Death anxiety as general factor to fear of cancer recurrence.

Objective: Fear of cancer recurrence or progress is strongly related to death anxiety (DA) in cancer patients, but due to lack of conceptualization and measurement methods, the relationship was not analyzed quantitatively before. The aim of the present study was to investigate the conceptual relationship of both constructs, with DA expected to be the general construct.

Methods: Cancer patients (N = 121) participated in an online study. They provided information on socio-demographical, medical and psychological measures including DA and fear of cancer recurrence or progression (FoP-Q-SF). Relation of constructs was assessed using a two-step process: Confirming individual construct structure with confirmatory factor analysis, including correlation of constructs and modification of measurement model, followed by structural equation modeling and comparison of structure models for best model fit.

Results: The measurement model was modified to include three residual correlations within and between constructs. Comparison of structure models supported a bifactor structure with DA as general factor and fear of recurrence or progression as group factor: SBχ (173) = 207.74 (p < 0.05), SB = 1.538, relative χ  = 1.2, rRMSEA = 0.05 [0.01, 0.07] (p > 0.05), SRMR = 0.07, CFI = 0.94, AIC = 7543.60.

Conclusions: DA can be interpreted as general factor to fear of cancer recurrence or progression. Psychological interventions to reduce emotional burden of cancer patients need to focus additionally on existential threat and individual fears regarding DA.