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.