Health locus of control and fear of cancer recurrence: the moderating role of emotion regulation in cross-sectional and longitudinal analyses

Objective: Health locus of control (HLC) encompasses beliefs about control over illness from three sources: ‘internal’, ‘powerful others’, and ‘chance’. An internal locus is adaptive in cancer patients, while powerful others and chance loci predict psychological distress. We examined the association between HLC and fear of cancer recurrence (FCR) in cancer survivors, considering the moderating role of emotion regulation. Methods and measures: One-hundred-and-sixteen survivors participated in a cross-sectional assessment, with a subsample of 56 short-term survivors completing a one-year follow-up. We utilised demographic and medical questionnaires, the Fear of Cancer Recurrence Inventory-Short Form, the Multidimensional Health Locus of Control scale, and the Difficulties in Emotion Regulation scale. We assessed whether emotion regulation moderated the HLC-FCR association. Results: Cross-sectional analysis revealed a negative association between internal HLC and FCR, whereas powerful others HLC, chance HLC, and difficulties in emotion regulation were positively associated with FCR. The associations of internal and chance HLC with FCR weakened in survivors with greater difficulties in emotion regulation, with longitudinal analysis confirming these exact interaction patterns. Conclusion: Increasing difficulties in emotion regulation diminish the benefits of an internal locus and the harms of a chance locus on FCR, underscoring the relevance of interventions addressing both factors.