Sleep

Resilience mediating the effects of cancer-related fatigue on depression, sleep, and quality of life among prostate cancer survivors.

TL;DR

Resilience partially mediates the relationship between cancer-related fatigue and depression, sleep quality, and quality of life in prostate cancer survivors, suggesting that incorporating resilience-building strategies into survivorship care may improve patient well-being.

Key Findings

Cancer-related fatigue showed strong direct effects on depression, prostate-specific quality of life, overall quality of life, and sleep disturbances in prostate cancer survivors.

  • Fatigue had a strong direct effect on depression (β = .69, p < .001)
  • Fatigue had a direct negative effect on prostate-specific quality of life (β = -.32, p < .001)
  • Fatigue had a direct negative effect on overall quality of life (β = -.25, p < .01)
  • Fatigue had a direct effect on sleep disturbances (β = .57, p < .001)
  • Study involved 122 prostate cancer patients recruited from two regional hospitals in southern Taiwan

Cancer-related fatigue was negatively associated with resilience among prostate cancer survivors.

  • Fatigue was negatively associated with resilience (β = -.61, p < .001)
  • Resilience was measured using the RSA (Resilience Scale for Adults)
  • The cross-sectional study used structural equation modeling (SEM) to examine this relationship

Resilience partially mediated the relationship between cancer-related fatigue and all four health outcomes studied.

  • After accounting for resilience as a mediator, the effect of fatigue on depression was reduced from β = .69 to β = .31
  • The effect of fatigue on prostate-specific quality of life was reduced from β = -.32 to β = -.09
  • The effect of fatigue on overall quality of life changed to β = .17 after mediation
  • The effect of fatigue on sleep disturbances was reduced from β = .57 to β = .37
  • Mediation was partial, indicating fatigue retained direct effects on outcomes even after accounting for resilience

The structural equation model demonstrated excellent fit to the data.

  • Model fit indices: χ²/df = 1.16, GFI = .99, RMSEA = .019
  • These values indicate excellent model fit by conventional standards (RMSEA < .05, GFI > .95)
  • Instruments used included BFI (fatigue), IIEF-5 (erectile function), RSA (resilience), CES-D (depression), PSQI (sleep quality), WHOQOL-BREF and EORTC QLQ-PR25 (quality of life)

The study was cross-sectional in design with a sample of 122 prostate cancer patients from two regional hospitals.

  • Participants were recruited from two regional hospitals in southern Taiwan
  • Sample size was 122 prostate cancer patients
  • All instruments used were validated measures
  • Cross-sectional design limits causal inference

What This Means

This research examined how fatigue, resilience, and health outcomes are connected in men who have survived prostate cancer. Using surveys and statistical modeling with 122 patients in Taiwan, the researchers found that cancer-related fatigue strongly worsened depression, disrupted sleep, and reduced both general and prostate-specific quality of life. At the same time, higher fatigue levels were associated with lower resilience — meaning more fatigued patients tended to have fewer psychological coping resources. Importantly, the study found that resilience acts as a 'buffer' between fatigue and its harmful effects. When resilience was accounted for in the analysis, the negative impact of fatigue on all four outcomes (depression, sleep, overall quality of life, and prostate-specific quality of life) was noticeably reduced. This means resilience partially explains why some patients cope better with fatigue than others — those with higher resilience experience less depression, better sleep, and better quality of life even when experiencing similar levels of fatigue. This research suggests that programs designed to build resilience — such as psychological support, stress management, or coping skills training — could be valuable additions to survivorship care for prostate cancer patients. Rather than only treating fatigue directly, helping patients develop stronger coping abilities may meaningfully improve their mental and physical well-being. The authors note that clinical trials are needed to evaluate specific resilience-building interventions in this population.

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Citation

Chen C, Lin H, Huang C. (2026). Resilience mediating the effects of cancer-related fatigue on depression, sleep, and quality of life among prostate cancer survivors.. European journal of oncology nursing : the official journal of European Oncology Nursing Society. https://doi.org/10.1016/j.ejon.2025.103093