"Anxiety and worry" induces fear transformation in cancer patients: an evidence-based exploration and theoretical consideration of the emotional evolution in tumor patients.

Abstract

<h4>Objective</h4>The aim is to empirically explore the relationship between the occurrence of affective distress and the fear transformation in cancer patients, and to analyze the theoretical implications of their development from multiple perspectives.<h4>Methods</h4>Relevant studies on the transformation of affective distress into fear in cancer patients were retrieved from databases including CNKI (China National Knowledge Infrastructure), Wan Fang Data, SinoMed (China Biomedical Literature Database), PubMed, Embase, and others, up to July 12, 2025. Meta-analysis of the included studies was performed using R 4.4.1.<h4>Results</h4>①A total of 27 studies were included in this research, covering 9 types of cancer and involving 14,011 participants. These included 24 cross-sectional studies, 2 cohort studies, and 1 case-control study. ②The meta-analysis revealed a significant association between the occurrence of fear and depressive emotions in cancer patients [1.63, 95% CI (1.40, 1.88), P < 0.001]. Multi-factor meta-regression analysis explained 59.31% of the total heterogeneity at the model level, although the source of heterogeneity remained unclear. Subgroup analysis showed that affective distress in cancer patients was more likely to evolve toward fear of cancer progression[2.13, 95% CI (1.41, 3.23), P < 0.001]. Additionally, female cancer patients were more susceptible to the influence of affective distress[2.36, 95% CI (1.54, 3.63), P < 0.001], leading to a higher likelihood of experiencing fear. ③Previous literature studies have shown that various hormones (such as dopamine, oxytocin, cortisol, etc.) influence the emotional evolution process through the neuroendocrine system, specifically the hypothalamic-pituitary-adrenal axis. Additionally, multiple pro-inflammatory cytokines, including microglial cells, are involved in this process and trigger immune responses, collectively affecting the fear circuits in the amygdala and prefrontal cortex.<h4>Conclusion</h4>The depressive emotions and fear states in cancer patients are independently associated, and several mechanisms and theories partially suggest a potential causal relationship. However, due to limitations in the research methods, further clinical trials and basic research are still needed to provide more robust evidence for this causal relationship and biological mechanisms.