Introduction

In China, there are about 28,000 new cases of malignant bone tumors each year, with a higher incidence in men than in women, and most of these cases involve adolescent children, which may be related to the vigorous bone growth that occurs in adolescents1. It is estimated that there were 3,970 new malignant bone and joint tumors and 2140 deaths in the United States in 20232. Although the 5-year survival rate of patients with malignant bone tumors has continuously improved with the early diagnosis and treatment of malignant bone tumors, which can reach 60%-70%, recurrence and metastasis are still the greatest problems facing patients because of the pathophysiological characteristics of malignant bone tumors and its recurrence rate of as high as 35%3.

Owing to this high recurrence rate, the fear of cancer recurrence has become an important psychological problem for adolescent patients with malignant bone tumors. A high fear of cancer recurrence level can trigger a series of abnormal psychological reactions, such as escapism and the inability to plan for the future, enhance patients’ negative emotions, and seriously affect their quality of life4. A study on FCR among breast cancer patients and caregivers indicates that cancer not only impacts patients’ physical and mental health but also imposes challenges and burdens on their entire families5. As the main caregivers of adolescent malignant bone tumor patients, these caregivers have been under a heavy economic and care burden for a long time, which makes them very prone to FCR, and their incidence rate is even higher than that among patients, which seriously affects their physical and mental health and care ability6.

Family resilience is the ability of families to actively adapt to difficulties and pressures in the face of life crises or family difficulties, and such resilience can alleviate negative emotions and help families better adapt to adversity, thereby reducing the negative impact of stress on individuals and families7. At the same time, family resilience has a buffering and protective effect, which can effectively reduce the adverse impact of illness on patients and the entire family, thereby alleviating the fear of cancer recurrence for both patients and caregivers8. A study about FCR and family resilience in liver cancer patients and their spouses revealed that family resilience was not only negatively correlated with patients’ own FCR, but it also affected the FCR of caregivers9. Research by Coyne et al.10 on family resilience among cancer patients and caregivers in Australia and Denmark indicates that when individuals and family members face health adversity, family resilience can serve as an internal strength, enabling individuals and families to better adapt to health challenges. Therefore, enhancing family resilience can help the entire family maintain a positive and optimistic attitude, which may reduce stress responses in both patients and caregivers, and alleviate levels of FCR. However, no studies have been focused on the interaction between family resilience and FCR from the perspective of adolescent patients with malignant bone tumors and their caregivers.

The term coping styles refers to the attitudes and behaviors that are adopted by an individual in the face of difficult situations and stressors, and they are divided into positive coping styles and negative coping styles11. Positive coping styles can help relieve stress and promote physical and mental health in both patients and caregivers, whereas negative coping styles can lead both patients and caregivers to adopt apathetic or avoidant practices for coping with stress, increasing their negative emotions such as anxiety and depression, and increase their fear of cancer recurrence12,13. Van et al.14 employed the APIM to investigate FCR in childhood cancer patients and their caregivers. They found that children’s stress coping abilities were interdependently associated with those of their parents. When both parties adopted positive coping strategies, they experienced greater benefits, their FCR levels decreased accordingly, and over time, the bidirectional associations between caregivers and patients became increasingly strong. A study on fear of cancer recurrence (FCR) and coping styles among bladder cancer patients of different age groups indicated that positive coping strategies can help alleviate disease-related distress and are associated with lower levels of FCR, whereas negative coping styles are linked to higher FCR15. However, few studies have dynamically explored the interaction between different coping styles and FCR from the perspectives of adolescent patients and caregivers with malignant bone tumors.

Family systems theory16 posits that the family should be viewed as an integrated whole composed of distinct subsystems—including the couple subsystem, parent–child subsystem, and sibling subsystem—rather than as a collection of independent individuals. Each family member interacts with one another, and family members rely on each other emotionally, economically, and socially. The emotions, economic challenges, and social obstacles of one family member can affect the stability of the entire family system. A cancer patient’s fear of recurrence can impact the cognition and emotions of their family caregivers, and the anxiety, helplessness, and depression of family members can also affect the patient’s emotions. Therefore, it is necessary to view adolescent patients with malignant bone tumors and their caregivers as an interconnected whole system, rather than as separate individuals, in order to more comprehensively and deeply understand the interconnected physical and mental health challenges they face together. This holistic perspective is crucial for developing multidimensional, integrated intervention strategies to improve the overall well-being of both patients and their caregivers, ultimately alleviating FCR for both parties. The implication of this theory for this study is that in this research, adolescents with idiopathic scoliosis and their caregivers should be regarded as a dyadic whole that influences each other. The family resilience and coping strategies of both the patient and the caregiver will affect the level of FCR for both parties.

The actor—partner interdependence model (APIM)17 is mainly used to analyze paired data, treating the research object as a whole and investigating it as a group. This model can explore the relationship between independent and dependent variables, while simultaneously estimating the effects of an individual and their counterpart in interpersonal relationships. It addresses the issue of data non-independence in dyadic relationships and provides an effective analytical method for dyadic data. FCR is a common psychological issue among adolescents with malignant bone tumors and their caregivers, affecting both parties’ mental health and quality of life. Therefore, it is very important to understand the interaction of factors influencing FCR in both groups18,19. However, no studies have applied this model to adolescent patients with malignant bone tumors and their caregivers. Therefore, this study used the actor‒partner interdependence model to analyze the interaction among the coping styles, family resilience and FCR of adolescent malignant bone tumor patients and their caregivers, with an aim of analyzing the impact of coping styles and family resilience on FCR from a binary perspective to provide targeted interventions for adolescent malignant bone tumor patients and their caregivers. We hypothesized that the FCR of adolescent patients with malignant bone tumors and their caregivers was related to their own coping styles and levels of family resilience, suggesting the presence of the actor effect. Similarly, the FCR of adolescent patients with malignant bone tumors and their caregivers was influenced by the coping styles and family resilience of the other party, indicating the presence of a partner effect.

Although an increasing number of studies have been focused on FCR as a psychological problem, there are still several shortcomings to this approach. FCR is common among cancer patients and caregivers, but the current research on FCR is more patient-oriented, less attention is given to caregivers, and the impact of coping styles and family resilience on the FCR of adolescent patients with malignant bone tumors and their caregivers has not been considered. Therefore, this study investigated patients and caregivers as a whole, constructed an actor–partner interdependence model of coping styles, family resilience and FCR in adolescents with malignant bone tumors, and explored the actor‒partner relationships between patients and their caregivers in regard to coping styles, family resilience and FCR.

Materials and methods

Aim

The purpose of this study was to investigate the correlations among coping styles, family resilience and FCR in adolescent patients with malignant bone tumors and their caregivers and to explore the actor‒partner effect between them via the actor‒partner interdependence model.

Study design and participants

For this study, convenience sampling was used to select adolescent patients with malignant bone tumors and their caregivers who were hospitalized in either of two tertiary hospitals in Zhejiang Province from January 2023 to July 2025. The sample size was calculated by G·power 3.1 software, and according to multivariate analysis, the medium effect size was f2 = 0.15, α = 0.05, 1-β = 0.90. The study used 24 independent variables, and the required sample size was calculated to be 206 pairs. Considering the 10% loss to follow-up rate, the final sample size was determined to be at least 207 pairs.

Inclusion and exclusion criteria

The inclusion criteria for patients were as follows: (1) they were diagnosed with malignant bone tumors by pathological tissue examination20; (2) they were adolescent patients aged 10–19 years; (3) they had no communication impairments, and they had normal cognitive function; and (4) they provided informed consent, and their participation was voluntary. The caregivers’ inclusion criteria were as follows: (1) they served as the patient’s primary caregiver and had a cumulative care time of ≥ 3 months; (2) they were aged ≥ 18 years; (3) they were caregivers who voluntarily participated in this study.

The patient exclusion criteria were as follows: (1) they had comorbidities with other serious medical or psychiatric illnesses; and (2) they participated in other investigations. The caregiver exclusion criteria were as follows: (1) they had cognitive impairment and were unable to cooperate; and (2) they had participated in other investigations.

Measures

Sociodemographic characteristics

For patients, the sociodemographic characteristics included 11 items pertaining to age, gender, education level, hospital level and reputation, medical payment methods, course of disease, number of chemotherapy sessions, tumor stage, number of hospitalizations per year, religious beliefs and participation in anticancer organizations. For caregivers, the sociodemographic characteristics included 6 items pertaining to age, gender, education level, religious beliefs, family per capita monthly income and career status.

Fear of progression questionnaire-short form (FoP-Q-SF)

The FoP-Q-SF scale was developed by Mehnert et al.21 in 2006 and adapted by the Chinese scholar Wu et al.22 in 2015. This scale has been widely used to understand the fear of cancer recurrence among cancer patients and caregivers. It consists of 2 dimensions, namely, physical health and social family, with a total of 12 items, and uses a 5-point Likert scale with a total score of 12–60 points. The higher the score is, the more severe the fear of cancer recurrence among patients and caregivers, with 12–22 being mild, 23–36 being moderate, and 37–60 being severe. In this study, the Cronbach’s α coefficients were 0.88 and 0.92 for patients and caregivers, respectively.

Simple coping style questionnaire (SCSQ)

The SCSQ scale was developed by Xie et al.23 in 1998 and contains two subscales: positive coping (12 items) and negative coping (8 items), with a total of 20 items. A 4-point Likert scale is used, and the score for each item ranged from 0 to 3 points. The positive coping score ranged from 0 to 36 points and the negative coping score ranged from 0 to 24 points. In the present study, the Cronbach’s α coefficients for positive coping were 0.90 and 0.89 for patients and their caregivers, respectively, and the Cronbach’s α coefficients for negative coping were 0.80 and 0.84 for patients and caregivers, respectively.

Family hardiness index (FHI)

The FHI scale was developed by the American scholar Mccubbin et al.24 in 1996, and it was sinicized by the Chinese scholar Liu et al.25 in 2014; it is composed of three dimensions, responsibility, control and challenge, for a total of 20 items. It is used to assess the resilience of the entire family in the face of stress and challenges. A 4-point Likert scale is used with a score range of 20–80 points, where higher scores indicate better family resilience for patients and their caregivers. In the present study, the Cronbach’s α coefficients for patients and caregivers were 0.80 and 0.82, respectively.

Statistical collection

Prior to the start of the investigation, the informed consent of the director of the relevant department was obtained, and an investigation team was established to train the two investigators on the process, methods and precautions of the investigation process. After the training was complete, informed consent was obtained from 10 adolescent patients with malignant bone tumors and their caregivers and a presurvey was conducted to verify the stability and reliability of the selected scales and evaluate the feasibility of the entire investigative process. During the formal investigation, the researcher used unified guidance and explanations and issued the questionnaire only after obtaining the consent of both the patient and the caregiver. Patients and caregivers participated simultaneously, and the researchers assigned separate numbers to them. Patients and caregivers independently completed the questionnaires at the same time. The questionnaire, which took no more than 30 min, was completed by the person according to the actual situation, was collected immediately after completion, and its information was checked and reviewed in a timely manner. A total of 560 questionnaires were distributed in this study, of which 538 valid questionnaires were recovered for an effective recovery rate of 96.07%.

Statistical analysis

The two investigators used EpiData 3.1 to enter and check the data, and SPSS 26.0 was used for statistical analysis. Count data are described as frequencies and percentages, and normally distributed data are expressed as the means ± standard deviations. Pearson correlation analysis was used to analyze the correlation of variables between the adolescent patients with malignant bone tumors and their caregivers. AMOS 26.0 software was used to construct a host‒object interdependence model of coping styles, family resilience, and FCR in adolescent patients with malignant bone tumors and their caregivers, and each pathway was analyzed and verified by the bootstrap method with 5,000 samples and a 95% confidence interval. The test level was α = 0.05.

Ethical consideration

This study proceeded according to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (Approval No. I2023053).

Results

Sociodemographic characteristics of the participants

A total of 269 pairs of adolescent patients with malignant bone tumors were surveyed in this study, and approximately two-thirds of the surveyed caregivers were between 40 and 59 years of age (62.4%). More than half of the patients were male (58%), but the majority of the caregivers were female (81.1%). A total of 46.1% of the patients had a middle school education, and 43.7% of the caregivers had a middle school education. More than half of the patients were from provincial hospitals (65%), most of them had medical insurance (96.7%), and nearly half of them had been diagnosed for < 1 year (47.2%). Forty-eight percent of the patients underwent 2–3 chemotherapy treatments, and more than half of the caregivers were unemployed (60.2%). The patient and caregiver characteristics are shown in Table 1.

Table 1 Socio-demographic characteristics of patients and caregivers with adolescent malignant bone tumors (n = 538).
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Correlations among coping styles, family resilience and FCR

A Pearson correlation analysis was conducted among coping styles, family resilience and FCR, and it revealed that FCR was positively correlated with negative coping (r = 0.482, P < 0.01) and negatively correlated with both positive coping (r = − 0.469, P < 0.01) and family resilience (r = − 0560, P < 0.01). The details are shown in Table 2.

Table 2 Pearson correlations among FCR, resilience, positive coping style and negative coping style in patients and caregivers.
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Comparisons among coping styles, family resilience, and FCR

The results of the independent samples t-test showed that there were differences between adolescent patients with malignant bone tumors and their caregivers in FCR, family resilience positive coping, and negative coping (P < 0.001). For details, see Table 3.

Table 3 Comparison of adolescent malignant bone tumors patients and caregivers’ positive coping, negative coping, family resilience and FCR.
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APIM analysis of coping styles, family resilience and FCR among adolescent patients with malignant bone tumors and their caregivers

This study first verified the differentiability between the patients and the caregivers. At the same time, it restricted the actor effect and the partner effect of the data to be equal, and tested whether the change in the model’s chi-square value was significant. The current data results show that the model’s chi-square = 14.887, df = 6, P = 0.021 < 0.05, that is, the data results are different, and the data of this research model are distinguishable paired data. Furthermore, the results show that Model chi-square is 14.887, the X2/df is 2.481 (< 3), the RMSEA is 0.074 (< 0.08), the GFI is 0.987, the AGFI is 0.919, the NFI is 0.984, and the CFI is 0.990, which are all > 0.90, thereby indicating that the model fits well.

Taking the coping styles and family resilience of adolescent patients with malignant bone tumors and their caregivers as predictors and FCR as the outcome variable, the actor‒partner interdependence model was constructed by using the maximum likelihood estimation method to explore the binary relationships among coping styles, family resilience and FCR in adolescent malignant bone tumor patients and their caregivers. This model is an unrestricted model.

The Actor-Partner Interdependence Model was established to explore coping style and family resilience effects on FCR in patients and their caregivers. Patients’ family resilience (β = − 0.32, P < 0.001), positive coping (β = − 0.14, P = 0.004), and negative coping (β = 0.18, P < 0.001) exerted actor effects on their own FCR. Meanwhile, patients’ family resilience (β = − 0.16, P = 0.002), positive coping (β = − 0.18, P < 0.001), and negative coping (β = 0.22, P < 0.001) exerted partner effects on caregivers’ FCR. Additionally, caregivers’ family resilience (β = − 0.27, P < 0.001) had an actor effect on their own FCR, whereas caregivers’ positive and negative coping (β = − 0.16, P = 0.004; β = 0.20, P < 0.001) exerted partner effects on patients’ FCR. However, caregivers’ positive and negative coping (β = -0.10, P = 0.066; β = 0.10, P = 0.059) had no actor effect on their own FCR, and caregivers’ family resilience (β = − 0.08, P = 0.176) had no partner effect on patients’ FCR. Details are shown (Fig. 1).

Fig. 1
Fig. 1The alternative text for this image may have been generated using AI.
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The actor-partner interdependence model of family hardiness index, positive coping, negative coping, and fear of caner in malignant bone tumor patients and their caregivers. Note: *: P < 0.05.

Discussion

In the present study, the APIM was used to analyze the relationships among coping styles, family resilience, and FCR in adolescent patients with malignant bone tumors and their caregivers. First, we identified differences in coping styles, family resilience, and FCR levels among adolescent patients with malignant bone tumors and their caregivers. In addition, our research findings are consistent with our hypothesis, indicating that coping styles and family resilience are significantly related to the FCR in adolescent patients with malignant bone tumors and their caregivers, and can significantly predict their own and each other’s FCR, demonstrating both actor and partner effects.

In this study, the FCR of the caregiver was significantly greater than that of the patient, which is similar to the results of the study of Braun et al.26 but different from the results of the study of Zhang et al.27. The reason for these associations may be that in this study, the patients were all adolescents and did not have to bear the financial pressure placed on the family; however, in the study of Zhang et al.27, the patients were 30 ~ 79 years old (average 54.84 ± 10.08 years old), and they had undertaken the responsibility of caring for the family, and they longed for the capacity to take care of their families rather than becoming a burden to their families, so the FCR levels of patients and caregivers differed among different age groups. We found that positive coping by adolescent patients with malignant bone tumors and their caregivers was negatively correlated with FCR (P < 0.01), and negative coping by these patients and their caregivers was positively correlated with FCR (P < 0.01), which is consistent with the results of Zhang et al.’s28 study on the correlation between coping style and FCR. This suggests that, to a large extent, FCR is influenced by coping style, particularly at the family and social levels. An analysis revealed that positive coping can help patients and caregivers calmly cope with various difficulties, reintegrate into society, build confidence in fighting cancer, and reduce their FCR. Negative coping methods increase the psychological pressure facing patients and caregivers and enhance negative emotions such as anxiety and fear; thus, patients and their caregivers tend to adopt avoidance and denial methods in the face of difficulties, further aggravating their FCR. In our study, the FCR of patients and caregivers was negatively correlated with the level of family resilience (P < 0.01), which aligns with the results reported in previous studies29. Not surprisingly, family resilience protects individuals and families from stress, thereby reducing the negative effects of stress on individuals and families. It can be seen that medical staff should regard patients and caregivers as a whole, provide joint training for patients and caregivers, encourage both parties to record each other’s positive behaviors every day, enhance the perception of each other’s positive behaviors, and help both parties build a healthy psychology. At the same time, when both parties have negative coping, healthcare workers should help them trace the root cause of the negative coping and provide targeted interventions (such as progressive muscle relaxation, mindfulness-based cognitive behavioral therapy, etc.)

Our research results indicate that the family resilience of adolescent patients with malignant bone tumors and their caregivers has an actor effect on both parties’ FCR (P < 0.001). This finding is consistent with the research results of Tao et al.30 regarding the relationship between family resilience and FCR of breast cancer patients and their caregivers. As a safe haven for adolescent patients with malignant bone tumors and their caregivers, the resilience level of the family directly affects the individual’s psychological adjustment ability. High-resilience families usually exhibit stronger family cohesion and more effective coping abilities31. We found that when the family resilience of adolescent patients and their caregivers is relatively high, their own FCR is relatively low. This may be due to the fact that high-resilience families can provide more sufficient emotional and material support for the patients and their families, and family members support and encourage each other, which helps to alleviate the negative emotions caused by stressors. In addition, high-resilience family members can more fully mobilize internal resources (such as emotional support, role flexibility) and external resources (such as social networks, medical information), thereby enhancing the individual’s psychological resilience in coping with stress and reducing FCR. These strategies not only enhance the patients’ sense of control over the treatment process, but also improve the self-efficacy of caregivers, thereby systematically reducing both parties’ catastrophic cognition of cancer recurrence. Similarly, this study indicates that the coping strategies of adolescent patients with malignant bone tumors have an actor effect on their own FCR, which is similar to Li’s15 study on the impact of coping strategies on FCR in bladder cancer patients. One possible explanation for our findings is that, in terms of the actor effect, patients adopt positive coping styles (such as communicating and confiding with family and friends) in the face of illness, which can effectively relieve psychological stress, assist in positively coping with the trauma caused by the disease, and reduce their respective FCR.Therefore, medical workers should strengthen the evaluation of the coping strategies of adolescent patients with malignant bone tumors, and provide pain management techniques (e.g., mindful breathing, use of pain medications, etc.); at the same time, healthcare professionals can provide regular counseling to help them develop positive coping methods and adjust negative thinking. In addition, patients should be encouraged to develop daily stress-reducing habits (such as walking, listening to music, practicing calligraphy, etc.) to improve coping skills, establish more effective coping patterns, and thereby reduce FCR. However, we observed that the coping styles of caregivers for adolescent patients with malignant bone tumors had no actor effects on their own FCR, inconsistent with Chen32 who reported the impact of coping strategies of primary caregivers for children with leukemia on their own FCR. Possible reasons for this inconsistency are: first, caregivers of adolescent patients with malignant bone tumors have long assumed heavy care responsibilities, and their positive coping behaviors cannot resolve their core psychological distress. Persistent care pressure and the uncertainty of a patients’ disease prognosis makes it difficult to effectively alleviate their own FCR. Second, caregivers who have adopted negative coping styles over a long time may be emotionally exhausted, which blunts the perception of their own emotions and leads to a reduced ability to perceive their own FCR.

Our research results indicate that the family resilience of adolescents with malignant bone tumors can predict the caregivers’ FCR. This finding is consistent with the results of Mellon et al.33, who used APIM to investigate the relationship between family resilience and FCR in cancer survivors and their caregivers. This supports the perspective of family systems theory16, which posits that there are interactions among family members, and each member’s behavior and emotions can affect other members of the family system. Patients with high family resilience are more inclined to actively suppress negative emotions (such as anxiety and despair) and are often better able to maintain stable and positive emotional states. These positive emotional signals are conveyed to caregivers through verbal or non-verbal channels (e.g., gentle communication, supportive facial expressions). Additionally, patients with stronger family resilience can draw greater strength from their families, making them more willing to comply with treatment. Their positive attitudes help alleviate caregivers’ psychological stress, reduce caregiver burden, and thereby mitigate caregivers’ FCR. However, caregivers’ family resilience has no partner effect on the FCR of adolescent patients with malignant bone tumors. A possible reason may be that during the cancer treatment process, patients may focus more on their own physical and mental changes and treatment responses. Although caregivers have high family resilience, if their coping behaviors are not effectively transformed into actions that patients can understand and participate in, or fail to match patients’ actual needs, it will be difficult to directly alleviate patients’ FCR.

In terms of the partner effect, there is a mutually dependent partner effect between the coping styles of adolescent patients with malignant bone tumors and their caregivers and their FCR. These results indicate that the positive coping styles of adolescent patients with malignant bone tumors and their caregivers have a negative predictive effect on the FCR of the other party; conversely, negative coping styles have a positive predictive effect on the FCR of the other party. This is similar to the previous research results on the coping styles of lung cancer patients and their caregivers and their FCR’s actor—partner effects34. Lulla et al.35 pointed out that during the treatment of malignant bone tumors, adolescent patients face many challenges, not only bearing physical pain but also psychological stress, which is a huge blow to the patients. The theory of emotional contagion36 indicates that in the high-pressure medical context, the emotional states of family members are unconsciously transmitted to each other through non-verbal cues, facial expressions, and tone of voice. When caregivers adopt positive coping styles, the positive emotions they convey are perceived and internalized by patients, who then feel the care and support from caregivers and develop greater confidence in overcoming the disease, thereby reducing their FCR. Conversely, when caregivers adopt negative coping styles, the anxiety and other negative emotions they convey also infect patients, intensifying catastrophic thoughts about the future and thus increasing patients’ FCR. Moreover, the theory of co-regulation37 indicates that in the disease management process, patients and caregivers form a dynamic emotional regulation system. When adolescent patients with malignant bone tumors adopt positive coping behaviors, caregivers observe patients’ active cooperation in treatment, experience positive feedback from them, and receive psychological encouragement and support, thereby reducing their sense of helplessness and alleviating their fear of cancer recurrence in patients. Conversely, when patients adopt negative coping styles, caregivers anticipate the need to undertake longer and more arduous care tasks in the future, increasing their care burden; this heavy burden then translates into heightened FCR in caregivers. Therefore, healthcare professionals should treat adolescent malignant bone tumor patients and caregivers as a whole, provide joint training for patients and caregivers, and teach positive coping strategies (e.g., effective emotional expression, mindfulness meditation, progressive muscle relaxation, etc.), abandon negative coping (such as avoiding treatment, suppressing emotions). At the same time, both parties can also be encouraged to record each other’s positive behaviors every day, strengthen each other’s perception of positive responses, and reduce the FCR of both parties.

Study limitations

Our study had several limitations. First, this was a cross-sectional study, and only a single time-point measurement was conducted, which cannot dynamically evaluate the coping style, family resilience, and FCR dynamics among adolescent patients with malignant bone tumors and their caregivers over time. In the future, longitudinal studies can be conducted to increase the number of measurements and the duration of follow-up and explore the dynamic associations among variables. In addition, this study is only a cross-sectional study. It is recommended that future research conduct integrated interventions involving both patients and caregivers to enhance family resilience and positive coping levels, reduce negative coping levels, and improve the ability of patients and their caregivers to manage stress, thereby alleviating fear of cancer recurrence.

Conclusions

Our findings support the hypothesis that actor–partner effects occur between the coping styles, family resilience, and FCR of adolescent patients with malignant bone tumors and those of their caregivers. We used the actor–partner interdependence model to analyze the impact of coping style and family resilience on the FCR of adolescent malignant bone tumor patients and caregivers from a binary perspective, thereby compensating for the shortcomings of data analysis taken from a single perspective and suggesting that clinical health care workers should treat adolescent malignant bone tumor patients and caregivers as a whole, while viewing them from a binary perspective and actively exploring targeted interventions involving coping style and family resilience to reduce the fear of cancer recurrence in both parties.