Purpose in life and mortality among breast cancer survivors

Purpose in life (PIL), referring to an individual's sense of direction and meaning, may enhance well-being among cancer survivors. However, its relationship with survival remains unclear. This study investigates the association between PIL and mortality among breast cancer survivors and explores potential underlying pathways.

We analyzed 3,692 breast cancer survivors from the Women's Health Initiative, a cohort of postmenopausal women aged 50-79 recruited between 1993 and 1998. PIL was assessed in 2012 using a modified seven-item measure from Ryff and Keyes' Psychological Well-Being scale. Breast cancer cases and causes of death were confirmed through medical record review and death certificates. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), with mediation analysis exploring underlying pathways.

Over 9.1 years of follow-up, 1,627 women (44.1%) died. Women in the highest PIL quartile had a 33% lower mortality risk than those in the lowest quartile (HR = 0.67, 95% CI = [0.58, 0.78], p for trend < .0001). Stronger associations were observed among women under 70 (HR = 0.34, 95% CI = [0.19, 0.63]) and those diagnosed within the past year (HR = 0.28, 95% CI = [0.13, 0.58]). Physical activity, low perceived stress, and social engagement mediated 14.2%, 18.3%, and 13.7% of the association, respectively, collectively explaining 51% of the association.

Higher PIL is associated with improved survival in breast cancer survivors, with physical activity, stress reduction, and social engagement as key pathways. Goal-oriented interventions promoting PIL may improve survivorship outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).