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Characteristics and influencing factors of fear of cancer recurrence among family caregivers of breast cancer patients: a latent class analysis

BMC Nursing volume 24, Article number: 352 (2025) Cite this article

Abstract

Background

Family caregivers of breast cancer patients often experience significant psychological challenges, including depression, anxiety, and fear of cancer recurrence (FCR), yet these issues receive insufficient attention. This study aims to explore the heterogeneity of FCR among family caregivers and identify distinct subgroups based on their FCR levels.

Methods

A cross-sectional survey was conducted with 866 family caregivers of breast cancer patients at two tertiary hospitals in Guangzhou, Guangdong Province. All participants completed the Fear of Cancer Recurrence Scale (FCR-7), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Scale (GAD-7) to assess their levels of FCR, depression, and anxiety. Latent class analysis (LCA) was used to identify subgroups of FCR, and multiple logistic regression analyses were performed to explore factors influencing FCR.

Results

Three distinct subgroups of FCR were identified: low FCR group (16.17%), moderate FCR group (13.16%), and high FCR group (70.67%). Predictors of higher FCR included lower income, higher anxiety, and higher depression levels.

Conclusions

Family caregivers of breast cancer patients exhibit varying levels of FCR, with significant predictors being income, anxiety, and depression. Targeted interventions (e.g., psychoeducation, stress management, mindfulness exercises, and cognitive-behavioral therapy) that address these factors may help improve the mental health and well-being of family caregivers.

Highlights

The majority of family caregivers of breast cancer patients experience high levels of fear of cancer recurrence (FCR), which significantly impacts their daily lives and thought processes.

While a minority of caregivers report low FCR, they remain highly concerned about physical symptoms in patients that could indicate a recurrence, potentially escalating their FCR.

Several family caregivers exhibit a paradoxical status, where they report high FCR despite a low perceived likelihood of cancer recurrence.

Higher levels of anxiety and depression, along with lower income, are key factors influencing and predicting elevated FCR among family caregivers of breast cancer patients.

Peer Review reports

Introduction

The incidence and mortality rates of breast cancer continue to rise in China [1]. In 2024, the National Cancer Center reported that breast cancer was among the top ten most common cancers, with approximately 420,000 new diagnoses [2]. It is also one of the top ten causes of cancer-related deaths. Despite significant advancements in medical research, there remains a substantial gap between the five-year survival rates of breast cancer patients in China and those in developed countries such as the United States [2]. Although the prognosis for breast cancer patients has improved, the probability of recurrence remains significant, ranging from 10 to 40% [3]. Moreover, breast cancer patients often experience various side effects from treatment, such as hair loss, bone marrow suppression, nausea, and vomiting, which, combined with the uncertainty surrounding recurrence, place considerable psychological stress on both patients and their family caregivers [4].

Fear of cancer recurrence (FCR) refers to anxiety or apprehension regarding the possibility of cancer returning or progressing, and it often manifests as increased worry and distress [5]. Family caregivers—such as spouses, children, and other close relatives—are those who provide unpaid care and support to cancer patients [6]. They are not only responsible for the patient’s physical needs but also need to endure huge psychological burdens, including FCR, during the caregiving process. Research has shown that 48% of cancer caregivers report clinically significant FCR [7], with approximately 20% experiencing high levels [8]. In the case of breast cancer, 51.6% of caregivers report significant FCR, which may stem from concerns about the patient’s health or the psychological strain of caregiving responsibilities [9].

Many family caregivers of breast cancer patients experience severe psychological disturbances within the first six months of caregiving [10], including depression, anxiety, and FCR [11, 12]. These psychological issues can lead to negative physical and emotional effects, causing disruption in caregivers’ daily lives and contributing to feelings of isolation [13].

The relationship between FCR in patients and their caregivers is complex and interconnected. Caregivers’ FCR is often heightened by the patient’s symptoms, creating a feedback loop that can exacerbate emotional distress [14, 15]. Moreover, caregiver burden is influenced by both the caregiver’s and patient’s psychological states, and their FCR are significantly linked [16]. While much research has focused on the psychological issues faced by breast cancer patients, insufficient attention has been paid to the psychological experiences of their family caregivers, particularly regarding FCR [17]. The psychological burden of caregiving, including depression and anxiety, may negatively affect both the caregiver’s quality of life and the patient’s treatment outcomes [18]. As such, targeted interventions, such as psychoeducation, and stress management are needed to alleviate caregiver’s FCR and improve their overall well-being [19].

Latent Class Analysis (LCA) is a human-centered data analysis method that classifies individuals based on their different response patterns on the manifest variables of the categories [20]. It helps us to identify the unique characteristics of each subgroup and recognize the heterogeneity among individuals, rather than simply classifying them based on total scores. As LCA is model-based, it generates fit statistics, which allows statistical inference when determining the most appropriate number of clusters for a population. In comparison to cluster analyses, LCA is therefore considered a more statistically robust method of clustering. Using LCA, one study identified three subgroups of breast cancer survivors based on their behavioral health and functioning: modal resilience, moderate symptoms, and elevated symptoms [21]. This method has also been applied to FCR among caregivers of patients with hematologic malignancy, identifying subgroups of “low FCR” and “high FCR” [22].

To the best of our knowledge, this is the first study to explore FCR among primary family caregivers of breast cancer patients using LCA. This study aims to: (1) explore the heterogeneity of FCR among caregivers and identify distinct subgroups based on their FCR levels; and (2) examine factors influencing and predicting FCR among family caregivers of breast cancer patients. By identifying the characteristics and influencing factors of FCR, targeted interventions that helps to improve the mental health and well-being of family caregivers should be developed and implemented.

Methods

Study design

A cross-sectional survey was conducted to investigate the levels and potential subgroups of FCR among primary family caregivers of breast cancer patients.

Participants and data collection

Convenience sampling was used, and finally 866 caregivers of breast cancer patients were recruited from Guangdong Provincial People’s Hospital and Southern Medical University Nanfang Hospital. In order to ensure that all requested information was accurately recorded, after obtaining informed consent from all participants, the research assistant distributed all questionnaires via the Wenjuanxing platform and set all items as mandatory, to ensure data completeness.

Inclusion criteria

Participants were included in the study if they met the following criteria: (1) aged 18 years or older; (2) primary family caregivers responsible for caring for a breast cancer patient; and (3) able to read and independently answer survey questions.

Exclusion criteria

Participants were excluded if they met any of the following conditions: (1) presence of serious health issues (e.g., cardiovascular, respiratory, liver, or kidney diseases, etc.); (2) diagnosed with cancer themselves; and (3) currently receiving psychological treatment (e.g., cognitive-behavioral therapy).

Sample size estimation

Latent class analysis typically requires a minimum of 50 participants per subgroup to ensure model accuracy. With a sample size of 866 valid questionnaires, the study exceeded the recommended threshold for latent class analysis, ensuring reliable model fitting [20].

Instruments

Basic information sheet

Participants’ basic socio-demographic information was collected, including age, relationship to patient, gender, marital status, education level, occupation, monthly income, presence of physical illness, and family history of cancer, etc.

Fear of Cancer recurrence Scale-7 (FCR-7)

The FCR scale was developed by Professor Gerry Humphris and colleagues at the University of St Andrews [23]. The FCR-7 has been translated and culturally adapted into a Chinese version and demonstrated robust psychometric properties [24]. This 7-item scale assesses fear and anxiety related to the recurrence or progression of cancer. The first six items evaluate anxiety levels, while the seventh item measures the impact of FCR on the participant’s life and social functioning. The total score is the sum of all items, with higher scores indicating more severe FCR [24]. Among family caregiver populations, the Cronbach’s alpha for the scale was 0.858, indicating good internal consistency.

Patient Health Questionnaire (PHQ-9)

The PHQ-9 is a scale designed to assess the severity of depressive symptoms, based on the DSM-IV criteria [25]. This scale has been widely used for screening depression in both clinical patients with depression and the general population [26], and the reliability and validity of the Chinese version of the PHQ-9 scale have been verified by several scholars in China [27]. Each item is scored on a 4-point scale (from “not at all” to “almost every day”). The total score is calculated by summing individual item scores, with higher scores indicating more severe depression. A total score of 0 to 4 indicates no depression, 5 to 9 indicates mild depression, 10 to 14 indicates moderate depression, and 15 or higher indicates severe depression. In this study, the Cronbach’s α coefficient of this scale was 0.901.

Generalized Anxiety Disorder-7 (GAD-7)

The GAD-7 scale, developed by Spitzer et al., is used to assess anxiety severity and its functional impact [28]. It has been proven to be applicable for screening patients with anxiety disorders as well as in primary care settings. The Chinese version of the GAD-7 scale has also been validated [29]. This scale uses a 4-point scoring system, where each item is rated from “never” to “almost every day.” The total score indicates the severity of anxiety. Scores of 0–4 indicate no anxiety, 5–9 indicate mild anxiety, 10–14 indicate moderate anxiety, and 15or higher indicate severe anxiety. In this study, the Cronbach’s α coefficient of this scale was 0.919.

Ethical considerations

This study was performed in accordance with the Helsinki standard and the study’s protocol was approved by Nanfang Hospital Research Ethics Committee (ref No: NFEC-2018-038), and Guangdong Provincial People’s Hospital Research Ethics Committee (ref No: 2018295 H(R1)). All participants provided informed consent. Investigators explained the study’s purpose, procedures, and precautions to the family caregivers before administering the questionnaires. Participants were assured that their responses would remain confidential and that no identifying information would be disclosed.

Data analysis

Data were analysed using SPSS 25.0 and Mplus 8.3. Descriptive statistics (mean ± standard deviation, frequency, and percentage) were used to summarize the general characteristics of the family caregivers. Pearson correlation was applied to examine relationships between FCR, anxiety, depression, and other factors. Latent class analysis was used to identify subgroups of FCR, with model evaluation based on the following indices: (1) Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and Adjusted Bayesian Information Criterion (aBIC): Lower values of these criteria indicate a better model fit [20]; (2) Entropy: A measure of classification accuracy, with values closer to 1 indicating higher accuracy (with values ≥ 0.800 indicating that 90% of cases are classified correctly); (3) Bootstrap Likelihood Ratio Test (BLRT) and Lo-Mendell-Rubin Test (LMR): P-values less than 0.05 indicate that a model with k classes fits significantly better than a model with k-1 classes; (4) Class Probability: Indicates the proportion of individuals in each class. Classes with fewer than 5% of participants may indicate poor model fit or overfitting. Multiple logistic regression was used to assess the effects of potential variables (e.g., anxiety and depression) on different FCR subgroups. The significance level was set at α = 0.05, with P-values < 0.05 indicating statistical significance.

Results

Baseline characteristics

The age of the 866 family caregivers ranged from 18 to 80 years, with a mean age of 42.71 ± 12.35 years. Among these caregivers, 464 (53.58%) were husbands of the patients, 617 (71.25%) were male, and 708 (81.76%) were married. In terms of education, 422 (48.73%) caregivers had a college degree. In employment, 603 (69.63%) caregivers were employed full-time, and 272 (31.41%) had a monthly family income of 3000–5000 RMB. Regarding health status, 753 (86.95%) family caregivers reported no other physical illness, 823 (95.03%) had no history of severe childhood illness, and 700 (80.83%) reported no family history of cancer.

Correlation analysis

Pearson correlation analysis revealed significant positive relationships between FCR and several variables: gender (r = 0.10, P < 0.001), physical illness (r = 0.10, P < 0.001), anxiety (r = 0.56, P < 0.001) and depression (r = 0.55, P < 0.001). Conversely, significant negative relationships were found between FCR and education level (r = -0.10, P < 0.001), and monthly income (r = -0.16, P < 0.001) (Supplementary Table 1).

Results of latent class analysis of FCR in family caregivers

Latent class analysis was performed using the seven items from the FCR scale as indicators. A series of one to five latent class models were explored. The fit indices (AIC, BIC, and aBIC) decreased as the number of classes increased, especially between models 1 to 3. After model 3, the decrease in these indices was minimal, indicating diminishing returns with additional classes. The 3-class model was deemed optimal because: (1) AIC, BIC, and aBIC values were minimized; (2) Entropy was high, indicating strong classification accuracy; (3) both the LMR and BLRT showed P < 0.001, confirming that the 3-class model was significantly better than the 2-class model; and (4) In contrast, the 5-class model did not show statistical significance (P > 0.05), and one of the categories in the 4-class model had too few members (< 5%), which made it an unsuitable choice (Table 1). Table 2 shows the classification accuracy and categorization precision, with high values on the diagonal indicating accurate classification. These results confirm the reliability of the 3-class model.

Table 1 Fitting index and entropy value of LCA model with different number of class
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Table 2 Average probability of attribution (columns) of each class of potential FCR (rows)
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Potential class characteristics and naming of FCR in family caregivers

Table 3 shows the mean ± standard deviation of the FCR, anxiety, and depression scores for family caregivers in each class. The three identified latent classes differed significantly in their FCR profiles (Fig. 1).

  1. 1)

    Class 1 (Moderate FCR Group): Caregivers in this group had moderate FCR scores across most items. However, they showed a pronounced dip in item 4 (“I have a very strong feeling that there will be a recurrence of cancer in my family”), indicating a slightly lower FCR compared to the other classes. This group accounted for 13.16% (n = 114) of the sample.

  2. 2)

    Class 2 (Low FCR Group): This group had lower FCR scores across all items. Despite having the lowest FCR levels, caregivers in this group were particularly concerned about the physical health of the patient, as evidenced by slightly higher scores on items 6 (“I will check my family for suspicious physical changes”) and 7 (“The extent to which the thought of a feared cancer recurrence interferes with and affects your daily thinking and living”). This group made up 16.17% (n = 140) of the caregivers.

  3. 3)

    Class 3 (High FCR Group): Caregivers in this group showed the highest FCR scores across all items, and the impact of FCR on their daily lives and thinking was most pronounced. This class represented the largest proportion, 70.67% (n = 612) of the sample.

Table 3 Scores of different potential class on FCR, PHQ-9 and GAD-7 (M ± SD)
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Fig. 1
figure 1

Plot of the conditional probability distribution of family caregivers of different categories of breast cancer patients at each entry of the FCR scale

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Multiple logistic regression analysis of factors influencing the latent classes of FCR in family caregivers

To examine factors influencing the likelihood of belonging to each of the three FCR classes, disordered multiple logistic regression was conducted with gender, physical illness, education level and monthly income as predictors (Supplementary Table 2). Due to the high correlation between anxiety and depression in this study (r = 0.83, P < 0.001, see supplementary Table 1), anxiety and depression were separately included in the aforementioned regression analysis to avoid the influence of potential multicollinearity, resulting in the following two regression models. Tables 4-1 and 4-2 presents only statistically significant findings.

Multiple logistic regression analysis of FCR, with depression, gender, physical illness, education level and monthly income as predictors

1) Using Class 1 (moderate FCR group) as the reference group: Higher baseline depression (OR = 3.15, 95%CI: 1.96 ~ 5.06, P < 0.05) predicted a higher likelihood of being classified into the high FCR group (Class 3). Lower baseline depression (OR = 0.40, 95%CI: 0.18 ~ 0.91, P < 0.05) predicted a higher likelihood of being classified into the lower FCR group (Class 2).

2) Using Class 2 (low FCR group) as the reference group: Higher baseline depression was associated with higher FCR, increasing the likelihood of being classified in the moderate FCR group (Class 1) and high FCR group (Class 3) (OR = 2.48, 95%CI: 1.10 ~ 5.59, P < 0.05; OR = 7.80, 95%CI: 3.86 ~ 15.76, P < 0.05). Caregivers with lower income (OR = 2.00, 95%CI: 1.06 ~ 3.79, P < 0.05) were more likely to be classified into the high FCR group (Class 3).

3) Using Class 3 (high FCR group) as the reference group: caregivers with higher depression were less likely to be classified in the moderate FCR group (Class 1) or the low FCR group (Class 2) (OR = 0.32, 95%CI: 0.20 ~ 0.51, P < 0.001; OR = 0.13, 95%CI: 0.06 ~ 0.26, P < 0.001). Caregivers with lower monthly income (OR = 0.50, 95%CI: 0.26 ~ 0.95, P < 0.05) were less likely to be classified in the low FCR group (Class 2) (Table 4-1).

Table 4-1 Multiple logistic regression analysis of potential categories of FCR among caregivers of breast cancer patients
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Multiple logistic regression analysis of FCR, with anxiety, gender, physical illness, education level and monthly income as predictors

1) Using Class 1 (moderate FCR group) as the reference group: Higher baseline anxiety (OR = 3.94, 95%CI: 2.33 ~ 6.67, P < 0.001) predicted a higher likelihood of being classified into the high FCR group (Class 3).

2) Using Class 2 (low FCR group) as the reference group: Higher baseline anxiety and lower income were significantly associated with higher FCR, increasing the likelihood of being classified in the high FCR group (Class 3) (OR = 5.12, 95%CI: 2.74 ~ 9.57, P < 0.001; OR = 2.07, 95%CI: 1.09 ~ 3.91, P < 0.05).

3) Using Class 3 (high FCR group) as the reference group: Caregivers with higher anxiety were less likely to be classified in the moderate FCR group (Class 1) or the low FCR group (Class 2) (OR = 0.25, 95%CI: 0.15 ~ 0.43, P < 0.001; OR = 0.20, 95%CI: 0.11 ~ 0.37, P < 0.001). Caregivers with lower monthly income (OR = 0.48, 95%CI: 0.26 ~ 0.91, P < 0.05) were less likely to be classified into the low FCR group (Class 2) (Table 4-2).

Table 4-2 Multiple logistic regression analysis of potential categories of FCR among caregivers of breast cancer patients
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Discussion

Heterogeneity of FCR among family caregivers of breast cancer patients

This current study is the first to employ latent class analysis (LCA) in exploring the heterogeneity of FCR among family caregivers of breast cancer patients in China. Our findings reveal a clear distinction in FCR levels, with the high FCR group (Class 3) comprising approximately 70.67% of caregivers. This figure is notably higher than what was reported for family caregivers of patients with hematologic malignancies, ovarian cancer and lymphoma (34.6%, 41.0% and 56.2%, respectively) [22, 30, 31]. The observed difference may be attributed to variations in the study sample and assessment tools used in the two studies. Additionally, variables such as the patient-caregiver relationship, the severity of the patient’s illness, caregiving workload, and individual psychological resilience may also influence the severity of FCR among different populations [22, 31].

Our main findings echo previous qualitative studies, which found that FCR can interfere with caregivers’ primary responsibilities, causing distress and negative ruminations [32]. These psychological difficulties are often associated with other mental health issues like anxiety and depression [33]. A systematic review in 2021 showed that high FCR is linked to poorer mental health, including diminished social functioning, emotional well-being, and overall quality of life—findings that align with our study [14]. Therefore, for family caregivers with high FCR, intensive and timely psychological interventions (e.g., cognitive-behavioral therapy) should be provided.

Despite the predominance of high FCR, a smaller proportion of caregivers (16.17%) in the low FCR group (Class 2) still expressed significant concerns about the patient’s physical health. Research has shown that even low FCR can motivate caregivers to engage in proactive health behaviours, such as regular screening [34], which may be a factor in the continued attentiveness of caregivers to patients’ physical well-being. This finding supports the idea that, although caregivers in the low FCR group may not experience intense anxiety over recurrence, they still remain vigilant regarding the patient’s health. Such concerns may eventually trigger or exacerbate FCR, particularly if the patient’s physical condition deteriorates or if cancer recurrence becomes a real threat [35]. Therefore, while these caregivers may seem to have a lower immediate FCR, the focus on the patient’s physical state could potentially lead to increased FCR over time [36].

The moderate FCR group (Class 1) (13.16%) demonstrated ambivalence. While their FCR levels were relatively moderate, they scored particularly low on the item related to the recurrence of cancer (“I have a strong feeling that the patient’s cancer would recur”). This suggests that caregivers in this group may harbour mixed emotions, balancing between hope and anxiety. This ambivalence could stem from the complexity of the caregiving experience, where caregivers are deeply invested in the patient’s recovery but also burdened by the ongoing demands of care [37]. It is crucial to acknowledge their emotional complexity and provide targeted interventions that address both their emotional distress and their hopeful outlook for recovery.

Lower income associated with higher FCR

Our study found that family caregivers with lower income levels were more likely to experience higher FCR, which is consistent with previous studies suggesting that financial strain can exacerbate the psychological burden of caregiving [31, 38]. The dual stress of financial hardship and caregiving responsibilities may heighten FCR by creating a sense of uncertainty about the future—both in terms of the patient’s health and the caregiver’s ability to manage the associated costs.

Higher baseline anxiety and depression associated with higher FCR

Our results highlight the strong influence of anxiety and depression on FCR among family caregivers. Caregivers with higher baseline levels of anxiety and depression were more likely to experience higher levels of FCR, which is consistent with previous findings [39]. Family caregivers often experience significant emotional stress, as they provide emotional, financial, and physical support for the patient while coping with the stress of uncertainty regarding the patient’s prognosis. This burden may intensify psychological distress and increase the likelihood of developing FCR, sometimes more acutely than the patients themselves [40, 41].

Previous studies have emphasized that caregivers often face long-term psychological challenges due to the emotional demands of cancer caregiving [42], these challenges can lead to chronic anxiety and depression, which in turn exacerbate FCR. Lambert et al. highlighted that depression and anxiety in family caregivers tend to persist over time, suggesting that caregivers may remain at risk for prolonged periods, thereby increasing the potential for chronic FCR [43]. This emphasizes the crucial role that healthcare professionals play in safeguarding family caregivers’ psychological well-being. Through personalized interventions targeting anxiety and depression, professionals can provide effective support, ensuring a more stable and fulfilling experience for both parties involved.

Implications

Interventions should be designed to accommodate the diverse needs of caregivers based on their unique profiles (e.g., family income, emotional distress). Different FCR subgroups should involve individualized guidance and support, as well as specific therapeutic techniques. For individuals with low and moderate FCR, psychoeducation, stress management and mindfulness exercises may be the primary focus. In contrast, for caregivers with high FCR, more intensive and personalized therapeutic approaches such as cognitive-behavioral therapy (CBT) are likely required. Educating caregivers about the realities of cancer recurrence and providing coping strategies can help alleviate their fears and improve mental health outcomes. Emotional support is also a key component of care for family caregivers, particularly for those with high anxiety and depression. Additionally, integrating support systems into cancer treatment plans, including counselling services and caregiver support groups, is also important in addressing these issues.

Limitations

While this study contributes valuable insights about FCR among family caregivers of breast cancer patients, several limitations should be acknowledged. First, convenience sampling was used in this study, the findings are limited to family caregivers of breast cancer patients and may not be generalized to caregivers of other types of cancer. The psychological and caregiving burdens associated with different cancers can vary widely, and thus FCR may manifest differently across various cancer diagnoses.

Second, further studies should incorporate additional variables that were not examined in the current study, such as cancer stage, caregiving duration, and family relationships. These variables may play a significant role in influencing the primary outcome of the current study and could provide deeper insights into the mechanisms underlying the observed effects.

Third, given that the study design is cross-sectional, data collected at a single point in time limits its ability to generalize findings. As breast cancer treatment is typically prolonged and caregiving progresses through multiple stages (e.g., recovery, hospitalization, treatment), understanding how FCR evolves over time becomes crucial. Therefore, while our current findings offer a snapshot of FCR experiences during the study period, further research should explore longitudinal designs that track changes in FCR, depression, and anxiety levels across different stages of treatment and recovery to provide more comprehensive insights into the development of caregiving experiences. Also, long-term follow-up could help in identifying predictive factors for sustained or fluctuating FCR levels, further clarifying the bidirectional relationship between anxiety, depression and FCR. This approach not only helps in understanding the psychological needs of caregivers but also contributes to a deeper comprehension of their mental health requirements.

Conclusion

This study underscores the high prevalence of FCR among family caregivers of breast cancer patients, and the varying severity of this fear among different caregiver groups. Our latent class analysis revealed three distinct categories of FCR: the high FCR group, the moderate FCR group, and the low FCR group. Caregivers in these groups demonstrated different patterns of psychological distress and demographic characteristics, with lower income being linked to higher levels of FCR, while anxiety and depression were strong predictors of high FCR across all groups. These findings highlight the need for tailored interventions based on the caregiver’s unique demographic and psychological profile. Early identification of caregivers at risk for high FCR, particularly those with higher anxiety and depression levels, is critical to providing appropriate psychological support. Addressing these emotional and practical challenges can help to improve the quality of life for family caregivers and reduce the adverse impact of FCR on their well-being.

Data availability

The dataset supporting the conclusions of this article is included within the article and its additional file.

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Acknowledgements

We are grateful to all the patients whom participated in this study.

Funding

This research was supported in part by the Guangzhou Science and Technology Project (2025A04J4743), the Start-up Funds of Guangdong Provincial People’s Hospital (KY0120211134), the NSFC Pilot Funds of Guangdong Provincial People’s Hospital (KY0120220783, KY012023710), and the Medical Scientific Research Foundation of Guangdong Province (A2023004).

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Author notes

  1. Wenting Liu, Wengao Li and Lili Deng contributed equally to the work.

Authors and Affiliations

  1. School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China

    Wenting Liu, Lili Deng, Yibing Tan, Jiagen Xiang, Yan Wu & Yanan Hu

  2. Department of Psychiatry, General Hospital of Southern Theatre Command, Guangzhou, China

    Wengao Li

  3. Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China

    Xian Luo

  4. Department of Radiotherapy, Cancer Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China

    Hengwen Sun

  5. Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510000, China

    Yuan Yang

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  1. Wenting Liu
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Contributions

Study design: YY, and HWS. Data collection, analysis and interpretation: WTL, WGL, XL, YNH and HWS. Drafting of the manuscript: WTL, LLD, YBT, JGX, YW and WGL. Critical revision of the manuscript: YY and HWS. Approval of the final version for publication: all co-authors.

Corresponding authors

Correspondence to Hengwen Sun or Yuan Yang.

Ethics declarations

Ethics approval and consent to participate

This study was performed in accordance with the Helsinki standard and the study’s protocol was approved by Nanfang Hospital Research Ethics Committee (ref No: NFEC-2018-038), and Guangdong Provincial People’s Hospital Research Ethics Committee (ref No: 2018295 H(R1)). Participants were informed about the research on the planned data collection date and their informed consent was obtained. Participation in the study was voluntary.

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Not applicable.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Liu, W., Li, W., Deng, L. et al. Characteristics and influencing factors of fear of cancer recurrence among family caregivers of breast cancer patients: a latent class analysis. BMC Nurs 24, 352 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12912-025-02964-7

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BMC Nursing

ISSN: 1472-6955

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