Objective To investigate the relationship of fear of cancer recurrence (FCR), self-efficacy and quality of life in the elderly breast cancer survivors. Methods A total of 116 elderly breast cancer patients admitted to Beijing Shijitan Hospital of Capital Medical University from May 2020 to January 2023 were enrolled as the study subjects. Chinese version of Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and Chinese version of Cancer Self-efficacy Assessment Scale and Quality of Life Questionnaire-Core 30 (QLQ-C30) were used to investigate the FCR, self-efficacy and quality of life of the elderly breast cancer survivors. Pearson correlation analysis was used to analyze the correlation between FCR, self-efficacy and quality of life in the elderly breast cancer survivors, and a structural equation model was constructed using AMO25.0 for mediation analysis. SPSS 19.0 was used for statistical analysis. Data comparison between two groups was performed using t test, analysis of variance orχ² test, depending on data type. Results The recovery rate of the valid questionnaires was 91.38% (106/116), and the average score of FoP-Q-SF scale in the elderly breast cancer patients was (31.66±4.32) points. Among the patients, 43 (40.57%) had psychological disorders. The total score on Chinese version of Cancer Self-Efficacy Assessment Scale was (26.14±3.58) points, and the average score on QLQ-C30 scale was (50.69±6.37) points. The scores of self-efficacy and quality of life in the patients complicated with psychological disorders were lower than those in the patients without psychological disorders, and the differences were statistically significant (P<0.05). Pearson correlation analysis showed that FCR was negatively correlated with self-efficacy and quality of life in the elderly breast cancer patients (r=-0.388, -0.325; P<0.001), and was positively correlated with self-efficacy and quality of life (r=0.294; P<0.001). Mediation analysis suggested that FCR had a direct negative predictive effect on the quality of life of the elderly breast cancer survivors (β=-0.338; P<0.05) and could indirectly affect the quality of life through self-efficacy (β=-0.188; P<0.05), with a total effect of β=-0.526. Conclusion Severe FCR can reduce the self-efficacy and quality of life of the elderly breast cancer survivors. It is recommended that attention should be paid to the FCR and the value of self-efficacy on regulating FCR and quality of life of the elderly breast cancer patients in clinical practice.