Mediating and moderating factors between stigma and adaptability to return to work for cancer survivors

Adaptability to return to work is a process by which cancer survivors(CSs) utilize accessible resources to reconstruct themselves. While the stigma, financial situation and social support are known to influence their adaptability to return to work, the mechanisms by which these factors work remain unclear. This study proposes a moderated mediation model to signify a pathway linking stigma to the adaptability to return to work. Data were analyzed using the PROCESS macro for R version 4.3.1. A total of 238 CSs, aged between 18 and 60 years (73.5% female), of whom 42.1% had returned to work, completed the ARTWS, SIS, COST-PROM, SSRS, HeLMS. Stigma had a negative associations on the adaptability to return to work. Both financial toxicity and social support mediated the relationship between stigma and the adaptability to return to work. Health literacy moderated both the direct pathway and the second half of the pathway mediated by financial toxicity. Specifically, the negative effects of stigma and financial toxicity on the adaptability to return to work were significantly attenuated when health literacy levels were high. CSs with higher health literacy may not experience excessive stigma, and experience less financial toxicity than those with lower health literacy. CSs possessing greater social support will be more effective in utilizing external resources to buffer the influence of financial toxicity, and thus adapt better to work.