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

## TL;DR

This study explores how fear of cancer progression affects the mental health and quality of life of middle-aged and older women with cancer.

## Contribution

The study identifies fear of progression as a key mediator between psychological distress and quality of life in these age groups.

## Key findings

- Older women showed slightly higher depression and poorer physical and social functioning compared to middle-aged women.
- Fear of progression significantly mediated the relationship between post-traumatic stress and quality of life.
- Fear of progression also mediated the relationship between depression and quality of life across age groups.

## Abstract

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.