., Loonen, J. J., van der Pal, H. J. H., et al. (2025) · Journal of Cancer Survivorship · doi:10.1007/s11764-024-01617-z · Cited by 7 · see citing works
“These outcomes may be attributed to uncertainty regarding the prognosis or to the fear of recurrence (FCR) which has shown to be associated to anxiety and depression [35].”
Fear of cancer recurrence experienced by pediatric survivors of childhood cancer: a scoping review
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“This is consistent with a recent meta-analysis on correlates of FCR [32].”
ResultLi, J., He, Y., Xie, F., Kang, Z., Mei, J., & Mei, B. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07242-z · Cited by 6 · see citing works
“A meta-analysis that included 11 studies to investigate factors correlated with fear of recurrence in cancer survivors found that fear of cancer recurrence was negatively correlated with quality of life [77].”
Menzies, R. E., Connery, T., Macdonald, D., & Riotto, G. D. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112373 · Cited by 6 · see citing works
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“Related studies 61 64 pointed out that gender is a risk factor in the FCR.”
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“FCR can significantly disrupt patients' daily lives, contributing to emotional distress, strained interpersonal relationships, family conflict, and diminished capacity to fulfill familial re-sponsibilities, which negatively affect both patients and their families [9].”
Urquhart, R., Kendell, C., & Lethbridge, L. N. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09242-x · Cited by 5 · see citing works
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“23 While international evidence highlights the influence of psychological well-being on the quality of life of cancer survivors, research in the Omani context remains limited.”
Zheng, M., Wang, S., Zhu, Y., & Wan, H. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-08085-8 · Cited by 5 · see citing works
“Studies have shown that negative emotions such as anxiety, depression and illness uncertainty can increase the level of FOP in cancer patients [33, 40].”
BackgroundFactors affecting the fear of recurrence in Breast cancer patients
Kussainova, D., Tursynbekova, A., Aimbetova, G. Е., Bagiyarova, F., & Kaidarova, D. (2024) · Research Journal of Pharmacy and Technology · doi:10.52711/0974-360x.2024.00049 · Cited by 4 · see citing works
Psychopathology in Cancer Patients and the Role of Cognitive Behavioral Therapy
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“[19] Fear of recurrence For many cancer survivors, the end of treatment does not signify the end of their cancer journey.”
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“FCR has also been found to be related to depression and anxiety [19–21].”
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“In sum, existing systematic reviews in this field have focused more broadly on the relationship between FOPR and mental health outcomes [17], and/or exclusively evaluated these outcomes in the context of cancer [14].”
Brearty, C. M., Bisaillon, L., Dorval, M., Nabi, H., Desbiens, C., Lemieux, J., Théberge, V., Baghdadli, A., Lauzier, S., & Savard, J. (2024) · Current Oncology · doi:10.3390/curroncol31020059 · Cited by 3 · see citing works
“Indeed, anxiety is a strong correlate of FCR [48–50].”
Background"Dancing on the edge of the abyss": Posttraumatic growth in men cancer survivors
Levin-Dagan, N., & Hamama, L. (2024) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2024.102553 · Cited by 3 · see citing works
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“…symptoms are more prevalent in women with BC as compared to age-matched women without BC. 4 Women with BC commonly experience fears of recurrence 5 and evaluate their health-related quality of life (HRQoL) as lower than women without BC. 6 Although consequences of BC on mental and physical…”
BackgroundQuality of life following pelvic exenteration in neoplasms
Zanatto, R. M., Mucci, S., Pinheiro, R. N., de Oliveira, J. C., Nicolau, U. R., Domezi, J. P., Silva, D. L. E., Pracucho, E. M., Zanatto, D. O., & Saad, S. S. (2024) · Journal of Surgical Oncology · doi:10.1002/jso.27760 · Cited by 3 · see citing works
“52 The recurrence itself results in negative impacts on patients' QoL, related to disease progression and the toxicity of oncological treatments.”
Wang, G., & Pan, S. (2025) · Nutrition and Cancer · doi:10.1080/01635581.2025.2564748 · Cited by 2 · see citing works
“Together, these improvements contributed to a significant enhancement in quality of life, supporting the patient-centered approach to comprehensive recovery (42,43).”
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“For example, a recent meta-analysis showed that fear of cancer recurrence is associated with fatigue [36].”
Bitan, S., Hasson‐Ohayon, I., & Daches, S. (2025) · Psychology and Health · doi:10.1080/08870446.2025.2550745 · Cited by 1 · see citing works
“Recent research has focused on the correlates of FCR, particularly cancer survivors’ sense of control over their illness and emotion regulation (guimond et al., 2019; Mititelu et al., 2016; Zhang et al., 2022).”
Guan, S., Wang, Y., Chen, J., Li, M., Yang, Z., Xie, Y., Li, X., Huang, Y., Qiu, Y., Mei, J., et al. (2025) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2025.100816 · Cited by 1 · see citing works
“46 Taken together, these findings suggest that the role of FCR may depend on its intensity and context, serving as a motivational factor at moderate levels but becoming maladaptive when excessive.”
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Interventions to Reduce Fear of Cancer Recurrence Among People With Cancer: Scoping Review
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Ecosystem Barriers and Facilitators Linked to the Fear of Cancer Recurrence: An Umbrella Review
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“Despite previous individual reviews identifying external cues, ecosystemic factors, or external factors contributing to the fear of recurrence [12,13], a systematic review allowing for an overview of ecosystemic factors contributing to FCR remains lacking.”
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“…(Hanprasertpong et al., 2017), which have shown that higher levels of FCR are associated with demographic, medical, and psychological characteristics such as female gender, late diagnosis, high education, advanced cancer, anxiety, and need for secondary surgery or chemotherapy (Zhang et al., 2022).”
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第二言語教育におけるホール・ランゲージ・アプローチに関する一考察--「ホール」の意味する言語観・言語教育観をふまえて
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- Authors
- Zhang, X., Sun, D., Qin, N., Liu, M., Jiang, N., & Li, X.
- Affiliations
- Jilin University (CN)
- China Medical University (TW)
- Corresponding author
- Li, Xiaohan
- Venue
- Cancer Nursing
- Published
- 2021-09-23
- Volume
- 45
- Issue
- 5
- Pages
- 406-415
- ISSN
- 0162-220X (ISSN-L)
- 1538-9804
- OpenAlex
- W3199674491
- Cited by
- 90
- References
- 70
- Citations by year
- 2026: 11 · 2025: 29 · 2024: 27 · 2023: 18 · 2022: 4
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cancer Nursing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- fear of cancer recurrence, cancer survivors, risk factors, anxiety, depression, avoidance, chemotherapy, psychological distress, intrusive thoughts, fatigue, rumination, neuroticism, optimism, social support, quality of life, self-efficacy, well-being, preventive interventions
- MeSH terms
- Cancer Survivors, Anxiety, Fear, Humans, Neoplasm Recurrence, Local, Quality of Life
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