Dyadic coping mediates cancer recurrence fear and survivor depression

Advances in diagnosis and treatment have extended survival for many people with gastrointestinal cancer, increasing attention to their long-term psychological health. Fear that cancer may return or progress is common among survivors and is closely associated with depression, reduced treatment adherence, and poorer quality of life. Spouses often serve as primary caregivers, particularly for middle-aged and older patients, and their communication and support may shape how couples respond to illness-related stress. However, the pathway linking recurrence fears, shared coping, and depression in gastrointestinal cancer survivors has remained unclear, especially within the Chinese social and family context.

A study (DOI: 10.48130/ejcc-0026-0003) published in European Journal of Cancer Care on 26 May 2026 by Silan Yang’s & Zhihong Zhu’s team, Affiliated Hospital of Jiaxing University, reports that dyadic coping partially mediated the association between recurrence fears and depression.

The researchers conducted a cross-sectional questionnaire study between February 2022 and June 2024 at a tertiary hospital in Jiaxing, China. Eligible participants were married gastrointestinal cancer survivors aged 45 years or older who could independently understand and complete the survey. Of 245 patients initially recruited, 10 declined to participate. After questionnaires with substantial missing data were excluded, the final analysis included 211 survivors, whose average age was 62.45 years; 63.98% were men. Participants completed a demographic and clinical questionnaire and three validated instruments.

The Fear of Progression Questionnaire-Short Form measured fear of cancer recurrence across physical-health and social-family domains. The Dyadic Coping Inventory assessed stress communication, supportive coping, collaborative coping, negative coping, and related couple-level responses. Researchers evaluated depressive symptoms using the depression subscale of the Hospital Anxiety and Depression Scale. They then performed group comparisons, Pearson correlation analysis, and mediation analysis based on 10,000 bootstrap samples, while controlling for living arrangement, occupation, residential area, and time since diagnosis. Average scores were 25.25 for fear of cancer recurrence, 129.56 for dyadic coping, and 18.47 for depression. Greater recurrence fear was associated with poorer dyadic coping (r = −0.390), while better dyadic coping was associated with lower depression scores (r = −0.408). Recurrence fear was also positively associated with depression (r = 0.431); all three correlations were statistically significant. Mediation analysis showed that recurrence fear had a direct effect of 0.083 on depression. It also had a negative effect on dyadic coping, while dyadic coping showed a negative effect on depression. The indirect effect through dyadic coping was 0.028, with a 95% confidence interval of 0.015-0.045, accounting for 25.23% of the total association. Because this was a single-center, cross-sectional study, the results demonstrate associations rather than causation and should be tested in multicenter longitudinal research.

Overall, the study identifies dyadic coping as a potentially modifiable protective factor in the psychological health of middle-aged and older gastrointestinal cancer survivors. The results suggest that clinicians should assess how patients and spouses communicate, share stress, and provide mutual support. Couple-based coping training and appropriate psychological interventions may help reduce depressive symptoms, although further research is needed to confirm their effectiveness across populations and determine how these relationships change over time.