Purpose <p>Gastric cancer patients often experience significant fear of recurrence, impacting their physical and mental health. This study explores how time perspective influences fear of cancer recurrence, considering the roles of intrusive rumination and catastrophizing.</p> Methods <p>A cross-sectional design was employed with 394 gastric cancer patients. Participants completed self-report measures assessing fear of cancer recurrence, time perspective, intrusive rumination, and catastrophizing. Pearson correlation analysis and bias-corrected percentile bootstrap methods were used to conduct chain mediation tests.</p> Results <p>The findings revealed that time perspective had significant direct and indirect effects on fear of cancer recurrence, with intrusive rumination and catastrophizing partially mediating this relationship. Negative past perspectives and fatalistic present perspectives were associated with increased levels of fear of recurrence through heightened intrusive rumination and catastrophizing. Conversely, positive past perspectives and future perspectives were linked to reduced fear of recurrence by decreasing intrusive rumination and catastrophizing. Distorted from the balanced time perspective significantly increased levels of intrusive rumination and catastrophizing, thereby heightening patients’ fear of recurrence.</p> Conclusion <p>The results indicate that intrusive rumination and catastrophizing are key pathways through which time perspective influences fear of cancer recurrence. This study enhances our understanding of these psychological dynamics and underscores the importance of interventions targeting these mediating factors to prevent fear of recurrence in this population.</p> Implications for cancer survivors <p>The chain mediating roles of rumination and Catastrophizing highlight that tailored interventions, such as time perspective therapy, can be targeted for this population, considering this population’s unique needs.</p>