Predictive Relationships Between Death Anxiety and Fear of Cancer Recurrence in Patients with Breast Cancer: A Cross-Lagged Panel Network Analysis

The aim of this study was to explore the longitudinal relationship between death anxiety (DA) and fear of cancer recurrence (FCR) in women newly diagnosed with breast cancer at baseline and 3 months post-discharge. A total of 426 women with breast cancer completed the Templer's Death Anxiety Scale and the Fear of Cancer Recurrence Inventory at hospital discharge and 3 months later. Cross-lagged panel analysis (CLPA) was used to describe the relationship of the two variables (DA and FCR) over time and identify the optimal intervention symptom nodes for breast cancer patients in different stages. The findings suggest that the specific symptoms of DA, known as "cognition", predict the subsequent symptom development for a variety of mental health problems in the network structure. The "Psychological distress" symptom in FCR is the most susceptible to other symptoms. In addition, death-related cognition may be a bridge symptom that connects the co-occurrence of DA and FCR. Death-related "time awareness" is the optimal symptom node for intervention in early-stage breast cancer patients, while it is "cognition" in advanced patients. The death-related cognition and emotional regulation of death may be the best target for interventions among breast cancer patients, considering their DA coincides with FCR. The best intervention for patients with early-stage breast cancer may be the time awareness of death, while it may be more effective for patients with advanced cancer to be educated about disease and death, as well as to enhance correct perception.