“Fear Has Big Eyes”: Illness Perception, Fear of Recurrence and Generalized Anxiety in Post-Treatment Thoracic Cancer Patients: A Serial Multi-Mediation Analysis

Background/Objectives: Illness perception plays a central role in psychological adjustment in cancer patients. However, its effects on post-treatment thoracic cancer pa-tients, particularly regarding fear of recurrence and generalized anxiety, remain under-studied; further research is especially needed to examine their mediational paths. This study aimed to examine the mediating roles of meaning-making and changes in beliefs and goals within a serial multiple mediation model between illness perception, fear of recurrence and generalized anxiety. Method: A cross-sectional study was conducted with 284 thoracic cancer patients (149 men and 135 women) who had completed treatment. Participants completed validated self-report measures assessing illness perception, meaning-making, changes in beliefs and goals, fear of cancer recurrence, and generalized anxiety. Hierarchical regression analyses and serial multiple-mediation models based on path analysis were employed to examine direct and indirect associations among varia-bles. Results: Negative illness perception was positively associated with fear of recurrence and generalized anxiety, while positive illness perception predicted lower levels of both outcomes. Path analyses revealed that meaning-making and changes in beliefs and goals jointly mediated the relationships between illness perceptions and psychological distress. Specifically, adaptive meaning-making and belief-goal restructuring buffered the effects of negative perceptions, whereas maladaptive processes amplified distress. Conclusions: Findings indicate that both negative and positive illness perceptions influence post-treatment emotional adjustment in thoracic cancer patients through mediation effects. Based on the meaning-making model, interventions targeting maladaptive illness perceptions, promoting meaning-making, and supporting adaptive changes in personal beliefs and goals may reduce fear of recurrence and anxiety. These results support the incorporation of meaning-centered strategies into psychosocial oncology care, emphasizing cognitive-motivational processes as critical targets for improving emotional well-being in cancer survivorship.