The interplay between stigma and sleep quality in breast cancer: A cross-sectional network analysis

Purpose: Stigma, a subjective internal shame, arises from the association of cancer with death. Sleep quality can be considered a product of stigma. However, the extent of overlap or difference between the two remains unclear. Methods: In total, 512 survivors with breast cancer were recruited from the "Be Resilient to Breast Cancer" project between May and August 2023. This study estimated the stigma, sleep quality, and their relationship by con-ducting a cross-sectional network analysis. The social impact scale and Pittsburgh Sleep Quality Index scale were employed in this study . Results: The core symptom for stigma from the network analysis was alienation by people (Strength = 1.213, Betweenness = 13, Closeness = 0.00211). The core symptom for sleep quality were the sleep quality (Str = 1.114, Bet = 17, Clo = 0.01586). Regarding the combination network, results showed that self-isolation and daytime dysfunction were the bridge nodes and that daytime dysfunction was positively associated with feeling less capable than before (according to self) (r = 0.15). Conclusion: Our study demonstrates the core symptoms in different symptomatic networks, which can be targeted for treatment personalization and aid in the improvement of sleep quality and stigma in breast cancer patients.