Abstract
BACKGROUND: Colorectal cancer (CRC) is rising globally, with China bearing the highest burden. Fear of cancer recurrence (FCR) significantly impacts postoperative patients' well-being but remains understudied in China. The roles of illness perception, emotional distress, and social support in FCR are unclear. This study aims to assess FCR levels and identify influencing factors to guide early clinical intervention. METHODS: From November 2023 to May 2024, a cross-sectional survey was conducted among 314 postoperative CRC patients at a tertiary cancer hospital in Shanghai. Eligible adults (≥18 years) with confirmed CRC who had completed primary treatment were recruited via convenience sampling. Validated questionnaires were completed independently or with staff assistance. These included the Fear of Cancer Recurrence Inventory (FCRI), the Brief Illness Perception Questionnaire (BIPQ), the Social Support Rating Scale (SSRS), the 15-Item Social Constraints Scale (SCS-15), and the Hospital Anxiety and Depression Scale (HADS). Pearson correlation analysis was conducted to examine associations among FCR, illness perception, social factors, and psychological symptoms. Subsequently, multivariable logistic regression was conducted to identify independent predictors of high FCR. RESULTS: Of the 330 questionnaires distributed, 314 were deemed valid, yielding a response rate of 95.2%. The sample included 193 males (61.5%) and 121 females (38.5%), with a mean age of 59.7±12.3 years. Participants showed a high level of FCR, with a mean FCRI score of 69.64±27.10 and severity dimension score of 13.91±5.996. Univariate analysis revealed significant differences in age, monthly income, and residence between high and low-to-moderate FCR groups (P<0.05). The high FCR group had greater illness perception (BIPQ), higher social constraints (SCS-15), elevated anxiety and depression (P<0.001), and lower social support (SSRS; P=0.01) compared to the low-to-moderate group. Correlation analysis showed that FCR was significantly positively correlated with illness perception (r=0.548, P<0.01), social constraints (SCS-15; r=0.275, P<0.01), and psychological distress, including anxiety (r=0.596, P<0.01) and depression (r=0.426, P<0.01), highlighting the interplay among cognitive, social, and emotional factors. Subsequent binary logistic regression analysis identified illness perception and anxiety symptoms as significant independent predictors of FCR in patients with CRC. CONCLUSIONS: FCR is common among postoperative CRC patients and is strongly linked to illness perception and anxiety. These findings underscore the need for routine psychological screening and tailored communication. Interventions addressing maladaptive beliefs and emotional distress, along with integrated psychoeducational and psychosocial support, may enhance resilience and improve quality of life in survivorship care.