The chain mediating role of social support and resilience in the relationship between symptom burden and psychological distress among lung cancer patients in the diagnostic phase_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YIN Congyu ^1,2 , LI Jina ¹ , YE Man ¹ , LI Yingxia ¹ , LI Wei ² , KANG Lu ¹ , ZHANG Yayi ¹ ,  HUANG Lingzhi ¹

1. Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, 410011, P. R. China;
2. Xiangya Nursing School of Central South University, Changsha, 410013, P. R. China;

Corresponding?author：

HUANG Lingzhi, Email: huanglingzhi@csu.edu.cn

Keywords：

Symptom burden; social support; resilience; psychological distress; lung cancer; diagnostic phase

DOI：

10.7507/1007-4848.202312009

Video：

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Objective To investigate the current status of symptom burden and psychological distress among lung cancer patients in the diagnostic phase, and to explore the chain mediating role of social support and resilience between symptom burden and psychological distress. Methods The patients with lung cancer in the diagnostic phase who were treated in the Department of Thoracic Surgery of the Second Xiangya Hospital of Central South University from October 2022 to June 2023 were investigated by a general information questionnaire using the MD Anderson Symptom Inventory, the Social Support Rating Scale, the Connor-Davidson Resilience Scale, and the Distress Thermometer. The chain mediating role of social support and resilience between symptom burden and psychological distress was analyzed. Results A total of 413 lung cancer patients were enrolled, including 173 males and 240 females, aged (54.69±10.82) years. The detection rate of psychological distress among lung cancer patients in the diagnostic phase was 48.18%, and the average score was (3.84±2.50) points. Psychological distress was positively correlated with symptom burden (P<0.01), and negatively correlated with social support and resilience (P<0.01). The mediating effect of resilience between symptom burden and psychological distress was significant. The chain mediating effect of social support and resilience between symptom burden and psychological distress was also significant. Conclusion Lung cancer patients in the diagnostic phase have a high detection rate of psychological distress. Symptom burden can directly impact psychological distress, and can affect psychological distress through the indirect path of resilience as well as the chain mediating path between social support and resilience among lung cancer patients in the diagnostic phase.

Citation： YIN Congyu, LI Jina, YE Man, LI Yingxia, LI Wei, KANG Lu, ZHANG Yayi, HUANG Lingzhi. The chain mediating role of social support and resilience in the relationship between symptom burden and psychological distress among lung cancer patients in the diagnostic phase. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(6): 798-804. doi: 10.7507/1007-4848.202312009 Copy

1.	Riba MB, Donovan KA, Andersen B, et al. Distress management, version 3. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(10): 1229-1249.
2.	Poole K. The emergence of the 'waiting game': A critical examination of the psychosocial issues in diagnosing breast cancer. J Adv Nurs, 1997, 25(2): 273-281.
3.	牟倩倩, 余春華, 李俊英. 肺癌初治患者心理痛苦的現狀調查及相關因素分析. 北京大學學報(醫學版), 2016, 48(3): 507-514.Mou QQ, Yu CH, Li JY. Investigation and analysis for impact factors of distress in patients with first diag-nosed lung cancer. J Peking Univ (Health Sci), 2016, 48(3): 507-514.
4.	Steinberg T, Roseman M, Kasymjanova G, et al. Prevalence of emotional distress in newly diagnosed lung cancer patients. Support Care Cancer, 2009, 17(12): 1493-1497.
5.	Linares-Moya M, Rodríguez-Torres J, Heredia-Ciuró A, et al. Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors. Support Care Cancer, 2022, 30(2): 1579-1586.
6.	Coyne JC, Downey G. Social factors and psychopathology: Stress, social support, and coping processes. Annu Rev Psychol, 1991, 42: 401-425.
7.	Ye ZJ, Qiu HZ, Li PF, et al. Predicting changes in quality of life and emotional distress in Chinese patients with lung, gastric, and colon-rectal cancer diagnoses: The role of psychological resilience. Psychooncology, 2017, 26(6): 829-835.
8.	Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: The M. D. Anderson Symptom Inventory. Cancer, 2000, 89(7): 1634-1646.
9.	張立力, 臧瑜. MD安德森癥狀評估量表肺癌模塊的修訂和考評. 腫瘤, 2013, 33(5): 434-438.Zhang LL, Zang Y. Revision and evaluation of the lung cancer module of the MD Anderson Symptom Inventory. Tumor, 2013, 33(5): 434-438.
10.	肖水源. 《社會支持評定量表》的理論基礎與研究應用. 臨床精神醫學雜志, 1994, 2: 98-100.Xiao SY. Theoretical basis and research application of Social Support Rating Scale. J Clin Psych, 1994, 2: 98-100.
11.	Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety, 2003, 18(2): 76-82.
12.	Yu XN, Lau JT, Mak WW, et al. Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents. Compr Psychiatry, 2011, 52(2): 218-224.
13.	張葉寧, 張海偉, 宋麗莉, 等. 心理痛苦溫度計在中國癌癥患者心理痛苦篩查中的應用. 中國心理衛生雜志, 2010, 24(12): 897-902.Zhang YN, Zhang HW, Song LL, et al. Application of the NCCN Distress Thermometer in Chinese cancer patients. Chin Ment Health J, 2010, 24(12): 897-902.
14.	王佳, 李巖. 艾司氯胺酮復合麻醉對肺癌根治術患者術后心理痛苦的影響. 中華麻醉學雜志, 2022, 42(3): 312-315.Wang J, Li Y. Effect of esketamine-based anesthesia on postoperative psychological distress in patients undergoing radical resection of lung cancer. Chin J Anesthesiol, 2022, 42(3): 312-315.
15.	Kim JY, Sun V, Raz DJ, et al. The impact of lung cancer surgery on quality of life trajectories in patients and family caregivers. Lung Cancer, 2016, 101: 35-39.
16.	Sonstag S. Illness as a Metaphor. Penguin, London: 1991.
17.	何紅葉, 宋永霞, 張甜, 等. 心理社會干預對肺癌患者生活質量影響的Meta分析. 現代預防醫學, 2018, 45(12): 2117-2123.He HY, Song YX, Zhang T, et al. Effect of psychosocial intervention on quality of life in lung cancer survivors: A meta-analysis. Mod Prev Med, 2018, 45(12): 2117-2123.
18.	Bi Z, Li W, Zhao J, et al. Negative correlations of psychological distress with quality of life and immunotherapy efficacy in patients with advanced NSCLC. Am J Cancer Res, 2022, 12(2): 805-815.
19.	Zhang X, Zhang H, Zhang Z, et al. The mediating effect of resilience on the relationship between symptom burden and anxiety/depression among chinese patients with primary liver cancer after liver resection. Patient Prefer Adherence, 2023, 17: 3033-3043.
20.	Lee JL, Jeong Y. Quality of life in patients with non-small cell lung cancer: Structural equation modeling. Cancer Nurs, 2019, 42(6): 475-483.
21.	Ludolph P, Kunzler AM, Stoffers-Winterling J, et al. Interventions to promote resilience in cancer patients. Dtsch Arztebl Int, 2019, 51-52(51-52): 865-872.
22.	Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav, 2011, 52(2): 145-161.
23.	Kumpfer KL. Factors and Processes Contributing to Resilience: The Resilience Framework. MA: Springer, Boston, 2002.
24.	Saravanan A, Bajaj P, Mathews HL, et al. Social support is inversely associated with sleep disturbance, inflammation, and pain severity in chronic low back pain. Nurs Res, 2021, 70(6): 425-432.
25.	Lei H, Tian X, Jin YF, et al. The chain mediating role of social support and stigma in the relationship between mindfulness and psychological distress among Chinese lung cancer patients. Support Care Cancer, 2021, 29(11): 6761-6770.
26.	Wang Y, Bao S, Chen Y. How does social media use influence the mental health of pancreatic cancer patients: A chain mediating effect of online social support and psychological resilience. Front Public Health, 2023, 11: 1166776.
27.	Yu H, Li H, Zuo T, et al. Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis. Asia Pac J Oncol Nurs, 2022, 9(9): 100069.
28.	Frydman MI. Social support, life events and psychiatric symptoms: A study of direct, conditional and interaction effects. Soc Psychiatry, 1981, 16(2): 69-78.

1. Riba MB, Donovan KA, Andersen B, et al. Distress management, version 3. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(10): 1229-1249.
2. Poole K. The emergence of the 'waiting game': A critical examination of the psychosocial issues in diagnosing breast cancer. J Adv Nurs, 1997, 25(2): 273-281.
3. 牟倩倩, 余春華, 李俊英. 肺癌初治患者心理痛苦的現狀調查及相關因素分析. 北京大學學報(醫學版), 2016, 48(3): 507-514.Mou QQ, Yu CH, Li JY. Investigation and analysis for impact factors of distress in patients with first diag-nosed lung cancer. J Peking Univ (Health Sci), 2016, 48(3): 507-514.
4. Steinberg T, Roseman M, Kasymjanova G, et al. Prevalence of emotional distress in newly diagnosed lung cancer patients. Support Care Cancer, 2009, 17(12): 1493-1497.
5. Linares-Moya M, Rodríguez-Torres J, Heredia-Ciuró A, et al. Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors. Support Care Cancer, 2022, 30(2): 1579-1586.
6. Coyne JC, Downey G. Social factors and psychopathology: Stress, social support, and coping processes. Annu Rev Psychol, 1991, 42: 401-425.
7. Ye ZJ, Qiu HZ, Li PF, et al. Predicting changes in quality of life and emotional distress in Chinese patients with lung, gastric, and colon-rectal cancer diagnoses: The role of psychological resilience. Psychooncology, 2017, 26(6): 829-835.
8. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: The M. D. Anderson Symptom Inventory. Cancer, 2000, 89(7): 1634-1646.
9. 張立力, 臧瑜. MD安德森癥狀評估量表肺癌模塊的修訂和考評. 腫瘤, 2013, 33(5): 434-438.Zhang LL, Zang Y. Revision and evaluation of the lung cancer module of the MD Anderson Symptom Inventory. Tumor, 2013, 33(5): 434-438.
10. 肖水源. 《社會支持評定量表》的理論基礎與研究應用. 臨床精神醫學雜志, 1994, 2: 98-100.Xiao SY. Theoretical basis and research application of Social Support Rating Scale. J Clin Psych, 1994, 2: 98-100.
11. Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety, 2003, 18(2): 76-82.
12. Yu XN, Lau JT, Mak WW, et al. Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents. Compr Psychiatry, 2011, 52(2): 218-224.
13. 張葉寧, 張海偉, 宋麗莉, 等. 心理痛苦溫度計在中國癌癥患者心理痛苦篩查中的應用. 中國心理衛生雜志, 2010, 24(12): 897-902.Zhang YN, Zhang HW, Song LL, et al. Application of the NCCN Distress Thermometer in Chinese cancer patients. Chin Ment Health J, 2010, 24(12): 897-902.
14. 王佳, 李巖. 艾司氯胺酮復合麻醉對肺癌根治術患者術后心理痛苦的影響. 中華麻醉學雜志, 2022, 42(3): 312-315.Wang J, Li Y. Effect of esketamine-based anesthesia on postoperative psychological distress in patients undergoing radical resection of lung cancer. Chin J Anesthesiol, 2022, 42(3): 312-315.
15. Kim JY, Sun V, Raz DJ, et al. The impact of lung cancer surgery on quality of life trajectories in patients and family caregivers. Lung Cancer, 2016, 101: 35-39.
16. Sonstag S. Illness as a Metaphor. Penguin, London: 1991.
17. 何紅葉, 宋永霞, 張甜, 等. 心理社會干預對肺癌患者生活質量影響的Meta分析. 現代預防醫學, 2018, 45(12): 2117-2123.He HY, Song YX, Zhang T, et al. Effect of psychosocial intervention on quality of life in lung cancer survivors: A meta-analysis. Mod Prev Med, 2018, 45(12): 2117-2123.
18. Bi Z, Li W, Zhao J, et al. Negative correlations of psychological distress with quality of life and immunotherapy efficacy in patients with advanced NSCLC. Am J Cancer Res, 2022, 12(2): 805-815.
19. Zhang X, Zhang H, Zhang Z, et al. The mediating effect of resilience on the relationship between symptom burden and anxiety/depression among chinese patients with primary liver cancer after liver resection. Patient Prefer Adherence, 2023, 17: 3033-3043.
20. Lee JL, Jeong Y. Quality of life in patients with non-small cell lung cancer: Structural equation modeling. Cancer Nurs, 2019, 42(6): 475-483.
21. Ludolph P, Kunzler AM, Stoffers-Winterling J, et al. Interventions to promote resilience in cancer patients. Dtsch Arztebl Int, 2019, 51-52(51-52): 865-872.
22. Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav, 2011, 52(2): 145-161.
23. Kumpfer KL. Factors and Processes Contributing to Resilience: The Resilience Framework. MA: Springer, Boston, 2002.
24. Saravanan A, Bajaj P, Mathews HL, et al. Social support is inversely associated with sleep disturbance, inflammation, and pain severity in chronic low back pain. Nurs Res, 2021, 70(6): 425-432.
25. Lei H, Tian X, Jin YF, et al. The chain mediating role of social support and stigma in the relationship between mindfulness and psychological distress among Chinese lung cancer patients. Support Care Cancer, 2021, 29(11): 6761-6770.
26. Wang Y, Bao S, Chen Y. How does social media use influence the mental health of pancreatic cancer patients: A chain mediating effect of online social support and psychological resilience. Front Public Health, 2023, 11: 1166776.
27. Yu H, Li H, Zuo T, et al. Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis. Asia Pac J Oncol Nurs, 2022, 9(9): 100069.
28. Frydman MI. Social support, life events and psychiatric symptoms: A study of direct, conditional and interaction effects. Soc Psychiatry, 1981, 16(2): 69-78.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The chain mediating role of social support and resilience in the relationship between symptom burden and psychological distress among lung cancer patients in the diagnostic phase

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