Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
Frailty and neuropathy in chemotherapy patients: moderated mediation roles of fatigue and mindfulness on CIPN, anxiety, and depression.
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Jin Yanfei, Li Huiyu, Kong Mei, Xiong Lina, Ma Hongwen
Аннотация
PURPOSE: To examine how frailty influences chemotherapy-induced peripheral neuropathy (CIPN) and psychological distress (anxiety and depression) in chemotherapy patients, exploring the mediating role of fatigue and the moderating (protective) role of mindfulness.
METHODS: A cross-sectional survey enrolled 445 chemotherapy patients from three tertiary hospitals in China during April 2024-February 2025. Participants completed validated measures including the Treatment-Induced Neuropathy Assessment Scale (TNAS), Tilburg Frailty Indicator (TFI), Cancer Fatigue Scale (CFS), Freiburg Mindfulness Inventory (FMI), and Hospital Anxiety and Depression Scale (HADS). Moderated mediation analyses were conducted using structural equation modeling (SEM) with bootstrap techniques.
RESULTS: Frailty significantly predicted higher CIPN symptoms (β = 0.179, 95% CI [0.101, 0.032]) and anxiety/depression (β = 0.216, 95% CI [0.140, 0.289]). Fatigue significantly mediated these relationships, with indirect effects of frailty on CIPN symptoms (β = 0.125, 95% CI [0.081, 0.179], accounting for 41.1% of total effect) and on anxiety/depression (β = 0.116, 95% CI [0.076, 0.163], accounting for 34.9% of total effect). Mindfulness moderated the association between frailty and fatigue (β = -0.106, 95% CI [-0.260, 0.006]) and between frailty and anxiety/depression (β = -0.083, 95% CI [-0.187, -0.005]); however, mindfulness did not significantly moderate fatigue-CIPN pathways (β = 0.022, 95% CI [-0.048, 0.089]).
CONCLUSION: Fatigue is a critical mediator linking frailty to CIPN and psychological distress. Mindfulness effectively buffers the negative impacts of frailty on fatigue and psychological distress. Integrating frailty assessment, targeted fatigue management, and mindfulness interventions into clinical practice may enhance symptom management and psychological well-being among chemotherapy patients.
METHODS: A cross-sectional survey enrolled 445 chemotherapy patients from three tertiary hospitals in China during April 2024-February 2025. Participants completed validated measures including the Treatment-Induced Neuropathy Assessment Scale (TNAS), Tilburg Frailty Indicator (TFI), Cancer Fatigue Scale (CFS), Freiburg Mindfulness Inventory (FMI), and Hospital Anxiety and Depression Scale (HADS). Moderated mediation analyses were conducted using structural equation modeling (SEM) with bootstrap techniques.
RESULTS: Frailty significantly predicted higher CIPN symptoms (β = 0.179, 95% CI [0.101, 0.032]) and anxiety/depression (β = 0.216, 95% CI [0.140, 0.289]). Fatigue significantly mediated these relationships, with indirect effects of frailty on CIPN symptoms (β = 0.125, 95% CI [0.081, 0.179], accounting for 41.1% of total effect) and on anxiety/depression (β = 0.116, 95% CI [0.076, 0.163], accounting for 34.9% of total effect). Mindfulness moderated the association between frailty and fatigue (β = -0.106, 95% CI [-0.260, 0.006]) and between frailty and anxiety/depression (β = -0.083, 95% CI [-0.187, -0.005]); however, mindfulness did not significantly moderate fatigue-CIPN pathways (β = 0.022, 95% CI [-0.048, 0.089]).
CONCLUSION: Fatigue is a critical mediator linking frailty to CIPN and psychological distress. Mindfulness effectively buffers the negative impacts of frailty on fatigue and psychological distress. Integrating frailty assessment, targeted fatigue management, and mindfulness interventions into clinical practice may enhance symptom management and psychological well-being among chemotherapy patients.