The Effect of Chemotherapy-Induced Alopecia Distress on Social Isolation and Quality of Life: A Structural Equation Modelling Study

<title>Abstract</title> <p> <bold>Purpose</bold> Chemotherapy-induced alopecia (CIA) affects approximately 65% of patients receiving cytotoxic agents and constitutes a significant psychosocial burden. Although prior studies have documented CIA's impact on body image and general quality of life, social isolation as an independent outcome and the differential contributions of distinct CIA distress dimensions to social isolation and quality of life have not been simultaneously modelled. This study examined the direct effects of CIA distress subdimensions — physical, emotional, activity-related, and relationship-related — on social isolation and quality of life using structural equation modelling. <bold>Methods</bold> A cross-sectional study was conducted between December 2022 and May 2023 at a tertiary oncology centre in Turkey. A total of 353 patients undergoing chemotherapy with Grade ≥2 alopecia (NCI-CTCAE) were recruited via convenience sampling. Data were collected using the Chemotherapy-Induced Alopecia Distress Scale (CADS), the Chemotherapy-Related Alopecia Quality of Life Scale (CRA-QoL), and the Social Isolation Scale. Path analysis was performed using SPSS 22.0 and AMOS 25. <bold>Results</bold> The mean CADS score was 17.81±8.64, exceeding the high-distress threshold. The overall model demonstrated good fit (χ²/df=1.73; GFI=0.99; RMSEA=0.05), with CIA distress explaining 61.5% of variance in social isolation and 68.6% in quality of life. In the subdimension model, emotional distress was the strongest predictor of social isolation (β=0.42, p&lt;.001), followed by activity-related (β=0.31) and relationship-related distress (β=0.17). Activity-related distress exerted the greatest negative effect on quality of life (β=−0.54, p&lt;.001), followed by emotional distress (β=−0.32). The subdimension model explained 62.9% and 69.0% of variance in social isolation and quality of life, respectively. <bold>Conclusions</bold> CIA distress substantially impairs social functioning and quality of life. Emotional distress is the primary driver of social isolation, while activity-related distress most strongly compromises quality of life. These findings offer oncology nurses an evidence-based framework for prioritising targeted psychosocial interventions in CIA care. </p>