The connection between mindfulness levels and life satisfaction among breast cancer patients: the sequential mediating effects of body appreciation and stress perception

Introduction

At present, cancer treatment has entered the era of “precision strike”, and the long-term quality of life of cancer patients after cure is increasingly valued (Sonkin, Thomas & Teicher, 2024). Breast cancer is the most common of the 38 malignant tumors worldwide (Barzaman et al., 2020). According to statistics from the American Cancer Society, there were about 2.309 million cases of breast cancer worldwide in 2022, accounting for 11.6% of all female malignant tumors. The worldwide occurrence of breast cancer continues to rise annually, with projections indicating that by 2024, the yearly incidence will surpass three million cases (Bray et al., 2024; Yuan et al., 2024). Advancements in the early diagnosis of breast cancer and treatment methods like targeted hormones have led to improved survival outcomes (Katsura et al., 2022). As a matter of fact, a breast cancer diagnosis can be a serious physical, psychological and financial burden for patients and their families (Javan Biparva et al., 2024; Den & Sisti, 2023). Therefore, in addition to considering the patient’s disease prognosis, the life satisfaction of breast cancer patients is also an important outcome indicator. Symptoms and adverse reactions at various stages of the disease, along with negative emotions like anxiety, fear, and depression, as well as a diminished quality of life, are all significant factors that contribute to the reduction of life satisfaction in breast cancer patients (Ghose et al., 2024).

Breast cancer diagnosis can cause emotional distress in patients, which can affect subjective well-being. One crucial cognitive measure of subjective well-being is life satisfaction (Tokay Argan & Mersin, 2021). Life satisfaction is a key indicator of a person’s perceived well-being. As one of the core cognitive components of the Diener subjective well-being model, life satisfaction reflects the overall evaluation of breast cancer patients on treatment process, interpersonal support, self-worth and other life fields (Tokay Argan & Mersin, 2021; Srivastava et al., 2021). Evidence indicates that psychosocial issues can significantly amplify the severity of physical symptoms associated with diseases (Cieślak et al., 2022; Javan Biparva et al., 2023). Breast cancer patients, due to both physical and psychological trauma, frequently experience less life satisfaction. As females are the most important members of the family, their life satisfaction not only affects their survival but also the cohesion of their family structure (Soria-Reyes et al., 2023). Consequently, it is essential to emphasize the importance of individuals’ well-being after a breast cancer diagnosis, and a primary goal of breast cancer treatment should be to enhance patients’ life satisfaction. This research investigates the inherent elements that influence breast cancer patients’ life satisfaction, offering a guide for reducing their stress perception and improving their subjective well-being.

Mindfulness, body appreciation, perceived stress, and life satisfaction

By promoting the enhancement in the mindfulness level of individuals with breast cancer, it can bring high life satisfaction, and breast cancer patients can achieve a positive body image by improving their mindfulness perception ability, thereby enhancing the subjective state of mind of individuals after being diagnosed with breast cancer (Ettridge et al., 2022). Research has found that body appreciation is negatively correlated with perceived stress. Positive body appreciation can maintain mental health and reduce personal stress (Rosenbaum, Gillen & Bloomer, 2024; Shi et al., 2024). Therefore, the following hypothesis were proposed:

H3: Body appreciation and perceived stress will act as mediators in the relationship between mindfulness and life well-being in individuals with breast cancer.

While some research has examined the effects of mindfulness on life satisfaction among individuals with breast cancer, there is a scarcity of studies investigating the roles of positive body imagery and perceived stress, particularly in women facing this disease (Marco-Salvador et al., 2024). A breast cancer diagnosis can adversely affect both the physical health and psychological well-being of the patient (Javan Biparva et al., 2023). This investigation focuses on breast cancer patients as research subjects and thoroughly explores the internal structure of how mindfulness impacts life satisfaction. The findings aim to enhance studies on the well-being of individuals with breast cancer and offer recommendations for improving their life satisfaction. Figure 1 presents the proposed conceptual model of the study.

Resources and Procedures

Outcomes

Analysis of the chain mediation model

The mediating effects of perceived stress and bodily appreciation on mindfulness and life satisfaction were investigated using Hayes’ SPSS macro-PROCESS. The findings indicated that mindfulness had a significant effect on life satisfaction (β = 0.439, P < 0.001). After accounting for mediating variables, mindfulness also showed a significant direct effect on overall well-being (β = 0.3135, P < 0.001). Additionally, it was negatively correlated with perceived stress (β =  − 0.3077, P < 0.001) and positively correlated with body appreciation (β = 0.3519, P < 0.001). Life satisfaction was positively predicted by body appreciation (β = 0.152, P < 0.01), negatively predicted by perceived stress (β =  − 0.183, P < 0.01). Table 3 displays the findings.

Table 3:

Regression analysis between variables.

Outcome variables	Predictive variables	R-sq	F	β	SEs	t	LLCL	ULCL
BAS (M1)	CAMSR(X)	0.123	43.817	0.351	0.111	6.619**	0.517	0.955
PSS(M2)	CAMSR(X)	0.201	38.948	−0.307	0.076	−5.665**	−0.582	−0.282
	BAS(M1)			−0.235	0.036	−4.34**	−0.23	−0.086
SWLS(Y)	CAMSR(X)	0.253	34.819	0.313	0.129	5.673**	0.478	0.987
	BAS(M1)			0.152	0.060	2.815**	0.051	0.289
	PSS(M2)			−0.183	0.091	−3.333**	−0.486	−0.125
SWLS(Y)	CAMSR(X)	0.192	73.999	0.439	0.119	8.602**	0.791	1.261

DOI: 10.7717/peerj.20485/table-3

Notes:

CAMSR

Mindfulness

BAS

Body appreciation

PSS

Perceived stress

SWLS

Life satisfaction

M1

BAS

M2

PSS

X

CAMSR

Y

SWLS

**P < 0.01.

The mediating effect test showed that the sequential mediating effect of body appreciation and perceived stress was significant, and the bootstrap 95% CI excluded 0, indicating that body appreciation and perceived stress were mediating factors of mindfulness affecting life satisfaction. The total effect of mindfulness on life satisfaction, mediated by body appreciation and perceived stress, is 1.0266. Specifically, the mediating effect between body appreciation and stress perception is composed of indirect impacts produced by the following three pathways: (1) the indirect effect of mindfulness → body appreciation → life satisfaction pathway1 (0.1255); (2) the indirect effect of mindfulness → perceived stress → life satisfaction pathway2 (0.1322); (3) the indirect effect of mindfulness → body appreciation → perceived stress → life satisfaction pathway3 (0.0356). The results are shown in Table 4. The path of mindfulness to life satisfaction in breast cancer patients is shown in Fig. 2.

Table 4:

Bootstrapping indirect effects and 95% confidence intervals (CI) for the mediational model.

	Effect	BootSE	BootLLCI, BootULCI
Total effect	1.0266	0.1193	0.7918, 1.2614
Direct effect	0.7332	0.1292	0.4789, 0.9875
TOTAL indirect effect	0.2934	0.0944	0.1355, 0.5036
Ind1	0.1255	0.0656	0.0111, 0.2705
Ind2	0.1322	0.0641	0.0335, 0.2851
Ind3	0.0356	0.0167	0.0084, 0.0737

DOI: 10.7717/peerj.20485/table-4

Notes:

Ind1mindfulness → body appreciation → life satisfaction.

Ind2mindfulness → perceived stress → life satisfaction.

Ind3mindfulness → body appreciation → perceived stress → life satisfaction; Confidence interval does not contain zeros.

Discussion

This study constructed a chain mediation model involving “mindfulness, body appreciation, perceived stress, and life satisfaction” to explore the psychological mechanisms through which mindfulness influences life satisfaction. It is found that the mindfulness can directly affect not only the life satisfaction of breast cancer patients, but also indirectly affect life satisfaction through perceived stress and body appreciation.

First, this research suggested H1 by demonstrating that body appreciation mediates the influence of mindfulness on overall well-being in cancer of the breast patients. Specifically, it is shown that mindfulness indirectly enhances the well-being of individuals with breast cancer by enhancing their positive appreciation of their own bodies, and this hypothesis was also supported. According to the research results, which are in line with those of Cox AE and other researchers, the more mindful one is, the more one appreciates one’s body, and as a result, the more satisfied one is with their life (Cox & McMahon, 2019).

Fatigue, lymphedema, hair loss, and gastrointestinal symptoms resulting from breast cancer treatment can lead to negative perceptions of a woman’s own body shape and lower quality of life (Akram et al., 2017). One of the most significant patient-reported surveillance results in breast cancer, according to the ICHOM Breast Cancer Working Group, is well-being and body perception (Fahad Ullah, 2019; Maughan, Lutterbie & Ham, 2010). For example, among the 243 premenopausal individuals who have survived breast cancer, Arraras et al. (2016) found that those with a more positive body image experienced fewer instances of poor quality of life. An investigation of 406 females that had recently had breast cancer surgery revealed that people with a more positive body perception had higher overall quality of life (Ettridge et al., 2022). A greater awareness of breast cancer patients’ body image can aid in the development and improvement of treatment measures as well as optimal procedures in service delivery.

The Three Axiom models of mindfulness (Dahl & Davidson, 2019; Crane et al., 2017; Jankowski & Holas, 2014) identify three fundamental elements: intention, focus, and mindset, specifically, empathy with others and overall well-being by focusing on the present moment, observing inner and outer experiences. The initial step in utilizing mindfulness to foster a positive body image, as outlined by the Three Axioms of Mindfulness, involves embracing self-acceptance. This means resisting the sway of external opinions, breaking free from patterns of negative and self-critical thoughts, and concentrating on cultivating your own sense of positivity (Culbreth & Spratling, 2022; Giannou & Mantzios, 2023). And focus your attention on the bodily sensations and perceive the positive signals sent by the body. A randomized, single-blind, controlled trial involving 60 women aged 18–45 years who received a 16-week intervention with mindfulness-based art therapy (MBAT) found significant improvements in body appreciation, consistent with the results of this study (Bafghi et al., 2024). Persons with significant amounts of mindfulness can relate to their physicality in a more balanced way, avoid over-identifying perceived physical impairments, increase levels of body appreciation, and thus improve patient life satisfaction (Swami et al., 2020).

Secondly, this study supports Hypothesis 2 by demonstrating that perceived stress mediates the relationship between mindfulness and life satisfaction. These findings suggest that increasing mindfulness may reduce perceived stress in breast cancer patients, which could subsequently enhance their life satisfaction. Those suffering from breast cancer can become uneasy and anxious outdoors due to noticeable alterations in their looks and nervousness about inquisitive stares from other people (Kołodziejczyk & Pawłowski, 2019). Improving your level of self-mindfulness can assist control such pressures efficiently.

The theory of mindfulness holds that consciously paying attention with an open mind frees the individual from emotions, thoughts, and stories related to themselves (Davidson & Kaszniak, 2015). Mindfulness, for example, increases self-awareness, allowing people to recognize indications of stress. Research indicates that individuals with high levels of mindfulness may have an enhanced awareness of their stress levels, which can lead to the development of effective coping strategies and help alleviate the adverse impacts of stress (Lu et al., 2019; Kckaou et al., 2023).

Furthermore, it has been suggested that people with mindfulness are more capable of handling a range of stressful events, that could potentially reduce the correlation between stress and negative psychological results (Ghawadra et al., 2020). Regarding the physiological mechanism of mindfulness in relieving stress, Creswell & Lindsay (2014) suggest that mindfulness works in two ways: by increasing activity in the prefrontal cortex, which increases inhibition of stress-processing areas to reduce stress response, and by lowering levels of stress-related hormones such as adrenaline and noradrenaline. A randomized controlled trial discovered that a six-week online mindfulness help could improve self-acceptance, minimize perceived stress, and poor body perception among breast cancer patients (Chang et al., 2022). Related studies found that mindfulness is a protective factor of mental health, negatively correlated with stress, positively correlated with happiness and life satisfaction, which is consistent with the results of this study (Jayewardene et al., 2017).

Ultimately, this study suggests Hypothesis 3 by demonstrating that body appreciation and perceived stress serve as sequential mediators in the relationship between mindfulness and life satisfaction. This finding indicates that a positive body image, coupled with lower levels of perceived stress, may be fundamental to the relationship between mindfulness and life satisfaction. Allowing and accepting a bad feeling in the body and maintaining a positive attitude toward the body can reduce perceived stress and bad emotions in the face of pain and improve life satisfaction (Tao et al., 2023). The extent of mindfulness is a crucial element in mental health, especially during periods of experiencing setbacks. body appreciation is considered a protective factor for mental health (Hooper et al., 2024). When individuals accept their physical appearance, they experience a notable decrease in negative emotions and perceived stress. Additionally, an appreciation for one’s body contributes to both the prevention and encouragement of seeking help for psychological disorders (Ersoy, Aslançin & Yardı mcı, 2024). Researchers have lately demonstrated a growing interest in mindfulness’s stress-relieving effects. A number of researchers have demonstrated that therapies based on mindfulness have considerable advantages in both clinical and other settings, such as a meta-analysis that found mindfulness-based therapies reduced anxiety and depression in cancer patients (Chayadi, Baes & Kiropoulos, 2022). Mindfulness seems to raise awareness, help subjects deal with stressful situations, and reduce anxiety, depression, and stress symptoms. In a similar vein, the present chain-mediated model uncovers the mechanism through which mindfulness influences life satisfaction among breast cancer patients. Therefore, positive body appreciation and lower levels of perceived stress can improve life satisfaction.

The future direction of cancer treatment is moving towards “precision, individualization and long-term management”, and the complexity of treatment, long-term health management stress, and uncertainty anxiety about recurrence may profoundly affect patients ’physical and mental health and quality of life (Sonkin, Thomas & Teicher, 2024). Mindfulness, as a scientifically proven practice, has unique advantages in stress management. Therefore, structured mindfulness interventions (e.g., MBSR, MBCT) are incorporated into supportive care for breast cancer patients to guide patients to actively participate and improve quality of life while pursuing longer survival.

Practical implications

The findings of this study have major consequences in theory as well as practice for enhancing life satisfaction of breast cancer patients. At a theoretical level, this research validated the relationship between mindfulness, body appreciation, perceived stress, and life satisfaction, while also uncovering the internal mechanisms through which mindfulness affects life satisfaction via a serial mediation model. Specifically, mindfulness directly enhances life satisfaction and indirectly impacts it by fostering greater body appreciation and reducing perceived stress. This finding supports key viewpoints in attention control theory and cognitive-behavioral models, which posit that mindfulness improves mental health by altering individuals’ responses to negative events and reducing negative cognitions and emotional responses (Morgan, 2003). First, attention control theory posits that mindfulness enhances individuals’ ability to manage their attention on present experiences, thereby diminishing distractions and emotional overreactions, while fostering greater awareness and acceptance of the present moment (Jankauskiene et al., 2024). Secondly, the cognitive-behavioral model emphasizes that mindfulness changes the way individuals respond to negative emotions and thoughts, reducing perceived stress and thereby improving mental health (Butler et al., 2006). A randomized controlled trial found that mindfulness-based stress management programs improved sleep and stress status in cancer patients better than cognitive behavioral therapy alone (Garland et al., 2014). Furthermore, previous studies have concentrated on the negative body perception experienced by individuals with breast cancer, exploring whether the disease leads to a detrimental attitude toward their bodies. In contrast, this research investigates the positive body image among breast cancer patients.

The findings of this research indicate that mindfulness practice may substantially boost the level of life satisfaction among breast cancer patients. Therefore, at a practical level, hospitals and communities can guide breast cancer patients to conduct mindfulness training and help breast cancer patients enhance their consciousness in the current time and reduce stress using techniques like mindfulness meditation, mindful breathing, and yoga. In addition, during mindfulness intervention, attention should also be paid to the body appreciation attitude and pressure felt by breast cancer patients. By enhancing their physical connection with nature, individuals can experience a sense of respect for their bodies, elevate their appreciation for themselves, and alleviate stress. Finally, the results support the effectiveness of the chain mediation model, suggesting that mindfulness can improve life satisfaction by improving body appreciation and reducing perceived stress. Consequently, psychological intervention strategies must consider these mediating factors and aim to substantially improve the quality of life for individuals with breast cancer by implementing interventions like meditation training.

Limitations and Future Directions

This research has a few drawbacks. Since this was a cross-sectional survey, it is crucial to recognize that causal relationships between variables cannot be inferred. Instead, only exploratory analysis can be conducted, with any findings requiring validation through subsequent intervention studies. In future work, the longitudinal follow-up study method may be employed to facilitate in-depth discussions on the questions raised in this investigation, enhancing the understanding of the correlation among mindfulness, body appreciation, perceived stress, and life satisfaction. Furthermore, potential bias may impact the methodology of the questionnaire, potentially compromising the study’s validity if respondents do not answer truthfully. Subsequent research endeavors should enhance this field by incorporating experimental and qualitative approaches. Additionally, the study’s sample size was limited to 312 participants from a single region, thereby constraining the generalizability of the findings.

Supplemental Information