Structural equation modeling of multidimensional determinants of postoperative quality of life in patients with oral cancer

Postoperative quality of life (QoL) in oral cancer patients is not only influenced by physical impairments but also by interrelated psychosocial factors. However, few studies have investigated these multidimensional pathways during the acute recovery phase. This study aimed to examine how speech disorder, self-esteem, social alienation, and body image interact in relation to QoL in the first week following oral cancer surgery. A cross-sectional study was conducted among 401 patients within 7 days post-surgery. Validated Chinese versions of standardized scales were administered to assess functional and psychosocial domains relevant to QoL. Structural equation modeling was used to test hypothesized pathways among speech disorder, self-esteem, social alienation, body image, and quality of life. Model fit was assessed with χ²/df, CFI, TLI, RMSEA, and SRMR, using established thresholds. Speech disorder was negatively associated with QoL both directly (β = −0.446) and indirectly through sequential pathways involving self-esteem, social alienation, and body image. Among these variables, speech disorder showed the strongest overall association with QoL when both direct and indirect pathways were considered (β = −0.824), whereas body image demonstrated the strongest direct association with QoL (β = −0.609). The structural equation modeling demonstrated acceptable model fit (χ² = 187.818, df = 78, χ²/df = 2.408, CFI = 0.969, TLI = 0.959, RMSEA = 0.059, SRMR = 0.039). Postoperative QoL in oral cancer patients is shaped by complex mediation pathways linking speech dysfunction, psychosocial vulnerabilities, and body image. These findings highlight the need for early multidisciplinary interventions that integrate functional rehabilitation with psychosocial support to improve recovery. Future research is warranted to validate these associations through longitudinal and interventional studies.