Transitioning into Survivorship: Life Engagement and the Role of Positive Automatic Thoughts in Shaping Long-Term Recurrence Worries and Cancer-Related Distress in Breast Cancer Survivors

Abstract

Receiving a breast cancer diagnosis and undergoing treatment is profoundly stressful, with fear of recurrence posing a major long-term concern for survivors. Predictors of sustained recurrence worries and cancer-related distress remain underexplored. One potentially important factor is life engagement, defined as vitality, motivation, and meaningful engagement across emotional, physical, social, and cognitive domains. &nbsp;Life engagement aligns with interventions like behavioral activation, acceptance and commitment therapy, and meaning-centered psychotherapy, which support survivors&rsquo; psychological well-being. However, its role in shaping long-term distress during survivorship remains unclear.To address this gap, this study used structural equation modeling to develop a latent construct of life engagement in breast cancer survivors using items from established psychosocial measures. We tested whether life engagement one-year after surgery predicted recurrence worries and cancer-related distress four years later, and whether positive automatic thoughts at 18 months mediated these associations. Analyses included 210 breast cancer survivors who remained recurrence free during the first five years after diagnosis, controlling for age, race/ethnicity, cancer stage, and adjuvant or hormone therapies.Life engagement, conceptualized as social and recreational connection, experiential pleasure, and creative commitment, fit well as a second-order factor. Greater engagement at one-year predicted fewer recurrence worries, cancer intrusions, and avoidance behaviors at four years and was associated with more positive automatic thoughts at 18 months, though mediation was not observed. &nbsp;These findings extend the life engagement framework to breast cancer survivorship and suggest that life engagement may protect against long-term distress. The one-year follow-up period may represent a key window to identify survivors struggling to re-engage in life and incorporate engagement-focused interventions into survivorship care.</p