Network Analysis of Mental Adjustment, Fear of Disease Progression, and Financial Toxicity in Colorectal Cancer Patients: A Cross-Sectional Study

Network Analysis of Mental Adjustment, Fear of Disease Progression, and Financial Toxicity in Colorectal Cancer Patients: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Network Analysis of Mental Adjustment, Fear of Disease Progression, and Financial Toxicity in Colorectal Cancer Patients: A Cross-Sectional Study chunju Yang, Mengnan Li, Lu Wang, Ping Chen, Jiaojiao Chen, Min Hong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8194628/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Mental adjustment, fear of disease progression, and financial toxicity are critical yet interrelated factors influencing the well-being of patients with colorectal cancer. This study aimed to explore the complex interplay among these domains using network analysis, with the goal of identifying key targets for intervention. Methods: A cross-sectional design was employed to conveniently sample 545 hospitalized patients with colorectal cancer from February 2023 to February 2024. Data were collected using the Mini-Mental Adjustment to Cancer (Min-MAC) scale, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the Comprehensive Score for Financial Toxicity (COST-FACIT) scale. An EBIC-glasso regularized partial correlation network was constructed in R to evaluate node strength, expected impact, bridge centrality, and predictability. Stability and accuracy were assessed through 1500 bootstrap iterations. Results: In the resulting network model, anxiety symptoms (node strength=1.196) and hopelessness (edge strength=0.653) within the mental adjustment domain emerged as central hubs. Financial toxicity exhibited the highest bridging centrality (bridge strength = 1.673) and was strongly associated with impaired social functioning and heightened fear of disease progression. Anxiety symptoms yielded the highest expected impact (1.024), underscoring their pivotal role within the network. Conclusion: Anxiety, hopelessness, and financial toxicity form a central nexus affecting psychological outcomes in patients with colorectal cancer. Financial toxicity may exacerbate fear by impairing social functioning. Targeted interventions that disrupt the anxiety–hopelessness cycle and alleviate financial burden are likely to yield substantial benefits for mental adjustment in this population. Biological sciences/Cancer Health sciences/Diseases Health sciences/Health care Health sciences/Oncology Biological sciences/Psychology Social science/Psychology Colorectal cancer Mental adjustment Fear of progression Financial toxicity Network analysis Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 07 May, 2026 Editor invited by journal 26 Nov, 2025 Editor assigned by journal 25 Nov, 2025 Submission checks completed at journal 25 Nov, 2025 First submitted to journal 24 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8194628","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":640356227,"identity":"589a31c8-bd4e-4162-9806-85d2aa4013fb","order_by":0,"name":"chunju Yang","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital(Affiliated People's Hospital，Hangzhou Medical College)","correspondingAuthor":false,"prefix":"","firstName":"chunju","middleName":"","lastName":"Yang","suffix":""},{"id":640356229,"identity":"4c399151-84cb-4174-91e9-fa2d2940095e","order_by":1,"name":"Mengnan Li","email":"","orcid":"","institution":"University of 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adjustment, Fear of progression, Financial toxicity, Network analysis","lastPublishedDoi":"10.21203/rs.3.rs-8194628/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8194628/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eMental adjustment, fear of disease progression, and financial toxicity are critical yet interrelated factors influencing the well-being of patients with colorectal cancer. This study aimed to explore the complex interplay among these domains using network analysis, with the goal of identifying key targets for intervention.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eA cross-sectional design was employed to conveniently sample 545 hospitalized patients with colorectal cancer from February 2023 to February 2024. Data were collected using the Mini-Mental Adjustment to Cancer (Min-MAC) scale, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the Comprehensive Score for Financial Toxicity (COST-FACIT) scale. An EBIC-glasso regularized partial correlation network was constructed in R to evaluate node strength, expected impact, bridge centrality, and predictability. Stability and accuracy were assessed through 1500 bootstrap iterations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eIn the resulting network model, anxiety symptoms (node strength=1.196) and hopelessness (edge strength=0.653) within the mental adjustment domain emerged as central hubs. Financial toxicity exhibited the highest bridging centrality (bridge strength = 1.673) and was strongly associated with impaired social functioning and heightened fear of disease progression. Anxiety symptoms yielded the highest expected impact (1.024), underscoring their pivotal role within the network.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/em\u003e Anxiety, hopelessness, and financial toxicity form a central nexus affecting psychological outcomes in patients with colorectal cancer. Financial toxicity may exacerbate fear by impairing social functioning. Targeted interventions that disrupt the anxiety–hopelessness cycle and alleviate financial burden are likely to yield substantial benefits for mental adjustment in this population.\u003c/p\u003e","manuscriptTitle":"Network Analysis of Mental Adjustment, Fear of Disease Progression, and Financial Toxicity in Colorectal Cancer Patients: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-15 10:28:11","doi":"10.21203/rs.3.rs-8194628/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-07T08:57:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-26T10:19:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-25T07:04:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-25T07:01:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-11-24T15:18:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1eb05e3a-6823-42cd-8acc-bb83c987be19","owner":[],"postedDate":"May 15th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"20","date":"2026-05-07T08:57:25+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":68146375,"name":"Biological sciences/Cancer"},{"id":68146376,"name":"Health sciences/Diseases"},{"id":68146377,"name":"Health sciences/Health care"},{"id":68146378,"name":"Health sciences/Oncology"},{"id":68146379,"name":"Biological sciences/Psychology"},{"id":68146380,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-15T10:28:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-15 10:28:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8194628","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8194628","identity":"rs-8194628","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}