Social Support Linked to Lower Fear of Cancer Recurrence in Chinese Breast Cancer Study

Among 857 women treated for breast cancer in China, greater social support was associated with lower fear of cancer recurrence, partly through links with illness perception and maladaptive cognitive emotion-regulation strategies. The multicenter, cross-sectional study found that stronger support was associated with less threatening interpretations of illness and lower use of self-blame, rumination, catastrophizing and blaming others. These factors, in turn, were associated with greater fear that the cancer would return. The results are observational, so they do not show that social support caused fear to decline or that changing any of these factors would improve outcomes over time.

Researchers recruited women from four tertiary hospitals in Jilin and Shanxi provinces, China. Participants were within five years after surgery, and their mean age was 47.18 years, with a standard deviation of 9.86. The team assessed social support with the Social Support Rating Scale, illness perception with the Brief Illness Perception Questionnaire, and fear of cancer recurrence with the Fear of Cancer Recurrence Inventory–Short Form. Maladaptive cognitive emotion-regulation strategies were measured with a 16-item composite drawn from the Cognitive Emotion Regulation Questionnaire, covering self-blame, rumination, catastrophizing and other-blame. The investigators tested a chain mediation model using PROCESS Model 6 and 5,000 bias-corrected bootstrap samples, adjusting for age and relevant clinical covariates.

Fear of cancer recurrence was positively correlated with illness perception and maladaptive cognitive emotion-regulation strategies and negatively correlated with social support. Social support was also negatively related to both the illness-perception measure and the maladaptive-strategies composite. The mediation analysis estimated a total indirect effect of b = −0.153 for the combined pathways involving illness perception and maladaptive cognitive emotion regulation, representing 48.88% of the total effect in the model. The specific indirect effect through illness perception was b = −0.070, accounting for 22.36% of the total effect, while the pathway through maladaptive cognitive emotion-regulation strategies was b = −0.066, accounting for 21.09%. A sequential pathway through illness perception followed by maladaptive cognitive emotion regulation had a smaller estimate, b = −0.017, accounting for 5.43%. The reported 95% confidence intervals for all three pathways excluded zero.

The study offers a detailed statistical account of how social support, beliefs about illness and cognitive coping strategies were related to recurrence fear in the participating breast cancer population. Its findings are consistent with a proposed pathway in which stronger support accompanies less threatening illness perceptions and fewer maladaptive regulatory strategies, while all three measures relate to fear of recurrence. However, the investigators emphasized that the cross-sectional design limits interpretation to theory-informed associations: the study did not track changes over time or test interventions. The results therefore cannot establish temporal order or show that altering support, illness perceptions or cognitive emotion regulation would reduce fear. The sample was limited to women treated at four tertiary hospitals in two Chinese provinces, and the findings do not by themselves establish effects in other populations or settings.

Subject of Research: Associations among social support, illness perception, cognitive emotion regulation and fear of cancer recurrence in women treated for breast cancer

Article Title: Social support and fear of cancer recurrence in breast cancer patients: the mediating role of illness perception and maladaptive cognitive emotion regulation strategies

Article References: Yang, T., Mei, S., Zhu, Z., Zhang, Y., Ao, Y., Shi, J., Tong, L., Yang, J., & Ren, H. (2026). Social support and fear of cancer recurrence in breast cancer patients: the mediating role of illness perception and maladaptive cognitive emotion regulation strategies. BMC Psychology. https://doi.org/10.1186/s40359-026-05336-1

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05336-1

Keywords: breast cancer, fear of cancer recurrence, social support, illness perception, emotion regulation, catastrophizing, rumination, cross-sectional study, Chinese patients, survivorship, Social, support