Self-perceived burden, fear of progression and psychological flexibility in cervical cancer survivors: A moderated network analysis.

OBJECTIVE

Self-perceived burden (SPB) and Fear of progression (FoP) have been reported in people living with cancer and together may increase overall distress. Acceptance and Commitment Theory (ACT) posits that psychological flexibility (PF) may ameliorate the effects of the co-occurrence of these symptoms, yet empirical evidence is scarce. We examined the symptoms associated with SPB and FoP in women with cervical cancer and tested whether PF moderates the association.

METHODS

In a cross-sectional study, 307 cervical cancer survivors enrolled in the 2024 "Be Resilient to Cervical Cancer" (BRCC) program completed the Personalized Psychological Flexibility Index (PPFI), the Self-Perceived Burden Scale for Cancer Patients (SPBS-CP), and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF). We constructed symptom-level networks to identify the strongest SPB-FoP connections, and explored the moderating role of PF using Johnson-Neyman analyses.

RESULTS

Among the 307 participants, the mean scores for PPFI were 59.13 (standard deviation [SD] ​= ​10.18), for FoP-Q-SF, 31.12 (SD ​= ​4.98), and for SPBS-CP, 48.18 (SD ​= ​17.12) indicating moderate levels of PF, fear of progression and SPB. Network analysis highlighted the "future worries"- "psychological burden" link as the strongest SPB-FoP link ( ​= ​0.34). Johnson-Neyman probing revealed threshold-dependent moderation by PF. PF attenuated one link at high levels (> 84.95) but amplified three links at moderate levels (> 47.51).

CONCLUSIONS

PF significantly moderates symptom-level associations between self-perceived burden on fear of progression among cervical cancer survivors. ACT-based interventions may attenuate such association to minimize patients' psychological distress.