Pain-Related Dysfunctional Beliefs About Sleep and Depression Mediate the Influence of Pain Severity on Fear of Progression Among Individuals With Cancer

Abstract

Objective This study investigated whether pain severity contributes meaningfully to fear of progression (FoP) among individuals with cancer and assessed the mediating roles of psychological symptoms, specifically pain-related dysfunctional beliefs about sleep and depressive symptoms, in this association. Methods We retrospectively reviewed medical records of 252 individuals with cancer who attended the Sleep Clinic for cancer patients at Asan Medical Center. Demographic and clinical data were extracted alongside responses to self-report questionnaires, including the Fear of Progression Questionnaire–Short Form (FoP-Q-SF), Pain-Related Beliefs and Attitudes about Sleep (PBAS), Patient Health Questionnaire-9 (PHQ-9), State subscale of the State-Trait Anxiety Inventory (STAI-S), Insomnia Severity Index (ISI), and numeric pain rating scales. Pearson correlation and linear regression analyses were conducted to examine associations among variables, particularly the contribution of pain and psychological symptoms to FoP. Mediation analysis was performed using maximum likelihood regression. Results FoP-Q-SF scores were significantly positively correlated with pain (r=0.36, p<0.001), PBAS (r=0.43, p<0.001), ISI (r=0.25, p<0.001), PHQ-9 (r=0.66, p<0.001), and STAI-S (r=0.22, p<0.001). Linear regression analysis indicated that FoP-Q-SF scores were predicted by age (β=-0.28, p<0.001), pain (β=0.13, p=0.013), PBAS (β=0.15, p=0.007), and PHQ-9 (β=0.55, p<0.001). Mediation analysis demonstrated that pain exerted a direct effect on FoP-Q-SF scores, with both PBAS and PHQ-9 partially mediating this relationship. Conclusion These findings suggest that pain-related dysfunctional beliefs about sleep and depressive symptoms mediate the influence of pain severity on fear of progression among individuals with cancer.