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. 2025 Jun 11:12:100743.
doi: 10.1016/j.apjon.2025.100743. eCollection 2025 Dec.

Impact of social support on cognitive function in patients with breast cancer undergoing chemotherapy: The chain-mediating role of fatigue and depression

Yuanqi Ding  1 , Qingmei Huang  1 , Fulei Wu  1 , Yang Yang  2 , Ling Wang  1 , Xuqian Zong  1 , Xiaoyan Yu  1 , Changrong Yuan  1
Affiliations

Impact of social support on cognitive function in patients with breast cancer undergoing chemotherapy: The chain-mediating role of fatigue and depression

Yuanqi Ding et al. Asia Pac J Oncol Nurs. .

Abstract

Objective: This study aims to examine the chain-mediating roles of fatigue and depression in the association between social support and cognitive function among patients with breast cancer undergoing chemotherapy.

Methods: This study involved a secondary analysis of cross-sectional data from 647 patients recruited from four provinces in China. Patient-reported outcomes were measured using the Chinese version of the Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief Scales, assessing cognitive function, social support, fatigue, and depression. Spearman correlation analysis was performed using SPSS 25.0. A chain mediation model was tested in Mplus 8.3 using maximum likelihood estimation with bootstrapping.

Results: The proposed model showed acceptable fit indices (χ2/df ​= ​4.07, RMSEA ​= ​0.069, CFI ​= ​0.986, TLI ​= ​0.973, SRMR ​= ​0.02). Social support was significantly associated with better cognitive function (total effect: β ​= ​0.217, SE ​= ​0.057, t ​= ​3.787, P ​< ​0.001). The direct effect remained significant (β ​= ​0.115, SE ​= ​0.053, t ​= ​2.176, P ​< ​0.05). Fatigue and depression each independently mediated the relationship between social support and cognitive function. The total indirect effect was significant (point estimate ​= ​0.102, SE ​= ​0.027, 95% CI [0.055, 0.162]).

Conclusions: Social support has both direct and indirect effects on cognitive function in patients with breast cancer receiving chemotherapy, with fatigue and depression serving as significant mediators. Psychosocial interventions aimed at enhancing social support and reducing fatigue and depressive symptoms may help prevent or alleviate cognitive impairment in this population.

Keywords: Breast neoplasms; Chemotherapy-related cognitive impairment; Depression; Fatigue; Social support.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Hypothetical chain mediation model.
Fig. 2
Fig. 2
Participant recruitment flowchart. BC, breast cancer.
Fig. 3
Fig. 3
Chain mediation model.
See this image and copyright information in PMC

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