Perceived Social Support, Nutrition Literacy, and Cancer-Related Fatigue Before Discharge After Minimally Invasive Esophagectomy: A Cross-Sectional Mediation and Network Analysis

Cancer-related fatigue (CRF) is a common and disabling symptom in patients with esophageal cancer, and the period before discharge after minimally invasive esophagectomy (MIE) is a clinically important point for assessment and discharge planning. This cross-sectional study examined whether nutrition literacy statistically accounted for part of the association between perceived social support and CRF, and whether this association was concentrated in specific dimensions. In total, 330 patients with esophageal cancer who had undergone MIE were recruited from two tertiary hospitals in Anhui, China, and assessed before discharge. Perceived social support, nutrition literacy, and CRF were measured with validated instruments. Associations were examined with path models using 5000 bootstrap resamples, and a seven-node dimension-level network was estimated with EBICglasso. Perceived social support correlated positively with nutrition literacy (r = 0.610) and negatively with CRF (r = −0.147). In the adjusted association model, the standardized indirect association through nutrition literacy was −0.081 (95% CI −0.141 to −0.032; p = 0.003), whereas the standardized direct association was close to zero (0.017, 95% CI −0.094 to 0.131; p = 0.774). In the exploratory network, the most prominent cross-module edge linked nutrition knowledge and cognitive fatigue (−0.149), and bridge strength was highest for nutrition knowledge (0.193) and cognitive fatigue (0.184). Nutrition knowledge is therefore a testable target for future longitudinal and intervention studies in this clinical phase.