Coping styles mediate the association between sense of coherence and symptom distress in patients with colorectal cancer undergoing chemotherapy: A cross-sectional study

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Objective Patients with colorectal cancer receiving chemotherapy commonly experience multidimensional symptom distress that impairs adherence and quality of life. Psychological resources such as sense of coherence (SOC) and individual coping styles may shape symptom experiences, but their interrelationships remain underexplored. This study aims to examine the association between SOC and symptom distress in patients with colorectal cancer undergoing chemotherapy, and to test whether coping styles mediate this association. Methods In this cross-sectional study, 255 consecutive patients with colorectal cancer were recruited between October 2024 and March 2025. Participants completed measures of sociodemographic/clinical characteristics, the Sense of Coherence Scale (SOC), the Medical Coping Modes Questionnaire (MCMQ), and the Memorial Symptom Assessment Scale (MSAS; Global Distress Index, GDI). Spearman correlation, hierarchical linear regression, and mediation analysis using bootstrapping (5,000 resamples) were performed in SPSS 25.0 to examine associations and indirect effects. Results The sample had a moderate SOC score (mean = 66.0) and a mean GDI of 1.44 ± 0.45. SOC was significantly correlated with confrontation ( β = 0.614, P < 0.01), avoidance ( β = −0.597, P < 0.01) and acceptance–resignation ( β = −0.735, P < 0.01). In regression analyses, SOC negatively predicted GDI ( β = −0.628, P < 0.01), while avoidance ( β = 0.151, P < 0.05) and acceptance–resignation ( β = 0.190, P < 0.05) positively predicted GDI. Mediation analysis indicated that the association between SOC and GDI operated via avoidance and acceptance–resignation coping styles. Conclusions In patients with colorectal cancer undergoing chemotherapy, a stronger sense of coherence is associated with lower symptom distress, and this relationship is partially mediated by maladaptive coping styles (avoidance and acceptance-resignation). Interventions that strengthen SOC and reduce reliance on avoidance/acceptance-resignation coping may help alleviate symptom burden. Longitudinal and intervention studies are warranted to confirm causal pathways and inform psychosocial care strategies. Trial registration The trial registration number was ChiCTR2400090844.

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