Background: Lung cancer survivors who were treated with curative intent have a high risk of cancer recurrence, and many experience clinically significant fear of cancer recurrence (FCR). Previous literature suggests that younger age is associated with greater FCR. Additionally, age is negatively correlated with concerns about illness and treatment, and previous literature has established a relationship between unresolved concerns and the development of anxiety and depression. Here, we explored the extent to which psychological distress may account for a relationship between age and FCR in lung cancer survivors treated with curative intent.

Methods: We examined baseline data on FCR, psychological distress, and age at consent in participants who enrolled in a randomized controlled trial of a brief, psychoeducational intervention aimed to improve quality of life in lung cancer survivors who recently completed curative intent treatment (n=109). Baseline measures included demographics, FCR assessed using the Fear of Cancer Recurrence Scale 7 (FCR-7), and psychological distress using the Hospital Anxiety and Depression Scale (HADs). We used PROCESS macro 4 for SPSS with 5,000 bootstrap samples to evaluate the relationship between age and FCR through psychological distress.

Results: Participants (M age=68.9 years, SD=7.2) were predominantly non-Hispanic, White (97%), 56% were female, and 44% were male. Mean FCR was in the moderate range (M = 17.67, SD = 7.69). In separate linear regression models, age predicted both FCR (unstandardized beta = -0.29, t = -2.90, p = 0.004, 95% CI = -0.48, -0.09) and psychological distress (unstandardized beta = -0.21, t = -2.05, p = 0.043, 95% CI = -0.41, -0.01). In a final model, age was indirectly associated with FCR through psychological distress (unstandardized beta = -0.14, BootSE = 0.06, Bootstrap 95% CI: -0.25, -0.01).

Discussion: Results indicate that older age is associated with lower FCR, and that lower general psychological distress may partially explain this relationship. Further research is needed to explore factors that may be related to psychological distress and increase FCR among younger cancer survivors, such as concerns about mortality and life role changes following treatment. Additionally, future research should explore age-related changes in coping mechanisms which may reduce psychological distress and FCR in the context of lung cancer survivorship.