# Two hearts, one fear? Dyadic fear-of-progression and quality of life among Thai gynecologic-cancer survivors and caregivers

## TL;DR

This study finds that fear of cancer progression mainly affects the individual's own quality of life, not their caregiver's, in Thai gynecologic cancer survivor-caregiver pairs.

## Contribution

The study is the first to examine dyadic fear-of-progression and quality of life in Thai gynecologic-cancer survivor–caregiver pairs using actor-partner interdependence models.

## Key findings

- Fear-of-progression (FoP) was strongly linked to lower quality of life (QOL) for both survivors and caregivers.
- FoP did not significantly affect the QOL of the partner in the dyad.
- Actor-only models best fit the data, indicating FoP mainly impacts the individual's own QOL.

## Abstract

To examine actor-partner interdependence between fear-of-progression (FoP) and global quality of life (QOL) in Thai gynecologic-cancer survivor–caregiver dyads.

A cross-sectional study recruited 300 survivor–caregiver pairs from tertiary oncology centers in Bangkok, Thailand. Survivors were ≥6 months post-treatment for cervical, ovarian, or uterine cancer. Dyads completed the Thai Fear of Progression Questionnaire Short Form and the WHOQOL-BREF. Actor–Partner Interdependence Models (APIM) were estimated with structural equation modeling, treating dyad members as distinguishable (patient vs. caregiver). Models controlled for age, time since diagnosis, and comorbidity count.

Mean FoP scores were 27.4 ± 9.3 for survivors and 26.8 ± 8.8 for caregivers; mean QOL totals were 88.9 ± 12.1 and 90.2 ± 12.4, respectively. FoP levels were moderately correlated within dyads (r = 0.37, p < 0.001). In APIM, higher FoP predicted poorer QOL for the same person (actor effects: β = −0.38, p < 0.001 for survivors; β = −0.25, p = 0.001 for caregivers). Partner effects were small and non-significant (caregiver FoP → survivor QOL: β = −0.03, p = 0.46; survivor FoP → caregiver QOL: β = −0.05, p = 0.28). Goodness-of-fit indices supported the actor-only pattern (χ2 = 3.4, df = 4, p = 0.49; RMSEA = 0.00; CFI = 1.00).

Among Thai gynecologic-cancer dyads, fear-of-progression erodes the individual’s own quality of life but does not appear to does not appear to exert a cross-partner influence. Psycho-oncology programs should therefore screen and treat FoP in both survivors and caregivers, yet expect QOL gains to arise chiefly from direct, rather than cross-partner, relief of fear. Because the design was cross-sectional, temporal ordering cannot be inferred; FoP–QOL associations may be bidirectional (e.g., poorer QOL amplifying FoP and vice versa). Longitudinal, multi-wave APIM is needed to establish directionality. Future work should test domain-level QOL outcomes and longitudinal APIM to determine whether subtle cross-partner effects emerge in specific life domains.