Associations between psychosocial distress and health-promoting lifestyles in patients with malignant tumors: the critical role of self-perceived burden

Background As cancer survivorship rates improve, the focus of oncological care has shifted toward enhancing long-term quality of life through health-promoting lifestyles (HPL). However, the adoption of such behaviors is often hindered by complex psychosocial barriers. This study aimed to investigate the associations between psychological resilience, cancer-related stigma, and self-perceived burden (SPB), and to explore their collective associations with HPL behaviors in a cohort of cancer patients. Methods A single-center retrospective cross-sectional study was conducted involving 162 patients with malignant tumors treated at The First Hospital of Hebei Medical University between January 2024 and December 2024. Demographic and clinical data were extracted from electronic medical records. Psychosocial status was assessed using the Connor-Davidson Resilience Scale (CD-RISC), Social Impact Scale (SIS), Self-Perceived Burden Scale (SPBS-CP), and Health-Promoting Lifestyle Profile II (HPLP-II). Multivariable linear regression, mediation, moderation, and Pearson correlation analyses were performed to identify factors associated with HPL. Results The cohort (mean age 61.3 ± 11.1 years; 54.3% male) exhibited moderate levels of resilience (65.04 ± 10.45) and high SPB (35.83 ± 6.55). The overall HPLP-II score was 122.42 ± 15.01, indicating a moderate level of health engagement. Advanced disease stage (III/IV) and longer disease duration (>6 months) were significantly associated with lower resilience and higher stigma ( p < 0.001). Correlation analysis revealed that HPL was positively correlated with resilience (r = 0.512, p < 0.001) and negatively correlated with stigma (r = −0.425, p < 0.001) and SPB (r = −0.541, p < 0.001). In the regression model, SPB was the strongest negative correlate of a health-promoting lifestyle ( β = −0.38, 95% CI [−0.55, −0.21], p < 0.001), followed by resilience as a positive factor ( β = 0.29, 95% CI [0.18, 0.40], p < 0.001). Furthermore, SPB partially mediated the relationship between stigma and HPL, while psychological resilience significantly moderated the negative association between SPB and HPL. Conclusion Psychological resilience acts as a protective factor, while stigma and self-perceived burden are significant barriers negatively associated with health-promoting lifestyles among cancer patients.