Post-traumatic stress disorder, resilience and cancer-related fatigue in breast cancer: A moderated network analysis

Cancer-related fatigue (CRF) is a prevalent and debilitating symptom among breast cancer survivors, often co-occurring with post-traumatic stress disorder (PTSD). Psychological resilience may attenuate this association, but the mechanisms and symptom-level dynamics remain unclear.

In a cross-sectional analysis of 285 breast cancer survivors, validated self-report measures of PTSD symptoms, resilience, and CRF were completed. We applied moderated network analysis to map item-level interrelations, followed by Johnson-Neyman probing of significant moderation pathways. Finally, three-dimensional response surface modelling quantified nonlinear and interactive effects of PTSD and resilience on CRF.

Between September and December 2024, 285 breast cancer survivors were enrolled. Intrusion (PTSD1) emerged as the most central PTSD symptom (expected influence = 1.35) and showed the strongest direct link with emotional fatigue (r = 0.28) in the moderated network analysis. Johnson-Neyman analysis indicated that the association between intrusion (PTSD1) and avoidance (PTSD3) weakened markedly as resilience increased (t = -4.94; p < 0.001). The positive hyperarousal-mental fatigue (PTSD2-CRF4) link became significant once resilience exceeded -16.2 (t = 1.59; p = 0.113). Response surface modelling confirmed a significant PTSD × resilience interaction (β = -0.02; p = 0.002), with survivors exhibiting low PTSD and high resilience reporting the lowest fatigue scores.

Resilience mitigates the impact of PTSD on CRF in breast cancer survivors. By decoupling intrusion and avoidance pathways and attenuating the association between hyperarousal and mental fatigue, these results underscore resilience-enhancing interventions as a comprehensive strategy to target PTSD symptom networks and alleviate fatigue in this population.