Mediating roles of cancer stigma and resilience in the relationship between type D personality and quality of life among patients with breast cancer undergoing chemotherapy

PURPOSE To determine the statistically mediating roles of cancer stigma and resilience in the relationship between Type D personality and quality of life (QoL) in patients with breast cancer undergoing chemotherapy. METHODS This cross-sectional correlational study included 129 inpatients with breast cancer recruited from a university hospital-affiliated cancer center ward. Participants completed questionnaires assessing their Type D personality, cancer stigma, resilience, and QoL. Data were analyzed using Pearson's correlation, hierarchical regression, and PROCESS Macro-mediation analysis (Model 4, 50,000 bootstrap samples). RESULTS Type D personality negatively correlated with resilience (r = -0.493, p < 0.001) and QoL (r = -0.407, p < 0.001) and positively correlated with cancer stigma (r = 0.387, p < 0.001). Cancer stigma negatively correlated with resilience (r = -0.257, p = 0.003) and QoL (r = -0.455, p < 0.001). Meanwhile, resilience was positively associated with QoL (r = 0.514, p < 0.001). Regression analysis showed that cancer stigma and resilience significantly predicted QoL (β = -0.305, p < 0.001; β = 0.326, p < 0.001), accounting for 26.4% of the variance. Bootstrapped mediation analysis indicated that cancer stigma and resilience explained the link between type D personality and QoL (B = -0.0128, 95% BootCI [-0.0194, -0.0070]). Two significant indirect pathways between type D personality and QoL were identified: perceived cancer stigma (B = -0.0058, 95% BootCI [-0.0104, -0.0018]) and resilience (B = -0.0070, 95% BootCI [-0.0130, -0.0025]). CONCLUSION Reducing cancer stigma and enhancing resilience may help improve QoL among patients with breast cancer receiving chemotherapy, particularly those with Type D personality. These findings underscore the importance of targeted psychosocial nursing interventions.