The Mediation and Suppression Effect of Demoralization in Breast Cancer Patients After Primary Therapy: A Structural Equation Model

Abstract

Background Because of the increasing 5-year survival rate of breast cancer, adjustment to breast cancer survivorship is pertinent to the patient's life after diagnosis. Despite the psychological changes occurring during the transitional period (first 5 years after diagnosis) and after primary therapy having a known, critical effect on survivorship status, the data related to this topic are very limited. Purpose This study was designed to examine the relationships among demoralization, stress, sleep disturbance, and psychological well-being in women with breast cancer after primary therapy. Methods Two hundred eight women with breast cancer (mean age = 51.96 ± 8.27) participated in a cross-sectional study in central Taiwan. Recruitment was conducted using convenience snowball sampling at a local teaching hospital. All of the participants had completed primary therapy and were in the 5-year postdiagnosis period. The average duration of cancer was 28 months. The participants completed the Stress of Breast Cancer after Primary Therapy Scale, Demoralization Scale, Pittsburgh Sleep Quality Inventory, and Ryff's Psychological Well-Being Scale–Short Form. Data were analyzed using a structural equation model to find plausible path relationships among stress, demoralization, sleep disturbances, and psychological well-being. Results Demoralization was shown to completely mediate the effect of stress on sleep disturbances. In addition, the predictive effect of sleep disturbances on psychological well-being was overwhelmingly explained by demoralization when competing with sleep disturbances. Furthermore, a positive path was found between stress and psychological well-being because of the suppression effect of demoralization. Conclusions/Implications for Practice Demoralization was found to be a mediator that suppressed the relationships among stress, sleep disturbances, and psychological well-being in the adaptation process of patients with breast cancer after primary therapy. This article adds to the limited research on women with breast cancer after primary therapy who are in their initial 5 years of diagnosis. In addition, this study used structural equation model to find the plausible path relationships among the psychological factors involved in the well-being of women with breast cancer. Supporting patients with cancer and effectively reducing their perceived demoralization will be key to transforming stress into personal growth and a facilitator of long-term recovery.

Understanding factors influencing demoralization among cancer patients based on the bio‐psycho‐social model: A systematic review

“…Globally, the pooled average of the mean demoralization score in cancer patients was higher than in non‐neoplastic patients from 2014 to 2020 4 . Demoralization is of particular concern among cancer patients as it is associated with several adverse consequences, such as decreased psychological well‐being, 5,6 reduced quality of life, 7 increased death anxiety, 8 heightened levels of existential distress, 9 and stronger prediction power on suicidal ideation than depression 10,11 . Thus, the wide‐ranging influencing factors behind the development of demoralization must be understood, which contributes toward developing interventions in the fields of research, clinical practice, service delivery, and policymaking for mitigating demoralization.…”

Psychological Well-Being Increment as Post-Traumatic Growth in Women with Breast Cancer: A Controlled Comparison Design Using Propensity Score Matching

“…Breast cancer is usually viewed as a trauma [ 8 ] associated with anxiety, depression, suicide, and neurocognitive and sexual dysfunctions, according to a systematic review [ 9 ]. Furthermore, it leads to psychological and physiological distress, such as stress, demoralisation, and sleeping disturbances [ 10 ]. In 2020, breast cancer surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%) worldwide.…”

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“…Third, if the MI values of a pair of items had a high correlation to each other, the item that lowered the χ 2 value most was deleted. 30,31…”