Document Type : Scientific Research
Authors
1 Department of Psychology, Faculty of Education and Psychology, Azarbaijan Shahid Madani University, Tabriz,, Iran
2 Faculty of Education and Psychology, Azarbijan Shahid Madani University, Tabriz, Iran
3 Department of Psychology, Faculty of Education and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
Abstract
Objective: Cancer is recognized as a fundamental global health challenge, profoundly affecting patients' quality of life. Among the numerous psychological complications stemming from the lived experience of cancer, "fear of cancer recurrence" (FCR) is reported as one of the most prevalent and distressing symptoms, with approximately 62% of cancer survivors experiencing high levels of this anxiety. This persistent fear of disease return not only hinders the patient's reintegration into normal daily life but also lays the groundwork for deep cognitive vulnerabilities and psychological distress. According to the Self-Regulatory Executive Function (S-REF) model, the activation of the cognitive-attentional syndrome (including rumination and threat monitoring) fuels the persistence of these chronic worries. In this framework, strengthening protective psychological resources can play a crucial role in mitigating these symptoms. Self-compassion (facing suffering with kindness and non-judgment) and mindfulness (purposeful, non-judgmental attention to the present moment) are two key components of self-regulation that enhance an individual's cognitive coping capacity when facing illness. Furthermore, resilience, defined as the ability to restore psychological equilibrium, plays a critical adaptive and buffering role in this path. Despite numerous studies, no structural model has yet been designed to simultaneously evaluate self-compassion and mindfulness, mediated by resilience, on the fear of recurrence in cancer patients. Therefore, the present study aimed to conduct structural equation modeling of the fear of disease recurrence based on self-compassion and mindfulness, with the mediating role of resilience, in patients with cancer. Method: The present study employed a descriptive-correlational design using Structural Equation Modeling (SEM). The statistical population comprised all cancer patients who were members of the Pezhvak Cancer Support Charity Association in Tabriz during the years 2023–2024. Using the Cochran (Plout) formula, the minimum required sample size for the model was estimated at 66 participants; however, to increase statistical power and ensure the reliability of the modeling results, 150 patients were selected via purposive sampling. Data collection instruments consisted of four standard questionnaires with established psychometric properties: 1) the Fear of Cancer Recurrence Inventory–Short Form (FCRI-SF) with 12 items; 2) the Self-Compassion Scale–Short Form (SCS-SF) with 12 items; 3) the Freiburg Mindfulness Inventory–Short Form (FMI-SF) with 14 items; and 4) the Connor-Davidson Resilience Scale (CD-RISC-10) with 10 items. Following coordination with the association and obtaining written informed consent from the patients, the questionnaires were completed by the participants. Ethical principles, including data confidentiality and the right to voluntary withdrawal, were strictly observed. Descriptive and demographic data were analyzed using SPSS (version 24). Evaluation of the conceptual model fit and analysis of the structural relationships (direct and indirect paths) were conducted through the partial least squares (PLS) approach utilizing SmartPLS (version 3) software. Results: Descriptive findings revealed that the majority of participants were aged between 36 and 50 years (62.6%), and most were female (64.6%) and married (57.3%). The descriptive indicators of the variables, including means and standard deviations, are reported in Table 1. Pearson correlation matrix results indicated that self-compassion (r=-0.47), mindfulness (r=-0.48), and resilience (r=-0.49) had significant negative relationships with fear of disease recurrence (p<0.01). Evaluation of the measurement model fit indices (Cronbach’s alpha, rho, composite reliability, and AVE) showed acceptable values well above the standard threshold. Furthermore, the structural model demonstrated a good fit (SRMR=0.065, NFI=0.910). Path analysis findings revealed that self-compassion exerted a significant direct negative effect on fear of recurrence (β=-0.26, t=5.17, p<0.01). Similarly, mindfulness showed a significant direct negative effect on FCR (β=-0.60, t=17.47, p<0.01). In addition, mediation hypotheses were supported; self-compassion had an indirect negative effect on FCR through the mediating role of resilience (β=-0.20, t=3.45, p<0.01), and mindfulness similarly exerted an indirect negative effect on FCR via resilience (β=-0.15, t=4.87, p<0.01). Thus, resilience plays a significant mediating role in these structural pathways.Conclusion: This study aimed to explain the fear of disease recurrence in cancer patients based on self-compassion and mindfulness, with the mediating role of resilience. Structural equation modeling results demonstrated that self-compassion and mindfulness exert significant direct and indirect negative effects (mediated by resilience) on reducing FCR, aligning with prior research. In explaining the effect of self-compassion, this construct replaces self-criticism with a kind and accepting attitude, bolstering patients' cognitive capacity to cope with challenges and preventing them from becoming trapped in a vicious cycle of anxiety. Mindfulness, by training non-judgmental present-moment awareness, helps patients view thoughts of disease return merely as transient mental events rather than reflections of reality, thereby reducing pain catastrophizing. Furthermore, enhancing these two components strengthens resilience as a dynamic coping resource. Resilient patients exhibit greater psychological flexibility in the face of stressors and suffer less from cognitive-attentional distress, which subsequently mitigates FCR. Ultimately, this study was limited by its reliance on self-report instruments and a sample restricted to Tabriz. Nonetheless, the findings confirm that resilience, self-compassion, and mindfulness are crucial psychological pillars in reducing patient distress. Fortifying these components in clinical protocols and psychological interventions in hospitals and cancer counseling centers will be highly effective.
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