Spiritual Well-Being and Quality of Life in Women with Breast Cancer: A Cross-sectional Serial Mediation Analysis of Rumination and Cognitive Reappraisal

Abstract

Background: Breast cancer imposes substantial psychological challenges in addition to its physical consequences. Objectives: This study examined the mediating roles of rumination and cognitive reappraisal in the association between spiritual well-being and quality of life among women with breast cancer. Methods: This descriptive-correlational study used partial least squares structural equation modeling. The study population comprised women diagnosed with breast cancer who were referred to the Imam Reza and Omid hospitals in Mashhad, Iran, between April and September 2025. Data were collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30); the QLQ-BR23 module was administered for descriptive purposes only. Data were analyzed using SmartPLS version 4. Results: Spiritual well-being was significantly and positively associated with quality of life (β = 0.41, P < 0.001) and cognitive reappraisal (β = 0.52, P < 0.001) and was significantly and negatively associated with rumination (β = -0.48, P < 0.001). Cognitive reappraisal and rumination significantly mediated the association between spiritual well-being and quality of life (P < 0.05). Conclusions: Spiritual well-being was associated with a higher quality of life among women with breast cancer, partly mediated by cognitive reappraisal and rumination. These findings should be interpreted in light of the cross-sectional design.