Cascading pathways from physical symptom burden to distress in adults with cancer

Psychological distress in cancer survivors may be partially attributable to fear of cancer recurrence (FCR). Simonelli et al. (2017) proposed a conceptual model of FCR, which suggests that cancer cues (e.g., physical symptoms) may prompt maladaptive emotional processing leading to heightened FCR, and thus increased psychological distress. This prospective study tested this model by examining the cascading pathways by which physical symptom burden, emotion dysregulation, and FCR were associated with posttraumatic stress symptoms (PTSS) and anxiety among recently diagnosed cancer survivors.

Psychosocial and well-being data from 486 breast (63.7%), prostate (25.7%), and colorectal (10.7%) cancer survivors (M_age = 58.7 years; 31% male) were collected over 12 months as they transitioned off primary treatment into early survivorship. A path analysis was performed to examine whether physical symptom burden led to more emotion dysregulation and elevated FCR and, in turn, more psychological distress (PTSS and anxiety).

Greater physical symptom burden at Time 1 was associated with more emotion dysregulation at Time 2, which was related to heightened FCR at Time 3 and, in turn, more psychological distress at Time 4. Additionally, the indirect effect of physical symptom burden on FCR through emotion dysregulation and the indirect effects of emotion dysregulation on PTSS and anxiety through FCR were also significant.

The findings support Simonelli et al.'s (2017) conceptual model of FCR and distress and highlight the importance of assessing and addressing physical symptom burden and improving emotional processing abilities to help mitigate heightened psychological distress among cancer survivors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).