{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T10:02:04Z","timestamp":1773655324871,"version":"3.50.1"},"reference-count":53,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The global prevalence of cancer is increasing, with 50% of new diagnoses occurring in people over 65 years old. Despite this demographic trend, psychosocial research has focused largely on younger populations, leaving a limited understanding of how middle-aged and older adults adjust to cancer. Fear of progression (FoP) has emerged as a key component of emotional vulnerability in cancer survivors, yet its role in shaping psychological distress and health-related quality of life (HQoL) in these age groups remains understudied. This study aimed to examine psychosocial adjustment in middle-aged and older women with cancer and to test the mediating role of FoP in the relationship between emotional distress, post-traumatic stress and HQoL. Methods: The sample consisted of 135 women aged 45 to 79 years (M = 52.94; SD = 6.58), of whom 80.7% (n = 109) were middle-aged (45\u201359 years) and 19.3% (n = 26) were older (60\u201379 years). In addition to a clinical and sociodemographic questionnaire, the following self-report measures were used: Fear of Progression Questionnaire\u2014Short Form (FoP-Q-SF), Hospital Anxiety and Depression Scale (HADS), Post-Traumatic Stress Disorder Checklist\u2014Civilian Version (PCL-C), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). Mann\u2013Whitney tests were used to explore age-group differences as part of the sample characterization. Correlational analyses examined associations among FoP, anxiety and depression, post-traumatic stress, and HQoL. The mediating role of FoP was tested using path analysis with bias-corrected percentile bootstrapping. Results: Older women reported slightly higher levels of depression and poorer physical and social functioning compared to middle-aged women, but with a small effect size (0.2). Path analysis revealed a significant indirect effect of FoP on the relationship between post-traumatic stress and HqoL (indirect effect 1; estimated effect = \u22120.174; 95% CI [\u22120.293, \u22120.084]; p &lt; 0.001), as well as between depression and HqoL (indirect effect 2; estimated effect = \u22120.181; 95% CI [\u22120.301, \u22120.086]; p &lt; 0.001). Conclusions: Middle-aged and older women with cancer showed broadly similar psychosocial profiles. FoP emerged as a central mechanism linking psychological distress to poorer HQoL across age groups. Interventions targeting FoP may therefore be beneficial for improving psychosocial adjustment in women living with cancer, regardless of age.<\/jats:p>","DOI":"10.3390\/jcm15062234","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T08:41:26Z","timestamp":1773650486000},"page":"2234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Fear of Progression in Psychosocial Adjustment in Middle-Aged and Older Women with Oncological Disease: A Path Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5928-259X","authenticated-orcid":false,"given":"Sandra","family":"Silva","sequence":"first","affiliation":[{"name":"RISE-Health, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0817-0157","authenticated-orcid":false,"given":"Ana","family":"B\u00e1rtolo","sequence":"additional","affiliation":[{"name":"RISE-Health@UPT, Portucalense University, 4200-072 Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D\u00e9bora","family":"Paiva","sequence":"additional","affiliation":[{"name":"Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel M.","family":"Santos","sequence":"additional","affiliation":[{"name":"William James Center for Research, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-3851","authenticated-orcid":false,"given":"Sara","family":"Monteiro","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal"},{"name":"Department of Social Sciences and Management, Universidade Aberta, 1269-001 Lisbon, Portugal"},{"name":"Center for Global Studies, Universidade Aberta, 1269-001 Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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