Fear of Cancer Progression as a Psychological Component of Cancer Rehabilitation in Men Treated for Reproductive System Malignancies: A Multi-Regional Cross-Sectional Study in Kazakhstan.
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Background: Fear of cancer progression (FoP) is a well-recognised, clinically significant dimension of quality of life in oncology, yet it remains largely unstudied among men treated for reproductive system malignancies in Central Asia. This study assessed the level and correlates of FoP among such patients across several regions of Kazakhstan, as part of a broader research programme aimed at improving rehabilitation services for this patient group. Methods: A cross-sectional survey was conducted among 1081 men treated for a malignancy of the reproductive system, recruited across seven administrative regions of Kazakhstan (Pavlodar, Karaganda, Astana, Shymkent, Kyzylorda, Taldykorgan and East Kazakhstan). Participants completed a 12-item, 5-point Likert-scale questionnaire covering the same thematic domains as the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), together with a structured sociodemographic and clinical questionnaire. Total FoP scores were calculated, together with two post hoc, exploratory subscales (somatic/health-related and social/occupational-family), reported descriptively only. Associations with sociodemographic and clinical variables were examined using t-tests, one-way ANOVA with Tukey post hoc comparisons, Spearman correlation and multivariable linear regression. Results: Internal consistency of the 12-item instrument was good (Cronbach's α = 0.864). The mean total FoP score was 38.6 ± 8.2 (observed and possible range, 12-60). Patients who had experienced disease recurrence or had an unclear disease status scored markedly higher than patients with no recurrence and no treatment in the preceding six months (mean difference 4.07 points, p < 0.001), as did patients who had received treatment in the past six months without recurrence (mean difference 2.90 points, p < 0.001). Patients receiving hormonal (androgen-deprivation-type) therapy reported higher fear scores than those who were not (39.4 vs. 37.7, p = 0.001), an association that remained significant after multivariable adjustment (β = 1.19, p = 0.024). Urban residents scored higher than rural residents (38.9 vs. 37.6, p = 0.019). Age, having minor children, and ethnicity were not significantly associated with FoP. In multivariable analysis, disease status and hormonal therapy were the only independent predictors of FoP (model R2 = 0.053, p < 0.001). Conclusions: Fear of cancer progression is common and clinically relevant among Kazakhstani men treated for reproductive system cancers, and was most strongly associated with current disease status and receipt of hormonal therapy rather than with age or family circumstances. These findings support integrating structured psychological screening into routine rehabilitation pathways for this patient group, with universal access to psychosocial support and proactive outreach particularly considered for patients with recurrent or recently treated disease and those receiving hormonal therapy.