The Mediating Role of Depressive Symptoms in the Association Between Pain and Self-Reported Cognitive Failures Among Gynecological Cancer Patients Undergoing Brachytherapy

Abstract

AbstractObjectivesThis study aimed to examine the mediating role of depression in the relationship between pain and self-reported cognitive symptoms among gynecological oncology patients undergoing brachytherapy.MethodsThe present study employed a descriptive, cross-sectional, correlational design. The present study sample comprised 130 gynecological cancer patients receiving brachytherapy at a city hospital. The data were collected using the following instruments: the Participant Information Form, the Pain Frequency Intensity and Burden Scale (P-FIBS), the Cognitive Failures Questionnaire (CFQ; a self-report measure of cognitive failures), and the Beck Depression Inventory (BDI). In order to evaluate the potential mediating effect of depression, correlation analyses and regression-based mediation path analysis with bootstrapping were applied.ResultsThe mean scores of the participants were 12.11 ± 4.44 for P-FIBS, 51.62 ± 13.89 for CFQ, and 38.44 ± 9.37 for BDI, indicating high levels of pain, self-reported cognitive failures, and depressive symptoms. A significant positive correlation was identified between pain and depression, as well as between cognitive failures and depression (P< .01). Mediation analysis showed evidence consistent with partial mediation, with depression accounting for approximately 17% of the total effect of pain on cognitive symptoms. Regression analyses indicated a statistically significant association between pain and depression (B = 0.68,P< .001), and between depression and cognitive symptoms (B = 0.30,P= .015).ConclusionsThe findings suggest that depression may represent an important pathway linking pain and cognitive symptoms in gynecological oncology patients undergoing brachytherapy. However, these results should be interpreted cautiously due to the cross-sectional study design and the reliance on self-report measures. Addressing depressive symptoms alongside pain management may be clinically important in this population.Implications for Nursing PracticeNurses play a central role in identifying and monitoring pain, depression, and cognitive changes. Incorporating systematic screening, psychoeducation, and psychosocial support into nursing care may improve treatment adherence, enhance quality of life, and foster holistic, patient-centered care in gynecological oncology settings.