Fear of Cancer Recurrence in Breast Cancer: A Moderated Serial Mediation Analysis of a Prospective International Study

Gabriella Bentley*, Osnat Zamir, Ilan Roziner, Rawan Dahabre, Shlomit Perry, Evangelos C. Karademas, Paula Poikonen-Saksela, Ketti Mazzocco, Albino J. Oliveira-Maia

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Women dealing with breast cancer (BC) face many challenges, one of which is the fear of cancer recurrence (FCR). This study examined whether disease severity predicts FCR 6 months after cancer diagnosis through psychological distress and whether cognitive–emotion regulation moderates this effect. Method: The study sample included 656 women from Italy (27.5%), Finland (31.9%), Israel (19.8%), and Portugal (20.8%) diagnosed with Stages I–III of BC. Participants’ age ranged between 40 and 70 years (M = 54.92, SD = 8.22). Participants were tracked following BC diagnosis and at 3 and 6 months follow-up. Participants filled out self-report questionnaires, including the FCR inventory-short form, the Hospital Anxiety and Depression Scale, and the cognitive–emotion regulation questionnaire along with medical–social–demographic data. Results: Greater disease severity at baseline indicated by higher cancer stage predicted greater psychological distress, which in turn predicted greater psychological distress at 3 months. The latter predicted greater FCR at 6 months. This serial mediation model was moderated by negative cognitive–emotion regulation. The mediating effect of disease severity on FCR through psychological distress was significant only in women with mean or higher levels of negative cognitive–emotion regulation. Conclusion: This study suggests that facilitating psychological well-being and effective cognitive–emotion regulation in the early stages after a cancer diagnosis may protect women from FCR.

Original languageEnglish
JournalHealth Psychology
StateAccepted/In press - 2024

Bibliographical note

Publisher Copyright:
© 2024 American Psychological Association


  • cognitive–emotion regulation
  • disease severity
  • fear of cancer recurrence
  • psychological distress


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