# “Fear Has Big Eyes”: Illness Perception, Fear of Recurrence, and Generalized Anxiety in Post-Treatment Thoracic Cancer Patients: A Serial Multiple Analysis

## TL;DR

This study explores how cancer survivors' views about their illness affect their fear of recurrence and anxiety, showing that meaning-making and belief changes play key roles.

## Contribution

The study introduces a serial multiple mediation model linking illness perception to psychological outcomes through meaning-making and belief changes in thoracic cancer survivors.

## Key findings

- Negative illness perception increases fear of recurrence and generalized anxiety.
- Positive illness perception reduces fear of recurrence and generalized anxiety.
- Meaning-making and belief restructuring mediate the relationship between illness perception and psychological distress.

## Abstract

Background/Objectives: Although illness perception has been examined in oncology populations, there is a lack of empirical studies focusing specifically on post-treatment thoracic cancer patients and on the mechanisms through which illness perception relates to fear of cancer recurrence and generalized anxiety. In particular, prior research has rarely tested meaning-making and changes in beliefs and goals as mediating factors. This study aimed to examine the mediating roles of meaning-making and changes in beliefs and goals within a serial multiple mediation model between illness perception, fear of recurrence, and generalized anxiety. Method: A cross-sectional study was conducted with 284 thoracic cancer patients (149 men and 135 women) who had completed treatment. Participants completed validated self-report measures assessing illness perception, meaning-making, changes in beliefs and goals, fear of cancer recurrence, and generalized anxiety. Hierarchical regression analyses and serial multiple-mediation models based on path analysis were employed to examine direct and indirect associations among variables. Results: Negative illness perception was positively associated with fear of recurrence and generalized anxiety, while positive illness perception predicted lower levels of both outcomes. Path analyses revealed that meaning-making and changes in beliefs and goals jointly mediated the relationships between illness perceptions and psychological distress. Specifically, adaptive meaning-making and belief–goal restructuring were associated with lower fear of recurrence and generalized anxiety, whereas maladaptive forms were associated with higher levels of both outcomes. Conclusions: Findings indicate that both negative and positive illness perceptions influence post-treatment emotional adjustment in thoracic cancer patients through mediation effects. Based on the meaning-making model, interventions targeting maladaptive illness perceptions, promoting meaning-making, and supporting adaptive changes in personal beliefs and goals may reduce fear of recurrence and anxiety. These results support the incorporation of meaning-centered strategies into psychosocial oncology care, emphasizing cognitive–motivational cognitive-motivational factors as critical targets for improving emotional well-being in cancer survivorship.