The Mediating Effects of Negative Affect and Cancer Coping in the Relationship between Perceived Stress and Health-Related Quality of Life among Gynecological Cancer Survivors: A Cross-Sectional Study

Purpose: The incidence of gynecological cancers is increasing, presenting significant challenges for patient care and outcomes. Perceived stress and negative affect can impede self-care behaviors and reduce health-related quality of life (HRQoL). This study examined the mediating effects of negative affect and cancer coping on the relationship between perceived hospital stress and HRQoL among patients with gynecological cancer. Methods: A cross-sectional mediation analysis was conducted with 118 gynecological cancer patients recruited from the outpatient clinic of a university hospital (October 2023 to February 2024). Participants completed validated instruments assessing perceived stress, negative affect, cancer coping, and HRQoL. Data were analyzed using Spearman’s correlations and the PROCESS macro (Model 4) with 95% bootstrap confidence intervals (CIs). Results: Perceived stress was significantly correlated with negative affect (r=.58, p<.001), cancer coping (r=.23, p=.012), and HRQoL (r=–.45, p<.001). Negative affect was correlated with HRQoL (r=–.59, p<.001). Furthermore, negative affect and cancer coping mediated the relationship between stress and HRQoL (B=–0.18, 95% CI=–0.27 to –0.11 and B=0.04, 95% CI=0.01 to 0.08, respectively). Conclusion: Negative affect and cancer coping significantly mediated the relationship between hospital stress and HRQoL. Targeted interventions aiming to reduce stress and strengthen emotional and coping strategies could enhance HRQoL among gynecological cancer patients.