The relationship between alexithymia, meaning in life, and quality of life in older breast cancer patients: a cross-sectional study based on variable-centered and person-centered perspectives

Abstract

Background Alexithymia, characterized by difficulties in identifying and expressing emotions, has been linked to diminished quality of life in older breast cancer patients, a vulnerable population facing multifaceted psychosocial challenges. While prior research has explored these associations, investigations have predominantly adopted a variable-centered approach, overlooking the potential statistical mediating role of meaning in life. Moreover, no studies have examined the heterogeneity of alexithymia and meaning in life through a person-centered lens, which may reveal distinct subgroups with different quality of life outcomes among older breast cancer patients. Methods A cross-sectional design was employed, recruiting 577 older breast cancer patients from four tertiary grade A hospitals in Sichuan Province, China, between April 2 and May 29, 2025. Participants completed validated self-report measures, including the 20-item Toronto Alexithymia Scale (TAS-20-C), the Meaning in Life Questionnaire (MLQ), the Quality of Life Scale (QOLS), and a demographic questionnaire. PROCESS macro (Model 4) was used to test a cross-sectional statistical mediation model from the variable-centered perspective, while latent profile analysis identified subgroups from the person-centered perspective. Results Variable-centered analyses showed that alexithymia was negatively associated with quality of life, and meaning in life statistically accounted for part of this association. Person-centered analyses identified two distinct latent profiles: a high alexithymia—low meaning in life subgroup, characterized by elevated emotional processing deficits and reduced purpose, and a medium alexithymia—medium meaning in life subgroup, exhibiting adaptive emotional regulation and strong existential coherence. The former subgroup reported significantly lower quality of life scores compared to the latter. Conclusion By applying meaning construction theory through a dual-perspective framework, this study clarifies patterns of association among alexithymia, meaning in life, and quality of life in older breast cancer patients and highlights the value of person-centered profiling for targeted interventions. These findings offer novel theoretical insights and practical implications, such as tailored psychotherapeutic strategies that may enhance meaning-making and address alexithymia, with the potential to promote quality of life in this population.