Introduction
Gynecological tumor is a common disease in women, including cervical
cancer (the incidence rate ranked fourth in the world in 2018) [1],
endometrial cancer (accounted for 7% of new cancer cases in American
women in 2019) [2], ovarian cancer (the mortality rate was 21.6% in
women) [3] and other malignant tumors. Because of the special
disease track, loss of female characteristics after surgery, and
accompanying symptoms of gynecological tumor, such as sexual health,
fertility, and sexual desire problems, physiological and psychological
problems are more prominent in the treatment process, affecting the
quality of life (QOL) of patients [4-7]. QOL evaluation is an
important outcome indicator of cancer research, reflecting the changes
of physiological, social, psychological and emotional aspects of
patients after illness [8]. Among the psychological factors
affecting the QOL, cancer-related depression and anxiety are more common
in the incidence of emotional disorders [9]. Research showed that
more than 25% of cancer patients experienced depression or anxiety
during the course of the disease [10]. The incidence of depression
and anxiety in cancer patients was about 3.6%-57% [11] and
1.3%-23% respectively [12]. In many kinds of cancer patients, the
anxiety level of female patients is significantly higher than that of
male patients, and gynecological cancer patients are one of the highest
anxiety groups [13,14]. While there was no difference in gender in
depressive level [15]. Studies have found that the psychological
status of patients can affect the progress and prognosis of tumor
[16]. A meta-analysis showed that anxiety and depression affect 10%
and 20% of cancer patients respectively at any stage of cancer
[17]. About 75% of patients with obvious depression and anxiety did
not receive any psychological or drug-related treatment systematically
or never [18], leading to the obstruction of anti-cancer
decision-making, poor treatment compliance, prolonged disease recovery
time, and the QOL [19]. According to relevant research, about
34%-44% of cancer patients have obvious psychological stress reaction
or psychological disorder, especially depression and anxiety, which
affects the coping style, treatment compliance, immune function, and
reduces the QOL [20].
In cancer patients, the most common cardiovascular disease is
hypertension. Hypertension can affect the QOL of the elderly population,
and has a greater impact on elderly women [21]. This showed that the
problem of hypertension in patients with gynecological tumor can not be
ignored. Epidemiological studies showed that the incidence rate of
hypertension and depression is more than 4.95% [22]. A survey in
Ghana found that 56.0% of hypertensive patients had anxiety symptoms
[23]. In the United States, an epidemiological survey on 168 630
patients with hypertension found that 4.3% of them had anxiety and
8.4% had depression [24]. The effects of depression, anxiety and
hypertension on QOL have been confirmed separately, however, few studies
have discussed the interaction effect of them on the QOL of
gynecological cancer patients. For patients with depression, anxiety and
hypertension coexisting, it is inevitable that their QOL will be
affected. Among them, hypertension can be treated by drugs, diet,
lifestyle and so on, while for patients with depression and anxiety, in
order to balance the impact of stressful life events, some studies have
emphasized the importance of social support on the QOL of patients with
mental illness [25]. Social support refers to the spiritual or
material help and support system given by the outside world, and a good
social support system helps to promote mental health [26]. Huang et
al. found that social support was a moderator of depression on QOL in
breast cancer patients, which can significantly alleviate the impact of
depression on QOL [27]. While Panayiotou et al. found that social
support helps, but does not buffer the negative impact of anxiety
disorders on QOL in anxiety disorders participants [28]. Anyway
social support directly and indirectly regulates the influence of
variables to play its role, that is, the “buffer hypothesis”, which
has been widely confirmed [29]. Therefore, this paper chose social
support as the moderating variable.
The purposes of this study are as follows: 1) This study analyzed the
effect of depression, anxiety, the interaction of depression and
hypertension, and the interaction of anxiety and hypertension on the
QOL. 2) For patients with depression and anxiety, it also aims to test
whether the social support could moderate the relationship between
depression, anxiety and the QOL of gynecological cancer patients, and to
provide the theoretical basis for improving the QOL of gynecological
cancer patients.