Fear of progression as a mediator between symptom burden and social alienation in lung cancer patients undergoing chemotherapy

Chemotherapy is one of the main treatment methods for lung cancer patients, but it brings a serious symptom burden to patients. Previous studies have shown that symptom burden may lead to social alienation, but the underlying mechanism of this relationship is not yet fully understood. This study aims to explore the mediating effect of fear of progression (FoP) between symptom burden and social alienation in lung cancer patients undergoing chemotherapy. This study adopted a cross-sectional survey design. A total of 216 lung cancer patients receiving chemotherapy were recruited from the outpatient clinics or inpatient wards of the Oncology Department at a tertiary grade-A hospital in Deyang City from March to July 2025 using convenience sampling. Data were collected using a general information questionnaire, the M.D. Anderson Symptom Inventory-Lung Cancer Module (MDASI-L), the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the Social Alienation Scale for Cancer Patients (SAS-CP). R version 4.5.2 was used to analyze the correlations among symptom burden, FoP, and social alienation, as well as to test the mediating effect of FoP between symptom burden and social alienation. The total social alienation score was 82.77 ± 10.48. Pearson correlation analysis showed that the total symptom burden score was positively correlated with the total social alienation score ( r = 0.356, P < 0.01) and with the FoP score ( r = 0.232, P < 0.01). The FoP score was also positively correlated with the total social alienation score ( r = 0.489, P < 0.01). Mediation analysis revealed that FoP partially mediated the relationship between symptom burden and social alienation, with a mediating effect of 0.103, accounting for 30.3% of the total effect. Symptom burden in patients with lung cancer undergoing chemotherapy can directly affect social alienation, and it can also indirectly affect social alienation through FoP. Therefore, it is necessary to strengthen the symptom assessment and management of lung cancer patients undergoing chemotherapy, and carry out targeted psychological counseling in a timely manner, especially the intervention of FoP, in order to reduce the patients’ sense of social alienation.