Disability, community participation, and life satisfaction in working-age cancer survivors

OBJECTIVE: To examine whether community participation mediates the disability-life satisfaction association in working-age cancer survivors, and whether contextual factors moderate this pathway. DESIGN: Cross-sectional online survey. SUBJECTS: 2,999 working-age US cancer survivors, employed or seeking employment (mean age 42.8 years; 53.1% male; 75.7% in remission). METHODS: Disability (World Health Organization Disability Assessment Schedule 2.0), perceived community participation (5-item Wisconsin Community Participation Scale), and life satisfaction (Satisfaction With Life Scale) were assessed. A single-mediator model was estimated with bias-corrected bootstrap; 7 moderators were tested with false-discovery-rate correction. RESULTS: Disability was associated with lower participation (β = -0.14) and life satisfaction (β = -0.12); participation with greater life satisfaction (β = 0.57). The indirect association (β = -0.08, 95% CI -0.10 to -0.06) accounted for 39.8% of the modest total association, but for only 13.0% when the full 12-item participation scale was used. At high instrumental support the conditional indirect association was indistinguishable from zero; at high self-efficacy and hope it reversed in sign. CONCLUSION: In this cross-sectional study, community participation statistically accounted for a measure-dependent part of the disability-life satisfaction association, and contextual factors were associated with differential attenuation across pathway segments. These hypothesis-generating findings require longitudinal confirmation before informing practice.