Research Article| Volume 62, 102237, February 2023

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Social functioning, depression, and quality of life among breast cancer patients: A path analysis

Published:November 10, 2022DOI:


      • The first study combined clinical variables into severity variables to increase the strength of this variable as a predictor.
      • This study found that BC patients with religious beliefs and less disease severity had better SF.
      • Nurses could encourage patients to have religious beliefs and help them reduce the severity of BC to increase their SF.



      To identify associations among social functioning, depression, and quality of life in breast cancer patients.


      A cross-sectional study was conducted. A total of 180 breast cancer patients were recruited from the surgical units in southern Taiwan hospital in 2021. Path analysis was employed to analyze the relationships between background information and social functioning, depression, and quality of life. Structural equation modeling (SEM) was used for examining the path analysis in this study.


      The path model showed that respondents with a religious belief (ß = 0.18, p < .000) and less severe disease (ß = −0.29, p < .01) showed better social functioning. Income did not affect social functioning directly but was directly related to the social interaction dimension (ß = 0.30, p < .000). Moreover, younger age (ß = -0.29, p < .000, lower income (ß = −0.10, p < .05) and more severe disease (ß = 0.35, p < .000) increased the level of depression. Less severe disease would also result in a better quality of life (ß = −0.45, p < .000). Breast cancer patients with better social function levels have low levels of depression (ß = −0.82, p < .000) and better quality of life (ß = 0.76, p < .000).


      Age, religion, income, and severity are crucial predictors of social functioning, depression, and quality of life. Furthermore, severity variables which combined clinical variables to make this variable a stronger predictor for SF, depression, and QOL.


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        • Alem T.
        • Nigatu D.
        • Birara A.
        • Fetene T.
        • Giza M.
        Quality of Life of Breast Cancer Patients in Amhara Region, Ethiopia: A Cross-Sectional Study.
        • Ambarwati A.
        Religion, culture, and education in development, reading Soedjatmoko's perspective: a preliminary note.
        Konfrontasi: Jurnal Kultural, Ekonomi Dan Perubahan Sosial. 2022; 9: 151-159
        • Bártolo A.
        • Santos I.M.
        • Valério E.
        • Monteiro S.
        Depression and health-related quality of life among young adult breast cancer patients: the mediating role of reproductive concerns.
        J. Adolesc. Young Adul. 2020; 9: 431-435
        • Beekman A.T.
        • Deeg D.J.
        • Van Limbeek J.
        • Braam A.W.
        • De Vries M.Z.
        • Van Tilburg W.
        Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands.
        Psychol. Med. 1997; 27: 231-235
        • Bosc M.
        Assessment of social functioning in depression.
        Compr. Psychiatr. 2000; 4: 63-69
        • Brothers B.M.
        • Andersen B.L.
        Hopelessness as a predictor of depressive symptoms for breast cancer patients coping with recurrence.
        Psycho Oncol. 2009; 18: 267-275
        • Bueno J.N.
        • Haddad C.A.S.
        • Rizzi S.
        • Giron P.S.
        • Facina G.
        • Nazario A.C.P.
        Evaluation of body image, quality of life, tactile sensitivity and pain in women with breast cancer submitted to surgical intervention.
        Rev. Assoc. Méd. Bras. 2018; 64: 530-536
        • Chen J.
        • You H.
        • Liu Y.
        • Kong Q.
        • Lei A.
        • Guo X.
        Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China.
        Medicine. 2021; 100: 1-7
        • Chhabria K.S.
        • Carnaby G.D.
        Psychometric validation of the center for epidemiological studies depression scale in head and neck cancer patients.
        Oral Oncol. 2017; 75: 158-162
        • Chi W.C.
        • Yang C.H.
        • Hsu C.
        • Lai C.C.
        Introduction of the EORTC disease-specific quality of life questionnaires for cancer patients.
        Formosan J. Med. 2002; 6: 220-227
        • Chien C.P.
        • Cheng T.A.
        Depression in Taiwan: epidemiological survey utilizing CCESD.
        Bull. Jpn. Soc. Neurol. Psychiatr. 1985; 87: 335-338
        • Daldoul A.
        • Khechine W.
        • Bhiri1 H.
        • Ammar1 N.
        • Bouriga R.
        • Krir M.W.
        • Soltani S.
        • Zoukar O.
        • Rhim M.S.
        • Bouslah S.
        • Dimassi S.
        • Abbess1 I.
        • Saidani Z.
        • Zaied S.
        Factors predictive of quality of life among breast cancer patients.
        Asian Pac. J. Cancer Prev. 2018; 19: 1671-1675
        • Dewan M.F.
        • Lyons K.S.
        • Song M.
        • Hassouneh D.
        Factors associated with depression in breast cancer patients in Saudi Arabia.
        Cancer Nurs. 2022; 45: E524-E530
        • Doege D.
        • Thong M.S.
        • Koch‐Gallenkamp L.
        • Jansen L.
        • Bertram H.
        • Eberle A.
        • et al.
        Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls.
        Cancer Med. 2020; 9: 8713-8721
        • Dolan L.B.
        • Barry D.
        • Petrella T.
        • Davey L.
        • Minnes A.
        • Yantzi A.
        • Marzolini S.
        • Oh P.
        The cardiac rehabilitation model improves fitness, quality of life, and depression in breast cancer survivors.
        J. Cardiopulm. Rehabil. 2018; 38: 246-252
        • Fayers P.M.
        Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30.
        Eur. J. Cancer. 2001; 37: 1331-1334
        • Firouzbakht M.
        • Hajian-Tilaki K.
        • Moslemi D.
        Analysis of quality of life in breast cancer survivors using structural equation modelling: the role of spirituality, social support and psychological well-being.
        Int. Health. 2020; 12: 354-363
        • Götze H.
        • Friedrich M.
        • Taubenheim S.
        • Dietz A.
        • Lordick F.
        • Mehnert A.
        Depression and anxiety in long-term survivors 5 and 10 years after cancer diagnosis.
        Support. Care Cancer. 2020; 28: 211-220
        • Graells-Sans A.
        • Serral G.
        • Puigpinós-Riera R.
        Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in barcelona (DAMA cohort).
        Cancer Epidemiol. 2018; 54: 38-47
        • Health Promotion Administration (HPA)
        Breast cancer prevention.
        (Retrieved from)
        • Hsu J.C.
        Experience of nursing care of an unmarried middle-aged woman who underwent surgery for breast cancer.
        VGH Nursing. 2016; 33: 100-107
        • International Agency for Research on Cancer (IARC)
        World Cancer Day 2021: Spotlight on IARC Research Related to Breast Cancer.
        2022 (Retrieved from)
        • Ismaili R.
        • Loukili L.
        • Mimouni H.
        • Haouachim I.E.
        • Hilali A.
        • Haddou Rahou B.
        • et al.
        The impact of socioeconomic determinants on the quality of life of moroccan breast cancer survivors diagnosed two years earlier at the National Institute of Oncology in Rabat.
        Obstet. Gynecol. Int. 2021; (2021)
        • Jeang S.R.
        • Chi M.T.
        • Wang P.H.
        • Ku Y.C.
        Process of seeking treatment for newly diagnosed breast cancer.
        VGH Nursing. 2015; 3: 10-20
        • Karunanithi G.
        • Sagar R.P.
        • Joy A.
        • Vedasoundaram P.
        Assessment of psychological distress and its effect on quality of life and social functioning in cancer patients.
        Indian J. Palliat. Care. 2018; 24: 72
        • Kline R.B.
        Principles and Practice of Structural Equation Modeling.
        fourth ed. The Guilford Press, New York2016
        • Kroenke C.H.
        • Rosner B.
        • Chen W.Y.
        • Kawachi I.
        • Colditz G.A.
        • Holmes M.D.
        Functional impact of breast cancer by age at diagnosis.
        J. Clin. Oncol. 2004; 22: 1849-1856
        • Le N.K.
        • Gabrick K.S.
        • Chouairi F.
        • Mets E.J.
        • Avraham T.
        • Alperovich M.
        Impact of socioeconomic status on psychological functioning in survivorship following breast cancer and reconstruction.
        Breast J. 2020; 26: 1695-1701
        • Mahmood A.A.
        • Amen M.R.
        Association between social support and quality of life in patients with breast cancer at Hiwa Cancer Hospital in Sulaimani City/Iraq.
        Mosul J. Nurs. 2022; 10: 16-26
        • Mikal J.P.
        • Grande S.W.
        • Beckstrand M.J.
        Codifying online social support for breast cancer patients: retrospective qualitative assessment.
        J. Med. Internet Res. 2019; 21 (e12880-e12880)
        • Milbury K.
        • Kavanagh A.
        • Meng Z.
        • Chen Z.
        • Chandwani K.D.
        • Garcia K.
        • Cohen L.
        Depressive symptoms and positive affect in Chinese and United States breast cancer survivors: a cross-cultural comparison.
        Support. Care Cancer. 2017; 25: 2103-2109
        • Ministry of Health and Welfare
        Health Promotion Administration. Cancer Registry Annual Report, 2019 Taiwan.
        Ministry of Health and Welfare, Taiwan2021
        • Mitchell A.J.
        • Ferguson D.W.
        • Gill J.
        • Paul J.
        • Symonds P.
        Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis.
        Lancet Oncol. 2013; 14: 721-732
        • Nia H.S.
        • Rezapour M.
        • Allen K.A.
        • Sharif S.P.
        • Jafari A.
        • Torkmandi H.
        • Goudarzian A.H.
        The psychometric properties of the center for epidemiological studies depression scale (CES-D) for Iranian cancer patients.
        Asian Pac. J. Cancer Prev. 2019; 20 (10.3.1557/APJCP.2019.20.9.2803): 2803
        • Nuryati S.
        • Mudigdo A.
        • Murti B.
        Path analysis on the influence of educational level, stages of cancer, social support, and coping strategy toward the quality of life of breast cancer patients in Dr. Moewardi Hospital, Surakarta.
        J. Epidemol. Pub H. 2017; 2: 225-235
        • Park E.M.
        • Gelber S.
        • Rosenberg S.M.
        • Seah D.S.E.
        • Schapira L.
        • Come S.E.
        • Partridge A.H.
        Anxiety and depression in young women with metastatic breast cancer: a cross-sectional study.
        Acad. Consult.-Liaison Psychiatr. 2018; 59: 251-258
        • Peng C.Y.
        An Exploratory Study of Hope, Social Support, Symptom Distress and Quality of Life Among Recurrent Liver Cancer Patients.
        Chang Gung University, 2014 (Unpublished master’s theses)
        • Puigpinós-Riera R.
        • Graells-Sans A.
        • Serral G.
        • Continente X.
        • Bargalló X.
        • Doménech M.
        • et al.
        Anxiety and depression in women with breast cancer: social and clinical determinants and influence of the social network and social support (DAMA cohort).
        Cancer Epidemiol. 2018; 55: 123-129
        • Radloff L.S.
        The CES-D scale: a self-report depression scale for research in general population.
        Appl. Psychol. Meas. 1977; 1: 385-401
        • Sun F.K.
        Developing a Social Functioning Scale for Women with Breast Cancer.
        Department of Nursing, I-Shou University, 2022
        • Syrowatka A.
        • Motulsky A.
        • Kurteva S.
        • Hanley J.A.
        • Dixon W.G.
        • Meguerditchian A.N.
        • Tamblyn R.
        Predictors of distress in female breast cancer survivors: a systematic review.
        Breast Cancer Res. Treat. 2017; 165: 229-245
        • Tsaras K.
        • Papathanasiou I.V.
        • Mitsi D.
        • Veneti A.
        • Kelesi M.
        • Zyga S.
        • Fradelos E.C.
        Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors.
        Asian Pac J Cancer Prev. 2018; 19: 1661
        • Vorn R.
        • Touch S.
        • Ryu E.
        Depression and health-related quality of life among Cambodian patients with cancer.
        Int. J. Health Plann. Manag. 2019; 34: e1747-e1759
        • World Health Organization (WHO)
        World Cancer Day: Closing the Care Gap.
        2022 (Retrieved from)
        • World Health Organization (WHO)
        Breast cancer.
        (Retrieved from)
        • Wu H.Y.
        The Correlational Study of the Using Behavior of the LINE Group, Social Support and the Quality of Life Among Breast Cancer Patients.
        School of Nursing, Kaohsiung Medical University, 2018
        • Xia J.
        • Tang Z.
        • Deng Q.
        • Yang R.
        • Wang J.
        • Yu J.
        Predictors of the quality of life in Chinese breast cancer survivors.
        Breast Cancer Res. Treat. 2018; 167: 537-545
        • Yang L.
        • Song W.P.
        • Chen Z.L.
        • Wang Y.
        • Chen Y.Y.
        • Hua Y.H.
        • et al.
        Correlation between social support and quality of life in patients with breast cancer at different periods of treatment.
        Zhonghua Zhong Liu Za Zhi [Chinese Journal of Oncology]. 2017; 39: 202-206
        • Yfantis A.
        • Sarafis P.
        • Moisoglou I.
        • Tolia M.
        • Intas G.
        • Tiniakou I.
        • et al.
        How breast cancer treatments affect the quality of life of women with non-metastatic breast cancer one year after surgical treatment: a cross-sectional study in Greece.
        BMC Surg. 2020; 20: 210
        • Zou Z.
        • Hu J.
        • McCoy T.
        Quality of life among women with breast cancer living in Wuhan, China.
        Int. J. Nurs. Sci. 2014; 1: 79-88