Network analysis of the intercorrelations between quality of life, trait mindfulness, and mental health among patients with breast cancer

Abstract

As cancer survival rates have improved, there is growing interest in enhancing patients' quality of life during and after treatment. Quality of life in cancer patients is a multidimensional construct encompassing physical, role, emotional, cognitive, and social functioning, along with physical symptoms and financial concerns. However, the complex interplay among these factors remains poorly understood. Mental health conditions, including anxiety, depression, and distress, are common in patients with breast cancer and significantly impair quality of life. Trait mindfulness, defined as a tendency toward present-moment awareness, is associated with reduced psychological distress and improved emotional regulation. This study aimed to examine the interrelationships among QoL domains, mental health problems, and trait mindfulness using network analysis. In particular, trait mindfulness was considered a potential factor that may enhance both quality of life and mental health in breast cancer patients. In this cross-sectional study, 196 breast cancer patients completed face-to-face interviews at various treatment phases, using structured questionnaires including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, the Hospital Anxiety and Depression Scale, the Distress Thermometer, and the Mindful Attention Awareness Scale. Network analysis was conducted using a Gaussian Graphical Model optimized via the Least Absolute Shrinkage and Selection Operator and the Extended Bayesian Information Criterion, with modularity analysis applied to identify community structures. Emotional functioning and trait mindfulness emerged as central nodes, and three distinct communities were identified: mind (emotional and cognitive functioning, depression, anxiety, distress, insomnia, and trait mindfulness), body (physical and role functioning, and physical symptom burden), and socioeconomic status (social functioning and financial difficulty). The positive correlation between trait mindfulness and emotional functioning suggests that cultivating trait mindfulness may be a promising strategy to enhance quality of life in patients with breast cancer.