The Role of Fear of Progression in Psychosocial Adjustment in Middle-Aged and Older Women with Oncological Disease: A Path Analysis.

Background/

Objectives

The global prevalence of cancer is increasing, with 50% of new diagnoses occurring in people over 65 years old. Despite this demographic trend, psychosocial research has focused largely on younger populations, leaving a limited understanding of how middle-aged and older adults adjust to cancer. Fear of progression (FoP) has emerged as a key component of emotional vulnerability in cancer survivors, yet its role in shaping psychological distress and health-related quality of life (HQoL) in these age groups remains understudied. This study aimed to examine psychosocial adjustment in middle-aged and older women with cancer and to test the mediating role of FoP in the relationship between emotional distress, post-traumatic stress and HQoL.

Methods

The sample consisted of 135 women aged 45 to 79 years (M = 52.94; SD = 6.58), of whom 80.7% (n = 109) were middle-aged (45-59 years) and 19.3% (n = 26) were older (60-79 years). In addition to a clinical and sociodemographic questionnaire, the following self-report measures were used: Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Hospital Anxiety and Depression Scale (HADS), Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). Mann-Whitney tests were used to explore age-group differences as part of the sample characterization. Correlational analyses examined associations among FoP, anxiety and depression, post-traumatic stress, and HQoL. The mediating role of FoP was tested using path analysis with bias-corrected percentile bootstrapping.

Results

Older women reported slightly higher levels of depression and poorer physical and social functioning compared to middle-aged women, but with a small effect size (0.2). Path analysis revealed a significant indirect effect of FoP on the relationship between post-traumatic stress and HqoL (indirect effect 1; estimated effect = -0.174; 95% CI [-0.293, -0.084]; p < 0.001), as well as between depression and HqoL (indirect effect 2; estimated effect = -0.181; 95% CI [-0.301, -0.086]; p < 0.001).

Conclusions

Middle-aged and older women with cancer showed broadly similar psychosocial profiles. FoP emerged as a central mechanism linking psychological distress to poorer HQoL across age groups. Interventions targeting FoP may therefore be beneficial for improving psychosocial adjustment in women living with cancer, regardless of age.