# Impacts of Self-Esteem and Self-Perceived Burden on Health-Related Quality of Life Among Patients with Ovarian Cancer: Does Age Matter?

## TL;DR

This study shows that self-esteem and reduced self-perceived burden improve quality of life for ovarian cancer patients, especially younger ones.

## Contribution

The study introduces a moderated mediation model showing how self-esteem and self-perceived burden affect quality of life, with age as a moderating factor.

## Key findings

- Self-esteem improves physical, emotional, and functional well-being by reducing self-perceived burden.
- The effect of self-esteem on well-being is stronger in younger patients.
- Age weakens the role of self-perceived burden in linking self-esteem to quality of life.

## Abstract

Ovarian cancer is the third most common gynecologic cancer and the second leading cause of death from gynecologic malignancy worldwide. Better health-related quality of life is an important predictor of improved prognosis. This study first demonstrated a moderated mediation model of quality of life involving self-esteem, self-perceived burden and patient’s age. Self-esteem could play positive roles on physical well-being, emotional well-being, and functional well-being via reducing self-perceived burden. The association between self-esteem and self-perceived burden, and the associations of self-perceived burden with physical well-being and emotional well-being, were gradually decreased with the increase in the patient’s age. Clinical programs integrating components that strengthen self-esteem and reduce self-perceived burden may be particularly beneficial for younger women with ovarian cancer.

Background: Ovarian cancer, the most lethal gynecologic malignancy, is characterized by a poor health-related quality of life (HRQoL). The present study examined the mediating role of self-perceived burden (SPB) in the impact of self-esteem on HRQoL and whether age moderated the associations among ovarian cancer patients. Methods: 203 patients effectively completed the Functional Assessment of Cancer Therapy-General (FACT-G), Rosenberg Self-Esteem Scale, and SPB scale, respectively. For the FACT-G, physical (PWB), social/family (SFWB), emotional (EWB), and functional well-being (FWB) were scored separately. Results: Significant mediation of SPB in the impacts of self-esteem on PWB (a × b = 0.074, 95% CI: 0.018, 0.153), EWB (a × b = 0.048, 95% CI: 0.001, 0.125), and FWB (a × b = 0.056, 95% CI: 0.009, 0.114) were revealed. Age positively moderated the impact of self-esteem on SPB (β = 0.159, p < 0.05), and the associations of SPB with PWB (β = 0.173, p < 0.05) and EWB (β = 0.240, p < 0.01), indicating a moderated mediation. Conclusions: Ovarian cancer patients’ self-esteem could improve the PWB, EWB, and FWB domains of HRQoL by reducing SPB. Age could attenuate SPB’s mediation in the impacts of self-esteem on PWB and EWB, indicating stronger impacts in younger patients. Clinical programs integrating components that strengthen self-esteem and reduce SPB may be particularly beneficial for younger women with ovarian cancer.