Social Support and Quality of Survival in Patients Undergoing Hepatocellular Carcinoma Surgery: The Mediating Roles of Fear of Cancer Recurrence and Resilience

Objective This study aims to: (1) examine the quality of survival and associated factors among postoperative HCC patients; (2) explore the relationship between social support, FCR, resilience, and quality of survival using a mediation model. Methods A multi-center cross-sectional study was conducted among 643 postoperative HCC patients recruited from three tertiary hospitals in Hunan Province from January 2023 to April 2025. Participants completed standard questionnaires to assess their quality of survival, social support, FCR, and resilience via the Quality of Life Scale for Liver Cancer Patients Version 2.0 (QOL-LC V2.0), Connor-Davidson Resilience Scale (CD-RISC), Social Support Rating Scale (SSRS), and Fear of Progression Questionnaire-Short Form (FoP-Q-SF), respectively. Multiple linear regression analysis was conducted to identify influencing factors of quality of survival, while a structured equation model (SEM) was employed to test the mediation associations between key variables. Results The quality of survival score of postoperative HCC patients was 118.82 ± 8.112. Regression analysis showed that social support (β = 2.29, P < 0.001), FCR (β=-0.26, P < 0.05), and resilience (β = 0.13, P < 0.05) were significantly associated with quality of survival. Mediation analysis showed that social support was associated with quality of survival both directly (direct effect: 0.673, 95%CI: 95%CI: 0.212, 0.885) and indirectly through FCR (indirect effect: -0.198; 95%CI: -0.031. -0.134) and resilience (indirect effect: 0.103, 95%CI: 0.041, 0.139), with FCR accounting for 65.78% of the total indirect effect. Conclusion Postoperative HCC patients exhibit poor quality of survival. Social support can not only improve patients' survival quality directly, but also indirectly through reducing FCR and enhancing resilience. Our findings offer crucial insights into the association and mechanism between social support and quality of survival, which may inform future targeted psychosocial interventions to improve the quality of survival.