Functional Exercise, Fear of Recurrence, and Sleep Quality: A Longitudinal Path Analysis of Quality of Life in Postoperative Breast Cancer Patients

Abstract

Objective: To investigate the impacts of functional exercise, fear of cancer recurrence (FCR), and sleep quality on the quality of life (QoL) of postoperative breast cancer patients and to elucidate their interrelationships via path analysis. Methods: A total of 50 eligible breast cancer patients were enrolled via convenience sampling(first diagnosis of primary breast cancer, age ≥18 years, modified radical mastectomy, normal communication and understanding ability, ability of patients or their family members to use electronic devices). The Functional Assessment of Cancer Therapy-Breast (FACT-B), Postoperative Functional Exercise Compliance Scale, Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), and Pittsburgh Sleep Quality Index (PSQI) were used to assess participants at three time points: pre-discharge (T1), 1 month post-surgery (T2), and 3 months post-surgery (T3). Four participants were lost to follow-up (attrition rate of 7.4%). Missing data from participant attrition were handled using Generalized Estimating Equations (GEE), which yield valid inferences under the missing completely at random (MCAR) assumption. Results: QoL scores fluctuated significantly over time (T1: 87.44±11.32, T2: 104.16±8.94, T3: 100.50±11.02). GEE analysis identified that older age (β=-12.35, 95% CI: -19.18 to -5.52), higher BMI (e.g., normal weight: β=-17.46, 95% CI: -28.67 to -6.26), longer daily working hours (e.g., 6-10h/d: β=-11.86, 95% CI: -16.30 to -7.43), and slower daily life pace (e.g., slow: β=-8.93, 95% CI: -14.51 to -3.36) were significant negative predictors of QoL (all P<0.05). Path analysis revealed that FCR exerted a significant direct negative effect on QoL (β=-0.920, P<0.001) and an indirect effect by reducing exercise compliance (indirect effect: -0.166). Poor sleep quality (PSQI score) directly impaired QoL (β=-1.139, P=0.003), while functional exercise compliance had a marginally significant positive direct effect (β=0.874, P=0.052). Conclusion: This exploratory study found that functional exercise, FCR, and sleep quality are dynamic and interrelated factors that significantly influence QoL after breast cancer surgery in the studied sample. Clinicians should implement staged, personalized interventions targeting these modifiable factors to improve postoperative patient outcomes.