Abstract
Loneliness is prevalent among patients with cancer in China and exerts adverse effects on both physical and mental health. This study aims to investigate the prevalence of loneliness and its associated factors, as well as to explore patients’ lived experiences, to inform clinical practice. A sequential explanatory mixed-methods design was adopted, incorporating a cross-sectional survey of 240 inpatients from oncology and general surgery departments of large-scale tertiary hospitals, along with descriptive phenomenological interviews conducted with 18 patients scoring ≥ 20 on the loneliness scale. Quantitative results revealed an average loneliness score of 19.13 ± 6.26, with 83.8% of patients experiencing moderate to severe loneliness. Multiple regression analysis identified introversion, absence of caregivers, disease duration > 3 years, low social support, depression, negative social expectations, and passive coping as significant predictors (P < 0.001). Qualitative analysis identified three main themes—experiences of loneliness, influencing factors (internal and external), and coping strategies—comprising seven subthemes. The findings underscore the importance of identifying high-risk patients and implementing targeted interventions, encouraging emotional expression, and providing supportive channels to mitigate loneliness.
Data availability
The datasets generated and analysed during the current study are not publicly available due to privacy and ethical restrictionson patient data, but are available from the corresponding author upon reasonable request.
References
Tan, S. S. et al. The association between loneliness and Health Related Quality of Life (HR-QoL) among community-dwelling older citizens. Int. J. Environ. Res. Public. Health 17(2), 600 (2020).
Lai, Y. C. Research progress on loneliness in the elderly. Chin. J. Gerontol. 32(11), 2429–2432 (2012).
Drageset, J. et al. Emotional loneliness is associated with mortality among mentally intact nursing home residents with and without cancer: a five-year follow-up study. J. Clin. Nurs. 22(1–2), 106–114 (2013).
Warren, N. et al. Psychosocial distress in women diagnosed with gynecological cancer. J. Health Psychol. 23(7), 893–904 (2018).
Ernst, M. et al. Loneliness predicts suicidal ideation and anxiety symptoms in long-term childhood cancer survivors. Int. J. Clin. Health Psychol. 21(1), 100201 (2021).
Secinti, E. et al. Social correlates of mental health in gastrointestinal cancer patients and their family caregivers: Exploring the role of loneliness. Support. Care Cancer. 27(6), 2077–2086 (2019).
Şahin, Z. A. & Tan, M. Loneliness, depression, and social support of patients with cancer and their caregivers. Clin. J. Oncol. Nurs. 16(2), 145–149 (2012).
Lin, J. J. et al. Relationship between illness perception, loneliness, anxiety and depression in gynecological cancer patients. Nurs. Res. 38(14), 2621–2627 (2024).
Sun, L. et al. Loneliness and its influencing factors in colorectal cancer patients. Shanghai J. Nurs. 25(02), 62–66 (2025).
Aßmann, E. S. et al. Risk factors and health behaviors associated with loneliness among cancer survivors during the COVID-19 pandemic. J. Behav. Med. 47(3), 405–421 (2024).
Choi, E. & Henneghan, A. M. Comparing fatigue loneliness, daytime sleepiness, and stress in younger and older breast cancer survivors: A cross-sectional analysis. Clin. J. Oncol. Nurs. 26(2), 155–164 (2022).
Xia, C. et al. Loneliness, spiritual well-being, and death perception, as well as their risk factors in urological cancer patients. Braz. J. Med. Biol. Res. 56, e12915 (2023).
Lin, J. et al. Factors Associated With Loneliness Among Chinese Patients With Cancer: A Cross-sectional Study. West. J. Nurs. Res. 46(1), 36–43 (2024).
Adams, R. N. et al. Cognitive and situational precipitants of loneliness among patients with cancer: A qualitative analysis. Oncol. Nurs. Forum. 43(2), 156–163 (2016).
Pape, E. et al. The trajectory of hope and loneliness in rectal cancer survivors with major low anterior resection syndrome: A qualitative study. Eur. J. Oncol. Nurs. 56, 102088 (2022).
Goossens, J. et al. Communication difficulties and the experience of loneliness in patients with cancer dealing with fertility issues: a qualitative study. Oncol. Nurs. Forum. 42(1), 34–43 (2015).
Meng, H. X. et al. A meta-analysis of the relationship between social media use and loneliness among the elderly. Stud. Psychol. Behav. 21(02), 280–288 (2023).
Yang, S. F. & Zhang, P. Z. Research on loneliness of the elderly in smart health care pension communities. J. Beijing Inst. Technol. (Social Sci. Edition). 24(06), 104–115 (2022).
Fan, X. H., Deng, J. L. & Li, X. T. Parental care and loneliness of left-behind children: a moderated mediation model. Psychol. Explor. 44(03), 226–231 (2024).
Zhang, Y., Zhang, C. L. & Wang, H. R. Relationship between self-esteem and depression in rural left-behind children: multiple mediating effects of social anxiety and loneliness. Mod. Prev. Med. 51(01), 55–59+87 (2024).
Bray, F. et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 74(3), 229–263 (2024).
Sung, H. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 71(3), 209–249 (2021).
Ni, P., Chen, J. L. & Liu, N. Sample size estimation in quantitative research in nursing. Chin. J. Nurs. 45(04), 378–380 (2010).
Adams, R. N. et al. The cancer loneliness scale and cancer-related negative social expectations scale: Development and validation. Qual. Life Res. 26(7), 1901–1913 (2017).
Cui, H. J. & Sun, Z. Chinese version and reliability and validity of the cancer loneliness scale and cancer-related negative social expectations scale. Nurs. Res. 34(15), 2676–2679 (2020).
Long, F. Y. Correlation study on social constraint, stoma acceptance, loneliness and psychosocial adaptation in colorectal cancer patients with stoma (Tianjin University of Traditional Chinese Medicine, 2022).
Li, J. Y. et al. Loneliness and influencing factors in nasopharyngeal carcinoma patients undergoing concurrent chemoradiotherapy. J. Nurs. Sci. 36(20), 73–76 (2021).
Zhao, Q. et al. A cross-sectional survey of loneliness and its impact on quality of life among cancer survivors in Xuhui District, Shanghai. Fudan Univ. J. Med. Sci. 50(01), 87–93+153 (2023).
Zuo, S. F. et al. Prevalence of loneliness among the elderly in China: a systematic review and Meta-analysis. Military Nurs. 41(09), 1–7 (2024).
Xu, D. Y. & Yang, Z. H. The mediating effect of social support between extraversion-introversion and loneliness in college students. Chin. Gen. Pract. 20(28), 3558–3562 (2017).
Allen, N. B. & Badcock, P. B. The social risk hypothesis of depressed mood: evolutionary, psychosocial, and neurobiological perspectives. Psychol. Bull. 129(6), 887–913 (2003).
Merdawati, L. et al. Factors associated with loneliness in middle-aged and older patients with breast cancer. Asia-Pacific J. Oncol. Nurs. 11(5), 100444 (2024).
Means-Christensen, A. J. et al. Relationships among pain, anxiety, and depression in primary care. Depress. Anxiety 25(7), 593–600 (2008).
Deckx, L. et al. Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Public. Health. 11, 825 (2011).
Andersen, B. L. et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J. Clin. Oncol. 32(15), 1605–1619 (2014).
Cai, L. X., Wang, S. Y. & Zheng, S. Effect of peer support intervention combined with health education on quality of life and BMI in patients after renal transplantation. Heilongjiang J. Traditional Chin. Med. 48(04), 103–104 (2019).
Funding
This article received no specific funding.
Author information
Authors and Affiliations
Contributions
Drafting the article and interpretation of analysis results: Xue Wang and Yanping Li; data acquisition: Xue Wang, Aiping Zhang and Lei Zhang; data analysis: Xue Wang and Yanping Li; manuscript preparation and revision: Zhao Liu and Cancan Han; conception and design of the study, interpretation of analysis results and final approval of the version to be submitted: Meixiang Jin and Yinji Jin.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval
This study was approved by the Approval to conduct the study was obtained from the study university and the Institutional Review Board (Approval no. 202410150425).
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Wang, X., Li, Y., Liu, Z. et al. Loneliness and its associated factors among patients with cancer in China: a sequential explanatory mixed-methods study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-46428-7
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-46428-7
