Fear of cancer recurrence and assessing its relationship with cognitive flexibility and coping strategies: a cross-sectional study.

Cancer is a major global health challenge, with 20 million new cases and 9.7 million cancer-related deaths worldwide in 2022 [, ]. It is the third leading cause of mortality in Iran, causing over 100,000 deaths annually []. Beyond its physical impact, cancer profoundly affects patients and their families psychologically, socially, and emotionally []. Fear of cancer recurrence (FCR) is increasingly acknowledged as a prevalent and distressing psychological sequela among cancer survivors and patients undergoing active treatment []. FCR is characterized by the apprehension or concern regarding the potential return of cancer in the primary site or elsewhere in the body. Its severity spans from transient, mild worries to persistent, intense fears that may substantially impair daily functioning []. Core features of FCR involve sustained preoccupation with recurrence and heightened sensitivity to somatic sensations, particularly when these concerns persist for a minimum of three months []. However, when FCR escalates to excessive levels, it can impede daily life and precipitate maladaptive coping behaviors. These may include excessive reassurance-seeking from healthcare professionals, repetitive symptom self-monitoring, avoidance of recommended follow-up care, or the unnecessary utilization of healthcare services []. Such responses not only exacerbate psychological distress but also impose considerable economic and organizational burdens on healthcare systems []. Epidemiological data reveal a high prevalence of FCR across the cancer continuum, with over 77% of survivors and 70% of those in active treatment reporting moderate to high levels []. Elevated FCR is consistently associated with poorer emotional well-being, reduced quality of life, increased fatigue, anxiety, and depression []. FCR can also impair health behaviors like screening and follow-up adherence, especially when psychosocial needs are unmet []. However, the psychological mechanisms behind varying FCR severity remain poorly understood [, ]. Dysfunctional FCR negatively influences illness adjustment and quality of life []. Identifying modifiable psychological factors is thus crucial for effective interventions. Cognitive flexibility has emerged as a key construct related to emotional regulation, problem-solving, and adaptation in cancer patients [, ].