{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T01:30:18Z","timestamp":1792287018478,"version":"4.4.0"},"reference-count":59,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T00:00:00Z","timestamp":1726876800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>While advancements in cancer treatments have improved survival rates, they also lead to adverse effects such as insomnia, which significantly impacts survivors' sleep quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study explores the influence of cancer\u2010related fatigue (CRF), Fear of Cancer Recurrence (FCR), and psychological distress, with rumination serving as a mediating factor, on the insomnia experienced by cancer survivors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study involved 220 cancer survivors attending Shohada\u2010e\u2010Tajrish Hospital's oncology center in Tehran, Iran. Participants were selected through convenience sampling and completed several questionnaires: the Insomnia Severity Index, Fear of Cancer Recurrence Inventory, Cancer Fatigue Scale, Kessler Psychological Distress Scale, and Rumination Response Scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results showed that the tested model had a good fit, and the correlation matrix demonstrated significant positive correlations between CRF (0.46), FCR (0.15), psychological distress (0.55), and rumination (0.42) with insomnia in cancer survivors (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Notably, CRF (B\u2009=\u20090.356, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and psychological distress (B\u2009=\u20090.339, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) affect insomnia both directly and indirectly through mediation by rumination, while the impact of FCR on insomnia was indirectly significant (B\u2009=\u20090.73, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings suggest that interventions focused on managing rumination could be potential targets to alleviate insomnia and improve the sleep quality of cancer survivors.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.70189","type":"journal-article","created":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T07:54:27Z","timestamp":1726905267000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Mediating effects of rumination on insomnia in cancer 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