Illness Perception and Fear of Cancer Recurrence in Elderly Cance r Patients: The Chain Mediating Role of Self-Efficacy and Social S upport

Illness Perception and Fear of Cancer Recurrence in Elderly Cance r Patients: The Chain Mediating Role of Self-Efficacy and Social S upport | 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 Research Article Illness Perception and Fear of Cancer Recurrence in Elderly Cance r Patients: The Chain Mediating Role of Self-Efficacy and Social S upport Yi Zhang, jingxuan Duan, Lei Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8650332/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Objective This study aims to investigate the relationship between illness perception and fear of cancer recurrence (FCR) in older adult cancer patients, as well as the mediating role of self-efficacy and social support in this association. The findings are intended to provide a theoretical foundation for developing targeted interventions to alleviate FCR in this demographic. Methods A total of 310 elderly cancer patients, admitted to the Oncology Department of three Grade A tertiary hospitals from January 2025 to August 2025,were selected through convenient sampling. The mean age of the 286 valid participants was 72.4 ± 7.7 years.Data were collected using the BriefIllness Perception Questionnaire, Fear of Cancer Recurrence Inventory, General Self-Efficacy Scale, and Social Support Rating Scale. Descriptive statistics, correlation analysis, and structural equation modeling were conducted usingSPSS 26.0 and AMOS 24.0 software. Results The study revealed that illness perception has a direct positive effect on FCR (β = 0.399, P < 0.001). Illness perception predicts FCR through two significant indirect pathways: the independent mediating effect of self-efficacy (β = 0.128, 95% CI: 0.078 ~ 0.182) and the chain mediating path of self-efficacy → social support (β = 0.083, 95% CI: 0.043 ~ 0.126). The independent mediating path of social support was not statistically significant (β = 0.000, 95% CI: -0.021 ~ 0.021). Conclusion The findings suggest that a more negative illness perception in older adult cancer patients is associated with higher levels of FCR. Self-efficacy and social support serve as chain mediators between illness perception and FCR. Clinically, addressing negative illness perceptions and enhancing self-efficacyand social support may effectively alleviate FCR and improve the mental health of older adult cancer patients. Geriatric oncology patients Illness perception Fear of cancer recurrence Self-efficacy Social support Chain mediating effect Figures Figure 1 Introduction The incidence of cancer among the elderly population is increasing due tofactors such as accelerated population aging and advancements in medical diagnostic technologies, positioning cancer as a significant threat to the health andwell-being of older adults[1].Beyond the challenges of tumor treatment, elderly cancer patients encounter numerous medication-related issues and the potential for inappropriate drug use, which contribute to substantial physical and psychological burdens[2-3].Their requirements for disease management and psychologicaladjustment are also multifaceted. Although improvements in diagnostic and therapeutic methods have enhanced patient survival rates, fear of cancer recurrence(FCR) has emerged as the most prominent negative emotional experience during the rehabilitation period for elderly patients. FCR is characterized bypersistent and intrusive concerns about cancer recurrence or metastasis, which can diminish treatment adherence and disrupt interpersonal relationships, thereby impairing quality of life[4]. It may even indirectly reduce survival by influencing stress responses and health behaviors[5]. Consequently, identifying the factors influencing FCR and its mechanisms is essential for developing effective intervention strategies[6]. illness perception is a critical variable in cognitive behavioral theory, encompassing an individual's cognitive representations, emotional experiences, and attribution patterns regarding a disease[7].According to the Leventhalself-regulation model, negative illness perception heightens the riskof negative emotions in cancer patients[8].Older adults, due to physiological decline, cognitive impairment, and comorbidities, are more susceptible to developing negative illness perceptions, thereby exacerbating their Functional Capacity for Recovery (FCR). However, the strength of the association and the underlying causalpathways between these factors remain unknown. Self-efficacy and social support arepivotal factors influencing FCR. Forms of social support, such as peer support,can mitigate FCR by enhancing psychological resilience[9-10],while patients with high self-efficacy are more likely to actively seek and utilize social support.It is posited that illness perception may influence FCR by affecting self-efficacy,thereby impacting patients' ability to obtain social support[11-12].However, this causal mechanism has not been validated in older adult cancer patients. Thisstudy aimed to explore the association between illness perception and FCR in elderly cancer patients, verify the chain-mediated effects of self-efficacy and socialsupport, elucidate the intrinsic mechanism of "diseaseperception → self-efficacy → social support → FCR," and provide practical referencesfor developingtargeted, multidimensional psychological intervention strategies for elderly cancer patients. 1. Subjects and Methods 1.1 Participants and Setting Convenience sampling was utilized, and the study was conducted from January 2025 to August 2025 within the oncology departments of three tertiary Grade A general hospitals in a specified region. The mean age of the 286 valid participants was 72.4±7.7 years.The study was conducted in accordance with the Declaration of Helsinki and received approval from the Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine ethics committee (approval no. KY2025-159). Inclusion criteria included: ①Age ≥60 years; ②Pathologically confirmed malignant tumor; ③≥6 months post-completion of initial treatment, with physician-confirmed risk of cancer recurrence; ④Clear consciousness and normal communication ability; ⑤Voluntary participation in the study, with signed written informed consent and an understanding of the study objectives and data confidentiality principles. Exclusion criteria were: ①Patients with a life expectancy of less than3 months; ②Patients with severe cognitive impairment or psychiatric disorders;③Patients with severe functional impairments in organs such as the heart, brain, or kidneys; ④Other patients unable to cooperate with the investigation. Consent to Participate Declaration: All participants provided written informed consent prior to enrollment. Participants were fully informed of the study’s purpose, procedures, potential risks, and confidentiality protections, and they had the right to withdraw from the study at any time without negative consequences. Clinical Trial Number ： not applicable. Sample size estimation was based on the requirements of the chain mediation model andstructural equation modeling (≥200 cases), accounting for a 20% invalidity rate,resulting in a minimum required sample size of 200×1.2=240. This study involved four core variables, with the model incorporating three mediationpaths. A total of 280 cases were planned for inclusion; however, 310 questionnaires weredistributed, and 286 valid responses were collected, achieving an effective response rate of 92.26%, which satisfied the model-fitting requirements. 1.2 Methods 1.2.1 Survey Tools 1.2.1.1 General Information Questionnaire he general information questionnaire was designed by the researcher after reviewing the relevant literature and considering the objectives of this study. It included demographic and disease-related data, such as the patient's sex, age, educational level, marital status, tumor type, disease duration, treatment modality,and income. 1.2.1.2 Brief Illness Perception Questionnaire (BIPQ) Developed by Broadbent et al., this instrument evaluates patients 'cognitiverepresentations, emotional representations, and cognitive understanding of the disease. This study employed the 2015 Chinese version of the questionnaire[13],comprising three dimensions: cognition (5 items), emotion (2 items), and understanding (1 item), totaling 9 items. The first eight items were scored on a 0–10scale, while the 9th item was an open-ended question requiring patients to list three significant factors contributing to the disease, which was not included in the total score. Items 3, 4, and 7 were reverse scored, with total scores ranging from 0 to 80. Higher scores indicate more severe negative perceptions of thedisease. The Cronbach's α coefficient for this questionnaire was 0.770, and in this study, it was 0.854. 1.2.1.3 Fear of Progression Questionnaire-Simplified Form (FOP-Q-SF) Developed by Mehnert[14]and localized by Wu et al.[15],this scale assesses patients 'fear of disease recurrence, progression, and severe consequences in chronic diseases and malignancies. Comprising 12 items divided into two dimensions—physiological health (six items) and social/family (six items)—it employs a 5-point Likert scale (1–5), with a total score range of 12–60. Higher scores indicate greater fear of disease progression, with <34 points denoting functional fear of disease progression and ≥34 points denoting dysfunctional fear of disease progression. The Cronbach's α coefficient in this study was 0.834. 1.2.1.4 General Self-Efficacy Scale (GSES) Developed by Schwarzer and localized into Chinese by Wang Cai-kang et al.[16],this 10-item Likert 4-point scale (1-4) measures self-efficacy across various environmental challenges. The total score ranges from 10 to 40, with higherscores indicating greater self-efficacy. The Cronbach's α coefficient in this study was 0.920. 1.2.1.5 Perceived Social Support Scale (PSSS) Developed by Zimet et al.[17]and localized into Chinese by Jiang Qianjin, this 12-item Likert scale (1-7) measures perceived support from family (fouritems), friends (four items), and other social relationships (four items). As a key stress-buffering mechanism, this study investigates whether "perceived social support" can alleviate patients 'fear. The 12-item scale yields a total score of 12-84, with higher scores indicating greater social support. The Cronbach's α coefficient in this study was 0.919. 1.2.2 Data Collection Methods Patients in the recovery phase who meet the inclusion criteria will be screened through the hospital's oncology follow-up system. After the telephone appointment, trained researchers conducted one-on-one questionnaire surveys either at the hospital's rehabilitation clinic or at the patient's home. Patients will be informed of the study objectives, procedures, and confidentiality principles, and an informed consent form will be signed before the questionnaire is distributed.For patients with poor vision or writing difficulties, the investigators read the items aloud individually, filled in the responses based on the patients' actual answers, and verified the responses by reciting them aloud. Questionnaires were collected on-site to ensure completeness and the absence of logical errors. Ineligible questionnaires were supplemented or excluded immediately. 1.2.3 Quality Control After finalizing the research protocol, the investigator conducted centralizedtraining for the research team members, covering survey methodologies, tool utilization, communication techniques, and invalid questionnaire identification criteria. Following obtaining informed consent from the patients, the investigator administered the scale or questionnaire on-site, with self-completion being the primary approach. For patients experiencing difficulties, the investigator assisted incompleting the form, followed by verbal verification to ensure accuracy. Thescale or questionnaire was collected immediately, and the data were entered after double-checking by two individuals. 1.2.4 Statistical Methods Data analysis and structural equation modeling were performed using SPSS (version 26.0) and AMOS (version 24.0). Categorical data are described as frequencies and composition ratios. Quantitative data that followed a normal distribution are described as means±standard deviations (x±s), while those thatdidnot follow a normal distribution are described as medians (interquartiles) [M (P 25 ,P 75 )].Correlation analysis: Pearson’s correlation was used for quantitativedata that followed a normal distribution, and Spearman’s correlation was used for those that did not. The structural equation model fit criteria were referenced in[18]: χ²/df <3 indicates good fit, GFI, AGFI, CFI, IFI, and NFI ≥ 0.90 indicate good fit, and RMSEA <0.08 indicates acceptable fit (<0.05 indicates good fit). 2 Results 2.1 General Data of Elderly Cancer Patients Table 1 Basic characteristics of elderly cancer patients (N = 286) Project Category Number of cases (n) Percentage (%) Mean ± SD Sex man 150 52.4 / woman 136 47.6 Age (years) 60–69 120 41.9 72.4 ± 7.7 70–79 105 36.7 ≥ 80 61 21.3 Degree of education Primary school and below 95 33.2 / junior middle school 100 34.9 High school or above 91 31.8 Marital status married 210 73.4 / Unmarried (divorced/widowed) 76 26.6 Duration (years) ≤ 1 75 26.2 2.17 ± 1.32 1–3 130 45.5 ≥ 3 81 28.3 Monthly per capita household income (yuan) ≤ 3000 90 31.5 4120 ± 1580 3000ཞ5000 125 43.7 ≥ 5000 71 24.8 Types of cancer carcinoma of the lungs 75 26.2 / gastric cancer 50 17.5 cancer of the liver 35 12.2 mammary cancer 40 14.0 colorectal cancer 55 19.2 Other types 31 10.8 Therapeutic Method operative treatment 80 27.9 / chemotherapy 65 22.7 radiotherapy 45 15.7 complex treatment 96 33.6 2.2 Common Method Bias Test Harman's single-factor test was employed to examine the common methodbias. The results indicated that there were four factors with eigenvalues > 1, and the first factor accounted for 32.41% of the variance, which was below the critical value of 40%[ 18 ]. This suggests that no common method bias was present in this study. 2.3 Descriptive Statistics and Correlation Analysis of Variables Pearson correlation analysis results (all P < 0.01) demonstrated that illness perception was significantly positively correlated with fear of cancer recurrence (r = 0.62), with stronger negative perception correlating to more pronounced recurrence fear. Both self-efficacy and social support showed significant negative correlations with illness perception and fear of cancer recurrence, while self-efficacy and social support exhibited significant positive correlations, indicating thatpatients with high self-efficacy were more adept at accessing and utilizing socialsupport resources. Details are presented in Table 2 . Table 2 Correlation Analysis of illness perception, Cancer Recurrence Fear, Self-Efficacy, and Social Support in Elderly Cancer Patients Variable Mean ± SD illness perception Fear of cancer recurrence Self efficacy Social support illness perception 45.26 ± 10.38 1 Fear of cancer recurrence 38.64 ± 8.72 0.62** 1 Self efficacy 22.58 ± 6.43 -0.47** -0.47** 1 Social support 56.32 ± 11.25 -0.52** -0.52** 0.45** 1 Note: P < 0.01** 2.4 Univariate Analysis of Factors Influencing Fear Scores of Cancer Recurrence in Elderly Cancer Patients With the fear of cancer recurrence (FCR) score as the dependent variable, univariate analyses were separately conducted for demographic variables (gender,age, educational level, marital status, monthly household income, disease duration, treatment modality) and core variables (illness perception, self-efficacy, social support) to examine their effects on FCR. The independent-samples t-test (for dichotomous variables) or one-way analysis of variance (ANOVA, for polytomous variables) was applied, with the test level set at α = 0.10. The results showed that educational level (F = 5.832, P = 0.003), marital status (t = 3.965, P < 0.001), disease duration (F = 6.328, P = 0.002), and monthly per capita household income (F = 4.751, P = 0.009) were identified as influencing factors for FCR. Among these, a higher educational level, longer disease duration, and higher monthly per capita household income were associated with lower FCR scores in patients;married patients had significantly lower FCR scores than non-married patients. No statistically significant effects on FCR were found for gender, age, cancer type, or treatment modality (all P > 0.05). Details are presented in Table 3 . Table 3 Univariate analysis of cancer recurrence fear in elderly cancer patients Influencing factor Category N FCR Score (x ± s) t/F-Value P-Value Sex man 150 37.82 ± 8.56 t = 1.243 0.215 woman 136 39.57 ± 8.81 Age (years) 60 ~ 69 120 37.51 ± 8.32 F = 2.107 0.124 70 ~ 79 105 38.96 ± 8.75 ≥ 80 61 40.63 ± 9.14 Degree of education Primary school and below 95 41.38 ± 8.97 F = 5.832 0.003 junior middle school 100 38.75 ± 8.64 High school or above 91 35.26 ± 7.98 Marital status married 210 37.24 ± 8.23 t = 3.965 0.000 Unmarried (divorced/widowed) 76 42.51 ± 9.06 Tumor type carcinoma of the lungs 75 40.12 ± 8.79 F = 1.864 0.104 gastric cancer 50 39.65 ± 8.53 cancer of the liver 35 41.28 ± 9.21 mammary cancer 40 36.83 ± 7.85 colorectal cancer 55 38.47 ± 8.46 Other tumors 31 37.92 ± 8.61 Duration (years) ≤ 1 75 41.56 ± 9.13 F = 6.328 0.002 1–3 130 38.27 ± 8.35 ≥ 3 81 35.74 ± 7.89 Monthly per capita household income (yuan) ≤ 3000 90 40.89 ± 8.86 F = 4.751 0.009 3000ཞ5000 125 38.35 ± 8.42 ≥ 5000 71 35.62 ± 7.75 Therapy method operative treatment 80 36.92 ± 8.07 F = 2.345 0.074 Radiotherapy treatment 45 39.76 ± 8.93 Chemotherapy 65 40.21 ± 9.01 complex treatment 96 37.58 ± 8.26 2.5 Linear Regression Analysis of Factors Influencing Fear of Cancer Recurrence in Elderly Cancer Patients With the score of fear of cancer recurrence (FCR) as the dependent variable, variables with a P-value < 0.10 in univariate analysis were included in the multiple linear regression model. Stepwise regression was adopted, where the total FCR score served as the dependent variable, and the independent variables included educational level (coded as:1 = primary school or below, 2 = junior high school, 3 = senior high school or above), marital status (coded as:0 = married,1 = unmarried/divorced/widowed), disease duration (coded as:1 = ≤ 1 year,2 = 1–3 years,3 = ≥ 3 years), monthly per capita income, total score of illness perception, total score of self-efficacy, and total score of social support. Model fit was evaluated by the coefficient of determination (R²) and adjusted R², and multicollinearity was diagnosed using the variance inflation factor (VIF), with a critical value of VIF < 10 for the absence of severe multicollinearity. The results showed that the regression equation was statistically significant (F = 28.653, P < 0.01), and the overall explanatory power of the model was R²=0.623, indicating that the included variables collectively explained 62.3% of the variance in FCR among the study population. Among these variables, illness perception, self-efficacy, social support, educational level, marital status and disease duration were identified asindependent influencing factors for FCR (all P < 0.05). Details are presented in Table 4 . Table 4 Linear regression analysis of factors influencing cancer recurrence fear in elderly cancer patients Variable B(SE) β T-Value P-Value 95% CI Constant term 25.37(3.22) - 7.89 <0.001 [18.99, 31.75] Illness perception 0.31(0.05) 0.40 5.998 <0.001 [0.21, 0.41] Self efficacy -0.25(0.06) -0.22 -4.013 <0.001 [-0.36, -0.14] Social support -0.19(0.05) -0.20 -3.816 <0.001 [-0.28, -0.10] Degree of education -1.52(0.47) -0.15 -3.254 0.001 [-2.45, -0.59] Marital status 2.86(0.73) 0.18 3.912 <0.001 [1.42, 4.30] Course of disease -1.29(0.42) -0.14 -3.101 0.002 [-2.11, -0.47] Note:R²=0.612, F = 28.65, P < 0.001 2.6 Mediating Effect Analysis of illness perception and Cancer Recurrence Fear on Self-Efficacy and Social Support Using illness perception as the independent variable (X) and fear of cancer recurrence as the dependent variable (Y), with self-efficacy (M1) and social support (M2) as mediating variables, the chain mediation effect was tested usingAMOS 24.0 and Bootstrap sampling (10,000 times), and the structural equationmodel was used to verify the fit. The model was fitted using the maximum likelihood method, and the comprehensive indicator model demonstrated good fit (χ2/df = 2.370 (< 3), NFI = 0.890,IFI = 0.930, GFI = 0.890, CFI = 0.972, RFI = 0.926, TLI = 0.917 (all ≥ 0.90), RMSEA = 0.076 (< 0.08)). Only NFI = 0.890 and GFI = 0.890 were slightly below 0.90, indicating an acceptable overall model fit. The path relationship test results showed that with illness perception as the predictor and self-efficacy as the outcome,illness perception negatively predicted self-efficacy (β=-0.483, P < 0.001). When illness perception and self-efficacy were the predictors and social support was theoutcome, illness perception did not directly predict social support (β = 0.003,P = 0.876); however, self-efficacy positively predicted social support (β = 0.461, P < 0.001). With illness perception, self-efficacy, and social support as predictors and fear of cancer recurrence as the outcome, illness perception positively predicted fear of cancer recurrence (β = 0.399, P < 0.001), self-efficacy negatively predicted fear of cancer recurrence (β=-0.265, P < 0.001), and social support negatively predicted fear of cancer recurrence (β=-0.372, P < 0.001). This indicates that self-efficacy and social support play a chain-mediation role between illness perception and fear of cancer recurrence. Details are presented in Fig. 1 . A bootstrap analysis with 10,000 resamples was employed to calculate 95% confidence intervals(CIs). The results indicated that the direct effect (from illness perception to fear of cancer recurrence) was 0.399 (95%CI: 0.306–0.492),accounting for 65.41% of the total effect. The first independent indirect pathway (illness perception→self-efficacy→fear of cancer recurrence) was 0.128 (95% CI:0.078–0.182), contributing 20.98% to the total effect. The second independent indirect pathway (illness perception→social support→fear of cancer recurrence)was non-significant (effect = 0.000, 95%CI:-0.021–0.021), accounting for 0.00%. The chain-mediated pathway (illness perception→self-efficacy→social support→fear of cancer recurrence) was 0.083 (95%CI:0.043–0.126), explaining 13.61% of the total effect. The total indirect effect was 0.211 (95%CI:0.149–0.275),which represented 34.59% of the total effect. These mediation analysis results are presented in Table 5 . Table 5 Results of Mediation Effect Testing for illness perception and Cancer Recurrence Fear in Self-Efficacy and Social Support Effect type Path Standard error (SE) Bootstrap95% CI Effect size (β) Mediation proportion (%) Direct effect Disease awareness → fear of cancer recurrence 0.048 [0.306–0.492] 0.399 65.41 Indirect effect (single) illness perception → self-efficacy → fear of cancer recurrence 0.027 [0.078–0.182] 0.128 20.98 Indirect effect (single) illness perception → socialsupport → fear of cancer recurrence 0.010 [-0.021-0.021] 0.000 0.00 Indirect effect (chain) illness perception → self-efficacy → social support → fear of cancer recurrence 0.021 [0.043–0.126] 0.083 13.61 Total indirect effect — 0.032 [0.149, 0.275] 0.211 34.59 Total effect — 0.038 [0.536–0.684] 0.610 100.00 3. Discussion 3.1 Relationship between illness perception and cancer recurrence fear in elderly cancer patients In this study, the mean score of the FOP-Q-SF among older adult patientswith cancer was 38.64±8.72, with 199 patients (69.6%) scoring ≥34 points, indicating that nearly 70% of older adult patients with cancer in the rehabilitation phase exhibited dysfunctional fear of recurrence, consistent with previous research findings and more pronounced in this population. Correlation analysis revealed a significant positive correlation between illness perception and fear of cancer recurrence (r=0.62, P<0.001). Regression analysis identified a regression coefficient of 0.312 (P<0.001) for illness perception, with a direct effect value of 0.399, accounting for 65.41% of the total effect, which closely aligns with Leventhal's self-regulation model.The mean score of the BIPQ in this study was 45.26±10.38, suggesting that older adult patients generally exhibited a moderately elevated negative illness perception. Due to physiological decline, older adult patients often have multiple underlying conditions and cognitive impairment, making them more prone to developing a negative illness perception of cancer as uncontrollable and having a poor prognosis[19].This cognitive bias leadspatients to become overly sensitive to subtle bodily changes, reinforcing thenegative expectation that "recurrence is a disaster," resulting in persistent intrusive worry, which ultimately exacerbates dysfunctional recurrence fear and affectstreatment adherence and quality of life[20-21].Conversely, a positive diseaseperception enables patients to rationally address the risk of disease recurrence and reduce unnecessary anxiety. Therefore, clinicians should pay attention to theillness perception status of older adult patients and promptly intervene to correct negative cognitive biases. 3.2 Mediating Role of Self-Efficacy in Cancer Recurrence Fear This study demonstrates that self-efficacy independently mediates the relationship between illness perception and fear of cancer recurrence, with a mediation effect size of 0.128, accounting for 20.98% of the total effect. Correlation analysis revealed a significant negative correlation between self-efficacy and illness perception (r=-0.47, P<0.001) and a significant negative correlation with fear of cancer recurrence (r=-0.47, P<0.001), with a regression coefficient of-0.245 (P<0.001). These findings indicate that self-efficacy serves as a crucial intrinsic buffer for alleviating fear of recurrence. According to Bandura's social learning theory, self-efficacy stems from an individual's cognitive assessment of their abilities. Negative illness perception can diminish patients 'judgment of their disease coping capacity, thereby weakening their confidence in addressing disease challenges[22].The mean GSES score in this study was 22.58±6.43, indicating that older adult patients exhibited moderate self-efficacy. Patients with lowself-efficacy lack proactive coping abilities and are prone to feelings of helplessness when facing disease-related stimuli, which amplifies the fear of recurrence[22].Conversely, a positive illness perception can enhance patients' self-efficacy. Patients with high self-efficacy are more likely to adopt proactive coping behaviors, such as adhering to medical advice and actively acquiring health knowledge, effectively reducing their perceived risk of recurrence. These results suggest that clinical interventions, such as disease knowledge training, sharing ofsuccessful cases, and recognition of phased achievements, can be employed to improve the self-efficacy of elderly patients, thereby providing intrinsic motivation for alleviating fear[23-25]. 3.3 Mediating Role of Social Support in Cancer Recurrence Fear In this study, the independent mediating effect of social support was not significant (effect size 0.000,95% CI: -0.021 to 0.021), whereas the chain mediating effect of illness perception→self-efficacy→social support→fear of cancer recurrence was significant, with an effect size of 0.083, accounting for 13.61% of the total effect. This indicates that social support, as an important external psychological resource, exerts its buffering effect on FCR not directly but through self-efficacy as a mediating factor. Patients must first possess a certain level of self-efficacy to effectively acquire and utilize external social support.In thisstudy, the mean PSSS score was 56.32 ± 11.25, suggesting that elderlypatientshad moderate levels of social support. There was a significant positivecorrelation between self-efficacy and social support (r = 0.45, P <0.001), indicating thatself-efficacy is a prerequisite for patients to acquire and utilize social support. Negative illness perception reduces patients 'self-efficacy, diminishing their confidence and ability to actively seek support. Even with external support resources, they may struggle to utilize them effectively, leading to low levels of social support[26]. Low social support exacerbates patients' feelings of loneliness and helplessness, further amplifying the fear of recurrence under disease stress[26,19]. Conversely, patients with high self-efficacy are more willing to proactivelyestablish support networks and obtain support from family, friends, medical teams, and other sources. This support can alleviate stress caused by the disease, enhance confidence in combating recurrence, and thereby reduce fear[28]. This finding reveals the indirect mechanism by which social support affects relapse fear and provides a new entry point for clinical intervention. 3.4 Impact of Demographic Characteristics on Fear of Cancer Recurrence and Implications for Comprehensive Intervention Univariate and multivariate linear regression analyses revealed that educational level, marital status, and disease duration were independent predictors of fear of cancer recurrence (P<0.05). Higher educational attainment (regression coefficient=-1.523) and longer disease duration (regression coefficient=-1.287) were associated with lower levels of recurrence fear. Married patients exhibited significantly lower recurrence fear than unmarried, divorced, or widowed patients (regression coefficient=2.864). Mechanistically, patients with higher educational attainment are more likely to access disease-related knowledge through multiple channels and possess stronger information interpretation skills, enabling them to rationally assess the risk of cancer recurrence[27]. Patients with a longer disease duration gradually develop a stronger sense of disease control through prolonged rehabilitation adaptation, thereby reducing excessive concerns about recurrence[28]. Married patients can receive continuous emotional support and care from their spouses, alleviating loneliness and consequently mitigating the fear of recurrence[29]. These demographic characteristics suggest that clinical interventions should emphasize individualized differences, with specialized interventionplans tailored for older adult patients with low educational attainment, unmarried status, divorce, widowhood, or short disease duration[30-31]. The analysis revealed three pathways through which illness perception influences fear of cancer recurrence: a direct pathway, a self-efficacy-mediated pathway, and a self-efficacy → social support chain-mediated pathway. The total mediation effect accounted for 34.59%, with the model explaining 62.3% of the variance. This multi-factor mechanism demonstrates that fear of recurrence inolder adult cancer patients arises from the combined effects of cognitive, psychological, and social factors, necessitating multidimensional clinical interventions[32]. 4. Conclusion This study provides a theoretical basis and practical guidance for the development of clinical psychological intervention strategies for older adult cancer patients, suggesting that comprehensive interventions should be implemented beyond routine medical care. These include health education to correct patients 'negative illness perceptions and establish a scientific understanding of cancer, skill training to enhance patients' self-efficacy, and the establishment of social support networks, with particular attention to the support needs of single patients. Individual differences should be considered, with focused interventions for patients with lower educational levels and shorter disease durations, thereby reducing their fear of recurrence and improving their quality of life. The study has certain limitations, such as convenience sampling affecting sample representativeness and the cross-sectional design failing to explore long-term causal relationships between variables or the long-term effects of the interventions. Future research should expand the sample size and conduct multicenter longitudinal studies to investigate the long-term effects of interventions and analyze the moderating role of demographic characteristics to provide support for the development of precise individualized intervention plans. Declarations Funding Declaration ： This study was supported by the 2024 Funded Research Project of the Chinese Nursing Association (Grant No.: ZHKYQ202406). Author Contribution Author Contributions StatementY.Z. and L.G. conceptualized and designed the study. Y.Z. conducted data collection, performed statistical analysis, and built the structural equation model. J.D. assisted in data collection, literature review, and preliminary data organization. Y.Z. drafted the initial manuscript. L.G. and J.D. contributed to manuscript revision, editing, and critical review. All authors read and approved the final version of the manuscript. References Chen X, Wang J. Critical moments in life course and time reconstruction: A study based on elderly cancer patients and social work intervention [J]. Social. 2021;41(02):192–217. Wondm AS, Moges A T, Dagnew BS, Wondm AS, ,Moges AT, ,Dagnew BS et al. Polypharmacy and potentially inappropriate medicine use in older adults with cancer: a multicenter cross-sectional study in Northwest Ethiopia oncologic centers.[J]. J Pharm policy Pract 2024,17(1):2397797. 10.1080/20523211.2024.2397797 Xu Jialan Y, Hong W, Jun, et al. Meta-analysis of the incidence of potential inappropriate medication use in elderly cancer patients [J]. China Gen Pract. 2025;28(30):3815–22. Federica A, Mara M, ,Chiara D et al. 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Mediating effect of disease perception and cognitive emotion regulation on social restriction and cancer recurrence fear in hematopoietic stem cell transplantation patients [J]. J Nurs. 2023;38(22):10–4. Han Xiaoxuan X, Cuiping Z, Chao, et al. Research progress on the impact of peer support on cancer patients' fear of recurrence [J]. J Nurs. 2023;38(23):116–20. Shen Zhiying S, Shuangjiao R, Chunhong, et al. A network meta-analysis of the effects of different psychological interventions on fear of cancer recurrence [J]. China Mental Health J. 2025;39(09):765–72. Yang Xueqing C, Yahong W, Jie, et al. A review of the scope of personalized digital health intervention programs for elderly cancer patients [J]. Military Nurs. 2024;41(09):17–20. Yue Hanlin Q, Tingting S, Di, et al. Study on the frailty status of elderly cancer patients and its relationship with health-related quality of life [J]. China Prev Med J. 2024;25(09):1124–9. Broadbent E, Petrie K J,Main J, Broadbent E,Petrie KJ, Main J et al. The Brief Illness Perception Questionnaire[J].J Psychosom Res,2006,60(6):631–710.1016/j.jpsychores.2005.10.020 Mehnert A, Herschbach P, Berg P et al. Progredienzangst bei Brustkrebspatientinnen–Validierung der Kurzform des Progredienzangstfragebogens PA-F-KF [Fear of progression in breast cancer patients–validation of the short form of the Fear of Progression Questionnaire (FoP-Q-SF)]. Z Psychosom Med Psychother 2006,52(3):274–88. 10.13109/zptm.2006.52.3.274 Wu Qiyun Y, Zhixia L, Li, et al. Chinese localization and reliability/validity analysis of the Simplified Scale for Cancer Patients' Fear of Disease Progression. Chin J Nurs. 2015;50(12):1515–9. 10.3761/j.issn.0254-1769.2015.12.021 . Wang CK, Hu HF, Liu L. A study on the reliability and validity of the General Self-Efficacy Scale. Appl Psychol. 2001;7(1):37–40. 10.3969/j.issn.1006-6020.2001.01.007 . Zimet GD, Powell SS, Farley GK, Zimet GD, Powell SS, Farley GK, et al. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990;55(3–4):610–7. 10.1080/00223891.1990.9674095 . Xiong Hongxing Z, Jing Y, Baojuan, et al. Model analysis of the influence of common method variance and its statistical control approaches [J]. Adv Psychol Sci. 2012;20(5):757–69. Parajuli J, Chen ZJ, Walsh A, Williams GR, Sun V, Bakitas M. Knowledge, beliefs, and misconceptions about palliative care among older adults with cancer. J Geriatr Oncol. 2023;14(1):101378. 10.1016/j.jgo.2022.09.007 . Zhang Lili F, Dou W, Xinmei, et al. Application of writing expression of positive emotions intervention in protective care for elderly cancer patients [J]. J Nurs. 2023;38(06):104–7. Zhang Xingke T, Yingxuan S, Li. Application progress of comprehensive geriatric assessment in pain management of elderly cancer patients [J]. Mod Oncol Med. 2021;29(03):528–30. Feng Yujia S, Mingzhu L, Yanxiu, et al. Systematic review of qualitative research on treatment decision-making in elderly cancer patients [J]. Med Soc. 2023;36(12):47–52. Huang Lujiao D, Bo Z, Xue, et al. Relationship between the elderly nutritional risk index and hospitalization duration in elderly cancer and non-cancer patients [J]. Mod Prev Med. 2022;49(23):4283–7. Chen, Feifei, Pang Yonghui. Research progress on frailty in elderly cancer patients [J]. Contemp Nurse (Late Edition). 2022;29(04):51–5. Yingtang M, Ge W, Meimei S, et al. Study on the influencing factors of frailty level in elderly cancer patients based on latent profile analysis [J]. Chin J Cancer Prev Treat. 2024;31(20):1252–8. Wang Suxing Z, Enming D, Zhengyue, et al. Research progress on the needs of supportive care for elderly cancer patients [J]. China Nurs Manage. 2022;22(09):1421–4. Li Siyu Z, Kaili X, Chao, et al. Study on the potential categories and influencing factors of intrinsic capacity in elderly cancer chemotherapy patients [J]. China Nurs Manage. 2025;25(02):219–25. He Xiaoyu Z, Ziqing Y, Dan, et al. Meta-analysis of qualitative research on informed consent preferences among elderly cancer patients [J]. Military Nurs. 2024;41(03):96–100. PRESLEY JC, GOMES F, BURD E C, et al. Immunotherapy in elderly cancer patients [J]. China Lung Cancer J. 2021;24(10):743–54. Zimmermann C, Swami N, Krzyzanowska M, Leighl N, Rydall A, Rodin G, Tannock I, Hannon B. Perceptions of palliative care among patients with advanced cancer and their caregivers. CMAJ. 2016;188(10):E217–27. 10.1503/cmaj.151171 . O’Keefe K, Chen M, Lesser JK, O’Keefe K, Chen M, Lesser JK, et al. Treating Mental Health and Quality of Life in Older Cancer Patients with Cognitive Behavioral Therapy: A Systematic Review and Meta-Analysis[J]. Int J Environ Res Public Health. 2024;21(7):881–881. 10.3390/ijerph21070881 . Springer F, Matsuoka A, Obama K, et al. Identifying central dimensions of quality of lifeincluding life-related values, preferences and functional health in older patients with cancer:a scoping review protocol[J]. Front Psychol. 2024;151455825–1455825. 10.3389/fpsyg.2024.1455825 . Additional Declarations No competing interests reported. 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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-8650332","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582311754,"identity":"47c60126-dd5f-46b8-a4db-a12ecbcd84f0","order_by":0,"name":"Yi Zhang","email":"","orcid":"","institution":"Guangxi University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Zhang","suffix":""},{"id":582311755,"identity":"3ad59883-a1ca-43dc-bf42-b4c91ebec23a","order_by":1,"name":"jingxuan Duan","email":"","orcid":"","institution":"Guangxi University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"jingxuan","middleName":"","lastName":"Duan","suffix":""},{"id":582311763,"identity":"bbde302f-0717-4b1b-a65c-5f1d8f3d8081","order_by":2,"name":"Lei Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYHACxgMMBjZAOrkBSDATpweoJQ1IJZKkheEwCVrk3Q8fOPCh4Lw9A3timwRDhXViA/vZA3i1GJ5JSzg4w+B2YgPPQ6CWM+lARl4Cfi0NOQaHeQxuJzBIAG1hbDuc2CDBY4BfS/8bg8N/DM7ZQ7T8I0KLvATQFgaDA4wNYC0NRGgxkHiWcLDHIDmxjedhs0XCsXTjNp4cArb0Jx988OOPnT0/e/LBGx9qrGX72c8QsOUAlMEGIhJgDLy2NBBSMQpGwSgYBaMAANnKRYaTFjCxAAAAAElFTkSuQmCC","orcid":"","institution":"鹰潭卫生职业技术学院","correspondingAuthor":true,"prefix":"","firstName":"Lei","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2026-01-20 14:55:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8650332/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8650332/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101632955,"identity":"58b8c8c5-0561-45d0-b1ac-8b8a699e87a3","added_by":"auto","created_at":"2026-02-02 05:56:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":87244,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eChain Mediation Effect Model Diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8650332/v1/a97ef775f2aa7b9a78e53407.png"},{"id":101632962,"identity":"3d8f9f20-f919-4100-8e57-108407513789","added_by":"auto","created_at":"2026-02-02 05:56:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1417544,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8650332/v1/5b2b78d6-9a75-41c9-ae43-9a83dd36dea5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Illness Perception and Fear of Cancer Recurrence in Elderly Cance r Patients: The Chain Mediating Role of Self-Efficacy and Social S upport","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe incidence of cancer among the elderly population is increasing due tofactors such as accelerated population aging and advancements in medical diagnostic technologies, positioning cancer as a significant threat to the health andwell-being of older adults[1].Beyond the challenges of tumor treatment, elderly cancer patients encounter numerous medication-related issues and the potential for inappropriate drug use, which contribute to substantial physical and psychological burdens[2-3].Their requirements for disease management and psychologicaladjustment are also multifaceted. Although improvements in diagnostic and therapeutic methods have enhanced patient survival rates, fear of cancer recurrence(FCR) has emerged as the most prominent negative emotional experience during the rehabilitation period for elderly patients. FCR is characterized bypersistent and intrusive concerns about cancer recurrence or metastasis, which can diminish treatment adherence and disrupt interpersonal relationships, thereby impairing quality of life[4]. It may even indirectly reduce survival by influencing stress responses and health behaviors[5]. Consequently, identifying the factors influencing FCR and its mechanisms is essential for developing effective intervention strategies[6]. illness perception is a critical variable in cognitive behavioral theory, encompassing an individual\u0026apos;s cognitive representations, emotional experiences, and attribution patterns regarding a disease[7].According to the Leventhalself-regulation model, negative illness perception heightens the riskof negative emotions in cancer patients[8].Older adults, due to physiological decline, cognitive impairment, and comorbidities, are more susceptible to developing negative illness perceptions, thereby exacerbating their Functional Capacity for Recovery (FCR). However, the strength of the association and the underlying causalpathways between these factors remain unknown. Self-efficacy and social support arepivotal factors influencing FCR. Forms of social support, such as peer support,can mitigate FCR by enhancing psychological resilience[9-10],while patients with high self-efficacy are more likely to actively seek and utilize social support.It is posited that illness perception may influence FCR by affecting self-efficacy,thereby impacting patients\u0026apos; ability to obtain social support[11-12].However, this causal mechanism has not been validated in older adult cancer patients. Thisstudy aimed to explore the association between illness perception and FCR in elderly cancer patients, verify the chain-mediated effects of self-efficacy and socialsupport, elucidate the intrinsic mechanism of \u0026quot;diseaseperception \u0026rarr; self-efficacy \u0026rarr; social support \u0026rarr; FCR,\u0026quot; and provide practical referencesfor developingtargeted, multidimensional psychological intervention strategies for elderly cancer patients.\u003c/p\u003e"},{"header":"1. Subjects and Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Participants and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConvenience sampling was utilized, and the study was conducted from January 2025 to August 2025 within the oncology departments of three tertiary Grade A general hospitals in a specified region. The mean age of the 286 valid participants was 72.4\u0026plusmn;7.7 years.The study was conducted in accordance with the Declaration of Helsinki and received approval from the Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine ethics committee (approval no. KY2025-159).\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eInclusion criteria included:\u0026nbsp;①Age\u0026nbsp;\u0026ge;60 years;\u0026nbsp;②Pathologically confirmed malignant tumor;\u0026nbsp;③\u0026ge;6 months post-completion of initial treatment, with physician-confirmed risk of cancer recurrence;\u0026nbsp;④Clear consciousness and normal communication ability;\u0026nbsp;⑤Voluntary participation in the study, with signed written informed consent and an understanding of the study objectives and data confidentiality principles.\u003c/li\u003e\n \u003cli\u003eExclusion criteria were:\u0026nbsp;①Patients with a life expectancy of less than3 months;\u0026nbsp;②Patients with severe cognitive impairment or psychiatric disorders;③Patients with severe functional impairments in organs such as the heart, brain, or kidneys;\u0026nbsp;④Other patients unable to cooperate with the investigation.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent prior to enrollment. Participants were fully informed of the study\u0026rsquo;s purpose, procedures, potential risks, and confidentiality protections, and they had the right to withdraw from the study at any time without negative consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003enot applicable.\u003c/p\u003e\n\u003cp\u003eSample size estimation was based on the requirements of the chain mediation model andstructural equation modeling (\u0026ge;200 cases), accounting for a 20% invalidity rate,resulting in a minimum required sample size of 200\u0026times;1.2=240. This study involved four core variables, with the model incorporating three mediationpaths. A total of 280 cases were planned for inclusion; however, 310 questionnaires weredistributed, and 286 valid responses were collected, achieving an effective response rate of 92.26%, which satisfied the model-fitting requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1 Survey Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.1 General Information Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ehe general information questionnaire was designed by the researcher after reviewing the relevant literature and considering the objectives of this study. It included demographic and disease-related data, such as the patient\u0026apos;s sex, age, educational level, marital status, tumor type, disease duration, treatment modality,and income.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.2 Brief Illness Perception Questionnaire (BIPQ)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Broadbent et al., this instrument evaluates patients \u0026apos;cognitiverepresentations, emotional representations, and cognitive understanding of the disease. This study employed the 2015 Chinese version of the questionnaire[13],comprising three dimensions: cognition (5 items), emotion (2 items), and understanding (1 item), totaling 9 items. The first eight items were scored on a 0\u0026ndash;10scale, while the 9th item was an open-ended question requiring patients to list three significant factors contributing to the disease, which was not included in the total score. Items 3, 4, and 7 were reverse scored, with total scores ranging from 0 to 80. Higher scores indicate more severe negative perceptions of thedisease. The Cronbach\u0026apos;s\u0026nbsp;\u0026alpha;\u0026nbsp;coefficient for this questionnaire was 0.770, and in this study, it was 0.854.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.3 Fear of Progression Questionnaire-Simplified Form (FOP-Q-SF)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Mehnert[14]and localized by Wu et al.[15],this scale assesses patients \u0026apos;fear of disease recurrence, progression, and severe consequences in chronic diseases and malignancies. Comprising 12 items divided into two dimensions\u0026mdash;physiological health (six items) and social/family (six items)\u0026mdash;it employs a 5-point Likert scale (1\u0026ndash;5), with a total score range of 12\u0026ndash;60. Higher scores indicate greater fear of disease progression, with \u0026lt;34 points denoting functional fear of disease progression and\u0026nbsp;\u0026ge;34 points denoting dysfunctional fear of disease progression. The Cronbach\u0026apos;s\u0026nbsp;\u0026alpha;\u0026nbsp;coefficient in this study was 0.834.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.4 General Self-Efficacy Scale (GSES)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Schwarzer and localized into Chinese by Wang Cai-kang et al.[16],this 10-item Likert 4-point scale (1-4) measures self-efficacy across various environmental challenges. The total score ranges from 10 to 40, with higherscores indicating greater self-efficacy. The Cronbach\u0026apos;s\u0026nbsp;\u0026alpha;\u0026nbsp;coefficient in this study was 0.920.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1.5 Perceived Social Support Scale (PSSS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Zimet et al.[17]and localized into Chinese by Jiang Qianjin, this 12-item Likert scale (1-7) measures perceived support from family (fouritems), friends (four items), and other social relationships (four items). As a key stress-buffering mechanism, this study investigates whether \u0026quot;perceived social support\u0026quot; can alleviate patients \u0026apos;fear. The 12-item scale yields a total score of 12-84, with higher scores indicating greater social support. The Cronbach\u0026apos;s\u0026nbsp;\u0026alpha;\u0026nbsp;coefficient in this study was 0.919.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.2 Data Collection Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients in the recovery phase who meet the inclusion criteria will be screened through the hospital\u0026apos;s oncology follow-up system. After the telephone appointment, trained researchers conducted one-on-one questionnaire surveys either at the hospital\u0026apos;s rehabilitation clinic or at the patient\u0026apos;s home. Patients will be informed of the study objectives, procedures, and confidentiality principles, and an informed consent form will be signed before the questionnaire is distributed.For patients with poor vision or writing difficulties, the investigators read the items aloud individually, filled in the responses based on the patients\u0026apos; actual answers, and verified the responses by reciting them aloud. Questionnaires were collected on-site to ensure completeness and the absence of logical errors. Ineligible questionnaires were supplemented or excluded immediately.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.3 Quality Control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter finalizing the research protocol, the investigator conducted centralizedtraining for the research team members, covering survey methodologies, tool utilization, communication techniques, and invalid questionnaire identification criteria. Following obtaining informed consent from the patients, the investigator administered the scale or questionnaire on-site, with self-completion being the primary approach. For patients experiencing difficulties, the investigator assisted incompleting the form, followed by verbal verification to ensure accuracy. Thescale or questionnaire was collected immediately, and the data were entered after double-checking by two individuals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.4 Statistical Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis and structural equation modeling were performed using SPSS (version 26.0) and AMOS (version 24.0). Categorical data are described as frequencies and composition ratios. Quantitative data that followed a normal distribution are described as means\u0026plusmn;standard deviations (x\u0026plusmn;s), while those thatdidnot follow a normal distribution are described as medians (interquartiles) [M (P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e)].Correlation analysis: Pearson\u0026rsquo;s correlation was used for quantitativedata that followed a normal distribution, and Spearman\u0026rsquo;s correlation was used for those that did not. The structural equation model fit criteria were referenced in[18]: \u0026chi;\u0026sup2;/df \u0026lt;3 indicates good fit, GFI, AGFI, CFI, IFI, and NFI \u0026ge; 0.90 indicate good fit, and RMSEA \u0026lt;0.08 indicates acceptable fit (\u0026lt;0.05 indicates good fit).\u003c/p\u003e"},{"header":"2 Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 General Data of Elderly Cancer Patients\u003c/h2\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBasic characteristics of elderly cancer patients (N\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003cp\u003e(n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e72.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u0026ndash;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDegree of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ejunior middle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried (divorced/widowed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonthly per capita household income (yuan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e4120\u0026thinsp;\u0026plusmn;\u0026thinsp;1580\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3000ཞ5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTypes of cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecarcinoma of the lungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003egastric cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecancer of the liver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emammary cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecolorectal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTherapeutic Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eoperative treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003echemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eradiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecomplex treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Common Method Bias Test\u003c/h2\u003e\n \u003cp\u003eHarman\u0026apos;s single-factor test was employed to examine the common methodbias. The results indicated that there were four factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1, and the first factor accounted for 32.41% of the variance, which was below the critical value of 40%[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. This suggests that no common method bias was present in this study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Descriptive Statistics and Correlation Analysis of Variables\u003c/h2\u003e\n \u003cp\u003ePearson correlation analysis results (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) demonstrated that illness perception was significantly positively correlated with fear of cancer recurrence (r\u0026thinsp;=\u0026thinsp;0.62), with stronger negative perception correlating to more pronounced recurrence fear. Both self-efficacy and social support showed significant negative correlations with illness perception and fear of cancer recurrence, while self-efficacy and social support exhibited significant positive correlations, indicating thatpatients with high self-efficacy were more adept at accessing and utilizing socialsupport resources. Details are presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation Analysis of illness perception, Cancer Recurrence Fear, Self-Efficacy, and Social Support in Elderly Cancer Patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eillness perception\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFear of cancer recurrence\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSelf efficacy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eillness perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.26\u0026thinsp;\u0026plusmn;\u0026thinsp;10.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFear of cancer recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.47**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.47**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.32\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.52**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.52**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cstrong\u003eNote: P\u0026thinsp;\u0026lt;\u0026thinsp;0.01**\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 Univariate Analysis of Factors Influencing Fear Scores of Cancer Recurrence in Elderly Cancer Patients\u003c/h2\u003e\n \u003cp\u003eWith the fear of cancer recurrence (FCR) score as the dependent variable, univariate analyses were separately conducted for demographic variables (gender,age, educational level, marital status, monthly household income, disease duration, treatment modality) and core variables (illness perception, self-efficacy, social support) to examine their effects on FCR. The independent-samples t-test (for dichotomous variables) or one-way analysis of variance (ANOVA, for polytomous variables) was applied, with the test level set at \u0026alpha;\u0026thinsp;=\u0026thinsp;0.10. The results showed that educational level (F\u0026thinsp;=\u0026thinsp;5.832, P\u0026thinsp;=\u0026thinsp;0.003), marital status (t\u0026thinsp;=\u0026thinsp;3.965, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), disease duration (F\u0026thinsp;=\u0026thinsp;6.328, P\u0026thinsp;=\u0026thinsp;0.002), and monthly per capita household income (F\u0026thinsp;=\u0026thinsp;4.751, P\u0026thinsp;=\u0026thinsp;0.009) were identified as influencing factors for FCR. Among these, a higher educational level, longer disease duration, and higher monthly per capita household income were associated with lower FCR scores in patients;married patients had significantly lower FCR scores than non-married patients. No statistically significant effects on FCR were found for gender, age, cancer type, or treatment modality (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Details are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eUnivariate analysis of cancer recurrence fear in elderly cancer patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInfluencing factor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFCR Score\u003c/p\u003e\n \u003cp\u003e(x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/F-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.57\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026thinsp;~\u0026thinsp;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.51\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u0026thinsp;~\u0026thinsp;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDegree of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.38\u0026thinsp;\u0026plusmn;\u0026thinsp;8.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;5.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ejunior middle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.75\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.26\u0026thinsp;\u0026plusmn;\u0026thinsp;7.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;3.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried (divorced/widowed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.51\u0026thinsp;\u0026plusmn;\u0026thinsp;9.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTumor type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecarcinoma of the lungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.12\u0026thinsp;\u0026plusmn;\u0026thinsp;8.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003egastric cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecancer of the liver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.28\u0026thinsp;\u0026plusmn;\u0026thinsp;9.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emammary cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecolorectal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.47\u0026thinsp;\u0026plusmn;\u0026thinsp;8.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.56\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;6.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonthly per capita household income (yuan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.89\u0026thinsp;\u0026plusmn;\u0026thinsp;8.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3000ཞ5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.35\u0026thinsp;\u0026plusmn;\u0026thinsp;8.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.62\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTherapy method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eoperative treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadiotherapy treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.21\u0026thinsp;\u0026plusmn;\u0026thinsp;9.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecomplex treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5 Linear Regression Analysis of Factors Influencing Fear of Cancer Recurrence in Elderly Cancer Patients\u003c/h2\u003e\n \u003cp\u003eWith the score of fear of cancer recurrence (FCR) as the dependent variable, variables with a P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.10 in univariate analysis were included in the multiple linear regression model. Stepwise regression was adopted, where the total FCR score served as the dependent variable, and the independent variables included educational level (coded as:1\u0026thinsp;=\u0026thinsp;primary school or below, 2\u0026thinsp;=\u0026thinsp;junior high school, 3\u0026thinsp;=\u0026thinsp;senior high school or above), marital status (coded as:0\u0026thinsp;=\u0026thinsp;married,1\u0026thinsp;=\u0026thinsp;unmarried/divorced/widowed), disease duration (coded as:1\u0026thinsp;=\u0026thinsp;\u0026le;\u0026thinsp;1 year,2\u0026thinsp;=\u0026thinsp;1\u0026ndash;3 years,3\u0026thinsp;=\u0026thinsp;\u0026ge;\u0026thinsp;3 years), monthly per capita income, total score of illness perception, total score of self-efficacy, and total score of social support. Model fit was evaluated by the coefficient of determination (R\u0026sup2;) and adjusted R\u0026sup2;, and multicollinearity was diagnosed using the variance inflation factor (VIF), with a critical value of VIF\u0026thinsp;\u0026lt;\u0026thinsp;10 for the absence of severe multicollinearity. The results showed that the regression equation was statistically significant (F\u0026thinsp;=\u0026thinsp;28.653, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and the overall explanatory power of the model was R\u0026sup2;=0.623, indicating that the included variables collectively explained 62.3% of the variance in FCR among the study population. Among these variables, illness perception, self-efficacy, social support, educational level, marital status and disease duration were identified asindependent influencing factors for FCR (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Details are presented in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLinear regression analysis of factors influencing cancer recurrence fear in elderly cancer patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB(SE)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant term\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.37(3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[18.99, 31.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIllness perception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31(0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.21, 0.41]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.25(0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[-0.36, -0.14]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.19(0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.816\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[-0.28, -0.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDegree of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.52(0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[-2.45, -0.59]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.86(0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[1.42, 4.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCourse of disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.29(0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[-2.11, -0.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cstrong\u003eNote:R\u0026sup2;=0.612, F\u0026thinsp;=\u0026thinsp;28.65, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e2.6 Mediating Effect Analysis of illness perception and Cancer Recurrence Fear on Self-Efficacy and Social Support\u003c/h2\u003e\n \u003cp\u003eUsing illness perception as the independent variable (X) and fear of cancer recurrence as the dependent variable (Y), with self-efficacy (M1) and social support (M2) as mediating variables, the chain mediation effect was tested usingAMOS 24.0 and Bootstrap sampling (10,000 times), and the structural equationmodel was used to verify the fit.\u003c/p\u003e\n \u003cp\u003eThe model was fitted using the maximum likelihood method, and the comprehensive indicator model demonstrated good fit (\u0026chi;2/df\u0026thinsp;=\u0026thinsp;2.370 (\u0026lt;\u0026thinsp;3), NFI\u0026thinsp;=\u0026thinsp;0.890,IFI\u0026thinsp;=\u0026thinsp;0.930, GFI\u0026thinsp;=\u0026thinsp;0.890, CFI\u0026thinsp;=\u0026thinsp;0.972, RFI\u0026thinsp;=\u0026thinsp;0.926, TLI\u0026thinsp;=\u0026thinsp;0.917 (all \u0026ge;\u0026thinsp;0.90), RMSEA\u0026thinsp;=\u0026thinsp;0.076 (\u0026lt;\u0026thinsp;0.08)). Only NFI\u0026thinsp;=\u0026thinsp;0.890 and GFI\u0026thinsp;=\u0026thinsp;0.890 were slightly below 0.90, indicating an acceptable overall model fit. The path relationship test results showed that with illness perception as the predictor and self-efficacy as the outcome,illness perception negatively predicted self-efficacy (\u0026beta;=-0.483, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When illness perception and self-efficacy were the predictors and social support was theoutcome, illness perception did not directly predict social support (\u0026beta;\u0026thinsp;=\u0026thinsp;0.003,P\u0026thinsp;=\u0026thinsp;0.876); however, self-efficacy positively predicted social support (\u0026beta;\u0026thinsp;=\u0026thinsp;0.461, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). With illness perception, self-efficacy, and social support as predictors and fear of cancer recurrence as the outcome, illness perception positively predicted fear of cancer recurrence (\u0026beta;\u0026thinsp;=\u0026thinsp;0.399, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), self-efficacy negatively predicted fear of cancer recurrence (\u0026beta;=-0.265, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and social support negatively predicted fear of cancer recurrence (\u0026beta;=-0.372, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates that self-efficacy and social support play a chain-mediation role between illness perception and fear of cancer recurrence. Details are presented in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eA bootstrap analysis with 10,000 resamples was employed to calculate 95% confidence intervals(CIs). The results indicated that the direct effect (from illness perception to fear of cancer recurrence) was 0.399 (95%CI: 0.306\u0026ndash;0.492),accounting for 65.41% of the total effect. The first independent indirect pathway (illness perception\u0026rarr;self-efficacy\u0026rarr;fear of cancer recurrence) was 0.128 (95% CI:0.078\u0026ndash;0.182), contributing 20.98% to the total effect. The second independent indirect pathway (illness perception\u0026rarr;social support\u0026rarr;fear of cancer recurrence)was non-significant (effect\u0026thinsp;=\u0026thinsp;0.000, 95%CI:-0.021\u0026ndash;0.021), accounting for 0.00%. The chain-mediated pathway (illness perception\u0026rarr;self-efficacy\u0026rarr;social support\u0026rarr;fear of cancer recurrence) was 0.083 (95%CI:0.043\u0026ndash;0.126), explaining 13.61% of the total effect. The total indirect effect was 0.211 (95%CI:0.149\u0026ndash;0.275),which represented 34.59% of the total effect. These mediation analysis results are presented in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of Mediation Effect Testing for illness perception and Cancer Recurrence Fear in Self-Efficacy and Social Support\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePath\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard error\u003c/p\u003e\n \u003cp\u003e(SE)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBootstrap95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect size\u003c/p\u003e\n \u003cp\u003e(\u0026beta;)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMediation proportion (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisease awareness \u0026rarr; fear of cancer recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.306\u0026ndash;0.492]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndirect effect (single)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eillness perception \u0026rarr; self-efficacy \u0026rarr; fear of cancer recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.078\u0026ndash;0.182]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndirect effect (single)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eillness perception \u0026rarr; socialsupport \u0026rarr; fear of cancer recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[-0.021-0.021]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndirect effect (chain)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eillness perception \u0026rarr; self-efficacy \u0026rarr; social support \u0026rarr; fear of cancer recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.043\u0026ndash;0.126]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal indirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.149, 0.275]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.536\u0026ndash;0.684]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003e\u003cstrong\u003e3.1 Relationship between illness perception and cancer recurrence fear in elderly cancer patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the mean score of the FOP-Q-SF among older adult patientswith cancer was 38.64\u0026plusmn;8.72, with 199 patients (69.6%) scoring\u0026nbsp;\u0026ge;34 points, indicating that nearly 70% of older adult patients with cancer in the rehabilitation phase exhibited dysfunctional fear of recurrence, consistent with previous research findings and more pronounced in this population. Correlation analysis revealed a significant positive correlation between illness perception and fear of cancer recurrence (r=0.62, P\u0026lt;0.001). Regression analysis identified a regression coefficient of 0.312 (P\u0026lt;0.001) for illness perception, with a direct effect value of 0.399, accounting for 65.41% of the total effect, which closely aligns with Leventhal\u0026apos;s self-regulation model.The mean score of the BIPQ in this study was 45.26\u0026plusmn;10.38, suggesting that older adult patients generally exhibited a moderately elevated negative illness perception. Due to physiological decline, older adult patients often have multiple underlying conditions and cognitive impairment, making them more prone to developing a negative illness perception of cancer as uncontrollable and having a poor prognosis[19].This cognitive bias leadspatients to become overly sensitive to subtle bodily changes, reinforcing thenegative expectation that \u0026quot;recurrence is a disaster,\u0026quot; resulting in persistent intrusive worry, which ultimately exacerbates dysfunctional recurrence fear and affectstreatment adherence and quality of life[20-21].Conversely, a positive diseaseperception enables patients to rationally address the risk of disease recurrence and reduce unnecessary anxiety. Therefore, clinicians should pay attention to theillness perception status of older adult patients and promptly intervene to correct negative cognitive biases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Mediating Role of Self-Efficacy in Cancer Recurrence Fear\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study demonstrates that self-efficacy independently mediates the relationship between illness perception and fear of cancer recurrence, with a mediation effect size of 0.128, accounting for 20.98% of the total effect. Correlation analysis revealed a significant negative correlation between self-efficacy and illness perception (r=-0.47, P\u0026lt;0.001) and a significant negative correlation with fear of cancer recurrence (r=-0.47, P\u0026lt;0.001), with a regression coefficient of-0.245 (P\u0026lt;0.001). These findings indicate that self-efficacy serves as a crucial intrinsic buffer for alleviating fear of recurrence. According to Bandura\u0026apos;s social learning theory, self-efficacy stems from an individual\u0026apos;s cognitive assessment of their abilities. Negative illness perception can diminish patients \u0026apos;judgment of their disease coping capacity, thereby weakening their confidence in addressing disease challenges[22].The mean GSES score in this study was 22.58\u0026plusmn;6.43, indicating that older adult patients exhibited moderate self-efficacy. Patients with lowself-efficacy lack proactive coping abilities and are prone to feelings of helplessness when facing disease-related stimuli, which amplifies the fear of recurrence[22].Conversely, a positive illness perception can enhance patients\u0026apos; self-efficacy. Patients with high self-efficacy are more likely to adopt proactive coping behaviors, such as adhering to medical advice and actively acquiring health knowledge, effectively reducing their perceived risk of recurrence. These results suggest that clinical interventions, such as disease knowledge training, sharing ofsuccessful cases, and recognition of phased achievements, can be employed to improve the self-efficacy of elderly patients, thereby providing intrinsic motivation for alleviating fear[23-25].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Mediating Role of Social Support in Cancer Recurrence Fear\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the independent mediating effect of social support was not significant (effect size 0.000,95% CI: -0.021 to 0.021), whereas the chain mediating effect of illness perception\u0026rarr;self-efficacy\u0026rarr;social support\u0026rarr;fear of cancer recurrence was significant, with an effect size of 0.083, accounting for 13.61% of the total effect. This indicates that social support, as an important external psychological resource, exerts its buffering effect on FCR not directly but through self-efficacy as a mediating factor. Patients must first possess a certain level of self-efficacy to effectively acquire and utilize external social support.In thisstudy, the mean PSSS score was 56.32\u0026nbsp;\u0026plusmn;\u0026nbsp;11.25, suggesting that elderlypatientshad moderate levels of social support. There was a significant positivecorrelation between self-efficacy and social support (r = 0.45, P \u0026lt;0.001), indicating thatself-efficacy is a prerequisite for patients to acquire and utilize social support. Negative illness perception reduces patients \u0026apos;self-efficacy, diminishing their confidence and ability to actively seek support. Even with external support resources, they may struggle to utilize them effectively, leading to low levels of social support[26]. Low social support exacerbates patients\u0026apos; feelings of loneliness and helplessness, further amplifying the fear of recurrence under disease stress[26,19]. Conversely, patients with high self-efficacy are more willing to proactivelyestablish support networks and obtain support from family, friends, medical teams, and other sources. This support can alleviate stress caused by the disease, enhance confidence in combating recurrence, and thereby reduce fear[28]. This finding reveals the indirect mechanism by which social support affects relapse fear and provides a new entry point for clinical intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Impact of Demographic Characteristics on Fear of Cancer Recurrence and Implications for Comprehensive Intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate and multivariate linear regression analyses revealed that educational level, marital status, and disease duration were independent predictors of fear of cancer recurrence (P\u0026lt;0.05). Higher educational attainment (regression coefficient=-1.523) and longer disease duration (regression coefficient=-1.287) were associated with lower levels of recurrence fear. Married patients exhibited significantly lower recurrence fear than unmarried, divorced, or widowed patients (regression coefficient=2.864). Mechanistically, patients with higher educational attainment are more likely to access disease-related knowledge through multiple channels and possess stronger information interpretation skills, enabling them to rationally assess the risk of cancer recurrence[27]. Patients with a longer disease duration gradually develop a stronger sense of disease control through prolonged rehabilitation adaptation, thereby reducing excessive concerns about recurrence[28]. Married patients can receive continuous emotional support and care from their spouses, alleviating loneliness and consequently mitigating the fear of recurrence[29]. These demographic characteristics suggest that clinical interventions should emphasize individualized differences, with specialized interventionplans tailored for older adult patients with low educational attainment, unmarried status, divorce, widowhood, or short disease duration[30-31].\u003c/p\u003e\n\u003cp\u003eThe analysis revealed three pathways through which illness perception influences fear of cancer recurrence: a direct pathway, a self-efficacy-mediated pathway, and a self-efficacy \u0026rarr; social support chain-mediated pathway. The total mediation effect accounted for 34.59%, with the model explaining 62.3% of the variance. This multi-factor mechanism demonstrates that fear of recurrence inolder adult cancer patients arises from the combined effects of cognitive, psychological, and social factors, necessitating multidimensional clinical interventions[32].\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThis study provides a theoretical basis and practical guidance for the development of clinical psychological intervention strategies for older adult cancer patients, suggesting that comprehensive interventions should be implemented beyond routine medical care. These include health education to correct patients \u0026apos;negative illness perceptions and establish a scientific understanding of cancer, skill training to enhance patients\u0026apos; self-efficacy, and the establishment of social support networks, with particular attention to the support needs of single patients. Individual differences should be considered, with focused interventions for patients with lower educational levels and shorter disease durations, thereby reducing their fear of recurrence and improving their quality of life. The study has certain limitations, such as convenience sampling affecting sample representativeness and the cross-sectional design failing to explore long-term causal relationships between variables or the long-term effects of the interventions. Future research should expand the sample size and conduct multicenter longitudinal studies to investigate the long-term effects of interventions and analyze the moderating role of demographic characteristics to provide support for the development of precise individualized intervention plans.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis study was supported by the 2024 Funded Research Project of the Chinese Nursing Association (Grant No.: ZHKYQ202406).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAuthor Contributions StatementY.Z. and L.G. conceptualized and designed the study. Y.Z. conducted data collection, performed statistical analysis, and built the structural equation model. J.D. assisted in data collection, literature review, and preliminary data organization. Y.Z. drafted the initial manuscript. L.G. and J.D. contributed to manuscript revision, editing, and critical review. All authors read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen X, Wang J. Critical moments in life course and time reconstruction: A study based on elderly cancer patients and social work intervention [J]. Social. 2021;41(02):192\u0026ndash;217.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWondm AS, Moges A T, Dagnew BS, Wondm AS, ,Moges AT, ,Dagnew BS et al. Polypharmacy and potentially inappropriate medicine use in older adults with cancer: a multicenter cross-sectional study in Northwest Ethiopia oncologic centers.[J]. 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Front Psychol. 2024;151455825\u0026ndash;1455825. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2024.1455825\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2024.1455825\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Geriatric oncology patients, Illness perception, Fear of cancer recurrence, Self-efficacy, Social support, Chain mediating effect","lastPublishedDoi":"10.21203/rs.3.rs-8650332/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8650332/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to investigate the relationship between illness perception and fear of cancer recurrence (FCR) in older adult cancer patients, as well as the mediating role of self-efficacy and social support in this association. The findings are intended to provide a theoretical foundation for developing targeted interventions to alleviate FCR in this demographic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 310 elderly cancer patients, admitted to the Oncology Department of three Grade A tertiary hospitals from January 2025 to August 2025,were selected through convenient sampling. The mean age of the 286 valid participants was 72.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7 years.Data were collected using the BriefIllness Perception Questionnaire, Fear of Cancer Recurrence Inventory, General Self-Efficacy Scale, and Social Support Rating Scale. Descriptive statistics, correlation analysis, and structural equation modeling were conducted usingSPSS 26.0 and AMOS 24.0 software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study revealed that illness perception has a direct positive effect on FCR (β\u0026thinsp;=\u0026thinsp;0.399, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Illness perception predicts FCR through two significant indirect pathways: the independent mediating effect of self-efficacy (β\u0026thinsp;=\u0026thinsp;0.128, 95% CI: 0.078\u0026thinsp;~\u0026thinsp;0.182) and the chain mediating path of self-efficacy \u0026rarr; social support (β\u0026thinsp;=\u0026thinsp;0.083, 95% CI: 0.043\u0026thinsp;~\u0026thinsp;0.126). The independent mediating path of social support was not statistically significant (β\u0026thinsp;=\u0026thinsp;0.000, 95% CI: -0.021\u0026thinsp;~\u0026thinsp;0.021).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings suggest that a more negative illness perception in older adult cancer patients is associated with higher levels of FCR. Self-efficacy and social support serve as chain mediators between illness perception and FCR. Clinically, addressing negative illness perceptions and enhancing self-efficacyand social support may effectively alleviate FCR and improve the mental health of older adult cancer patients.\u003c/p\u003e","manuscriptTitle":"Illness Perception and Fear of Cancer Recurrence in Elderly Cance r Patients: The Chain Mediating Role of Self-Efficacy and Social S upport","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 05:55:46","doi":"10.21203/rs.3.rs-8650332/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-11T07:08:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T17:48:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T14:12:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-29T08:51:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48048398857779386088052987204685895955","date":"2026-01-29T08:25:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152314700729599079250137811549354485675","date":"2026-01-28T19:41:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237222640621024291773592826058651499613","date":"2026-01-28T17:35:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T17:30:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-28T12:50:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-27T16:01:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-01-27T15:50:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bfdd8752-c8a4-4e2c-93eb-3ebdb4db7d6f","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T14:24:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 05:55:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8650332","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8650332","identity":"rs-8650332","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}