Association between postoperative bowel symptoms and social isolation in patients with rectal cancer: the moderating effects of social support and psychological resilience

Background60% ~ 90% of patients with rectal cancer undergoing sphincter-preserving surgery experience persistent bowel symptoms, and patients also report varying degrees of social isolation. Those bowel symptoms are often particularly pronounced during the first month after surgery, when patients may also experience substantial challenges in resuming social participation. However, evidence regarding the association between bowel symptoms and social isolation remains limited, and the potential moderating roles of psychosocial resources are not well understood.ObjectiveTo investigate the association between postoperative bowel symptoms and social isolation among patients with rectal cancer following sphincter-preserving surgery, and to further examine the moderating effects of perceived social support and psychological resilience.MethodsThis secondary analysis used data from an ongoing prospective observational cohort study of patients with rectal cancer undergoing sphincter-preserving surgery at a tertiary hospital in China. Demographic and clinical characteristics, perceived social support, and psychological resilience were assessed preoperatively, while bowel symptoms and social isolation were assessed at the 1-month postoperative follow-up. Baseline and 1-month postoperative data were used in this study. Spearman correlation analysis and hierarchical multiple linear regression analysis were performed to examine the association between postoperative bowel symptoms and social isolation. Simple slope analysis and Johnson–Neyman (J-N) analysis were conducted to evaluate the moderating roles of perceived social support and psychological resilience.ResultsA total of 351 patients were included in the final analysis. Postoperative bowel symptoms were significantly and positively correlated with social isolation (rs = 0.595, p < 0.001). After adjusting for relevant demographic and clinical factors, bowel symptoms remained independently associated with higher levels of social isolation (B = 0.506, p < 0.001). Separate moderation analyses showed significant interactions for perceived social support (B = −0.020, 95% CI −0.032 to −0.009, ΔR2 = 0.018, p = 0.001) and psychological resilience (B = −0.011, 95% CI −0.019 to −0.004, ΔR2 = 0.013, p = 0.003), although the additional variance explained by the interaction terms was modest. Simple slope analyses indicated that the association between bowel symptoms and social isolation remained significant across low, mean, and high levels of both moderators. Johnson–Neyman analysis showed that the association became nonsignificant only within a narrow range at the upper end of the observed social support distribution (actual scores ≥ approximately 69), whereas it remained significant across the entire observed range of psychological resilience.ConclusionPostoperative bowel symptom burden was positively associated with social isolation among patients with rectal cancer following sphincter-preserving surgery. Higher perceived social support and psychological resilience were associated with weaker bowel symptom–social isolation relationships. These findings support an integrated supportive-care approach that combines bowel symptom management with psychosocial and social support to address postoperative social isolation and facilitate social functioning.