The chain mediating effects of psychological resilience and family support the association between chemotherapy-induced taste alteration and cancer anorexia among Chinese breast cancer patients: a cross-sectional study

The chain mediating effects of psychological resilience and family support the association between chemotherapy-induced taste alteration and cancer anorexia among Chinese breast cancer patients: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The chain mediating effects of psychological resilience and family support the association between chemotherapy-induced taste alteration and cancer anorexia among Chinese breast cancer patients: a cross-sectional study Xin Chen, Dongjun Zhang, Zhen Li, Yingjie Ma, Huijie Hou, Yanyan Dong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7268370/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Nov, 2025 Read the published version in BMC Psychology → Version 1 posted 11 You are reading this latest preprint version Abstract Background The incidence of breast cancer is high, and chemotherapy is easy to cause taste changes, induce cancer anorexia, affect treatment tolerance and quality of life. However, clinical attention is mostly paid to obvious symptoms, ignoring taste changes and cancer anorexia, and patients rarely report actively. Objectives To explore the influence of chemotherapy-induced taste alteration on cancer anorexia in patients with breast cancer, as well as the mediating role of psychological resilience and family support. Design A cross-sectional study. Methods By using the convenience sampling method, breast cancer patients who visited a tertiary general hospital in Henan Province were selected as the research subjects. Questionnaire surveys were conducted through the general information questionnaire, the Chemotherapy-induced Taste Alteration Scale, the Cancer Anorexia Scale, the Psychological Resilience Scale, and the Family Support Scale, and 346 valid data were collected. Results (1)Cancer-related anorexia was negatively correlated with Chemotherapy-induced taste alteration ( r = -0.377, P < 0.01), and positively correlated with psychological resilience and family support ( r = 0.242, 0.318, P < 0.01); (2)The direct effect of chemotherapy-induced taste alteration on cancer anorexia in breast cancer patients was significant ( β =-0.108, P < 0.001); (3)Between chemotherapy-induced taste alteration and cancer-related anorexia, psychological resilience and family support not only play a mediating role alone but also jointly play a chain mediating role, with a total mediating effect of 28.48%. Conclusions Chemotherapy-induced taste alteration can not only directly affect cancer anorexia in breast cancer patients, but also indirectly affect cancer anorexia through psychological resilience and family support. Clinical trial number Not applicable Breast cancer Chemotherapy-induced taste alteration Cancer anorexia Psychological resilience Family support Chain mediating effect Figures Figure 1 Figure 2 1. Introduction Global cancer statistics for 2022 reported approximately 2.309 million new cases of breast cancer, comprising 11.6% of all malignant tumors in women and ranking second to lung cancer(Bray et al., 2024 ). Chemotherapy, a vital treatment for cancer patients, effectively eradicates tumor cells but also harms normal tissue cells, resulting in various toxic reactions and symptoms such as changes in taste and smell. These side effects reduce patients’ enjoyment of food and contribute to loss of appetite(Kim et al., 2020 ; Pedersini et al., 2021 ). Research indicates that chemotherapy-induced taste disturbances affect a significant proportion of cancer patients, with prevalence rates ranging from 38–84%(Gamper et al., 2012 ). These alterations predominantly present as diminished taste perception or sensitivity, playing a crucial role in the development of cancer-associated anorexia(Hovan et al., 2010 ; Wang et al., 2024 ). Specifically, these taste disruptions can give rise to disagreeable taste sensations like dysgeusia and hypogeusia, diminishing the enjoyment and gratification associated with food consumption. Furthermore, these alterations limit dietary preferences, leading to decreased appetite, lower caloric intake, and potentially anorexia in affected individuals(Al-Amouri & Badrasawi, 2024 ). Cancer-related anorexia (CA) is characterized by reduced appetite due to various factors such as the tumor itself, adverse effects of anticancer therapy, and psychological changes. It may occur with or without weight loss and often persists throughout the cancer disease trajectory, yet it is frequently underestimated(Sato et al., 2025 ). CA leads to decreased food consumption, potentially causing malnutrition and weight loss, which can progress to cancer anorexia cachexia syndrome (CACS)(Du C et al., 2021 ). CACS not only reduces patients' ability to tolerate treatment and affects therapeutic outcomes negatively but also diminishes their quality of life and, to some extent, undermines their confidence in antitumor therapy(Blauwhoff-Buskermolen et al., 2016 ; Muscaritoli et al., 2017 ). Therefore, we propose Hypothesis 1: Taste alteration in breast cancer patients receiving chemotherapy may adversely predict the development of cancer-related anorexia. The Cognitive Adaptation Theory (CAT) suggests that individuals actively modify their cognitive processes to adapt to external changes or internal needs, ensuring cognitive equilibrium and efficiency(Tomich & Helgeson, 2006 ). Psychological resilience denotes the capacity to manage stress and trauma effectively(Wagnild & Young, 1993 ). Fradelos et al.’s research demonstrates that psychological resilience significantly impacts patients’ attitudes toward illness. Strengthening resilience can mitigate adverse physiological and psychological effects of major life events, safeguarding mental well-being(Fradelos et al., 2017 ). Negative emotions correlate closely with anorexia symptoms, exacerbating the condition and compromising nutritional status and quality of life(Amano et al., 2022 ). CAT posits that breast cancer patients undergoing chemotherapy with higher resilience levels can better navigate treatment-induced stress, including taste alterations affecting eating habits. By adjusting their mindset and employing effective coping mechanisms, they can alleviate discomfort from taste changes, maintaining appetite and nutritional intake. Building upon this, we propose Hypothesis 2: Psychological resilience may play a mediating role between chemotherapy-induced taste alteration and cancer anorexia in breast cancer patients. The family functions as a complex and interconnected system in which emotions, behaviors, and communication patterns among members significantly influence individuals(Ding et al., 2024 ). Family support not only encompasses tangible support in terms of economy and material, but also intangible support at the psychological and emotional levels(Han et al., 2016 ). As the primary social support network, familial support can help individuals, particularly patients, alleviate psychological stress and bolster their confidence in confronting illness(Qiu et al., 2025 ). Studies demonstrate that robust family dynamics and support from relatives and friends positively impact the emotional well-being of cancer patients(Gui et al., 2025 ). Jiang et al. observed that for individuals with breast cancer, family support not only aids in disease acceptance, coping, and recovery but also effectively mitigates negative psychological states, enhances illness perception, and improves quality of life. It serves as a pivotal element in patients’ successful adjustment to a new way of life(Jiang et al., 2022 ). Building upon this, we propose Hypothesis 3: Family support may play a mediating role between chemotherapy-induced taste alteration and cancer anorexia in breast cancer patients. This study is grounded in Folkman and Lazarus’s stress coping theory, which posits that stress is a dynamic process stemming from individuals perceiving an imbalance between coping resources and demands following subjective evaluation of environmental stressors. Coping involves cognitive and behavioral strategies aimed at alleviating stress(Folkman et al., 1986 ). The theory underscores the importance of primary appraisal, secondary appraisal, and reappraisal when individuals are confronted with stressors to determine appropriate coping responses(Seib et al., 2018 ). Breast cancer patients undergoing chemotherapy experience not only direct physiological toxic side effects but also psychological stress from the disease itself, prompting individual psychological adaptation mechanisms. Patients with higher psychological resilience are more likely to utilize cognitive restructuring strategies (e.g., reframing taste alterations as temporary treatment-related effects) and proactive coping behaviors (e.g., mobilizing family support) to reduce stress. This process can potentially decrease the risk of cancer-related anorexia by enhancing eating experiences and emotional well-being. Consequently, we propose Hypothesis 4: Psychological resilience and family support act as sequential mediators in the association between chemotherapy-induced taste alterations and cancer-related anorexia in breast cancer patients. Our study investigates the chain mediation effects of psychological resilience and family support among breast cancer patients undergoing chemotherapy to understand the relationship between chemotherapy-induced taste alterations and cancer-related anorexia. The study aims to offer theoretical insights, targeted interventions, and practical recommendations for managing taste alteration-induced anorexia in chemotherapy patients with breast cancer. The framework of the research hypothesis is shown in Fig. 1 . 2. Methods 2.1. Study design and setting By using the convenience sampling method, a cross-sectional questionnaire survey was conducted among patients undergoing breast cancer chemotherapy in a tertiary general hospital in Henan Province from November 2024 to April 2025. This study was conducted in line with the principles of the Declaration of Helsinki and approved by the Ethics Committee of Henan Provincial People’s Hospital (Review Number: 2022 − 172). Inclusion criteria for patients: (1) Age ≥ 18 years old; (2) Diagnosed as breast cancer by histopathology and in the postoperative treatment stage(Li et al., 2024 ); (3) Clarify one's own disease diagnosis and the progression of the condition; (4) Possess good language comprehension and communication skills; (5) Agree to participate in the research and sign the informed consent form. Exclusion criteria: (1) Those who cannot be swallowed orally; (2) Those with mental illness or consciousness disorders; (3) Accompanied by major diseases such as cachexia, systemic infection or failure of major organs like the heart and liver. According to the sample size calculation method of analytical research, the sample size should be 5 to 10 times the number of variables. This study involves 26 independent variables. To ensure the quality of the questionnaire and consider a 10% dropout rate, the sample size should be 145–289 participants. 2.2. Data collection During the hospitalization and chemotherapy period of breast cancer patients, researchers informed the patients of the research purpose and significance using unified instructions. After obtaining the patients’ consent, questionnaires were distributed for face-to-face surveys, and the disease-related information was filled in according to the patients' medical records. Ultimately, a total of 360 questionnaires were distributed in this survey, and 346 valid questionnaires were retrieved, with an effective recovery rate of 96.11%. 2.3. Measurements 2.3.1. General information questionnaire This questionnaire was developed independently through the discussion of the research team. The contents include BMI, age, marital status, educational level, religious belief, place of residence, etc. Disease-related information, such as surgical methods, tumor differentiation degree, other adjuvant treatments, combined chronic diseases, chemotherapy regimens, etc. 2.3.2. Chemotherapy-induced Taste Alteration Scale (CiTAS) This scale was developed by Kano et al(Kano & Kanda, 2013 ). And localized by Pang et al(Pang et al., 2019 ). It includes four dimensions and 18 items: basic taste changes, abnormal taste changes, overall taste changes, and patients’ eating disturbances. It uses a Likert 5-level scoring system, with scores ranging from 1 to 5 assigned from “no change” to “very severe”. The average score of each dimension was obtained by adding up the scores of each dimension item and then dividing by the number of items. The total score of the scale ranged from 18 to 90 points. The higher the score, the more severe the taste change. In this study, the Cronbach’s α coefficient was 0.899. 2.3.3. Functional Assessment of Anorexia Cachexia Therapy Anorexia/Cachexia Subscale (FAACT-ACS) This scale is currently the main assessment tool widely used internationally to evaluate the anorexia status of patients with advanced cancer. Developed by Ribaudo et al(Ribaudo et al., 2000 ). And translated into Chinese by Zhou et al.(Zhou et al., 2017 ), this scale consists of 12 items and uses a Likert 5-level scoring system. Points ranging from 0 to 4 are assigned from “strongly disagree” to “strongly agree”, with a total score ranging from 0 to 48. The higher the score, the lower the risk of cancer-related anorexia in patients. A total score of ≤ 24 indicates the presence of cancer-related anorexia. In this study, the Cronbach’s α coefficient was 0.607. 2.3.4. 25-item Connor-Davidson resilience scale (CD-RISC-25) This scale was jointly developed by Connor and Davidson(Connor & Davidson, 2003 ). It includes three dimensions, namely resilience (13 items), self-improvement (8 items), and optimism (4 items), totaling 25 items. The Likert 5-level scoring method was adopted; “completely non-compliant” to “completely compliant” will be scored from 0 to 4 points in sequence. The total score ranges from 0 to 100 points, and the higher the score, the higher the psychological resilience of the test subject. In this study, the Cronbach’s α coefficient was 0.949. 2.3.5. Family Adaptation, Partnership, Growth, Affection, Resolve Index (APGAR) This questionnaire was compiled by Smilkstein in 1978(Smilkstein, 1978 ). Medical staff often understand the family support situation of patients through the APGAR questionnaire. The questionnaire consists of five items: fitness, intimacy, emotion, cooperation and growth. The Likert three-level scoring method was adopted. “Almost rarely” received 0 points, “sometimes like this” received 1 point, and “often like this” received 2 points. The total score of the questionnaire ranged from 0 to 10 points. A score of 0 to 3 indicated severe impairment of family care, 4 to 6 indicated moderate impairment of family care, and 7 to 10 indicated good family care. In this study, the Cronbach’s α coefficient was 0.881. 2.4. Statistical analysis The data were entered and verified by two people using Excel software, and the data were processed and analyzed using SPSS 26.0 statistical software. Statistical description was conducted using frequency and general data that constituted the comparison research objects. Normality tests are conducted on continuous variables. Continuous variables that conform to a normal distribution are expressed as mean ± standard deviation. The influence of general data on cancer anorexia in patients with breast cancer was analyzed by t-test and one-way ANOVA. Pearson correlation analysis was used to analyze the correlations between cancer anorexia in breast cancer patients and chemotherapy-related taste changes, family support, and psychological resilience. The chain mediating effect was verified using Model 6 in the PROCESS v4.1 plugin of the SPSS macro program written by Hayes(Hayes & Scharkow, 2013 ). The mediating effect was tested using the Bootstrap method. The sample size was repeatedly sampled 5,000 times, and the 95% confidence interval (CI) was calculated. P < 0.05 was considered statistically significant. 3. Results 3.1. Common method deviation test Harman’s single-factor test was conducted to assess common method bias (CMB) before data analysis(Podsakoff et al., 2003 ). The results revealed that there were 12 factors with eigenvalues greater than 1, and the variance explained by the first factor was 22.57% (lower than the 40% threshold), indicating that no serious CMB exists in this study. 3.2. Multicollinearity assessment In this study, the Variance Inflation Factor (VIF) method was employed to perform a covariance test. The results indicated that the VIF values ranged from 1.070 to 2.903, all of which were below the threshold of 5, suggesting that there was no significant collinearity issue among the variables. 3.3. Sample characteristics The characteristics of the patients are shown in Table 1 . In this survey, all 346 breast cancer patients were female. 40% of the patients had an overweight BMI, 42% were aged between 46 and 59, and 44% had a junior high school education level. In terms of disease stage, 40% of the patients were in the third stage of the disease, and 77% of the patients had cancer metastasis. Based on BMI, age, education level, TNM stage, whether metastasis occurred and the number of other adjuvant treatments received, statistically significant differences were observed in the scores of breast cancer patients for cancer anorexia ( P < 0.05). 3.4. Mean scores and correlations between variables Relevant analysis indicates that there is a significant correlation between each pair of variables. Cancer-related anorexia was positively correlated with psychological resilience and family support ( r = 0.242, 0.318, P < 0.01), and negatively correlated with chemotherapy-related taste changes ( r = -0.377, P < 0.01), as shown in Table 2 . 3.5. Chain mediating effect test After standardizing the data, we used chemotherapy-related taste changes (X) as the independent variable, psychological resilience (M1) and family support (M2) as mediating variables, and cancer-related anorexia (Y) as the dependent variable. We conducted a mediation effect test using the PROCESS 4.1 Model 6 macro program in SPSS, and analyzed the chain mediation effects of psychological resilience and family support between chemotherapy-related taste changes and cancer-related anorexia using the bias-corrected non-parametric percentile Bootstrap method (with 5000 resampling repetitions and a 95% confidence interval). The regression analysis results (Table 3 and Fig. 2 ) indicate that chemotherapy-related taste changes negatively predict psychological resilience, family support, and cancer anorexia ( β =-0.392, -0.116, -0.108, P < 0.01). Psychological resilience positively predicts family support and cancer anorexia ( β = 0.043,0.034, P < 0.01), and family support positively predicts cancer anorexia ( β = 0.217, P < 0.01). The results of the mediating effect analysis (Table 4 ) showed that the effect value of chemotherapy-related taste changes → psychological resilience → cancer anorexia was − 0.013, and the 95% confidence intervals did not include 0. The mediating effect was established. The effect size of chemotherapy-related taste changes → family support → cancer anorexia was − 0.025, and the 95% confidence intervals did not include 0, indicating the establishment of the mediating effect. The effect value of chemotherapy-related taste changes → psychological resilience → family support → cancer anorexia was − 0.004, and the 95% confidence intervals did not include 0. The chain mediating effect was established. Table 1 Comparison of different characteristics of participants( N = 346) Variables Group N (%) Mean ± SD t/F P BMI (kg/m²) <18.5 28(8) 16.07 ± 4.52 24.883 b <0.001 18.5–23.9 134(39) 20.22 ± 3.77 24−27.9 139(40) 20.89 ± 3.51 ≥ 28 45(13) 23.64 ± 3.49 Age (years) 18–30 11(3) 22.91 ± 4.66 14.572 b <0.001 31–45 97(28) 22.39 ± 3.56 46–59 145(42) 20.31 ± 4.07 ≥ 60 93(27) 18.91 ± 3.67 Marital status Single 6(2) 19.33 ± 3.20 0.766 b 0.514 Married 327(95) 20.67 ± 4.10 Divorced 4(1) 21.00 ± 3.83 Widowed 9(3) 18.89 ± 3.41 Educational level Primary school and below 55(16) 19.51 ± 3.83 11.373 b <0.001 Junior high school 138(40) 19.73 ± 3.36 High school or technical secondary school 97(28) 21.06 ± 4.67 University (including junior college) or above 56(16) 23.02 ± 4.07 Residence Rural area 129(37) 20.16 ± 3.98 2.759 b 0.065 Town 74(21) 20.19 ± 4.04 Urban area 143(41) 21.21 ± 4.11 Household monthly income percapita (RMB) 10000 89(26) 21.47 ± 4.34 Main carer No 5(1) 21.00 ± 3.74 0.856 b 0.464 Nursing assistant 2(1) 16.50 ± 3.54 Family and friends 329(95) 20.59 ± 4.07 Nursing staff and relatives work together 10(3) 21.50 ± 4.20 Type of surgery Breast-preserving surgery 70(20) 21.30 ± 3.92 1.719 b 0.163 Total mastectomy 138(40) 20.63 ± 3.96 Modified radical mastectomy 125(36) 20.37 ± 4.24 Other ways 13(4) 18.77 ± 3.94 Cancer stage(TNM) Ⅰ 50(14) 23.16 ± 2.98 23.316 b <0.001 Ⅱ 127(37) 21.65 ± 4.55 Ⅲ 139(40) 19.40 ± 3.04 Ⅳ 30(9) 17.43 ± 3.79 Metastasis No 80(23) 24.61 ± 2.78 4.482 a 0.035 Yes 266(77) 19.39 ± 3.59 Number of chemotherapy cycles under way 1 34(10) 20.21 ± 3.75 0.675 b 0.568 2 41(12) 20.97 ± 3.90 3 46(13) 19.96 ± 4.62 ≥ 4 225(65) 20.72 ± 4.03 Number of other adjuvant treatments received No 109(32) 23.28 ± 2.70 39.891 b <0.001 1 160(46) 20.20 ± 3.84 2 46(13) 17.80 ± 3.69 ≥ 3 31(9) 17.42 ± 4.02 Merge other chronic diseases No 255(74) 20.64 ± 4.04 0.155 b 0.927 1 69(20) 20.57 ± 3.84 2 18(5) 20.56 ± 4.71 ≥ 3 4(1) 19.25 ± 7.41 Chemotherapy regimen TAH(P) 30(9) 21.37 ± 3.79 1.315 b 0.250 TP(Cb,DDP)H(P) 65(19) 20.42 ± 3.96 TCH(P) 48(14) 20.02 ± 4.82 TH(P) 33(10) 19.73 ± 3.76 TAC 50(14) 21.76 ± 3.80 TC 57(16) 20.46 ± 4.06 AC 63(18) 20.53 ± 3.98 Note: SD = standard deviation; a = Independent-sample t-tests, b = one-way ANOVA. T, taxanes, including docetaxel, albumin-bound paclitaxel, and paclitaxel; A, anthracyclines, including epirubicin, pirarubicin, doxorubicin, doxorubicin; C, cyclophosphamide; P, Cb, carboplatin, DDP, Cisplatin; H/P, approved trastuzumab, pertuzumab Table 2 Mean scores and correlations between variables. Variables Mean ± SD 1 2 3 4 1.Chemotherapy-induced taste alteration 41.942 ± 10.175 1 - - - 2.Psychological resilience 47.439 ± 13.049 −0.306** 1 - - 3.Family support 7.191 ± 2.657 −0.510** 0.348** 1 - 4.Cancer anorexia 20.601± 4.066 −0.377** 0.242** 0.318** 1 Note: ** P <0.01. Table 3 Regression analysis for mediation model.( N = 346) Regression Equation Global Fitting Index Regression Coefficient Significance Outcome Variable Predictor Variable R R 2 F β t P Psychological resilience Chemotherapy-induced taste alteration 0.306 0.094 35.461 −0.392 −5.955 <0.001 Family support Chemotherapy-induced taste alteration 0.548 0.301 73.707 −0.116 −9.390 <0.001 Psychological resilience 0.043 4.458 <0.001 Cancer anorexia Chemotherapy-induced taste alteration 0.417 0.174 23.998 −0.108 −4.681 <0.001 Psychological resilience 0.034 2.072 0.039 Family support 0.217 2.414 0.016 Table 4 Decomposition of standardized effects from the model.( N = 346) Mediating Path Effect Size BootSE BootLLCI BootULCI Efficiency ratio(%) Total Effect −0.151 0.020 −0.190 −0.111 100 Direct Effect −0.108 0.023 −0.154 −0.063 71.52 Mediating Effect −0.043 0.014 −0.071 −0.017 28.48 Ind1 −0.013 0.007 −0.028 −0.001 8.61 Ind2 −0.025 0.012 −0.049 −0.003 16.56 Ind3 −0.004 0.002 −0.008 −0.001 2.65 Note: Ind1༚Chemotherapy-induced taste alteration→Psychological resilience→Cancer anorexia;Ind2༚Chemotherapy-induced taste alteration→Family support→Cancer anorexia༛Ind3༚Chemotherapy-induced taste alteration→Psychological resilience→Family support→Cancer anorexia 4. Discussion To our knowledge, this is the first study to explore the interrelationships between psychological resilience, family support, chemotherapy-induced taste alteration, and cancer anorexia among breast cancer patients in China, Our findings unveiled three distinct pathways through which chemotherapy-induced taste alteration indirectly influenced cancer anorexia: (a) only through psychological resilience, (b) only via family support, and (c) through the combined effect of psychological resilience and family support. The results of univariate analysis in this study showed that BMI, age, education level, TNM stage, whether metastasis occurred and the number of other adjuvant treatments received were the influencing factors of cancer anorexia in breast cancer patients ( P < 0.05). Among them, patients with a body weight that is too low (BMI < 18.5) may have insufficient nutritional reserves and poor tolerance to chemotherapy. The loss of appetite caused by changes in taste has a more significant impact on their nutritional status, and thus they are more prone to cancer-related anorexia. As people age, the physiological functions of the human body gradually decline, and the sensitivity of taste and smell also decreases. Chemotherapy further aggravates this change, causing elderly patients to have a weakened perception of food taste and a reduced appetite(Dotan et al., 2021 ). Patients with a lower level of education may lack knowledge about the disease and treatment, have insufficient awareness of the side effects of chemotherapy, and thus find it difficult to take effective measures to relieve the discomfort caused by changes in taste, making them more prone to anorexia. Patients with a higher TNM stage usually have more severe conditions, increased physical consumption, and the intensity of chemotherapy may also be relatively greater, which has a more obvious impact on their taste and appetite(Rha & Lee, 2021 ). Patients with metastasis face a more serious disease threat. The body’s stress response and metabolic disorders may lead to abnormal taste and loss of appetite. Patients who receive a large number of other adjuvant treatments may simultaneously suffer from the side effects of multiple treatments (such as radiotherapy, targeted therapy, etc.), remain in a state of treatment stress for a long time, and their body’s metabolic regulation mechanism is disrupted, which aggravates the impact on taste and appetite. Notably, Pearson correlation analysis in this study showed that taste changes in breast cancer patients undergoing chemotherapy negatively predicted their risk of cancer-related anorexia, verifying Hypothesis 1. From a physiological mechanism perspective, chemotherapy drugs (such as cisplatin and doxorubicin) can cause damage to taste bud cells and related neural pathways in the oral cavity(Ravasco, 2005 ). Taste buds, as key receptors for sensing taste stimuli, their impaired function can lead to changes in the perception of food flavors. Damage to neural pathways can affect the transmission of taste information to the brain, causing deviations in the brain's recognition of food flavors and thereby reducing the patient's interest in eating(Vukmanovic et al., 2022 ). Therefore, the taste changes related to chemotherapy cause patients to experience unpleasant taste changes such as hallucinations and taste loss, which affect the palatability of food and further weaken their appetite, thus making them even more reluctant to eat(Penna, 2023 ). It is recommended that medical staff formulate targeted and individualized chemotherapy plans for different patients, intervene from multiple dimensions such as diet, nutrition, oral care and psychological support, regularly monitor the recovery of taste, reduce the risk of cancer anorexia, and improve the prognosis of patients(Hopkinson, 2018 ). Additionally, our research found that psychological resilience plays a mediating role in chemotherapy-related taste changes and cancer anorexia in breast cancer patients, which validates Hypothesis 2. That is, patients with chemotherapy-related taste changes can reduce the risk of cancer-related anorexia by enhancing psychological resilience. Research shows that patients with higher psychological resilience can better regulate their emotions, actively deal with difficulties and challenges in life, and thus maintain a relatively stable psychological state when facing diseases(Izydorczyk et al., 2018 ). Specifically, such patients are adept at using positive coping strategies to face the challenges of chemotherapy. They can proactively adjust their mindset and actively seek solutions, such as trying different food flavors and adjusting their diet structure, to alleviate the discomfort caused by changes in taste and better maintain their appetite and nutrient intake. Meanwhile, we found that family support plays a mediating role in chemotherapy-related taste changes and cancer anorexia in breast cancer patients, which validates Hypothesis 3. That is, patients with chemotherapy-related taste changes can indirectly alleviate cancer anorexia by seeking family support. Research shows that family support can provide emotional comfort and practical assistance to patients, making them feel the care and support from their families, and thereby enhancing their confidence and courage to face the disease(Zhong et al., 2025 ). When facing eating difficulties caused by changes in taste, the encouragement and company of family members can relieve the patient's anxiety and stress, help the patient maintain a good psychological state, and at the same time provide meals according to the patient's taste preferences to promote the recovery of appetite(Vukmanovic et al., 2022 ). Furthermore, our research's mediating model regression analysis indicates that psychological resilience and family support play a chain mediating role in chemotherapy-related taste changes and cancer anorexia in breast cancer patients, which supports Hypothesis 4. This discovery reveals the mechanism by which psychological resilience and family support regulate chemotherapy-related taste changes and cancer anorexia in breast cancer patients, that is, chemotherapy-related taste changes influence cancer anorexia through the chain mediation of psychological resilience and family support. Research shows that strong psychological resilience helps patients play a supportive role in their families through good emotional communication and enhance their subjective decision-making ability within the family system. Specifically, good psychological resilience enables patients to seek and accept family support more effectively when facing taste changes caused by chemotherapy. The enhancement of family support can also improve the patient's adaptability, jointly acting on the appetite status and reducing the risk of cancer-related anorexia. Therefore, when conducting clinical intervention, nursing managers should simultaneously pay attention to the patients' internal psychological adjustment and the optimization of the external family support environment, and form a comprehensive intervention strategy to improve the cancer anorexia problem of breast cancer patients, enhance their quality of life and treatment effect. 4.1. Limitations There were some limitations in this study. Firstly, the study only selected breast cancer patients from one hospital, and the sample source was rather limited, which might have restricted the extrapolation of the research results. Secondly, the study adopted a cross-sectional questionnaire survey, which only collected data from patients once during chemotherapy, making it impossible to determine a causal relationship. Thirdly, the study didn’t conduct long-term follow-up on the patients, making it impossible to assess the dynamic changes and evolution over time of chemotherapy-related taste alterations and cancerous anorexia. Future research can further verify these findings by adopting longitudinal design, expanding sample sources and dynamic tracking. 4.2. Clinical implications Drawing upon our research findings, healthcare providers must recognize the direct impact of chemotherapy-related taste changes on cancer anorexia in breast cancer patients, as well as the crucial chain effect of psychological resilience and family support in this complex process. The research results suggest that medical staff should pay attention to the taste changes of patients during chemotherapy and formulate personalized intervention plans from multiple dimensions such as diet, nutrition, oral care and psychological support. At the same time, the significance of psychological resilience training and the optimization of family support was emphasized, providing a theoretical basis for clinical practice, promoting multidisciplinary team collaboration, and forming a comprehensive intervention strategy. This not only helps to reduce the risk of cancer anorexia in patients, but also improves their treatment compliance and quality of life, providing scientific support for the improvement of the nursing practice guidelines for breast cancer patients. 5. Conclusions This study investigated the crucial role of psychological resilience and family support in cancer-related anorexia in Chinese breast patients. Additionally, we provided preliminary evidence demonstrating that psychological resilience and family support play a significant mediating role in the relationship between chemotherapy-related taste changes and cancer-related anorexia. Therefore, when formulating future healthcare strategies, medical professionals should pay attention to changes in patients’ taste and improve their appetite and quality of life by enhancing psychological resilience and optimizing family support. Declarations Acknowledgments We would like to express our sincere gratitude to all the breast cancer patients who participated in this study and Hayes, who provided the PROCESS macro for SPSS. CRediT authorship contribution statement Xin CHEN: Writing-original draft, Software, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Dongjun ZHANG: Writing - review &editing, Validation, Methodology. Zhen LI: Writing -review & editing, Formal analysis, Conceptualization. Yingjie MA: Data curation, Investigation. Huijie HOUand Yanyan DONG: Supervision. All authors read and approved the final manuscript. Funding This work was supported by the Henan Provincial Medical Science and Technology Research Project (SBGJ202102002). Ethics approval and consent to participate This study was approved by the Ethics Committee of Henan Provincial People's Hospital [Ethics Approval No. (2022) Lun Shen No. (172)] and complied with the Declaration of Helsinki.The purpose of the study was explained to all participants before the survey was conducted and informed consent was obtained. Consent for publication Not applicable. Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Author details 1 School of Nursing, Xinxiang Medical University, Xinxiang, Henan, 453003, China 2 School of Psychology, Xinxiang Medical University, Xinxiang, Henan, 453003, China 3 Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, China References Al-Amouri, F. M., & Badrasawi, M. (2024). Taste alteration and its relationship with nutritional status among cancer patients receiving chemotherapy, cross-sectional study [Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't]. Plos One , 19(5), e302990. http://doi.org/10.1371/journal.pone.0302990 Amano, K., Hopkinson, J., & Baracos, V. (2022). Psychological symptoms of illness and emotional distress in advanced cancer cachexia [Journal Article; Review]. Current Opinion in Clinical Nutrition and Metabolic Care , 25(3), 167-172. http://doi.org/10.1097/MCO.0000000000000815 Blauwhoff-Buskermolen, S., Ruijgrok, C., Ostelo, R. W., de Vet, H., Verheul, H., de van der Schueren, M., & Langius, J. (2016). The assessment of anorexia in patients with cancer: cut-off values for the FAACT-A/CS and the VAS for appetite [Journal Article]. Supportive Care in Cancer , 24(2), 661-666. http://doi.org/10.1007/s00520-015-2826-2 Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [Journal Article; Research Support, Non-U.S. Gov't]. Ca-a Cancer Journal for Clinicians , 74(3), 229-263. http://doi.org/10.3322/caac.21834 Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC) [Clinical Trial; Comparative Study; Journal Article; Validation Study]. Depression and Anxiety , 18(2), 76-82. http://doi.org/10.1002/da.10113 Ding, Z., Fan, Y., Zhong, G., Zhang, X., Li, X., Qiao, Y., & Cui, H. (2024). A dyadic analysis of family adaptation among breast cancer patients and their spouses based on the framework of family stress coping theory [Journal Article]. Frontiers in Public Health , 12, 1453830. http://doi.org/10.3389/fpubh.2024.1453830 Dotan, E., Walter, L. C., Browner, I. S., Clifton, K., Cohen, H. J., Extermann, M., Gross, C., Gupta, S., Hollis, G., Hubbard, J., Jagsi, R., Keating, N. L., Kessler, E., Koll, T., Korc-Grodzicki, B., McKoy, J. M., Misra, S., Moon, D., O Connor, T., Owusu, C., Rosko, A., Russell, M., Sedrak, M., Siddiqui, F., Stella, A., Stirewalt, D. L., Subbiah, I. M., Tew, W. P., Williams, G. R., Hollinger, L., George, G. V., & Sundar, H. (2021). NCCN Guidelines® Insights: Older Adult Oncology, Version 1.2021 [Journal Article]. Journal of the National Comprehensive Cancer Network , 19(9), 1006-1019. http://doi.org/10.6004/jnccn.2021.0043 Du C, Wang, C., Guan, X., Li, J., Du X, Xu, Z., Li, B., Liu, Y., Fu, F., Huo, H., & Zheng, Z. (2021). Asprosin is associated with anorexia and body fat mass in cancer patients [Journal Article]. Supportive Care in Cancer , 29(3), 1369-1375. http://doi.org/10.1007/s00520-020-05621-8 Folkman, S., Lazarus, R. S., Gruen, R. J., & DeLongis, A. (1986). Appraisal, coping, health status, and psychological symptoms [Journal Article; Research Support, Non-U.S. Gov't]. Journal of Personality and Social Psychology , 50(3), 571-579. http://doi.org/10.1037//0022-3514.50.3.571 Fradelos, E. C., Papathanasiou, I. V., Veneti, A., Daglas, A., Christodoulou, E., Zyga, S., & Kourakos, M. (2017). Psychological Distress and Resilience in Women Diagnosed with Breast Cancer in Greece [Journal Article]. Asian Pac J Cancer Prev , 18(9), 2545-2550. http://doi.org/10.22034/APJCP.2017.18.9.2545 Gamper, E. M., Zabernigg, A., Wintner, L. M., Giesinger, J. M., Oberguggenberger, A., Kemmler, G., Sperner-Unterweger, B., & Holzner, B. (2012). Coming to your senses: detecting taste and smell alterations in chemotherapy patients. A systematic review [Journal Article; Meta-Analysis; Review; Systematic Review]. 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Psychosocial Support in Cancer Cachexia Syndrome: The Evidence for Supported Self-Management of Eating Problems during Radiotherapy or Chemotherapy Treatment [Journal Article; Review]. Asia-Pacific Journal of Oncology Nursing , 5(4), 358-368. http://doi.org/10.4103/apjon.apjon_12_18 Hovan, A. J., Williams, P. M., Stevenson-Moore, P., Wahlin, Y. B., Ohrn, K. E., Elting, L. S., Spijkervet, F. K., & Brennan, M. T. (2010). A systematic review of dysgeusia induced by cancer therapies [Journal Article; Review; Systematic Review]. Supportive Care in Cancer , 18(8), 1081-1087. http://doi.org/10.1007/s00520-010-0902-1 Izydorczyk, B., Kwapniewska, A., Lizinczyk, S., & Sitnik-Warchulska, K. (2018). Psychological Resilience as a Protective Factor for the Body Image in Post-Mastectomy Women with Breast Cancer [Journal Article; Review]. International Journal of Environmental Research and Public Health , 15(6) http://doi.org/10.3390/ijerph15061181 Jiang, H., Wang, A. P., Xu, H., Liu, Y., Dong, Y., Sun, Y., & Li, S. (2022). Relationship between family support, serum lipid knowledge and quality of life in Chinese breast cancer women with adjuvant endocrine therapy [Journal Article]. Supportive Care in Cancer , 30(12), 10043-10050. http://doi.org/10.1007/s00520-022-07444-1 Kano, T., & Kanda, K. (2013). Development and validation of a chemotherapy-induced taste alteration scale [Journal Article; Validation Study]. Oncology Nursing Forum , 40(2), E79-E85. http://doi.org/10.1188/13.ONF.E79-E85 Kim, Y. H., Kim, G. M., Son, S., Song, M., Park, S., Chung, H. C., & Lee, S. M. (2020). Changes in taste and food preferences in breast cancer patients receiving chemotherapy: a pilot study [Journal Article]. Supportive Care in Cancer , 28(3), 1265-1275. http://doi.org/10.1007/s00520-019-04924-9 Li, J., Hao, C., Wang, K., Zhang, J., Chen, J., Liu, Y., Nie, J., Yan, M., Liu, Q., Geng, C., Wang, X., Wang, H., Wang, S., Wu, J., Yin, Y., Song, E., & Jiang, Z. (2024). Chinese Society of Clinical Oncology (CSCO) Breast Cancer guidelines 2024 [Journal Article; Review]. Transl Breast Cancer Res , 5, 18. http://doi.org/10.21037/tbcr-24-31 Muscaritoli, M., Lucia, S., Farcomeni, A., Lorusso, V., Saracino, V., Barone, C., Plastino, F., Gori, S., Magarotto, R., Carteni, G., Chiurazzi, B., Pavese, I., Marchetti, L., Zagonel, V., Bergo, E., Tonini, G., Imperatori, M., Iacono, C., Maiorana, L., Pinto, C., Rubino, D., Cavanna, L., Di Cicilia, R., Gamucci, T., Quadrini, S., Palazzo, S., Minardi, S., Merlano, M., Colucci, G., & Marchetti, P. (2017). Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study [Journal Article]. Oncotarget , 8(45), 79884-79896. http://doi.org/10.18632/oncotarget.20168 Pang, D., Qian, L., Chen, Z. J., Lu, Q., Heitkemper, M. M., Yang, P., & Jin, S. (2019). Psychometric properties of the Chinese version of the chemotherapy-induced taste alteration scale [Journal Article]. European Journal of Oncology Nursing , 42, 7-13. http://doi.org/10.1016/j.ejon.2019.07.007 Pedersini, R., di Mauro, P., Bosio, S., Zanini, B., Zanini, A., Amoroso, V., Turla, A., Vassalli, L., Ardine, M., Monteverdi, S., Zamparini, M., Gurizzan, C., Cosentini, D., Ricci, C., Simoncini, E. L., & Berruti, A. (2021). Changes in eating habits and food preferences in breast cancer patients undergoing adjuvant chemotherapy [Journal Article]. Scientific Reports , 11(1), 12975. http://doi.org/10.1038/s41598-021-92138-7 Penna, S. (2023). Chemotherapy-Induced Taste Alteration [Journal Article]. Clinical Journal of Oncology Nursing , 27(5), 479-485. http://doi.org/10.1188/23.CJON.479-485 Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies [Journal Article; Review]. Journal of Applied Psychology , 88(5), 879-903. http://doi.org/10.1037/0021-9010.88.5.879 Qiu, X., Mao, J., Wang, C., Yang, X., & Li, Q. (2025). Family Resilience and Its Influencing Factors in Patients With Cancer and Their Family Members: A Systematic Review [Journal Article; Review; Systematic Review]. Journal of Clinical Nursing , 34(4), 1124-1148. http://doi.org/10.1111/jocn.17485 Ravasco, P. (2005). Aspects of taste and compliance in patients with cancer [Journal Article; Review]. European Journal of Oncology Nursing , 9 Suppl 2, S84-S91. http://doi.org/10.1016/j.ejon.2005.09.003 Rha, S. Y., & Lee, J. (2021). Stable Symptom Clusters and Evolving Symptom Networks in Relation to Chemotherapy Cycles [Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't]. Journal of Pain and Symptom Management , 61(3), 544-554. http://doi.org/10.1016/j.jpainsymman.2020.08.008 Ribaudo, J. M., Cella, D., Hahn, E. A., Lloyd, S. R., Tchekmedyian, N. S., Von Roenn, J., & Leslie, W. T. (2000). Re-validation and shortening of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire [Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Validation Study]. Quality of Life Research , 9(10), 1137-1146. http://doi.org/10.1023/a:1016670403148 Sato, R., Da, F. G., Das, N. W., & von Haehling, S. (2025). Mechanisms and pharmacotherapy of cancer cachexia-associated anorexia [Journal Article; Review]. Pharmacology Research & Perspectives , 13(1), e70031. http://doi.org/10.1002/prp2.70031 Seib, C., Porter-Steele, J., Ng, S. K., Turner, J., McGuire, A., McDonald, N., Balaam, S., Yates, P., McCarthy, A., & Anderson, D. (2018). Life stress and symptoms of anxiety and depression in women after cancer: The mediating effect of stress appraisal and coping [Journal Article; Research Support, Non-U.S. Gov't]. Psycho-Oncology , 27(7), 1787-1794. http://doi.org/10.1002/pon.4728 Smilkstein, G. (1978). The family APGAR: a proposal for a family function test and its use by physicians [Case Reports; Journal Article]. Journal of Family Practice , 6(6), 1231-1239. Tomich, P. L., & Helgeson, V. S. (2006). Cognitive adaptation theory and breast cancer recurrence: Are there limits? [Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't]. Journal of Consulting and Clinical Psychology , 74(5), 980-987. http://doi.org/10.1037/0022-006X.74.5.980 Vukmanovic, N. I., Palacios, J. L., Kezian, S., Luong, G., Tran, A., Vu, K., Henson, B. S., Nosrat, P., Lutfy, K., & Nosrat, C. A. (2022). Brain-derived neurotrophic factor overexpression in taste buds diminishes chemotherapy induced taste loss [Journal Article]. European Journal of Neuroscience , 56(7), 4967-4982. http://doi.org/10.1111/ejn.15799 Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the Resilience Scale [Journal Article; Research Support, Non-U.S. Gov't]. Journal of Nursing Measurement , 1(2), 165-178. Wang, L., Tan, Y., Yao, L., & He, D. (2024). A taste alteration-related scale assesses megestrol to improve chemotherapy-induced anorexia [Journal Article; Research Support, Non-U.S. Gov't]. Supportive Care in Cancer , 32(5), 300. http://doi.org/10.1007/s00520-024-08499-y Zhong, H., Li, F., Xiao, T., Liu, C., Li, Q., Li, L., Xiao, R., Zhou, L., Qiu, X., & Chen, X. (2025). How Does Family Function Affect the Activation Of patients With Cancer Anorexia Undergoing Chemotherapy? A Mixed Methods Study [Journal Article]. Seminars in Oncology Nursing , 41(3), 151904. http://doi.org/10.1016/j.soncn.2025.151904 Zhou, T., Yang, K., Thapa, S., Fu, Q., Jiang, Y., & Yu, S. (2017). Validation of the Chinese version of functional assessment of anorexia-cachexia therapy (FAACT) scale for measuring quality of life in cancer patients with cachexia [Journal Article]. Supportive Care in Cancer , 25(4), 1183-1189. http://doi.org/10.1007/s00520-016-3508-4 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Nov, 2025 Read the published version in BMC Psychology → Version 1 posted Editorial decision: Revision requested 03 Oct, 2025 Reviews received at journal 20 Sep, 2025 Reviews received at journal 12 Sep, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviewers agreed at journal 04 Sep, 2025 Reviewers invited by journal 04 Sep, 2025 Editor invited by journal 07 Aug, 2025 Editor assigned by journal 03 Aug, 2025 Submission checks completed at journal 03 Aug, 2025 First submitted to journal 01 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7268370","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512679061,"identity":"c5ce0d27-32ea-4796-ae52-89267b4c1402","order_by":0,"name":"Xin Chen","email":"","orcid":"","institution":"Xinxiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Chen","suffix":""},{"id":512679062,"identity":"ebb5cf9b-4315-41c9-bb7d-2c3847f0b220","order_by":1,"name":"Dongjun Zhang","email":"","orcid":"","institution":"Xinxiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Dongjun","middleName":"","lastName":"Zhang","suffix":""},{"id":512679063,"identity":"c00bc3e7-1d70-4c00-8b6d-2159861c4d25","order_by":2,"name":"Zhen Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIie3QMQrCMBTG8RcCb0rbNQ6CRwgUnAriOVySpZu7Q4eCUMeuPYZQcA4EMgm9QnuDXkCxFfc+N8H85+/HIwEIhX6wGLi14wkh4dz1JIKAZmjuCKsL5opIRJpGFYDqxEbSSGK3UmBsWidAQZEdCFdsLidjbi6yPfj8WC4SVnqp5ExirVjpCISzSmqFpj0LJWkEOVdWo7lyMhHIhtJi2rjpkzXlLUnSje7x9Ou6dq4fi2yZfPL791IT53PF7otxKBQK/Vsvx3I8RCIeeAkAAAAASUVORK5CYII=","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Li","suffix":""},{"id":512679065,"identity":"c9daa97b-9516-4aa1-b98b-7301a2263c9c","order_by":3,"name":"Yingjie Ma","email":"","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yingjie","middleName":"","lastName":"Ma","suffix":""},{"id":512679066,"identity":"36581ffe-abaf-49ca-a438-9ccd3679afc7","order_by":4,"name":"Huijie Hou","email":"","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huijie","middleName":"","lastName":"Hou","suffix":""},{"id":512679068,"identity":"8754ea75-26dd-41c5-9693-05ebbba81df6","order_by":5,"name":"Yanyan Dong","email":"","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanyan","middleName":"","lastName":"Dong","suffix":""}],"badges":[],"createdAt":"2025-08-01 07:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7268370/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7268370/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-025-03761-2","type":"published","date":"2025-11-25T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91103954,"identity":"637ec14f-a929-4f25-b97d-b09bfaf27061","added_by":"auto","created_at":"2025-09-11 15:11:10","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40548,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram of the chain mediation hypothesis model\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7268370/v1/2f25ba5221dc355194db3efb.jpeg"},{"id":91103952,"identity":"5953a354-4373-4249-8290-8cbb960d26dc","added_by":"auto","created_at":"2025-09-11 15:11:09","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43211,"visible":true,"origin":"","legend":"\u003cp\u003eChain mediation structural equation model\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7268370/v1/02d265e48179fc52e8f19695.jpeg"},{"id":97178411,"identity":"7ba7330f-0d17-442c-b449-171d04aedd6d","added_by":"auto","created_at":"2025-12-01 16:09:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1341719,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7268370/v1/83c26a03-293a-412c-9ca9-4dfc94113030.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The chain mediating effects of psychological resilience and family support the association between chemotherapy-induced taste alteration and cancer anorexia among Chinese breast cancer patients: a cross-sectional study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eGlobal cancer statistics for 2022 reported approximately 2.309\u0026nbsp;million new cases of breast cancer, comprising 11.6% of all malignant tumors in women and ranking second to lung cancer(Bray et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Chemotherapy, a vital treatment for cancer patients, effectively eradicates tumor cells but also harms normal tissue cells, resulting in various toxic reactions and symptoms such as changes in taste and smell. These side effects reduce patients\u0026rsquo; enjoyment of food and contribute to loss of appetite(Kim et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Pedersini et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Research indicates that chemotherapy-induced taste disturbances affect a significant proportion of cancer patients, with prevalence rates ranging from 38\u0026ndash;84%(Gamper et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). These alterations predominantly present as diminished taste perception or sensitivity, playing a crucial role in the development of cancer-associated anorexia(Hovan et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Specifically, these taste disruptions can give rise to disagreeable taste sensations like dysgeusia and hypogeusia, diminishing the enjoyment and gratification associated with food consumption. Furthermore, these alterations limit dietary preferences, leading to decreased appetite, lower caloric intake, and potentially anorexia in affected individuals(Al-Amouri \u0026amp; Badrasawi, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Cancer-related anorexia (CA) is characterized by reduced appetite due to various factors such as the tumor itself, adverse effects of anticancer therapy, and psychological changes. It may occur with or without weight loss and often persists throughout the cancer disease trajectory, yet it is frequently underestimated(Sato et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). CA leads to decreased food consumption, potentially causing malnutrition and weight loss, which can progress to cancer anorexia cachexia syndrome (CACS)(Du C et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). CACS not only reduces patients' ability to tolerate treatment and affects therapeutic outcomes negatively but also diminishes their quality of life and, to some extent, undermines their confidence in antitumor therapy(Blauwhoff-Buskermolen et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Muscaritoli et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Therefore, we propose Hypothesis 1: Taste alteration in breast cancer patients receiving chemotherapy may adversely predict the development of cancer-related anorexia.\u003c/p\u003e\u003cp\u003eThe Cognitive Adaptation Theory (CAT) suggests that individuals actively modify their cognitive processes to adapt to external changes or internal needs, ensuring cognitive equilibrium and efficiency(Tomich \u0026amp; Helgeson, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Psychological resilience denotes the capacity to manage stress and trauma effectively(Wagnild \u0026amp; Young, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Fradelos et al.\u0026rsquo;s research demonstrates that psychological resilience significantly impacts patients\u0026rsquo; attitudes toward illness. Strengthening resilience can mitigate adverse physiological and psychological effects of major life events, safeguarding mental well-being(Fradelos et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Negative emotions correlate closely with anorexia symptoms, exacerbating the condition and compromising nutritional status and quality of life(Amano et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). CAT posits that breast cancer patients undergoing chemotherapy with higher resilience levels can better navigate treatment-induced stress, including taste alterations affecting eating habits. By adjusting their mindset and employing effective coping mechanisms, they can alleviate discomfort from taste changes, maintaining appetite and nutritional intake. Building upon this, we propose Hypothesis 2: Psychological resilience may play a mediating role between chemotherapy-induced taste alteration and cancer anorexia in breast cancer patients.\u003c/p\u003e\u003cp\u003eThe family functions as a complex and interconnected system in which emotions, behaviors, and communication patterns among members significantly influence individuals(Ding et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Family support not only encompasses tangible support in terms of economy and material, but also intangible support at the psychological and emotional levels(Han et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). As the primary social support network, familial support can help individuals, particularly patients, alleviate psychological stress and bolster their confidence in confronting illness(Qiu et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Studies demonstrate that robust family dynamics and support from relatives and friends positively impact the emotional well-being of cancer patients(Gui et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Jiang et al. observed that for individuals with breast cancer, family support not only aids in disease acceptance, coping, and recovery but also effectively mitigates negative psychological states, enhances illness perception, and improves quality of life. It serves as a pivotal element in patients\u0026rsquo; successful adjustment to a new way of life(Jiang et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Building upon this, we propose Hypothesis 3: Family support may play a mediating role between chemotherapy-induced taste alteration and cancer anorexia in breast cancer patients.\u003c/p\u003e\u003cp\u003eThis study is grounded in Folkman and Lazarus\u0026rsquo;s stress coping theory, which posits that stress is a dynamic process stemming from individuals perceiving an imbalance between coping resources and demands following subjective evaluation of environmental stressors. Coping involves cognitive and behavioral strategies aimed at alleviating stress(Folkman et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1986\u003c/span\u003e). The theory underscores the importance of primary appraisal, secondary appraisal, and reappraisal when individuals are confronted with stressors to determine appropriate coping responses(Seib et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Breast cancer patients undergoing chemotherapy experience not only direct physiological toxic side effects but also psychological stress from the disease itself, prompting individual psychological adaptation mechanisms. Patients with higher psychological resilience are more likely to utilize cognitive restructuring strategies (e.g., reframing taste alterations as temporary treatment-related effects) and proactive coping behaviors (e.g., mobilizing family support) to reduce stress. This process can potentially decrease the risk of cancer-related anorexia by enhancing eating experiences and emotional well-being. Consequently, we propose Hypothesis 4: Psychological resilience and family support act as sequential mediators in the association between chemotherapy-induced taste alterations and cancer-related anorexia in breast cancer patients.\u003c/p\u003e\u003cp\u003eOur study investigates the chain mediation effects of psychological resilience and family support among breast cancer patients undergoing chemotherapy to understand the relationship between chemotherapy-induced taste alterations and cancer-related anorexia. The study aims to offer theoretical insights, targeted interventions, and practical recommendations for managing taste alteration-induced anorexia in chemotherapy patients with breast cancer. The framework of the research hypothesis is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study design and setting\u003c/h2\u003e\u003cp\u003eBy using the convenience sampling method, a cross-sectional questionnaire survey was conducted among patients undergoing breast cancer chemotherapy in a tertiary general hospital in Henan Province from November 2024 to April 2025. This study was conducted in line with the principles of the Declaration of Helsinki and approved by the Ethics Committee of Henan Provincial People\u0026rsquo;s Hospital (Review Number: 2022\u0026thinsp;\u0026minus;\u0026thinsp;172).\u003c/p\u003e\u003cp\u003eInclusion criteria for patients: (1) Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years old; (2) Diagnosed as breast cancer by histopathology and in the postoperative treatment stage(Li et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e); (3) Clarify one's own disease diagnosis and the progression of the condition; (4) Possess good language comprehension and communication skills; (5) Agree to participate in the research and sign the informed consent form. Exclusion criteria: (1) Those who cannot be swallowed orally; (2) Those with mental illness or consciousness disorders; (3) Accompanied by major diseases such as cachexia, systemic infection or failure of major organs like the heart and liver. According to the sample size calculation method of analytical research, the sample size should be 5 to 10 times the number of variables. This study involves 26 independent variables. To ensure the quality of the questionnaire and consider a 10% dropout rate, the sample size should be 145\u0026ndash;289 participants.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Data collection\u003c/h2\u003e\u003cp\u003eDuring the hospitalization and chemotherapy period of breast cancer patients, researchers informed the patients of the research purpose and significance using unified instructions. After obtaining the patients\u0026rsquo; consent, questionnaires were distributed for face-to-face surveys, and the disease-related information was filled in according to the patients' medical records. Ultimately, a total of 360 questionnaires were distributed in this survey, and 346 valid questionnaires were retrieved, with an effective recovery rate of 96.11%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Measurements\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.3.1. General information questionnaire\u003c/h2\u003e\u003cp\u003eThis questionnaire was developed independently through the discussion of the research team. The contents include BMI, age, marital status, educational level, religious belief, place of residence, etc. Disease-related information, such as surgical methods, tumor differentiation degree, other adjuvant treatments, combined chronic diseases, chemotherapy regimens, etc.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.3.2. Chemotherapy-induced Taste Alteration Scale (CiTAS)\u003c/h2\u003e\u003cp\u003eThis scale was developed by Kano et al(Kano \u0026amp; Kanda, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). And localized by Pang et al(Pang et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It includes four dimensions and 18 items: basic taste changes, abnormal taste changes, overall taste changes, and patients\u0026rsquo; eating disturbances. It uses a Likert 5-level scoring system, with scores ranging from 1 to 5 assigned from \u0026ldquo;no change\u0026rdquo; to \u0026ldquo;very severe\u0026rdquo;. The average score of each dimension was obtained by adding up the scores of each dimension item and then dividing by the number of items. The total score of the scale ranged from 18 to 90 points. The higher the score, the more severe the taste change. In this study, the Cronbach\u0026rsquo;s α coefficient was 0.899.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.3.3. Functional Assessment of Anorexia Cachexia Therapy Anorexia/Cachexia Subscale (FAACT-ACS)\u003c/h2\u003e\u003cp\u003eThis scale is currently the main assessment tool widely used internationally to evaluate the anorexia status of patients with advanced cancer. Developed by Ribaudo et al(Ribaudo et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). And translated into Chinese by Zhou et al.(Zhou et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), this scale consists of 12 items and uses a Likert 5-level scoring system. Points ranging from 0 to 4 are assigned from \u0026ldquo;strongly disagree\u0026rdquo; to \u0026ldquo;strongly agree\u0026rdquo;, with a total score ranging from 0 to 48. The higher the score, the lower the risk of cancer-related anorexia in patients. A total score of \u0026le;\u0026thinsp;24 indicates the presence of cancer-related anorexia. In this study, the Cronbach\u0026rsquo;s α coefficient was 0.607.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.3.4. 25-item Connor-Davidson resilience scale (CD-RISC-25)\u003c/h2\u003e\u003cp\u003eThis scale was jointly developed by Connor and Davidson(Connor \u0026amp; Davidson, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). It includes three dimensions, namely resilience (13 items), self-improvement (8 items), and optimism (4 items), totaling 25 items. The Likert 5-level scoring method was adopted; \u0026ldquo;completely non-compliant\u0026rdquo; to \u0026ldquo;completely compliant\u0026rdquo; will be scored from 0 to 4 points in sequence. The total score ranges from 0 to 100 points, and the higher the score, the higher the psychological resilience of the test subject. In this study, the Cronbach\u0026rsquo;s α coefficient was 0.949.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e2.3.5. Family Adaptation, Partnership, Growth, Affection, Resolve Index (APGAR)\u003c/h2\u003e\u003cp\u003eThis questionnaire was compiled by Smilkstein in 1978(Smilkstein, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1978\u003c/span\u003e). Medical staff often understand the family support situation of patients through the APGAR questionnaire. The questionnaire consists of five items: fitness, intimacy, emotion, cooperation and growth. The Likert three-level scoring method was adopted. \u0026ldquo;Almost rarely\u0026rdquo; received 0 points, \u0026ldquo;sometimes like this\u0026rdquo; received 1 point, and \u0026ldquo;often like this\u0026rdquo; received 2 points. The total score of the questionnaire ranged from 0 to 10 points. A score of 0 to 3 indicated severe impairment of family care, 4 to 6 indicated moderate impairment of family care, and 7 to 10 indicated good family care. In this study, the Cronbach\u0026rsquo;s α coefficient was 0.881.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Statistical analysis\u003c/h2\u003e\u003cp\u003eThe data were entered and verified by two people using Excel software, and the data were processed and analyzed using SPSS 26.0 statistical software. Statistical description was conducted using frequency and general data that constituted the comparison research objects. Normality tests are conducted on continuous variables. Continuous variables that conform to a normal distribution are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The influence of general data on cancer anorexia in patients with breast cancer was analyzed by t-test and one-way ANOVA. Pearson correlation analysis was used to analyze the correlations between cancer anorexia in breast cancer patients and chemotherapy-related taste changes, family support, and psychological resilience. The chain mediating effect was verified using Model 6 in the PROCESS v4.1 plugin of the SPSS macro program written by Hayes(Hayes \u0026amp; Scharkow, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The mediating effect was tested using the Bootstrap method. The sample size was repeatedly sampled 5,000 times, and the 95% confidence interval (CI) was calculated. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. Common method deviation test\u003c/h2\u003e\n \u003cp\u003eHarman\u0026rsquo;s single-factor test was conducted to assess common method bias (CMB) before data analysis(Podsakoff et al., \u003cspan class=\"CitationRef\"\u003e2003\u003c/span\u003e). The results revealed that there were 12 factors with eigenvalues greater than 1, and the variance explained by the first factor was 22.57% (lower than the 40% threshold), indicating that no serious CMB exists in this study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2. Multicollinearity assessment\u003c/h2\u003e\n \u003cp\u003eIn this study, the Variance Inflation Factor (VIF) method was employed to perform a covariance test. The results indicated that the VIF values ranged from 1.070 to 2.903, all of which were below the threshold of 5, suggesting that there was no significant collinearity issue among the variables.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3. Sample characteristics\u003c/h2\u003e\n \u003cp\u003eThe characteristics of the patients are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. In this survey, all 346 breast cancer patients were female. 40% of the patients had an overweight BMI, 42% were aged between 46 and 59, and 44% had a junior high school education level. In terms of disease stage, 40% of the patients were in the third stage of the disease, and 77% of the patients had cancer metastasis.\u003c/p\u003e\n \u003cp\u003eBased on BMI, age, education level, TNM stage, whether metastasis occurred and the number of other adjuvant treatments received, statistically significant differences were observed in the scores of breast cancer patients for cancer anorexia (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4. Mean scores and correlations between variables\u003c/h2\u003e\n \u003cp\u003eRelevant analysis indicates that there is a significant correlation between each pair of variables. Cancer-related anorexia was positively correlated with psychological resilience and family support (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.242, 0.318, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and negatively correlated with chemotherapy-related taste changes (\u003cem\u003er\u003c/em\u003e= -0.377, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), as shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5. Chain mediating effect test\u003c/h2\u003e\n \u003cp\u003eAfter standardizing the data, we used chemotherapy-related taste changes (X) as the independent variable, psychological resilience (M1) and family support (M2) as mediating variables, and cancer-related anorexia (Y) as the dependent variable. We conducted a mediation effect test using the PROCESS 4.1 Model 6 macro program in SPSS, and analyzed the chain mediation effects of psychological resilience and family support between chemotherapy-related taste changes and cancer-related anorexia using the bias-corrected non-parametric percentile Bootstrap method (with 5000 resampling repetitions and a 95% confidence interval).\u003c/p\u003e\n \u003cp\u003eThe regression analysis results (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) indicate that chemotherapy-related taste changes negatively predict psychological resilience, family support, and cancer anorexia (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.392, -0.116, -0.108, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Psychological resilience positively predicts family support and cancer anorexia (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043,0.034, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and family support positively predicts cancer anorexia (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.217, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n \u003cp\u003eThe results of the mediating effect analysis (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) showed that the effect value of chemotherapy-related taste changes \u0026rarr; psychological resilience \u0026rarr; cancer anorexia was \u0026minus;\u0026thinsp;0.013, and the 95% confidence intervals did not include 0. The mediating effect was established. The effect size of chemotherapy-related taste changes \u0026rarr; family support \u0026rarr; cancer anorexia was \u0026minus;\u0026thinsp;0.025, and the 95% confidence intervals did not include 0, indicating the establishment of the mediating effect. The effect value of chemotherapy-related taste changes \u0026rarr; psychological resilience \u0026rarr; family support \u0026rarr; cancer anorexia was \u0026minus;\u0026thinsp;0.004, and the 95% confidence intervals did not include 0. The chain mediating effect was established.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of different characteristics of participants(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;346)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/F\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003cp\u003e(kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e24.883\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.5\u0026ndash;23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026minus;27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e14.572\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145(42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMarital\u003c/p\u003e\n \u003cp\u003estatus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.766\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327(95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003cp\u003elevel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003cp\u003eand below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e11.373\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school or technical secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity (including\u003c/p\u003e\n \u003cp\u003ejunior college) or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e2.759\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143(41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eHousehold monthly income percapita (RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e2.127\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3000\u0026ndash;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5000\u0026ndash;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.54\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMain carer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.856\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing assistant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily and friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e329(95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.59\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing staff and\u003c/p\u003e\n \u003cp\u003erelatives work together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreast-preserving surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e1.719\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModified radical mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125(36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther ways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eCancer stage(TNM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e23.316\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.65\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMetastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e4.482\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e266(77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eNumber of chemotherapy cycles under way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.675\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225(65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eNumber of other adjuvant treatments received\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109(32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e39.891\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e160(46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMerge other chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e255(74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.155\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003eChemotherapy regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTAH(P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003e1.315\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"7\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTP(Cb,DDP)H(P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTCH(P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTH(P)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.46\u0026thinsp;\u0026plusmn;\u0026thinsp;4.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eNote: SD\u0026thinsp;=\u0026thinsp;standard deviation; a\u0026thinsp;=\u0026thinsp;Independent-sample t-tests, b\u0026thinsp;=\u0026thinsp;one-way ANOVA.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eT, taxanes, including docetaxel, albumin-bound paclitaxel, and paclitaxel; A, anthracyclines, including epirubicin, pirarubicin, doxorubicin, doxorubicin; C, cyclophosphamide; P, Cb, carboplatin, DDP, Cisplatin; H/P, approved trastuzumab, pertuzumab\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMean scores and correlations between variables.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.Chemotherapy-induced taste alteration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.942\u0026thinsp;\u0026plusmn;\u0026thinsp;10.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.Psychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.439\u0026thinsp;\u0026plusmn;\u0026thinsp;13.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.306**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.Family support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.191\u0026thinsp;\u0026plusmn;\u0026thinsp;2.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.510**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.348**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.Cancer anorexia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.601\u0026plusmn;\u0026thinsp;4.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.377**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.242**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.318**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eNote: **\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRegression analysis for mediation model.(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;346)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eRegression Equation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eGlobal Fitting Index\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRegression Coefficient Significance\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOutcome Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy-induced\u003c/p\u003e\n \u003cp\u003etaste alteration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;5.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy-induced\u003c/p\u003e\n \u003cp\u003etaste alteration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e73.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;9.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eCancer anorexia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemotherapy-induced\u003c/p\u003e\n \u003cp\u003etaste alteration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e23.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;4.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDecomposition of standardized effects from the model.(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;346)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMediating Path\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect Size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBootSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBootLLCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBootULCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEfficiency ratio(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMediating Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInd1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInd2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInd3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eNote: Ind1༚Chemotherapy-induced taste alteration\u0026rarr;Psychological resilience\u0026rarr;Cancer anorexia;Ind2༚Chemotherapy-induced taste alteration\u0026rarr;Family support\u0026rarr;Cancer anorexia༛Ind3༚Chemotherapy-induced taste alteration\u0026rarr;Psychological resilience\u0026rarr;Family support\u0026rarr;Cancer anorexia\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTo our knowledge, this is the first study to explore the interrelationships between psychological resilience, family support, chemotherapy-induced taste alteration, and cancer anorexia among breast cancer patients in China, Our findings unveiled three distinct pathways through which chemotherapy-induced taste alteration indirectly influenced cancer anorexia: (a) only through psychological resilience, (b) only via family support, and (c) through the combined effect of psychological resilience and family support.\u003c/p\u003e\n\u003cp\u003eThe results of univariate analysis in this study showed that BMI, age, education level, TNM stage, whether metastasis occurred and the number of other adjuvant treatments received were the influencing factors of cancer anorexia in breast cancer patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Among them, patients with a body weight that is too low (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5) may have insufficient nutritional reserves and poor tolerance to chemotherapy. The loss of appetite caused by changes in taste has a more significant impact on their nutritional status, and thus they are more prone to cancer-related anorexia. As people age, the physiological functions of the human body gradually decline, and the sensitivity of taste and smell also decreases. Chemotherapy further aggravates this change, causing elderly patients to have a weakened perception of food taste and a reduced appetite(Dotan et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Patients with a lower level of education may lack knowledge about the disease and treatment, have insufficient awareness of the side effects of chemotherapy, and thus find it difficult to take effective measures to relieve the discomfort caused by changes in taste, making them more prone to anorexia. Patients with a higher TNM stage usually have more severe conditions, increased physical consumption, and the intensity of chemotherapy may also be relatively greater, which has a more obvious impact on their taste and appetite(Rha \u0026amp; Lee, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Patients with metastasis face a more serious disease threat. The body\u0026rsquo;s stress response and metabolic disorders may lead to abnormal taste and loss of appetite. Patients who receive a large number of other adjuvant treatments may simultaneously suffer from the side effects of multiple treatments (such as radiotherapy, targeted therapy, etc.), remain in a state of treatment stress for a long time, and their body\u0026rsquo;s metabolic regulation mechanism is disrupted, which aggravates the impact on taste and appetite.\u003c/p\u003e\n\u003cp\u003eNotably, Pearson correlation analysis in this study showed that taste changes in breast cancer patients undergoing chemotherapy negatively predicted their risk of cancer-related anorexia, verifying Hypothesis 1. From a physiological mechanism perspective, chemotherapy drugs (such as cisplatin and doxorubicin) can cause damage to taste bud cells and related neural pathways in the oral cavity(Ravasco, \u003cspan class=\"CitationRef\"\u003e2005\u003c/span\u003e). Taste buds, as key receptors for sensing taste stimuli, their impaired function can lead to changes in the perception of food flavors. Damage to neural pathways can affect the transmission of taste information to the brain, causing deviations in the brain\u0026apos;s recognition of food flavors and thereby reducing the patient\u0026apos;s interest in eating(Vukmanovic et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, the taste changes related to chemotherapy cause patients to experience unpleasant taste changes such as hallucinations and taste loss, which affect the palatability of food and further weaken their appetite, thus making them even more reluctant to eat(Penna, \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). It is recommended that medical staff formulate targeted and individualized chemotherapy plans for different patients, intervene from multiple dimensions such as diet, nutrition, oral care and psychological support, regularly monitor the recovery of taste, reduce the risk of cancer anorexia, and improve the prognosis of patients(Hopkinson, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAdditionally, our research found that psychological resilience plays a mediating role in chemotherapy-related taste changes and cancer anorexia in breast cancer patients, which validates Hypothesis 2. That is, patients with chemotherapy-related taste changes can reduce the risk of cancer-related anorexia by enhancing psychological resilience. Research shows that patients with higher psychological resilience can better regulate their emotions, actively deal with difficulties and challenges in life, and thus maintain a relatively stable psychological state when facing diseases(Izydorczyk et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). Specifically, such patients are adept at using positive coping strategies to face the challenges of chemotherapy. They can proactively adjust their mindset and actively seek solutions, such as trying different food flavors and adjusting their diet structure, to alleviate the discomfort caused by changes in taste and better maintain their appetite and nutrient intake. Meanwhile, we found that family support plays a mediating role in chemotherapy-related taste changes and cancer anorexia in breast cancer patients, which validates Hypothesis 3. That is, patients with chemotherapy-related taste changes can indirectly alleviate cancer anorexia by seeking family support. Research shows that family support can provide emotional comfort and practical assistance to patients, making them feel the care and support from their families, and thereby enhancing their confidence and courage to face the disease(Zhong et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). When facing eating difficulties caused by changes in taste, the encouragement and company of family members can relieve the patient\u0026apos;s anxiety and stress, help the patient maintain a good psychological state, and at the same time provide meals according to the patient\u0026apos;s taste preferences to promote the recovery of appetite(Vukmanovic et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFurthermore, our research\u0026apos;s mediating model regression analysis indicates that psychological resilience and family support play a chain mediating role in chemotherapy-related taste changes and cancer anorexia in breast cancer patients, which supports Hypothesis 4. This discovery reveals the mechanism by which psychological resilience and family support regulate chemotherapy-related taste changes and cancer anorexia in breast cancer patients, that is, chemotherapy-related taste changes influence cancer anorexia through the chain mediation of psychological resilience and family support. Research shows that strong psychological resilience helps patients play a supportive role in their families through good emotional communication and enhance their subjective decision-making ability within the family system. Specifically, good psychological resilience enables patients to seek and accept family support more effectively when facing taste changes caused by chemotherapy. The enhancement of family support can also improve the patient\u0026apos;s adaptability, jointly acting on the appetite status and reducing the risk of cancer-related anorexia. Therefore, when conducting clinical intervention, nursing managers should simultaneously pay attention to the patients\u0026apos; internal psychological adjustment and the optimization of the external family support environment, and form a comprehensive intervention strategy to improve the cancer anorexia problem of breast cancer patients, enhance their quality of life and treatment effect.\u003c/p\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e4.1. Limitations\u003c/h2\u003e\n \u003cp\u003eThere were some limitations in this study. Firstly, the study only selected breast cancer patients from one hospital, and the sample source was rather limited, which might have restricted the extrapolation of the research results. Secondly, the study adopted a cross-sectional questionnaire survey, which only collected data from patients once during chemotherapy, making it impossible to determine a causal relationship. Thirdly, the study didn\u0026rsquo;t conduct long-term follow-up on the patients, making it impossible to assess the dynamic changes and evolution over time of chemotherapy-related taste alterations and cancerous anorexia. Future research can further verify these findings by adopting longitudinal design, expanding sample sources and dynamic tracking.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e4.2. Clinical implications\u003c/h2\u003e\n \u003cp\u003eDrawing upon our research findings, healthcare providers must recognize the direct impact of chemotherapy-related taste changes on cancer anorexia in breast cancer patients, as well as the crucial chain effect of psychological resilience and family support in this complex process. The research results suggest that medical staff should pay attention to the taste changes of patients during chemotherapy and formulate personalized intervention plans from multiple dimensions such as diet, nutrition, oral care and psychological support. At the same time, the significance of psychological resilience training and the optimization of family support was emphasized, providing a theoretical basis for clinical practice, promoting multidisciplinary team collaboration, and forming a comprehensive intervention strategy. This not only helps to reduce the risk of cancer anorexia in patients, but also improves their treatment compliance and quality of life, providing scientific support for the improvement of the nursing practice guidelines for breast cancer patients.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study investigated the crucial role of psychological resilience and family support in cancer-related anorexia in Chinese breast patients. Additionally, we provided preliminary evidence demonstrating that psychological resilience and family support play a significant mediating role in the relationship between chemotherapy-related taste changes and cancer-related anorexia. Therefore, when formulating future healthcare strategies, medical professionals should pay attention to changes in patients\u0026rsquo; taste and improve their appetite and quality of life by enhancing psychological resilience and optimizing family support.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to all the breast cancer patients who participated in this study and Hayes, who provided the PROCESS macro for SPSS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eXin CHEN:\u0026nbsp;\u003c/strong\u003eWriting-original draft, Software, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. \u003cstrong\u003eDongjun ZHANG:\u003c/strong\u003e Writing - review \u0026amp;editing, Validation, Methodology. \u003cstrong\u003eZhen LI:\u0026nbsp;\u003c/strong\u003eWriting -review \u0026amp; editing, Formal analysis, Conceptualization. \u003cstrong\u003eYingjie MA:\u003c/strong\u003e Data curation, Investigation. \u003cstrong\u003eHuijie HOUand Yanyan DONG:\u003c/strong\u003e Supervision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Henan Provincial Medical Science and Technology Research Project (SBGJ202102002).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Henan Provincial People\u0026apos;s Hospital [Ethics Approval No. (2022) Lun Shen No. (172)] and complied with the Declaration of Helsinki.The purpose of the study was explained to all participants before the survey was conducted and informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eSchool of Nursing, Xinxiang Medical University, Xinxiang, Henan, 453003, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eSchool of Psychology, Xinxiang Medical University, Xinxiang, Henan, 453003, China \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eHenan Provincial People\u0026apos;s Hospital, Zhengzhou, Henan, 450003, China\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAl-Amouri, F. 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Re-validation and shortening of the Functional Assessment of Anorexia/Cachexia \u0026nbsp;Therapy (FAACT) questionnaire [Clinical Trial; Journal Article; Research Support, Non-U.S. Gov\u0026apos;t; Validation Study]. \u003cem\u003eQuality of Life Research\u003c/em\u003e, 9(10), 1137-1146. http://doi.org/10.1023/a:1016670403148\u003c/li\u003e\n \u003cli\u003eSato, R., Da, F. G., Das, N. W., \u0026amp; von Haehling, S. (2025). Mechanisms and pharmacotherapy of cancer cachexia-associated anorexia [Journal Article; Review]. \u003cem\u003ePharmacology Research \u0026amp; Perspectives\u003c/em\u003e, 13(1), e70031. http://doi.org/10.1002/prp2.70031\u003c/li\u003e\n \u003cli\u003eSeib, C., Porter-Steele, J., Ng, S. K., Turner, J., McGuire, A., McDonald, N., Balaam, S., Yates, P., McCarthy, A., \u0026amp; Anderson, D. (2018). Life stress and symptoms of anxiety and depression in women after cancer: The \u0026nbsp;mediating effect of stress appraisal and coping [Journal Article; Research Support, Non-U.S. Gov\u0026apos;t]. \u003cem\u003ePsycho-Oncology\u003c/em\u003e, 27(7), 1787-1794. http://doi.org/10.1002/pon.4728\u003c/li\u003e\n \u003cli\u003eSmilkstein, G. (1978). The family APGAR: a proposal for a family function test and its use by \u0026nbsp;physicians [Case Reports; Journal Article]. \u003cem\u003eJournal of Family Practice\u003c/em\u003e, 6(6), 1231-1239.\u003c/li\u003e\n \u003cli\u003eTomich, P. L., \u0026amp; Helgeson, V. S. (2006). Cognitive adaptation theory and breast cancer recurrence: Are there limits? 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Validation of the Chinese version of functional assessment of anorexia-cachexia \u0026nbsp;therapy (FAACT) scale for measuring quality of life in cancer patients with \u0026nbsp;cachexia [Journal Article]. \u003cem\u003eSupportive Care in Cancer\u003c/em\u003e, 25(4), 1183-1189. http://doi.org/10.1007/s00520-016-3508-4\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Chemotherapy-induced taste alteration, Cancer anorexia, Psychological resilience, Family support, Chain mediating effect","lastPublishedDoi":"10.21203/rs.3.rs-7268370/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7268370/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e The incidence of breast cancer is high, and chemotherapy is easy to cause taste changes, induce cancer anorexia, affect treatment tolerance and quality of life. However, clinical attention is mostly paid to obvious symptoms, ignoring taste changes and cancer anorexia, and patients rarely report actively.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjectives\u003c/b\u003e To explore the influence of chemotherapy-induced taste alteration on cancer anorexia in patients with breast cancer, as well as the mediating role of psychological resilience and family support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDesign\u003c/b\u003e A cross-sectional study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e By using the convenience sampling method, breast cancer patients who visited a tertiary general hospital in Henan Province were selected as the research subjects. Questionnaire surveys were conducted through the general information questionnaire, the Chemotherapy-induced Taste Alteration Scale, the Cancer Anorexia Scale, the Psychological Resilience Scale, and the Family Support Scale, and 346 valid data were collected.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e (1)Cancer-related anorexia was negatively correlated with Chemotherapy-induced taste alteration (\u003cem\u003er\u003c/em\u003e= -0.377, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and positively correlated with psychological resilience and family support (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.242, 0.318, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01); (2)The direct effect of chemotherapy-induced taste alteration on cancer anorexia in breast cancer patients was significant (\u003cem\u003eβ\u003c/em\u003e=-0.108, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); (3)Between chemotherapy-induced taste alteration and cancer-related anorexia, psychological resilience and family support not only play a mediating role alone but also jointly play a chain mediating role, with a total mediating effect of 28.48%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e Chemotherapy-induced taste alteration can not only directly affect cancer anorexia in breast cancer patients, but also indirectly affect cancer anorexia through psychological resilience and family support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical trial number\u003c/b\u003e Not applicable\u003c/p\u003e","manuscriptTitle":"The chain mediating effects of psychological resilience and family support the association between chemotherapy-induced taste alteration and cancer anorexia among Chinese breast cancer patients: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 15:11:05","doi":"10.21203/rs.3.rs-7268370/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-03T07:18:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-20T12:18:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-12T19:30:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236524553389372478224211822385884396272","date":"2025-09-11T05:54:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97844022231969701488970631590160492717","date":"2025-09-09T17:45:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250469650640659487722467532753118066125","date":"2025-09-04T12:59:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T12:43:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-07T07:00:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-03T22:46:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-03T22:45:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-08-01T07:07:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be05ce1b-bc97-4d59-9fc9-2b5841feb623","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:02:02+00:00","versionOfRecord":{"articleIdentity":"rs-7268370","link":"https://doi.org/10.1186/s40359-025-03761-2","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2025-11-25 15:57:50","publishedOnDateReadable":"November 25th, 2025"},"versionCreatedAt":"2025-09-11 15:11:05","video":"","vorDoi":"10.1186/s40359-025-03761-2","vorDoiUrl":"https://doi.org/10.1186/s40359-025-03761-2","workflowStages":[]},"version":"v1","identity":"rs-7268370","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7268370","identity":"rs-7268370","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}