Self-rated health and health-related quality of life among cancer patients: the serial multiple mediation of anxiety and depression

Abstract Background Health-related quality of life (HRQOL) in cancer patients has attracted increasing attention, which may be associated with self-rated health (SRH), anxiety, and depression. However, limited studies have focused on the mediating role of anxiety and depression in the relationship between SRH and HRQOL among cancer patients. Therefore, this study aims to explore the serial multiple mediating effects of anxiety and depression between SRH and HRQOL in cancer patients. Methods This cross-sectional study investigated a total of 565 hospitalized cancer patients in Anhui province in China from November 2020 to October 2021. SRH was assessed using a single-item measure, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and HRQOL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Socio-demographic and clinical characteristics were analyzed using descriptive statistics. The relationships between SRH, anxiety, depression, and HRQOL were evaluated by Pearson correlation analysis. The serial multiple mediation of anxiety and depression was assessed by SPSS PROCESS macro. Results SRH, anxiety, depression and HRQOL were significantly correlated( P < 0.001). In comparison to the fair SRH, the good SRH exhibited a significantly positive direct effect ( Effect = 0.2366, Bootstrap 95%CI : 0.0642 ~ 0.4090) and total effect on HRQOL ( Effect = 0.4761, Bootstrap 95%CI : 0.2975 ~ 0.6546). Conversely, the poor SRH demonstrated a significantly negative total effect on HRQOL ( Effect = -0.4321, Bootstrap 95%CI : -0.7544~ -0.1099). When considering the fair SRH as the reference group, the poor SRH displayed a negative indirect effect on HRQOL through the single mediation of anxiety ( Effect = -0.1058, Bootstrap 95%CI : -0.2217~ -0.0107) and the serial mediation of anxiety and depression ( Effect = -0.0528, Bootstrap 95%CI : -0.1233~ -0.0035). Conversely, the good SRH had a positive indirect impact on HRQOL through the single mediation of anxiety ( Effect = 0.1153, Bootstrap 95%CI : 0.0583 ~ 0.1900) and depression ( Effect = 0.0667, Bootstrap 95%CI : 0.0206 ~ 0.1234), as well as the serial mediation of anxiety and depression ( Effect = 0.0575, Bootstrap 95%CI : 0.0192 ~ 0.1030). Conclusion SRH can improve HRQOL through the decrease of anxiety and depression in cancer patients. Focusing on SRH would be beneficial for their mental health and HRQOL in cancer patients.