Cancer-specific coping strategies, psychological distress, and health-related quality of life among women with breast cancer: A mediation analysis

Abstract

Cancer-specific coping strategies influence psychological wellbeing and health-related quality of life (HRQoL) among women living with breast cancer, but the mechanisms underlying these relationships remain poorly understood, particularly in low-resource settings. This study examined whether anxiety and depression mediate the relationship between cancer-specific coping strategies and HRQoL among women receiving breast cancer treatment in Ghana. A cross-sectional survey was conducted among 205 women receiving care at a tertiary hospital. Participants completed the Mini-Mental Adjustment to Cancer Scale, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-Breast questionnaire. Pearson correlation and mediation analyses using Hayes’ PROCESS macro with 5,000 bootstrap samples were performed. Helplessness-hopelessness and anxious preoccupation were associated with poorer HRQoL and greater anxiety and depression, whereas fighting spirit, cognitive avoidance, and fatalism were associated with better HRQoL and lower psychological distress. Anxiety and depression significantly mediated the relationship between helplessness-hopelessness and HRQoL, while depression mediated the association between anxious preoccupation and HRQoL. Both anxiety and depression mediated the relationships between fighting spirit and cognitive avoidance and HRQoL, while depression mediated the relationship between fatalism and HRQoL. Integrating psychological assessment and psychosocial interventions into oncology care may promote adaptive coping, reduce distress, and improve quality of life.