The Relationship Between Symptom Burden and Death Anxiety in Ovarian Cancer Patients: The Mediating Effect of Alexithymia

Purpose: This study aimed to reveal the relationship between death anxiety, symptom burden and alexithymia in ovarian cancer patients, and to explore the potential mediating role of alexithymia in the relationship between symptom burden and death anxiety. Patients and Methods: 247 patients with ovarian cancer in five tertiary hospitals in Sichuan, China were investigated by convenient sampling method from March 2024 to March 2025. Participants completed demographic questionnaires, the MD Anderson Symptom Inventory, the Toronto Alexithymia Scale, and the Templer-Death Anxiety Scale. SPSS 27.0 software was used for Pearson correlation analysis and analysis of variance, and mediation analysis was conducted with Model 4 in the Process v4.2. Results: Most patients were aged 45 years or older, had a senior high school education or below, were married, had medical insurance under the New Rural Cooperative Medical Scheme or Resident Basic Medical Insurance, and had a household income between 5000 and 10,000 yuan. The score of the Templer-Death Anxiety scale for ovarian cancer patients was (46.38 ± 6.92), which was at a high level. Statistically Significant differences were observed in death anxiety scores among patients of different ages, educational levels, tumor stages, disease duration, and marital status. Correlation analysis revealed significant correlations among symptom burden, alexithymia, and death anxiety. Symptom burden had a significant positive influence on alexithymia and death anxiety. Additionally, alexithymia had a significant positive impact on death anxiety. Mediation analysis revealed that alexithymia partially mediated the relationship between symptom burden and death anxiety. Conclusion: We should focus on patients who are younger, unmarried or divorced/widowed, have lower educational attainment, are at a later stage of tumor progression, and have a shorter disease course. Symptom burden influences death anxiety in ovarian cancer patients by affecting alexithymia. Focusing solely on symptom burden without addressing patients’ alexithymia may not be sufficient to reduce their death anxiety. Keywords: ovarian cancer, psychological factors, symptom assessment, emotional regulation