Unmet Needs Mediate the Impact of Fear of Cancer Recurrence on Screening Participation Among Cancer Survivors: A Cross-Sectional Study

<b>Background/Objectives</b>: Cancer survivors require ongoing follow-up care, including regular health screening, to detect recurrence or secondary malignancies. Nonetheless, psychosocial factors may influence their participation in screening. This study aimed to investigate the associations among fear of cancer recurrence (FCR), unmet needs, and screening behavior in cancer survivors and to explore whether unmet needs mediated the relationship between FCR and health screening participation. <b>Methods</b>: Data from a cross-sectional pilot survey of 326 adult cancer survivors who completed primary cancer treatment in Korea were analyzed. Screening participation was defined as having undergone either a general health check-up or cancer screening within the past 2 years. Factors associated with screening behavior were identified using logistic regression analysis. Additionally, mediation analysis was conducted to examine the indirect effects of FCR on screening through unmet needs. <b>Results:</b> Higher income, older age, longer time since diagnosis, and fewer unmet needs were significantly associated with screening participation. FCR was not directly associated with screening but was positively associated with higher unmet needs (OR: 4.59 [95% CI: 2.66, 7.94], <i>p</i> < 0.001), which were negatively associated with screening (OR: 0.41 [95% CI: 0.20, 0.84], <i>p</i> = 0.015). The indirect effect of FCR on screening for unmet needs was statistically significant (OR: 0.25 [95% CI: 0.08, 0.85], <i>p</i> = 0.027). <b>Conclusions</b>: Unmet needs may mediate the relationship between FCR and screening behavior in cancer survivors. Addressing these needs may represent a promising strategy for improving adherence to recommended follow-up screening.