Abstract
OBJECTIVE: This study aimed to explore the impact of fear of cancer recurrence on anxiety and depression in female cancer patients, and to examine the chain mediating roles of financial toxicity and psychological distress in this relationship. METHODS: Between February and July 2024, a total of 417 female cancer patients from top-tier cancer hospitals across 13 regions in China were recruited. Participants completed the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS), the Comprehensive Score for Financial Toxicity (COST), and the Distress Thermometer (DT). RESULTS: (1) Fear of recurrence, financial toxicity, psychological distress, anxiety, and depression were significantly correlated. (2) Two mediating pathways were identified: a direct path where fear of recurrence increased psychological distress, leading to heightened anxiety and depression; and an indirect chain mediation path wherein fear of recurrence elevated financial toxicity, which in turn intensified psychological distress, ultimately contributing to anxiety and depression. CONCLUSIONS: Health care providers should be aware of the psychological and financial burdens associated with fear of recurrence in women with cancer. Addressing these issues may enhance the effectiveness of psychological interventions, reduce emotional distress, and ultimately improve patients' quality of life.