Contemporary oncology focuses not only on drug treatment, but also on a broader understanding of the experiences of patients and their families, prioritizing resource allocation, planning and delivery of holistic care that has a significant impact on quality of life. Many studies have highlighted how a patient’s mental state changes with time, disease progression and treatment, and how a positive attitude plays an important role in the recovery process, highlighting the importance of psychological variables in facilitating or, conversely, hindering the care process56,57.
In particular, the measurement of quality of life in cancer patients has been the subject of interest in many studies58,59,60. For example, Montazieri et al.60 conducted a study of 129 lung cancer patients and highlighted that patients’ overall quality of life prior to starting cancer treatment was an important predictor of survival. The study of more than 400 cancer patients by Li et al.61 came to the same conclusion, finding that health-related quality of life was a strong and independent predictor of overall survival.
By specifically analyzing studies involving hematology patients62,63, it becomes clear how certain characteristics of hematological malignancies, such as acute onset, rapid progression, easy recurrence, complex treatment methods and high treatment costs, can seriously affect the physical health, but also the mental health and quality of life of patients. Based on these considerations, our research aimed to assess the psychological adjustment of hematology patients, focusing on the psychological consequences of the disease in terms of depression and PTSD, psychological resources such as resilience and perceived social support, and their impact on perceived quality of life.
In addition, the aim was to assess which variables among demographics, clinical outcomes and psychological resources predict patients’ quality of life and whether resilience plays a protective role.
About the first objective, our data confirm that hematological patients, like patients with other types of cancer, manifest significant levels of depression and PTSD, moderate levels of perceived resilience and social support, and a medium–low quality of life, in line with previous research57,64,65.
Specifically, although not all cancers pose the same level of risk to life, the initial cancer diagnosis is interpreted as a life-threatening experience and may increase the risk of post-traumatic stress disorder and depression.
For example, Amir and Ramati64 found significantly higher rates of PTSD in female breast cancer survivors compared with controls. Lewandowska et al.57 conducted a large survey of 800 patients diagnosed with different types of cancer and found that 50 per cent of them showed symptoms of depression and 48 per cent showed fear and anxiety about the future. Similar findings were reported by Dehkordi et al.66 who showed that the most common problems among cancer patients treated with chemotherapy were fear of the future (29%), thinking about the disease and its consequences (26.5%) and depression (17.5%). Similarly, Nayak et al.67 surveyed more than 700 cancer patients and found that 54.4% of participants reported depression and the majority (98.3%) said they did not feel comfortable participating in social life.
Our data confirms a close relationship between quality of life, age variables, psychological outcomes and resources, in line with previous studies. In particular, we found that female gender, older age and high levels of depression are risk factors that negatively impact patients’ quality of life.
Similarly, Geffen et al.68 conducted a study of 44 patients with Hodgkin’s disease and found that 32% of survivors had partial or complete PTSD and that the diagnosis of PTSD correlated with significantly lower quality of life than patients without PTSD. Similarly, in a large sample of 289 cancer patients, Gold et al.65 found that 45% of the sample had a clinical score of PTSD, which was associated with higher mood disorder scores and lower quality of life scores.
Our results also suggest gender and age differences in QOL perceptions: in particular, female and older patients report lower QOL, confirming what previous research has documented.
For example, Modlinska et al.69 showed that the anxious response to cancer significantly affects QoL in terminally ill patients under the age of 65, with more negative outcomes in older patients due to the greater impact of the disease on daily life and reduced autonomy.
In terms of gender, studies by Grassi et al.46 had already found greater levels of psychological distress in female cancer patients than in men, associated with a higher incidence of depression, hopelessness and anxiety, which in turn negatively affect perceptions of quality of life. It is hypothesized that for women, the emotional burden is compounded by the sense of responsibility they feel for the impact of treatment and hospitalization on the management of their children and family.
Now that the negative impact of cancer has been widely documented, it is also interesting to analyze the psychological resources that may play a protective role in counteracting the impact of psychological distress on quality of life in cancer patients, as shown in previous studies.
In our study, quality of life appears to be correlated with levels of resilience, but not with perceived social support. In addition, the mediation model highlights a mediating role of resilience in counteracting the negative effects of age, gender and depression on QoL (Fig. 1).
Mediational model for age, gender, depression, resilience and QoL.
Previously, Ristevska-Dimitrovska et al.70 conducted a study with 218 consecutive breast cancer patients and found that overall quality of life was positively correlated with resilience levels. Specifically, all functional quality of life scales (physical, role, emotional, cognitive and social functioning) correlated positively to resilience, while symptom severity correlated negatively. The study also found that patients with higher levels of resilience had fewer symptoms of depression, confirming that resilience is a protective factor against depression and distress. Less resilient breast cancer patients reported poorer body image, were more pessimistic about their future prospects, and suffered more severe side effects from the treatments and therapies they received.
Wu et al.71 also tested a mediation model on a sample of 40 adolescent cancer patients and found that distress symptoms had a negative impact on quality of life, but that resilience levels played a role in buffering the negative impact of symptoms.
Focusing on hematology patients, other research had already highlighted63 how hematological malignancies such as leukemia, lymphoma and myeloma usually involve complex and long-term treatment processes that pose considerable psychological and emotional challenges for patients and their families. Therefore, psychological resilience plays a crucial role in the study of patients with hematological malignancies, affecting not only their mental health but also treatment outcomes and quality of life. For example, Tian and Wang63 recently conducted a study of 100 patients with hematological malignancies to assess the relationship between patient characteristics (age, gender, education level), fear of progression, resilience and sleep quality, a key aspect in patients’ lives as it is closely related to mood and depression levels. The results suggest that fear of progression has a negative impact on sleep quality, but resilience plays a mediating role in mitigating its effects.
Contrary to expectations, we did not find a protective effect of social support on quality of life. However, this finding is consistent with previous studies that have found conflicting evidence in this regard.
For example, Lewandowska et al.57 found a high percentage of patients who reported that the disease had brought them closer to family and friends. The authors therefore suggested that an extremely important aspect of cancer patients’ quality of life was the impact of the disease on their marital, family and social relationships and the support they received.
Their study found that for 37% of respondents, relationships with family and friends had not been altered by the disease and remained satisfactory, while for 28% of patients, relationships with partners had actually improved.
Similarly, Gangane et al.72 conducted a study of 208 female patients with infiltrating breast cancer and found that partner absence was negatively correlated with quality of life, mental health and social relationships.
In a study of cancer patients, Rodriguez et al.73 found that social support, resilience and optimism were positively correlated with quality of life. Support from friends was the variable that most improved patients’ overall health, while support from partners was the variable that best improved patients’ coping with the disease. Similarly, emotional support from a partner, together with support from family, were the variables that most helped to reduce patients’ symptoms. The research showed that both resilience and optimism improved overall health and functioning and reduced symptoms. Like our study, Rodriguez et al.73 also found gender differences, with women having a lower quality of life than men, particularly in the way they coped with cancer.
However, findings on the role of social support are inconsistent: for example, Jacob et al.74 found that unmarried patients reported higher social/family well-being than married patients, and married women reported lower social/family well-being than unmarried women.
In conclusion, this work has highlighted the importance of quality of life in hematology patients and the mediating role of resilience in counteracting the effects of variables such as age, gender and depression.
However, there are some limitations to this study: the sample size was relatively small, which may affect the generalizability of the results. Future studies with larger and more diverse samples may provide more robust results. Secondly, self-report questionnaires were used to measure the variables studied, which limits the measures to patients’ perceptions of their level of depression, PTSD, resilience or quality of life. This approach introduces the possibility of response bias, and the lack of objective measures limits the accuracy of the assessments. The inclusion of clinical interviews or other objective methods in future research may provide a more comprehensive understanding of these psychological variables.
The cross-sectional design of this study provides a snapshot of the relationships between psychological outcomes, resources and quality of life. However, it does not allow for the exploration of causal relationships or how these variables interact over time. Longitudinal studies could provide deeper insights into the dynamic processes involved.
A further limitation consists in not having taken into consideration aspects of the illness, as the stage, the time since diagnosis and the severity of cancer that could impact on quality of life of the patient. This limit is mitigated by the fact that there was a certain homogeneity in the sample due to the inclusion criteria which required a diagnosis for at least three months and a life expectancy of at least six months, but a specific analysis of the role played by the duration and severity of illness could lead to more effective results.
Finally, resilience and quality of life are complex, multifaceted constructs that may not be adequately captured by quantitative questionnaires alone. The inclusion of qualitative interviews in future studies could enrich the findings by capturing patients’ personal experiences and coping strategies.
Despite these limitations, the study provides useful guidance for clinical practice, suggesting that clinicians pay attention not only to the physical condition but also to the psychological state of patients and help them to develop an optimistic and self-reinforcing attitude and reduce negative psychological problems. In addition, he suggests implementing personalized intervention plans tailored to the specific needs of patients to improve psychological resilience more effectively.
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