Dynamic Association Between Health Literacy and Fear of Progression Among Nasopharyngeal Cancer Survivors During the Post‑treatment Survivorship Period: A Multicenter Exploratory Longitudinal Study

Objective: To explore the dynamic association and predictive effect between health literacy and Fear of Progression (FoP) among nasopharyngeal carcinoma (NPC) patients during post‑treatment survivorship period. Methods: A multicenter exploratory longitudinal study design was adopted. A total of 94 newly diagnosed patients with stage III and above non-metastatic nasopharyngeal carcinoma were enrolled from the Department of Radiotherapy between August 2023 and December 2024.Three follow-up time points were set at 3 months (T1), 6 months (T2), and 12 months (T3) after treatment completion, at which patients' health literacy and Fear of Progression (FoP) levels were assessed. The correlation between health literacy and FoP, as well as the predictive effect of health literacy on FoP, were further analyzed. Results: The mean age of the 94 NPC patients was 48.6 ± 12.3 years. Health literacy remained moderate across the three time points, while FoP was consistently high. Health literacy was significantly negatively correlated with FoP at all time points, with stronger correlations in the resource utilization and threat perception dimensions. The lagged linear model showed health literacy had a significant unadjusted negative predictive association on subsequent FoP. However, after controlling for prior FoP's inertia effect, health literacy's independent predictive effect disappeared, while FoP's inertia remained extremely strong. Dimensional decomposition revealed only health literacy's resource utilization dimension had a significant protective effect on FoP, with the threat perception dimension marginally significant. Sensitivity analysis confirmed findings' robustness. Conclusion: NPC patients' FoP showed high temporal stability during the post‑treatment survivorship period; single-modality health literacy interventions failed to alter this chronic psychological state short-term. Clinically, early combined interventions of health literacy enhancement and psychological cognitive restructuring are recommended. Prioritize improving patients' medical resource utilization capacity, with a multidisciplinary support system to provide sustained health and psychological support during family reintegration.