{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T09:33:38Z","timestamp":1787045618091,"version":"build-2736575974"},"reference-count":98,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alexithymia, characterized by difficulties in identifying and expressing emotions, has been linked to diminished quality of life in older breast cancer patients, a vulnerable population facing multifaceted psychosocial challenges. While prior research has explored these associations, investigations have predominantly adopted a variable-centered approach, overlooking the potential statistical mediating role of meaning in life. Moreover, no studies have examined the heterogeneity of alexithymia and meaning in life through a person-centered lens, which may reveal distinct subgroups with different quality of life outcomes among older breast cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional design was employed, recruiting 577 older breast cancer patients from four tertiary grade A hospitals in Sichuan Province, China, between April 2 and May 29, 2025. Participants completed validated self-report measures, including the 20-item Toronto Alexithymia Scale (TAS-20-C), the Meaning in Life Questionnaire (MLQ), the Quality of Life Scale (QOLS), and a demographic questionnaire. PROCESS macro (Model 4) was used to test a cross-sectional statistical mediation model from the variable-centered perspective, while latent profile analysis identified subgroups from the person-centered perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Variable-centered analyses showed that alexithymia was negatively associated with quality of life, and meaning in life statistically accounted for part of this association. Person-centered analyses identified two distinct latent profiles: a high alexithymia\u2014low meaning in life subgroup, characterized by elevated emotional processing deficits and reduced purpose, and a medium alexithymia\u2014medium meaning in life subgroup, exhibiting adaptive emotional regulation and strong existential coherence. The former subgroup reported significantly lower quality of life scores compared to the latter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>By applying meaning construction theory through a dual-perspective framework, this study clarifies patterns of association among alexithymia, meaning in life, and quality of life in older breast cancer patients and highlights the value of person-centered profiling for targeted interventions. These findings offer novel theoretical insights and practical implications, such as tailored psychotherapeutic strategies that may enhance meaning-making and address alexithymia, with the potential to promote quality of life in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1708876","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T09:10:07Z","timestamp":1787044207000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between alexithymia, meaning in life, and quality of life in older breast cancer patients: a cross-sectional study based on variable-centered and person-centered perspectives"],"prefix":"10.3389","volume":"13","author":[{"given":"Qi","family":"Lv","sequence":"first","affiliation":[{"name":"Surgical Department, Affiliated Hospital of North Sichuan Medical College","place":["Nanchong, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yawen","family":"Deng","sequence":"additional","affiliation":[{"name":"School of Management, North Sichuan Medical College","place":["Nanchong, Sichuan, China"]},{"name":"Key Laboratory of Digital-Intelligent Disease Surveillance and Health Governance, North Sichuan Medical College","place":["Nanchong, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"649","DOI":"10.32604\/oncologie.2022.027640","article-title":"Epidemiology of breast cancer","volume":"24","author":"Shang","year":"2022","journal-title":"Oncologie"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2569","DOI":"10.3390\/cancers14102569","article-title":"Breast cancer-epidemiology, classification, pathogenesis and treatment (review of literature)","volume":"14","author":"Smolarz","year":"2022","journal-title":"Cancers (Basel)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"93","DOI":"10.15557\/JoU.2022.0016","article-title":"Immunohistochemical subtypes of the breast Cancer in the ultrasound and clinical aspect - literature review","volume":"22","author":"Dobruch-Sobczak","year":"2022","journal-title":"J Ultrason"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"681476","DOI":"10.3389\/fonc.2021.681476","article-title":"Current triple-negative breast Cancer subtypes: dissecting the Most aggressive form of breast Cancer","volume":"11","author":"Ensenyat-Mendez","year":"2021","journal-title":"Front Oncol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/s12943-025-02445-0","article-title":"Advances in novel cell death mechanisms in breast cancer: intersecting perspectives on ferroptosis, cuproptosis, disulfidptosis, and pyroptosis","volume":"24","author":"Jing","year":"2025","journal-title":"Mol Cancer"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"477","DOI":"10.3322\/caac.21863","article-title":"Breast cancer statistics 2024","volume":"74","author":"Giaquinto","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1186\/s12885-025-13893-8","article-title":"Breast cancer care for the aging population: a focus on age-related disparities in breast cancer treatment","volume":"25","author":"Bertozzi","year":"2025","journal-title":"BMC Cancer"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"27","DOI":"10.2147\/BCTT.S501448","article-title":"From pioneering discoveries to innovative therapies: a journey through the history and advancements of nanoparticles in breast Cancer treatment","volume":"17","author":"Basingab","year":"2025","journal-title":"Breast Cancer (Dove Med Press)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1002\/cac2.12358","article-title":"Breast cancer: an up-to-date review and future perspectives","volume":"42","author":"Hong","year":"2022","journal-title":"Cancer Commun (Lond)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1016\/j.ejso.2022.07.003","article-title":"Is there evidence of age bias in breast cancer health care professionals' treatment of older patients?","volume":"48","author":"Neal","year":"2022","journal-title":"Eur J Surg Oncol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"863641","DOI":"10.3389\/fonc.2022.863641","article-title":"Social media listening to understand the lived experience of individuals in Europe with metastatic breast Cancer: a systematic search and content analysis study","volume":"12","author":"Mazza","year":"2022","journal-title":"Front Oncol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1114139","DOI":"10.3389\/fpubh.2023.1114139","article-title":"Listening to voices from multiple sources: a qualitative text analysis of the emotional experiences of women living with breast cancer in China","volume":"11","author":"Li","year":"2023","journal-title":"Front Public Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.psychres.2010.07.046","article-title":"Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning","volume":"190","author":"Nicol\u00f2","year":"2011","journal-title":"Psychiatry Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"112375","DOI":"10.1016\/j.paid.2023.112375","article-title":"Conceptualizing alexithymia","volume":"215","author":"Preece","year":"2023","journal-title":"Pers Individ Dif"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"S747","DOI":"10.1192\/j.eurpsy.2021.1981","article-title":"The role of alexithymia on psychological resilience in women with breast cancer","volume":"64","author":"Atkan","year":"2021","journal-title":"Eur Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s41256-024-00393-8","article-title":"Effects of population aging on quality of life and disease burden: a population-based study","volume":"10","author":"Xi","year":"2025","journal-title":"Glob Health Res Policy"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/geriatrics8010012","article-title":"Mini-mental state examination: optimal cut-off levels for mild and severe cognitive impairment","volume":"8","author":"Salis","year":"2023","journal-title":"Geriatrics"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1146\/annurev-publhealth-052120-012811","article-title":"Health-related quality of life measurement in public health","volume":"43","author":"Kaplan","year":"2022","journal-title":"Annu Rev Public Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1186\/s12905-023-02755-9","article-title":"Factors affecting quality of life in women with breast cancer: a path analysis","volume":"23","author":"Faroughi","year":"2023","journal-title":"BMC Womens Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"9321","DOI":"10.3390\/ijerph18179321","article-title":"Socio-demographic and general health factors associated with quality of life in long-term breast Cancer survivors from southwestern Poland","volume":"18","author":"Socha","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1007\/s11764-021-01075-x","article-title":"Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors","volume":"16","author":"Von Ah","year":"2022","journal-title":"J Cancer Surviv"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40266-024-01167-0","article-title":"Patient-reported outcomes in geriatric oncology-balancing quality of life and therapeutic effectiveness using primary breast Cancer as a model","volume":"42","author":"Francis","year":"2025","journal-title":"Drugs Aging"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"8872","DOI":"10.3390\/curroncol30100641","article-title":"Alexithymia, self-compassion, emotional resilience, and cognitive emotion regulation: charting the emotional journey of Cancer patients","volume":"30","author":"Ozonder Unal","year":"2023","journal-title":"Curr Oncol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.jad.2021.09.085","article-title":"Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation","volume":"296","author":"Preece","year":"2022","journal-title":"J Affect Disord"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"734198","DOI":"10.3389\/fpsyg.2021.734198","article-title":"Meaning making for psychological adjustment and quality of life in older long-term breast Cancer survivors","volume":"12","author":"Nilsen","year":"2021","journal-title":"Front Psychol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/s00520-024-09115-9","article-title":"Effectiveness of meaning-centered interventions on anxiety and depressive symptoms, sense of meaning, and quality of life in patients with advanced cancer: a meta-analysis of randomized controlled trials","volume":"33","author":"Shen","year":"2025","journal-title":"Support Care Cancer"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1037\/dev0000176","article-title":"The meaningful identity: a longitudinal look at the interplay between identity and meaning in life in adolescence","volume":"52","author":"Negru-Subtirica","year":"2016","journal-title":"Dev Psychol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"571","DOI":"10.2147\/PPA.S391014","article-title":"The mediating effect of perceived social support and medical coping modes between psychological resilience and meaning in life in COVID-19 patients","volume":"17","author":"Zhang","year":"2023","journal-title":"Patient Prefer Adherence"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"111","DOI":"10.5114\/hpr\/199541","article-title":"What is life worth living for? A systematic review on meaning in life and meaning in work as protective factors for healthcare professionals' wellbeing","volume":"13","author":"Corbella","year":"2025","journal-title":"Health Psychol Rep"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1186\/s12885-024-12433-0","article-title":"The mediating role of meaning in life between experiential avoidance and death anxiety among cancer patients: a cross-sectional study","volume":"24","author":"Yan","year":"2024","journal-title":"BMC Cancer"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1007\/s00520-025-09415-8","article-title":"Latent profile analysis and related factors for meaning in life among young and middle-aged cancer patients","volume":"33","author":"Wang","year":"2025","journal-title":"Support Care Cancer"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"102287","DOI":"10.1016\/j.ejon.2023.102287","article-title":"Cancer-related symptoms among young and middle-aged women undergoing chemotherapy for breast cancer: application of latent class analysis and network analysis","volume":"63","author":"Cai","year":"2023","journal-title":"Eur J Oncol Nurs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.21037\/apm-24-54","article-title":"Is cancer back?-psychological issues faced by survivors of breast cancer","volume":"13","author":"Bergerot","year":"2024","journal-title":"Ann Palliat Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"973640","DOI":"10.3389\/fpsyg.2022.973640","article-title":"Social isolation in adults with cancer: an evolutionary concept analysis","volume":"13","author":"Liang","year":"2022","journal-title":"Front Psychol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e70077","DOI":"10.1002\/ijop.70077","article-title":"Relationship between meaning in life and resilience: a longitudinal study and a randomised controlled trial intervention","volume":"60","author":"Li","year":"2025","journal-title":"Int J Psychol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1177\/1049732320968069","article-title":"\"I will not be defined by this. I'm not going to live like a victim; it is not going to define my life\": exploring breast Cancer survivors' experiences and sense of self","volume":"31","author":"Rashidi","year":"2021","journal-title":"Qual Health Res"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1146\/annurev-psych-072420-122921","article-title":"The science of meaning in life","volume":"72","author":"King","year":"2021","journal-title":"Annu Rev Psychol"},{"key":"ref38","first-page":"1025","article-title":"Meaning and the sense of meaning in life from a health perspective","volume":"33","author":"Mulahalilovi\u0107","year":"2021","journal-title":"Psychiatr Danub"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"657992","DOI":"10.3389\/fpsyg.2022.657992","article-title":"Stigma and quality of life in women with breast Cancer: mediation and moderation model of social support, sense of coherence, and coping strategies","volume":"13","author":"Zamanian","year":"2022","journal-title":"Front Psychol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1097\/NCC.0000000000000936","article-title":"Spiritual and emotional experience with a diagnosis of breast cancer: a scoping review","volume":"45","author":"Le\u00e3o","year":"2022","journal-title":"Cancer Nurs"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1007\/s12282-025-01697-4","article-title":"Relationship between psychological resilience and cognitive function on breast cancer chemotherapy patients: a person-centered method","volume":"32","author":"Ding","year":"2025","journal-title":"Breast Cancer (Auckl)"},{"key":"ref42","volume-title":"Alexithymia, Meaning, and Well-being: How Emotional Processes Relate to Meaning in Life and Calling in Career","author":"O'Connor","year":"2018"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1097\/j.pain.0000000000001487","article-title":"Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis","volume":"160","author":"Aaron","year":"2019","journal-title":"Pain"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1146\/annurev-orgpsych-110721-045646","article-title":"Person-centered modeling: techniques for studying associations between people rather than variables","volume":"11","author":"Woo","year":"2024","journal-title":"Annu Rev Organ Psychol Organ Behav"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1177\/1094428117744021","article-title":"Variable-centered, person-centered, and person-specific approaches: where theory meets the method","volume":"21","author":"Howard","year":"2018","journal-title":"Organ Res Methods"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"105660","DOI":"10.1016\/j.actpsy.2025.105660","article-title":"The impact of perceived stigma on appearance anxiety in postoperative rhinoplasty patients: a variable-centered and person-centered perspective","volume":"260","author":"Yang","year":"2025","journal-title":"Acta Psychol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1627422","DOI":"10.3389\/fpsyt.2025.1627422","article-title":"Psychological capital and death anxiety in pancreatic cancer patients: a latent profile analysis","volume":"16","author":"Yang","year":"2025","journal-title":"Front Psych"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s00520-023-07798-0","article-title":"Characteristics and influencing factors of social isolation in patients with breast cancer: a latent profile analysis","volume":"31","author":"He","year":"2023","journal-title":"Support Care Cancer"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1007\/s11764-024-01648-6","article-title":"Latent profile analysis for assessing symptom clusters in women with breast cancer","volume":"20","author":"Park","year":"2026","journal-title":"J Cancer Surviv"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"101587","DOI":"10.1016\/j.asieco.2023.101587","article-title":"Retirement policy, employment status, and gender pay gap in urban China","volume":"85","author":"Liu","year":"2023","journal-title":"J Asian Econ"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s10680-018-9467-3","article-title":"Age of retirement and human capital in an aging China, 2015\u20132050","volume":"35","author":"Feng","year":"2019","journal-title":"Eur J Popul"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"2595","DOI":"10.1200\/jco.2013.54.8347","article-title":"International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer","volume":"32","author":"Wildiers","year":"2014","journal-title":"J Clin Oncol"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e327","DOI":"10.1016\/S1470-2045(20)30741-5","article-title":"Updated recommendations regarding the management of older patients with breast cancer: a joint paper from the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG)","volume":"22","author":"Biganzoli","year":"2021","journal-title":"Lancet Oncol"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1093\/jnci\/djaf337","article-title":"Neighborhood deprivation on increasing deficit accumulation in older breast cancer survivors and noncancer control individuals","volume":"118","author":"Choi","year":"2025","journal-title":"JNCI J Natl Cancer Inst"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"2917","DOI":"10.1097\/CM9.0000000000003667","article-title":"Global, regional, national incidence, and mortality of breast cancer in older women: a population-based cancer registry data analysis","volume":"138","author":"Li","year":"2025","journal-title":"Chin Med J"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"104518","DOI":"10.1016\/j.breast.2025.104518","article-title":"Tumor site, stage, and receptor-specific efficacy of radiation therapy in Asian breast cancer patients aged 60 years and older: a SEER database survival analysis incorporating clinicopathological features and nomograms","volume":"82","author":"Mao","year":"2025","journal-title":"Breast"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"263","DOI":"10.5935\/abc.20140013","article-title":"Prevalence of metabolic syndrome in elderly and agreement among four diagnostic criteria","volume":"102","author":"Saad","year":"2014","journal-title":"Arq Bras Cardiol"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.ajem.2008.10.027","article-title":"Identification of an age cutoff for increased mortality in patients with elderly trauma","volume":"28","author":"Caterino","year":"2010","journal-title":"Am J Emerg Med"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/0022-3999(94)90006-X","article-title":"The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity","volume":"38","author":"Bagby","year":"1994","journal-title":"J Psychosom Res"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1111\/jpm.12298","article-title":"Cross-cultural validation of the 20-item Toronto alexithymia scale in Chinese adolescents","volume":"23","author":"Ling","year":"2016","journal-title":"J Psychiatr Ment Health Nurs"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1080\/07347332.2012.703769","article-title":"How social sharing and social support explain distress in breast cancer after surgery: the role of alexithymia","volume":"30","author":"Boinon","year":"2012","journal-title":"J Psychosoc Oncol"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1007\/s00520-006-0209-4","article-title":"Factors related to anxiety and depression in women with breast cancer and their husbands: role of alexithymia and family functioning","volume":"15","author":"Mantani","year":"2007","journal-title":"Support Care Cancer"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1037\/0022-0167.53.1.80","article-title":"The meaning in life questionnaire: assessing the presence of and search for meaning in life","volume":"53","author":"Steger","year":"2006","journal-title":"J Couns Psychol"},{"key":"ref64","first-page":"604","article-title":"Applicability and generalizability of the revised meaning in life questionnaire: based on classical test theory and multidimensional rasch model","volume":"23","author":"Chen","year":"2015","journal-title":"Chin J Clin Psych"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/1477-7525-1-60","article-title":"The quality of life scale (QOLS): reliability, validity, and utilization","volume":"1","author":"Burckhardt","year":"2003","journal-title":"Health Qual Life Outcomes"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"947465","DOI":"10.3389\/fpubh.2022.947465","article-title":"Relationship between internet use intensity and quality of life in chronic patients during the COVID-19 pandemic: the role of physical exercise and health insurance","volume":"10","author":"Wang","year":"2022","journal-title":"Front Public Health"},{"key":"ref67","volume-title":"Principles and Practice of Structural Equation Modeling","author":"Kline","year":"2023"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1159\/000330888","article-title":"Alexithymia in cancer patients: review of the literature","volume":"81","author":"De Vries","year":"2012","journal-title":"Psychother Psychosom"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"267","DOI":"10.3389\/fpsyg.2020.00267","article-title":"Going beyond the visible in type 2 diabetes mellitus: Defense mechanisms and their associations with depression and health-related quality of life","volume":"11","author":"Martino","year":"2020","journal-title":"Front Psychol"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1037\/emo0001366","article-title":"Age-related changes of interoceptive brain networks: implications for interoception and alexithymia","volume":"24","author":"Dobrushina","year":"2024","journal-title":"Emotion"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1037\/a0018301","article-title":"Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events","volume":"136","author":"Park","year":"2010","journal-title":"Psychol Bull"},{"key":"ref72","doi-asserted-by":"crossref","DOI":"10.1037\/10397-000","volume-title":"Meaning Reconstruction & the Experience of loss","author":"Neimeyer","year":"2001"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1002\/pon.574","article-title":"The first year after breast cancer diagnosis: hope and coping strategies as predictors of adjustment","volume":"11","author":"Stanton","year":"2002","journal-title":"Psychooncology"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1037\/0882-7974.22.3.456","article-title":"Longitudinal study of social support and meaning in life","volume":"22","author":"Krause","year":"2007","journal-title":"Psychol Aging"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s13195-018-0381-z","article-title":"Meaning in life: resilience beyond reserve","volume":"10","author":"Bartr\u00e9s-Faz","year":"2018","journal-title":"Alzheimer's Res Ther"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1002\/pon.1556","article-title":"Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial","volume":"19","author":"Breitbart","year":"2010","journal-title":"Psychooncology"},{"key":"ref77","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/01.psy.0000127689.38525.7d","article-title":"Posttraumatic growth after breast cancer: patient, partner, and couple perspectives","volume":"66","author":"Manne","year":"2004","journal-title":"Psychosom Med"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/s12888-016-0796-7","article-title":"Understandings of spirituality and its role in illness recovery in persons with schizophrenia and mental-health professionals: a qualitative study","volume":"16","author":"Ho","year":"2016","journal-title":"BMC Psychiatry"},{"key":"ref79","doi-asserted-by":"publisher","first-page":"e70177","DOI":"10.1111\/jep.70177","article-title":"Post-surgery loneliness and its influencing factors in elderly patients with breast cancer: a cross-sectional study","volume":"31","author":"Lin","year":"2025","journal-title":"J Eval Clin Pract"},{"key":"ref80","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.2147\/CMAR.S470862","article-title":"Influence of financial toxicity on the quality of life in lung Cancer patients undergoing immunotherapy: the mediating effect of self-perceived burden","volume":"16","author":"Zhang","year":"2024","journal-title":"Cancer Manag Res"},{"key":"ref81","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.ejso.2020.10.008","article-title":"Breast cancer in the oldest old (\u2265 89 years): tumor characteristics, treatment choices, clinical outcomes and literature review","volume":"47","author":"Di Lascio","year":"2021","journal-title":"Eur J Surg Oncol"},{"key":"ref82","doi-asserted-by":"publisher","first-page":"23743735221092630","DOI":"10.1177\/23743735221092630","article-title":"Barriers to self-care planning for family caregivers of patients with severe mental illness","volume":"9","author":"Karimirad","year":"2022","journal-title":"J Patient Exp"},{"key":"ref83","doi-asserted-by":"publisher","first-page":"2827","DOI":"10.3390\/cancers16162827","article-title":"Mental health challenges in cancer patients: a cross-sectional analysis of depression and anxiety","volume":"16","author":"Shalata","year":"2024","journal-title":"Cancers (Basel)"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.ijnss.2021.12.011","article-title":"Symptom trajectories in patients with breast cancer: an integrative review","volume":"9","author":"Cai","year":"2022","journal-title":"Int J Nurs Sci"},{"key":"ref85","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1002\/ejp.2106","article-title":"The importance of measurement content and study design. Comment on Habibi Asgarabad et al. (2023). The relationship of alexithymia to pain and other symptoms in fibromyalgia: a systematic review and meta-analysis","volume":"27","author":"Veirman","year":"2023","journal-title":"Eur J Pain"},{"key":"ref86","doi-asserted-by":"publisher","first-page":"3099","DOI":"10.1002\/nop2.1022","article-title":"Effects of sandplay therapy in reducing emotional and behavioural problems in school-age children with chronic diseases: a randomized controlled trial","volume":"8","author":"Tan","year":"2021","journal-title":"Nurs Open"},{"key":"ref87","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s00520-023-08029-2","article-title":"Experiences of breast cancer survivors with exercise rehabilitation: qualitative systematic review and meta-synthesis","volume":"31","author":"Lu","year":"2023","journal-title":"Support Care Cancer"},{"key":"ref88","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1353\/ken.2024.a958996","article-title":"Autonomy and mental health care: enabling the pursuit of a life of meaning","volume":"34","author":"Gosselin","year":"2024","journal-title":"Kennedy Inst Ethics J"},{"key":"ref89","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1177\/10892680221109201","article-title":"The clinical relevance of a socioecological conceptualization of self-worth","volume":"27","author":"Batchelder","year":"2023","journal-title":"Rev Gen Psychol"},{"key":"ref90","doi-asserted-by":"publisher","first-page":"S56","DOI":"10.1370\/afm.2924","article-title":"Patient and health care professional perspectives on stigma in integrated behavioral health: barriers and recommendations","volume":"21","author":"Phelan","year":"2023","journal-title":"Ann Fam Med"},{"key":"ref91","doi-asserted-by":"publisher","first-page":"1394355","DOI":"10.3389\/fpsyg.2024.1394355","article-title":"Interoception and body image in breast cancer patients: a mindfulness-based stress reduction protocol","volume":"15","author":"Sebri","year":"2024","journal-title":"Front Psychol"},{"key":"ref92","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/S0140-6736(21)02314-X","article-title":"Report of the lancet commission on the value of death: bringing death back into life","volume":"399","author":"Sallnow","year":"2022","journal-title":"Lancet"},{"key":"ref93","doi-asserted-by":"publisher","first-page":"2132","DOI":"10.1016\/j.socscimed.2005.04.026","article-title":"The role of constructed meaning in adaptation to the onset of life-threatening illness","volume":"61","author":"Fife","year":"2005","journal-title":"Soc Sci Med"},{"key":"ref94","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1007\/s10549-019-05468-6","article-title":"Emotional distress and psychosocial needs in patients with breast cancer in British Columbia: younger versus older adults","volume":"179","author":"Naik","year":"2020","journal-title":"Breast Cancer Res Treat"},{"key":"ref95","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1177\/1359105317731823","article-title":"Narrative meaning making and integration: toward a better understanding of the way falling ill influences quality of life","volume":"25","author":"Hartog","year":"2020","journal-title":"J Health Psychol"},{"key":"ref96","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1200\/JCO.2011.40.8922","article-title":"Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis","volume":"31","author":"Faller","year":"2013","journal-title":"J Clin Oncol"},{"key":"ref97","doi-asserted-by":"publisher","first-page":"1534735419829573","DOI":"10.1177\/1534735419829573","article-title":"The efficacy of cognitive Behavioral therapy to treat depression and anxiety and improve quality of life among early-stage breast Cancer patients","volume":"18","author":"Sun","year":"2019","journal-title":"Integr Cancer Ther"},{"key":"ref98","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.genhosppsych.2024.01.006","article-title":"Effects of cognitive behavioral therapy on anxiety and depressive symptoms in advanced cancer patients: a meta-analysis","volume":"87","author":"Xia","year":"2024","journal-title":"Gen Hosp Psychiatry"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1708876\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T09:10:09Z","timestamp":1787044209000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1708876\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":98,"alternative-id":["10.3389\/fmed.2026.1708876"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1708876","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1708876"}}