The association between radiation dermatitis severity and social integration among patients with head and neck cancer undergoing radiotherapy: Statistical mediation by mood states.

Objectives: This study aimed to examine whether positive and negative mood composites statistically mediate the association between radiation dermatitis severity and social integration among patients with head and neck cancer undergoing radiotherapy. Methods: Employing a cross-sectional design, this study recruited 223 eligible patients with head and neck cancer undergoing radiotherapy through consecutive sampling at a tertiary-level hospital in Liaoning Province, China, from January to December 2024. Research instruments included a demographic questionnaire, the Radiation-Induced Skin Reaction Assessment Scale, the Profile of Mood States-Short Form, and the Social Cohesion Scale. The mediation analysis focused on the subsample of 183 patients with dermatitis. A parallel mediation analysis was performed using the SPSS PROCESS macro (Model 4), controlling for potential confounders including age, sex, marital status, education, radiation dose, and concurrent chemotherapy. Results: The severity of radiation dermatitis was significantly negatively correlated with social integration and positive emotions, while being significantly positively correlated with negative emotions. After controlling for covariates, the direct association between dermatitis severity and social integration was not statistically significant. The bootstrap-based mediation analysis revealed statistically significant indirect associations through both the positive and negative mood composites. Specifically, greater dermatitis severity was associated with higher negative emotions and lower positive emotions, which in turn were associated with reduced social integration. Conclusions: These cross-sectional findings suggest that mood states may represent relevant pathways linking radiation dermatitis severity to social integration in patients with head and neck cancer undergoing radiotherapy. As the present design cannot establish causality, the observed associations are hypothesis-generating. Psychological screening and supportive care warrant further evaluation alongside dermatitis management. Longitudinal and interventional studies are required to confirm the directionality of these pathways and to determine whether targeting mood states improves social integration outcomes in this population.