Breast cancer, a prevalent malignancy with rising incidence rates, originates from malignant transformations in the breast's glandular or ductal epithelial cells [37]. It remains a formidable health concern for women globally, given its physical implications and the profound psychological distress it imposes on patients [29]. Extensive research consistently highlights the simultaneous presence of anxiety and depression among breast cancer patients, leading to a substantial deterioration in their overall quality of life [4, 10].
Breast cancer surgeries, such as modified radical surgery and breast-conserving surgery, are common interventions for breast cancer management[33]. These surgeries elicit various emotional and psychological complexities in patients [23]. Patients undergoing surgery for breast cancer often experience heightened anxiety, fear, and uncertainty before the procedure, followed by a range of emotional responses post-surgery, including relief, sadness, grief, or apprehension related to changes in body image[1].
Patients undergoing breast cancer surgery may experience physical effects such as pain, discomfort, restricted mobility, and fatigue, which can contribute to emotional distress[19]. Furthermore, long-term psychological challenges related to body image, self-consciousness, and relationship changes may arise, highlighting the importance of proactive identification and management of mental well-being to enhance overall wellness and quality of life in these patients[43].
In recent years, psycho-oncology has witnessed the rise of psychological interventions as a promising avenue for addressing the mental health requirements of individuals grappling with cancer, affording them invaluable support and guidance throughout their cancer trajectory[5]. The Managing Cancer and Living Meaningfully (CALM) intervention has gained notable recognition among these interventions. Tailored to the unique needs of cancer patients, CALM aims to facilitate the discovery of purpose and significance in life, fortify coping mechanisms, and enhance emotional well-being [30]. By honing in on the psychological dimensions of the cancer experience, these interventions endeavor to alleviate distressing symptoms and foster resilience among patients.
While previous research has demonstrated the efficacy of CALM interventions in alleviating anxiety and depressive symptoms among individuals diagnosed with diverse cancer types, their potential value in supporting breast cancer patients remains promising[3]. However, despite these encouraging findings, the mechanisms underlying the impact of CALM interventions on mental health outcomes for patients with breast cancer are still poorly understood. To enhance our understanding of the intricate dynamics experienced by patients post-breast cancer, it is crucial to explore the interactions between CALM interventions, mental health outcomes, quality of life, perceived social support, and psychological resilience, thereby providing further insights into this complex domain.
Perceived social support encompasses the subjective perception of receiving assistance, understanding, and acceptance from various sources, including family, friends, healthcare professionals, support groups, and others. It encompasses multiple dimensions, such as emotional support (empathy, listening, understanding), instrumental support (practical assistance), and informational support (guidance, advice) [38]. Perceived social support is crucial in fostering a sense of belonging, reassuring, and facilitating adaptive coping strategies among breast cancer patients [35]. Psychological resilience, characterized by adapting to and recovering from adversity, protects against cancer-related stress [34, 39]. Moreover, resilience can safeguard body image and prevent negative self-esteem following mastectomy. Breast cancer patients with higher resilience tend to perceive more excellent social support, including emotional encouragement, practical assistance, and guidance [17]. Studies have demonstrated that breast cancer patients with higher levels of resilience and social support experience enhanced emotional well-being, reduced pain, improved coping mechanisms, and increased life satisfaction [21]. Thus, resilience and social support are vital in assisting patients in navigating the challenges of breast cancer, facilitating positive adjustment, and ultimately improving their quality of life.
The primary objective of this study is to examine the effects of the CALM intervention on the mental health of postoperative breast cancer patients, specifically focusing on anxiety, depression, and quality of life. Additionally, we aim to investigate the potential mediating role of perceived social support in the relationship between psychological resilience and quality of life. By analyzing the interconnections among the CALM intervention, mental health outcomes, and psychological resilience, we aim to uncover the mechanisms that underlie the positive impact of the CALM intervention on mental well-being. Three hypotheses guide our study. Firstly, we hypothesize that postoperative breast cancer patients exhibit low levels of psychological resilience. Secondly, we predict that the CALM intervention will enhance psychological resilience among postoperative breast cancer patients. Lastly, we hypothesize that perceived social support mediates the association between changes in psychological resilience and quality of life.