Fear of disease progression and psychological factors in postoperative lung cancer patients

Abstract

BACKGROUND

Patients who undergo lung cancer surgery frequently experience a fear of disease progression (FoP), which can negatively affect their quality of life. Understanding the varying degrees of FoP and related psychological distress experienced by such patients is essential to develop effective interventions. Thus, in this study, we hypothesized that certain psychological factors, namely anxiety and depression, would be associated with FoP in postoperative patients with lung cancer.

AIM

To investigate FoP levels and their association with psychological factors in patients who have undergone lung cancer surgery.

METHODS

A sample size was determined with reference to prior research findings and considerations regarding statistical power. Subsequently, 368 patients who had undergone lung cancer surgery were recruited from a university hospital in China for this cross-sectional investigation. Data were obtained through general information questionnaires, the fear of progression questionnaire-short form (FoP-Q-SF), self-rating anxiety scale (SAS), and self-rating depression scale (SDS). A multivariate linear regression analysis was used to examine the influencing factors.

RESULTS

The total FoP-Q-SF, SAS, and SDS scores were 35.52 ± 6.73, 51.23 ± 6.35, and 54.48 ± 7.15, respectively. Anxiety and depression rates were 62.50% and 59.24%, respectively, among the participants. Marital status, education level, payment method, tumor stage, and SAS and SDS scores independently increased the FoP-Q-SF scores (P < 0.05). The FoP-Q-SF scores were positively correlated with SAS (r = 0.733) and SDS (r = 0.377) scores; physical health factors had stronger associations than social-family factors. Higher anxiety/depression was correlated with higher FoP. The multivariate model, with R² = 0.773 and an area under the curve value of 0.895, had better predictive efficacy than the single emotional indicators.

CONCLUSION

Patients post lung cancer surgery have moderate FoP, which is affected by multiple factors and requires targeted psychological intervention.

Key Words: Lung cancer; Postoperative; Fear of disease progression; Psychological factors; Anxiety; Depression

Core Tip: This study identified levels of fear of disease progression and associated psychological factors in individuals who have undergone lung cancer surgery. Its findings provide a foundation for personalized psychological support to enhance the quality of life of such patients. Furthermore, to our knowledge, it is the first study to comprehensively analyze the multidimensional psychological indicators associated with fear of disease progression in this cohort.

INTRODUCTION

Lung cancer is a highly prevalent malignant tumor that endangers public health and causes fear of disease progression (FoP) in patients after surgical treatment. FoP refers to persistent concerns regarding disease recurrence, deterioration, and associated consequences[1]. It can reduce treatment compliance, exacerbate psychological distress, and significantly impede the patient’s rehabilitation and quality of life[2].

Previous studies have preliminarily explored relevant factors that influence FoP. Educational level, disease duration, tumor stage, and self-rating anxiety scale (SAS) scores were found to be significantly associated with postoperative FoP; specifically, higher educational levels, shorter disease duration, and early tumor stages were correlated with lower FoP levels[3]. Furthermore, marital status, payment method, and self-rating depression scale (SDS) scores were also significant influencing factors; married individuals, those covered by medical insurance, and those without depression exhibited lower FoP scores[3]. Liu et al[4] found that FoP is influenced by gender (male), age (young patients), education level (highly educated individuals), income level (low-income families), and recurrence frequency (multiple recurrences). Xuan et al[5] showed that female sex, living in a rural area, burden of care, economic burden, family hardiness index, and positive coping style had independent influences on fear of cancer recurrence.

However, previous studies have limitations of small sample sizes, single-dimensional factor analysis, and failure to systematically integrate sociodemographic traits, clinical disease markers, and multiple psychological variables, such as the simultaneous inclusion of anxiety and depression. This study aimed to overcome these issues by first expanding the sample size to 368 patients. Second, we analyzed the combined impact of social factors, such as marital status and payment method; disease-related factors, such as tumor stage; factors related to mental health, such as anxiety and depression, on FoP in postoperative patients with lung cancer. To the best of our knowledge, this is the first such attempt. To summarize, this study aimed to investigate the FoP levels and associated psychological factors in individuals who have undergone lung cancer surgery to support the development of accurate clinical psychological intervention strategies.

MATERIALS AND METHODS

Participants

This study included 368 patients who underwent lung cancer surgery at the Affiliated Zhangjiagang Hospital of Soochow University between June 2023 and May 2025. The inclusion criteria were patients: (1) With pathologically confirmed lung cancer who had undergone surgical treatment; (2) One to six months post-surgery with clear consciousness; and (3) Who voluntarily participated and signed the informed consent form. The exclusion criteria were those who had: (1) Severe mental illness or cognitive impairment; (2) Other malignant tumors; or (3) Incomplete clinical data. This study was reviewed and approved by the Ethics Committee of the Affiliated Zhangjiagang Hospital of Soochow University (Approval No. ZJGYYLL-2023-05-LW002).

Sample size calculation

This cross-sectional study utilized the fear of progression questionnaire-short form (FoP-Q-SF) scores, a quantitative measure, of postoperative patients with lung cancer, as the core. Based on prior research data[6], the standard deviation (σ) of the total FoP-Q-SF score was 6.60. With α set at 0.05 (Z1 - α/2 = 1.96 for two-tailed test) and an allowable error (δ) of 0.74 points (higher precision standard was adopted to enhance the stability of results), calculations via the formula indicated that 306 cases were required. Considering a 20% loss to follow-up rate, 368 patients were included.

Research instruments

The general information questionnaire obtained participants’ gender, age, marital status, educational attainment, payment mode, and tumor stage. The FoP-Q-SF scale comprises two dimensions: Physical health and social family, with each dimension consisting of 6 items, for a total of 12 items. Each item is rated on a 5-point Likert scale, ranging from 1 (never) to 5 (always). The total score ranges from 12 to 60, with higher scores indicating a more severe FoP. Specifically, a total score < 34 indicates mild fear, between 34 to 42 indicates moderate fear, and > 42 indicates severe fear. The Cronbach’s α of this scale was 0.89 in a previous study[7].

The SAS assesses the frequency of anxiety symptoms experienced by an individual. It consists of 20 items and uses a 4-point rating system, ranging from 1 (no or very little of the time) to 4 (most or all the time). Standard score (total score) is calculated by multiplying the sum of all items by 1.25. A score of 50 or below indicates the absence of anxiety, between 50 and 60 indicates mild anxiety, between 61 and 70 indicates moderate anxiety, and above 70 indicates severe anxiety. The Cronbach’s α of this scale was 0.85 in a previous study[8]. The SDS comprises 20 items scored on a scale from 1 (a little of the time) to 4 (most of the time). Standard score for this scale is calculated by multiplying the sum of all items by 1.25. A score of 50 or below is considered normal, between 50 and 60 indicates mild depression, between 61 and 70 indicates moderate depression, and above 70 indicates severe depression. The Cronbach’s α of this scale was 0.88 in a previous study[9].

Data collection

Questionnaires were distributed on-site by trained researchers, who instructed patients to complete them independently and collected the forms immediately. Of the 380 questionnaires distributed, 368 valid ones were received, which resulted in an effective recovery rate of 96.8%.

Statistical analysis

Data were analyzed using SPSS version 26.0. Measurement data were expressed as mean ± SD, with comparisons across groups performed via t-test or analysis of variance. Count data were presented as n (%), while inter-group comparisons were analyzed via the χ² test. Pearson’s correlation analysis was used to assess correlations between the variables. Multifactor analysis was conducted via multivariate linear regression. The predictive performance of the multivariate regression model was verified using the receiver operating characteristic curve and the corresponding area under the curve (AUC). Statistical significance was defined as a P value of < 0.05.

RESULTS

Patients’ baseline demographic and clinical features

Of the 368 patients, 201 were male (54.6%) and 167 were female (45.4%). Their ages ranged from 35-78 (mean 53.43 ± 7.96) years. Furthermore, 292 were married (79.3%) and 76 were unmarried, divorced, or widowed (20.7%). Regarding their educational level, 58 patients (15.8%) had received primary school education or below, 124 (33.7%) had received junior high school education, 102 (27.7%) had received senior high school education, and 84 (22.8%) had received junior college education or higher school education. Regarding medical insurance, 186 patients were covered by employee medical insurance (50.5%), 122 by resident medical insurance (33.2%), and 60 paid out-of-pocket (16.3%). Regarding the tumor stage, 230 patients were at stage I-II (62.5%) and 138 were at stage III-IV (37.5%) (Table 1).

Table 1 Participants’ baseline characteristics and distribution (n = 368).

Indicators	Categories	n (%)
Gender	Male	201 (54.6)
	Female	167 (45.4)
Age (years)	< 50	118 (32.07)
	50-65	200 (54.35)
	> 65	50 (13.59)
Marital status	Married	292 (79.3)
	Unmarried/divorced/widowed	76 (20.7)
Educational level	Primary school and below	58 (15.8)
	Junior high school	124 (33.7)
	Senior high school/technical secondary school	102 (27.7)
	College degree and above	84 (22.8)
Payment method	Employee medical insurance	186 (50.5)
	Resident medical insurance	122 (33.2)
	Self-payment	60 (16.3)
Tumor stage	Stage I-II	230 (62.5)
	Stage III-IV	138 (37.5)

FoP-Q-SF, SAS, and SDS scores

The overall FoP-Q-SF score was 35.52 ± 6.73 points. It comprised 18.30 ± 5.97 points and 17.19 ± 3.33 points for the physical health and social-family factors, respectively. Standard SAS score was 51.23 ± 6.35 points, and the anxiety incidence was 62.50% (230 out of 368). Standard SDS score was 54.48 ± 7.15 points, and the depression incidence was 59.24% (218 out of 368) (Table 2).

Table 2 Patients’ scores on the fear of progression questionnaire-short form, self-rating anxiety scale, and self-rating depression scale (n = 368), n (%)/mean ± SD.

Scale	Total score	Factor score	Abnormality rate
FoP-Q-SF	35.52 ± 6.73	Physical health factor: 18.30 ± 5.97	-
		Social-family factor: 17.19 ± 3.33	-
SAS	51.23 ± 6.35	-	230 (62.50)
SDS	54.48 ± 7.15	-	218 (59.24)

FoP-Q-SF: Fear of progression questionnaire-short form; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Comparison of the FoP-Q-SF scores among patients with different characteristics

Gender: Male (n = 201, 35.94 ± 6.67) vs female (n = 167, 35.02 ± 6.77), P = 0.192. Age: < 50 years (n = 118, 34.64 ± 6.41), 50 years to 65 years (n = 200, 36.10 ± 6.78), > 65 years (n = 50, 35.28 ± 7.00), P = 0.166. Marital status: Married (n = 292, 33.77 ± 6.13) vs others (n = 76, 42.22 ± 4.28), P < 0.001. Educational level: Primary school and below (n = 58, 43.17 ± 4.20) > junior high school (n = 124, 37.94 ± 5.80) > senior high school/technical secondary school (n = 102, 33.18 ± 4.76) > college degree and higher (n = 84, 29.51 ± 4.14), P < 0.001. Payment method: Self-payment (n = 60, 42.72 ± 4.34) > resident medical insurance (n = 122, 37.58 ± 5.63) > employee medical insurance (n = 186, 31.84 ± 5.45), P < 0.001. Tumor stage: Stage III-IV (n = 138, 38.73 ± 6.00) > stage I-II (n = 230, 33.59 ± 6.40), P < 0.001. Anxiety status: With anxiety (n = 230, 39.25 ± 4.73) > without anxiety (n = 138, 29.30 ± 4.65), P < 0.001. Depression status: With depression (n = 218, 37.53 ± 6.13) > without depression (n = 150, 32.60 ± 6.49), P < 0.001 (Table 3).

Table 3 Comparison of the fear of progression questionnaire-short form scores among patients with different characteristics, mean ± SD.

Indicators	Categories	n	FoP-Q-SF scores (points)	t	P value
Gender	Male	201	35.94 ± 6.67	1.308	0.192
	Female	167	35.02 ± 6.77
Age (years)	< 50	118	34.64 ± 6.41	1.802	0.166
	50-65	200	36.10 ± 6.78
	> 65	50	35.28 ± 7.00
Marital status	Married	292	33.77 ± 6.13	11.320	< 0.001
	Unmarried/divorced/widowed	76	42.22 ± 4.28
Educational level	Primary school and below	58	43.17 ± 4.20	105.700	< 0.001
	Junior high school	124	37.94 ± 5.80
	Senior high school/technical secondary school	102	33.18 ± 4.76
	College degree and above	84	29.51 ± 4.14
Payment method	Employee medical insurance	186	31.84 ± 5.45	107.400	< 0.001
	Resident medical insurance	122	37.58 ± 5.63
	Self-payment	60	42.72 ± 4.34
Tumor stage	Stage I-II	230	33.59 ± 6.40	7.634	< 0.001
	Stage III-IV	138	38.73 ± 6.00
Anxiety status	With anxiety	230	39.25 ± 4.73	19.660	< 0.001
	Without anxiety	138	29.30 ± 4.65
Depression status	With depression	218	37.53 ± 6.13	7.401	< 0.001
	Without depression	150	32.60 ± 6.49

FoP-Q-SF: Fear of progression questionnaire-short form.

Correlations involving FoP-Q-SF scores

The FoP-Q-SF scores were positively correlated with SAS (r = 0.733, P < 0.001) and SDS scores (r = 0.377, P < 0.001) and negatively correlated with educational level (r = -0.678, P < 0.001). Furthermore, they were positively associated with tumor stage (r = 0.448, P < 0.001). Additionally, SAS scores were negatively correlated with educational level (r = -0.451, P < 0.001) and positive correlated with tumor stage (r = 0.353, P < 0.001) (Figure 1).

Figure 1 Heatmap of the correlations between the fear of progression questionnaire-short form scores and related variables. FoP-Q-SF: Fear of progression questionnaire-short form; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Association analysis between each factor of the FoP-Q-SF and related variables

We conducted an association analysis on the physical health and social-family factors of the FoP-Q-SF. Results revealed that the associations of the physical health factor with marital status, educational level, payment method, tumor stage, SAS, and SDS (r = 0.476, -0.657, 0.565, 0.389, 0.647, and 0.301 respectively; all P < 0.001) were notably greater compared with those of the social-family factor (r = 0.173, -0.190, 0.212, 0.207, 0.321, and 0.220 respectively; all P < 0.001) (Figure 2).

Figure 2 Heatmap of the associations between each factor of the fear of progression questionnaire-short form and related variables. SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Gradient differences in FoP-Q-SF levels among patients with different degrees of anxiety and depression

SAS standard scores were categorized into mild (50-59 points, n = 197), moderate (60-69 points, n = 30), and severe anxiety (≥ 70 points, n = 3). Corresponding FoP-Q-SF scores were 38.47 ± 4.04 points, 43.27 ± 5.53 points, and 50.33 ± 3.77 points, respectively. All groups differed significantly (P < 0.001), and scores increased linearly with the severity of anxiety experienced (F = 26.840, P < 0.001). SDS standard scores were classified into mild (53-62 points, n = 162), moderate (63-72 points, n = 54), and severe depression (≥ 73 points, n = 2), with the corresponding FoP-Q-SF scores being 36.85 ± 6.33 points, 39.09 ± 4.60 points, and 50.50 ± 2.50 points respectively. Similar significant gradient differences were observed (F = 7.699, P < 0.001) (Figure 3).

Figure 3 Gradient differences in the fear of progression questionnaire-short form levels among patients with different degrees of anxiety and depression. A: Degree of anxiety; B: Degree of depression. ^aP < 0.05, ^bP < 0.001. FoP-Q-SF: Fear of progression questionnaire-short form.

Linear regression analysis for multivariate factors

We used the total FoP-Q-SF score as the outcome variable and incorporated variables with significant univariate associations (marital status, educational level, payment method, tumor stage, and SAS and SDS scores) into the regression model. Results indicated that being unmarried, divorced, or widowed (β = 0.156), having a low educational level (β = -0.295), self-payment (β = 0.201), tumor stage III-IV (β = 0.094), and high SAS (β = 0.391) and SDS scores (β = 0.095) were independent risk factors for increased total FoP-Q-SF scores (P < 0.05) (Table 4).

Table 4 Multiple linear regression analysis of factors influencing fear of progression in postoperative patients with lung cancer.

Variable	Assignment	Unstandardized coefficient β (95%CI)	Standardized coefficient β	SE	t	P value
Constant	-	9.554 (5.316-13.792)	-	2.155	4.434	< 0.001
Marital status	0 = married; 1 = unmarried/divorced/widowed	2.805 (1.894-3.717)	0.169	0.464	6.051	< 0.001
Educational level	1 = Primary school and below; 2 = junior high school; 3 = senior high school/technical secondary school; 4 = college degree and above	-1.972 (-2.376 to -1.569)	-0.295	0.205	-9.615	< 0.001
Payment method	1 = employee medical insurance; 2 = resident medical insurance; 3 = self-payment	1.819 (1.284-2.354)	0.201	0.272	6.69	< 0.001
Tumor stage	1 = stage I; 2 = stage II; 3 = stage III; 4 = stage IV	0.606 (0.255-0.957)	0.094	0.178	3.392	0.001
SAS	Actual value	0.415 (0.350-0.479)	0.391	0.033	12.659	< 0.001
SDS	Actual value	0.090 (0.040-0.139)	0.095	0.025	3.552	< 0.001

CI: Confidence interval; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Construction and predictive efficacy validation of the multiple regression model

Leveraging the results of multiple linear regression analysis, we deduced a regression equation: Total FoP-Q-SF score = 9.554 + 2.805 × marital status + (-1.972) × educational level + 1.819 × payment method + 0.606 × tumor stage + 0.415 × SAS score + 0.090 × SDS score (variable assignments aligned with Table 4). We utilized an internal validation approach (10-fold cross-validation) to assess the predictive capability of the multiple regression model. Results demonstrated that the model’s coefficient of determination (R²) was 0.773 and root mean square error was 3.237. Considering a total FoP-Q-SF score of ≥ 40 as the threshold for high fear status (determined via the Youden index), we plotted the receiver operating characteristic curve of the model’s predicted values, and obtained an AUC of 0.895 [95% confidence interval (95%CI): 0.80-0.96]. Optimal predictive threshold corresponded to a model score of 41, which featured a sensitivity and specificity of 92.8% and 91.8%, respectively. AUC values for models that included only SAS (0.786, 95%CI: 0.739-0.832) and SDS scores (0.638, 95%CI: 0.581-0.696) were markedly lower than those of the full model (Z = 2.119, P = 0.013; Z = 1.262, P = 0.032). Hence, the combined multifactor model possessed superior predictive efficacy (Figure 4).

Figure 4 Receiver operating characteristic curve of the multiple regression model for predicting high fear status. SAS: Self-rating anxiety scale; SDS: Self-rating depression Scale.

DISCUSSION

A survey of postoperative patients with lung cancer revealed that their total FoP-Q-SF score was 35.52 ± 6.73, which reflects a moderate level of FoP. The incidence rates of anxiety and depression were 62.50% and 59.24%, respectively, among the patients. Significant differences were observed in the FoP-Q-SF scores among patients with distinct characteristics. Marital status, educational level, payment method, tumor stage, and anxiety and depression status were all correlated with the FoP-Q-SF scores. Correlation analysis indicated that the FoP-Q-SF score was positively associated with SAS and SDS scores and tumor stage and negatively correlated with educational level. Stratified association analysis of physical health and social-family factors revealed that the physical health factor generally had stronger correlations with various factors compared with the social-family factor. Additionally, the constructed multiple regression model exhibited favorable predictive efficacy, with an AUC of 0.895, which was superior to that of the models that included only the SAS or SDS scores.

Comparison with previous studies

Many recent studies have focused on FoP and related psychological factors in patients with lung cancer. Tao et al[10] reported that FoP in patients with lung cancer was linked to various factors, with anxiety being a key factor. This aligns with our finding that the FoP-Q-SF scores had a significant positive association with SAS scores, which further verifies the role of anxiety in worsening patients’ FoP. Borg et al[11] found that patients with lung cancer and lower educational levels tended to experience more difficulties in coping with the disease and exhibited higher FoP levels, which is consistent with the negative correlation between educational level and FoP-Q-SF scores in our study. Hence, educational level may affect patients’ understanding of disease-related information and their choice of coping strategies. Regarding tumor stage, Kolsteren et al[12] and Manzoor et al[13] observed that patients with advanced-stage lung cancer (stage III-IV) had further noticeable FoP. This corresponds with our result showing that the FoP-Q-SF scores of patients in stage III-IV were remarkably higher than those of patients in stage I-II. This indicates that disease severity influenced patients’ psychological state. Regarding marital status, Zhang et al[14] found that patients with cancer who were unmarried, divorced, or widowed experienced a greater psychological burden and higher FoP levels, which is consistent with our findings. Hence, a stable marital relationship might offer patients emotional support and reduce their fear.

Exploring the potential mechanisms

Mechanisms of psychological factors: Anxiety is associated with FoP and may amplify it by altering patients’ cognitive patterns and coping strategies. Patients in an anxious state may tend to overly concentrate on negative information related to the disease and magnify the perceived risk of disease progression[15-17]. This study observed that patients with anxiety had markedly higher FoP-Q-SF scores than those without anxiety; furthermore, scores increased with the severity of anxiety experienced. This implies that anxiety could be a key psychological factor impacting FoP. Moreover, anxiety can disturb aspects of daily life, such as sleep and diet, which can further weaken one’s psychological ability to cope and create a vicious cycle[18-21]. Regarding the association between depression and FoP, depressive conditions lower psychological resilience, which can lead to pessimistic future expectations[22]. Psychological resilience refers to an individual’s capacity to adapt effectively amid adversity, trauma, tragedy, threats, or other major stressors[23,24]. Studies reveal that psychological resilience regulates the relationships among depression, anxiety, and well-being[25]. Hence, pessimism may heighten FoP, as evidenced by the elevated FoP-Q-SF scores among patients with depression in this study. Depression may also reduce patients’ motivation to participate in rehabilitation, which can increase the risk of disease progression and further strengthen their fear[26].

Mechanisms of sociodemographic factors: Patients with lower educational levels may struggle to access and comprehend disease-related information[27]. Difficulty in accurately assessing disease risks and treatment options can intensify their FoP. In this study, the FoP-Q-SF scores were highest in patients with primary school or lower education and gradually decreased with higher educational levels. Hence, improving educational attainment or optimizing health education approaches may alleviate FoP. Patients who are married typically receive emotional support and daily care from their spouses, which can increase their confidence and ability to cope[28]. In contrast, unmarried, divorced, or widowed patients lack a stable emotional support system, which makes them further psychologically vulnerable and prone to intense FoP, a finding strongly supported by our results.

Mechanisms underlying disease-related factors: Patients with advanced stages of lung cancer (III-IV) have more serious disease conditions, higher risk of tumor metastasis, and worse prognosis[29]. Their direct awareness of disease progression and worries regarding unfavorable outcomes intensify their fear. This was indicated by the significantly higher FoP-Q-SF scores in patients with stage III-IV cancer compared with those with stage I-II cancer. Patients with advanced lung cancer are more prone to fearing disease progression owing to higher progression risks and poorer prognosis[30,31]. They might have fewer treatment choices and experience greater uncertainty regarding treatment effectiveness compared with patients in the early stage, which further increases their anxiety and fear[30]. Furthermore, self-paying patients shoulder a heavier financial burden and may be concerned about not being able to maintain optimal treatment due to economic limitations, which can increase FoP[32]. Patients with resident medical insurance experience relatively less financial stress; however, they may still incur some out-of-pocket costs. In contrast, those with employee medical insurance have better financial security and lower levels of fear. Differences in the FoP-Q-SF scores among those with different payment methods in our study confirm this hypothesis.

Limitations

This study has some limitations. First, we only enrolled postoperative lung cancer patients from a single region. Hence, our sample lacked sufficient geographical representativeness and possibly failed to accurately mirror the actual situation of patients with lung cancer in various regions. Regional differences in factors, such as medical resources and cultural background, may affect patients’ psychological states and the intensity of their FoP. Future studies should broaden the sample scope to include patients from diverse regions to enhance the generalizability of the findings. Second, we adopted a cross-sectional survey design. Hence, we cannot clarify the causal relationships between variables. Although multiple factors were associated with FoP, whether these factors cause such fear or are arising consequences remains unclear. Subsequent studies should use prospective cohort designs to thoroughly explore the causal mechanisms between the factors. Third, although we utilized widely used scales, such as the FoP-Q-SF, SAS, and SDS, these may not fully capture patients’ complex psychological states or all the influencing factors. Some patients may have unique psychological experiences and unrecognized influencing factors that are not covered by the scales. Future research should consider combining qualitative research methods to comprehensively understand patients’ feelings and improve the assessment of relevant factors.

CONCLUSION

FoP in postoperative patients with lung cancer was impacted by psychological aspects, such as anxiety and depression, in addition to marital status, educational attainment, payment mode, and tumor stage. Physical health factors had more notable associations with FoP. Furthermore, the multiple regression model had favorable predictive ability. Our results suggest that psychological assessments should be prioritized. Interventions, such as cognitive-behavioral therapy, may help patients with anxiety and depression. Health education should be improved for patients with low educational levels using easy-to-understand language to convey disease-related information. In addition, social support should be enhanced to focus on unmarried, divorced, or widowed patients and reduce financial strain for self-paying patients. Patients’ psychological conditions should be considered during treatment planning. For those with advanced-stage cancer, communication approaches should be emphasized, and effective treatment should be provided. Furthermore, comprehensive interventions can improve patients’ psychological state and boost their quality of life and rehabilitation results, which can offer references for clinical management.