Social Support and Psychological Capital in Older Adults with Esophageal and Gastric Cancer: A Cross-Sectional Study

Abstract

Background

Gastrointestinal cancers impose a significant psychological burden on older adults by depleting crucial personal resources. While social support is a known buffer against distress, its specific association with psychological capital (PsyCap) in this population, particularly after the completion of primary treatment, remains under-investigated. This study aimed to examine the relationship between perceived social support and PsyCap (self-efficacy, hope, resilience, and optimism) in this patient group.

Methods

This descriptive, cross-sectional study was conducted in Tehran, Iran, between July and December 2024. The sample included 310 adults aged ≥60 years with non-metastatic esophageal or gastric cancer. Crucially, all participants were assessed during their follow-up phase, 3–12 months after completing their primary treatment (surgery and/or chemo/radiotherapy). Data were collected using the MacGee Psychological Capital Questionnaire (26 items) and the Multidimensional Scale of Perceived Social Support (MSPSS, 22 items), and analyzed using correlation and multiple linear regression.

Results

A significant positive correlation was found between overall perceived social support and psychological capital (r = 0.380, p < 0.01). PsyCap levels were moderate (mean = 71.21), with hope and resilience as the strongest components. Notably, support from friends was rated higher than support from family. Continued engagement in part-time work was a significant predictor of both higher social support and PsyCap.

Conclusion

In this post-treatment cohort, higher perceived social support is associated with greater psychological capital. However, due to the cross-sectional design, these findings should be interpreted as state-dependent, hypothesis-generating data rather than evidence for definitive clinical recommendations. Future longitudinal studies are essential to establish causality and to inform targeted supportive care interventions.

Implications for Nursing Practice

Findings suggest that nursing interventions aimed at assessing and strengthening social networks, particularly friendships, and encouraging meaningful engagement like part-time work, may be beneficial for bolstering the psychological resources of older cancer survivors in their recovery phase.

Graphical Abstract

Video abstract

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Introduction

Aging is characterized by the decrease in the functioning of various body systems, including the cardiovascular, respiratory, urinary, reproductive, endocrine, and immune systems.¹ Statistics show that every 15 years, the population over 60 increases by about 4%, so the number of elderly people worldwide is expected to grow from 13% to 22% - by 2050.^2,3 Chronic illnesses during this stage can lead to pain, disability, reduced quality of life, social and economic issues, and increased long-term and specialized care costs.⁴ Cancer, as one of these chronic diseases, becomes more common with age.⁵ In elderly men, after skin conditions, gastrointestinal cancers are the most common, while in women, gastric cancer is among the top cancers after breast cancer.⁶ It is predicted that by 2030, 70% of cancer patients will be over 65, and more than 67% of cancer-related deaths will occur in the elderly.⁷

In the present era, changes in lifestyle and urbanization have contributed significantly to the rising incidence of gastrointestinal cancers.⁸ Globally, gastric cancer ranks as the second leading cause of cancer-related mortality, while esophageal cancer holds the fifth position.^8,9

A diagnosis of cancer profoundly impacts an individual’s life, increases the number of physical, psychological, social, economic, and familial challenges.^10,11 It disrupts daily functioning, social activities, and mental peace, often necessitating the adoption of new roles.¹² Therefore, patients tend to become more dependent and less capable of supporting others or engaging in routine social interactions.¹³

Social support, which involves mutual, informal, and spontaneous interpersonal exchanges within one’s social network, has a beneficial role in coping with the disease. It includes two key dimensions: perceived social support that represents individuals’ views regarding the support they receive, and social network size, which refers to the number of contacts known by the individual or patient.^14,15 As one of the most potent coping factors, social support facilitates confrontation with cancer and stressful circumstances, thereby easing the burden of difficulties faced by patients.^15–17

On the other hand, one of the most critical qualities that enables individuals to adapt effectively during the challenging experience of cancer is psychological capital. This construct is measured through components such as self-efficacy, optimism, hope, and resilience.¹⁸ Psychological capital includes hope, which helps individuals overcome desperation, pursue their goals, and reduce feelings of intolerability about the future. Optimism reflects positive expectations regarding outcomes.¹⁹ Resilience shows the ability of positive adaptation and flexibility in the face of adverse conditions, representing not merely passive resistance but also active and constructive participation in one’s environment.²⁰

Self-efficacy is the confidence is one’s ability to perform specific tasks. These components, through an interactive and evaluative process, give meaning to life, sustain efforts to change stressful situations, and prepare individuals for action.^20,21

Psychological capital is used to treat mental health issues, enhance hope, effort, resilience, strengthen defenses, and improve psychological well-being.²² Due to its broad dimensions, patients with gastrointestinal cancers are expected to face difficulties in this area.²³ Psychological capital does not develop in isolation so supportive social networks may play a significant role in its formation.²⁴

Given the chronic nature of cancer, perceived social support plays a vital role in advanced stages of the disease, protecting individuals from stress, reducing negative psychological outcomes, and facilitating adaptation and endurance of the illness.²⁵ Additionally, it helps prevent physiological complications,²⁶ positively impacting physical and psychological symptoms, self-efficacy, creativity, competence, and overall psychological capital, thereby protecting patients from crises. Recognizing these supports aids in promoting adaptive behaviors.²⁷

While the beneficial roles of social support and psychological capital (PsyCap) are independently recognized, there is a gap in understanding how these two constructs interrelate within a specific and highly vulnerable population, older adults who have already completed the arduous primary treatment for esophageal or gastric cancer. This survivorship phase presents unique psychological challenges, yet it remains under-investigated. Furthermore, psychological outcomes in oncology are known to be highly dependent on the timing of assessment relative to the treatment trajectory. Therefore, the primary aim of this cross-sectional study was to investigate the relationship between perceived social support and the components of psychological capital (hope, self-efficacy, resilience, and optimism) specifically in older adults during their post-treatment follow-up period.

Methods

Study Design

This is a descriptive-analytical, cross-sectional study conducted to assess perceived social support and its relationship with psychological capital in elderly patients with esophageal and gastric cancers who visited the Imam Khomeini Hospital in Tehran. The study population included patients with gastrointestinal cancers who sought treatment at this hospital between July and December 2024. The Imam Khomeini, affiliated with Tehran University of Medical Sciences, which offers inpatient and outpatient services through specialized clinics. This center serves individuals from all socioeconomic backgrounds in Tehran and surrounding areas of other cities in Iran.²⁸

Study Population and Data Sources

The study sample population included patients with gastrointestinal cancers of the Esophageal cancer or Gastric cancer who visited the selected hospital. Participants were at least 60 years old, diagnosed definitively with non-metastatic cancer based on pathological results and confirmed by an oncologist, and had completed their primary course of treatment (defined as post-surgery and/or completion of the final cycle of chemotherapy/radiotherapy) and were in their follow-up phase. Data was collected from patients who were between 3 to 12 months post-treatment. They also had to be willing to participate in the study. Patients who had passed away before completing the questionnaire or who completed less than 70% of it were excluded. Additionally, based on medical records, patients with a history of psychological disorders, psychotic illnesses, Alzheimer’s, or similar conditions were not included. To determine the sample size for estimating the mean of Psychological Capital and Social Support, the sample size calculator provided by the University of California, San Francisco (UCSF) at https://sample-size.net/sample-size-conf-interval-mean was utilized. The parameters for Type I error, estimation precision, and standard deviation were inputted, resulting in a calculated sample size of 252 participants. Accounting for a 10% rate of non-response or incomplete questionnaire completion, the sample size was adjusted to 280 participants. Ultimately, 310 participants were included in the study. Due to practical constraints, convenience sampling was used, which may limit generalizability but was deemed sufficient to achieve the study’s objectives.

After obtaining approval and ethical clearance from Tehran University of Medical Sciences Ethics Committee, the researcher approached the Cancer Institute at Imam Khomeini Hospital. To find suitable participants, the researcher initially explained the purpose and objectives of the study in meetings attended by department officials and supervisors. Subsequently, the researcher, present in various departments, provided information about the study to eligible patients. After explaining the goals, the voluntary nature of participation, and the confidentiality of all data, written informed consent was obtained through questionnaires. All questionnaires were administered by a trained researcher. For participants with literacy challenges, the questionnaires were read aloud by a trained researcher in a private setting, and the participant’s verbal responses were recorded verbatim. This was done to ensure consistency and minimize potential bias.

Data Collection Tools

After reviewing extensive studies, we selected the MacGee Psychological Capital Questionnaire and the Multidimensional Scale of Perceived Social Support (MSPSS), as these aligned with our research objectives. These tools, along with a demographic information questionnaire, were provided to participants in printed form. Currently, these instruments are used in several countries.

Demographic Questionnaire

The demographic characteristics of the patients included age, gender, marital status, cancer type, education level, job status, sufficiency income, duration of illness and frequency of hospitalization.

MacGee Psychological Capital Questionnaire

The MacGee Psychological Capital Questionnaire consists of 26 items developed by MacGee and colleagues to assess psychological capital across four subscales: (a) self-efficacy, (b) hope, (c) resilience, and (d) life orientation. The scale uses a six-point Likert response format (1 = strongly disagree to 6 = strongly agree). Higher scores indicate greater psychological capital.²⁹ The face and content validity of this questionnaire were established by Golparvar (2011) in Iran, and it achieved a Cronbach’s alpha of 0.83 in this study.³⁰

Multidimensional Scale of Perceived Social Support (MSPSS)

This is a 22-item measure of perceived adequacy of social support from three sources: family, friends, and significant others; using a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). For each item, the lowest score is 1 and the highest score is 7. Therefore, the scores of the questionnaire can vary from 22 to 154. A score of 22 shows the minimum score (indicating lack of social support), score 23 to 66 indicates a relative social support, and score 67 to 183 indicate high social support and 184 indicate the maximum social support.³¹ The content validity of MSPSS was established through comments of ten experts (oncologists, psychiatrists, psychiatric Nurses) by some modifications and its reliability was confirmed by test-retest method with correlation coefficient over 0.85.

To ensure accuracy, a preliminary study was conducted on a sample of 30 patients, and Cronbach’s alpha coefficients for the questionnaires were calculated, resulting in a value of 0.91. It is important to note that data from this preliminary study were not used in the final analysis.

Statistical Analysis

After data collection and entry into SPSS version 16, the data were analyzed using descriptive statistics such as mean, variance, and standard deviation.To determine the relationships between variables, Pearson and Spearman correlation coefficients were employed, with a significance level of 5%.

Result

This study aimed to investigate the status of perceived social support and its relationship with cognitive resources among elderly patients with gastrointestinal cancers who visited treatment centers affiliated with Tehran University of Medical Sciences in 2023. The collected data, including demographic characteristics, economic status, disease duration, and hospitalization frequency, are presented in Table 1. Among the 310 participants, 127 (40.9%) were male, and 183 (59.1%) were female. The mean age of participants was 68.21 years (±7.55 years), indicating a predominantly middle-aged and elderly population. Additionally, 84.9% of the participants were married, highlighting the potential role of familial networks as a source of social support.

Table 1.

Demographic and Clinical Characteristics of Study Participants (n = 310)

Variable		N (%) or Mean ± SD
Sex	Male	127 (40.9%)
	Female	183 (59.1%)
Age, year		68.21 ± 7.55
Marital Status	Single	47 (15.1%)
	Married	263 (84.9%)
Cancer Type	Esophageal cancer	124 (40.0%)
	Gastric cancer	186 (60.0%)
Education level	Illiterate	37 (12.1%)
	R & W	57 (18.5%)
	Highschool	92 (29.8%)
	Diploma	70 (22.6%)
	Bsc.	45 (14.5%)
	Msc. Or Ph.D	9 (2.4%)
Job status	Homeworker or retired	147 (47.6%)
	Unemployed	70 (22.6%)
	Part-time	63 (20.2%)
	Full-time	30 (9.7%)
Sufficiency income	Have	142 (46.0%)
	Not have	168 (54.0%)
Duration of illness, month		11.30 ± 2.43
Frequency of hospitalization		4.46 ± 9.62

Abbreviations: SD, Standard deviation; R & W, Reading and Writing.

In terms of education, 12.1% of participants were illiterate, while 18.5% had basic reading and writing skills. Participants with a middle school degree (29.8%), high school diploma (22.6%), bachelor’s degree (14.5%), and postgraduate education (2.4%) were also included. These results reflect a relatively low educational level among the studied population, which may influence their understanding and utilization of social support and related services. Regarding employment status, 47.6% of participants were homemakers or retired, 22.6% were unemployed, 20.2% worked part-time, and only 9.7% were employed full-time. This distribution indicates reduced economic and social engagement among elderly patients.

Economically, only 46% of participants reported sufficient income to meet their needs, while 54% faced financial challenges. This finding underscores the significant impact of economic factors on quality of life and the ability to access social support in this group. Furthermore, the average duration of illness among participants was 11.30 months (±12.43 months), with an average hospitalization frequency of 4.46 times (±9.62 times). Frequent hospitalizations may independently increase the need for social support while simultaneously exacerbating financial and psychological pressures on patients and their families.

The statistical indices and reliability of the dimensions of psychological capital and perceived social support are presented in Table 2. The analysis revealed that the mean score for participants’ psychological capital was 71.21, with a standard deviation of 22.80 and a Cronbach’s alpha of 0.943, indicating high reliability of the measurement tool. The dimensions of psychological capital, including self-efficacy, hope, resilience, and optimism, were also assessed. The mean score for self-efficacy was 18.74 (±7.14) with a Cronbach’s alpha of 0.864, hope was 18.94 (±6.63) with a Cronbach’s alpha of 0.921, resilience was 16.33 (±5.73) with a Cronbach’s alpha of 0.894, and optimism was 17.13 (±5.70) with a Cronbach’s alpha of 0.884. These findings suggest that hope and resilience were stronger dimensions of psychological capital in this group.

Table 2.

Statistical Indices and Reliability of Dimensions of Psychological Capital and Perceived Social Support

Factor	# Items	Mean ± SD	Cronbach’s Alpha
Psychological capital	26	71.21 ± 22.80	0.943
Self-efficacy	7	18.74 ± 7.14	0.864
Hope	7	18.94 ± 6.63	0.921
Resilience	6	16.33 ± 5.73	0.894
Optimism	6	17.13 ± 5.70	0.884
MSPSS	12	2.02 ± 0.72	0.914
Family support	4	1.86 ± 0.81	0.889
Friends support	4	2.33 ± 1.0	0.935
Others support	4	1.88 ± 0.88	0.923

In the domain of perceived social support, the mean overall score for the Multidimensional Scale of Perceived Social Support (MSPSS) was 2.02 (±0.72) with a Cronbach’s alpha of 0.914, indicating the tool’s satisfactory reliability. The dimensions of social support, including support from family, friends, and others, were measured. The mean score for family support was 1.86 (±0.81) with a Cronbach’s alpha of 0.889, support from friends was 2.33 (±1.0) with a Cronbach’s alpha of 0.935, and support from others was 1.88 (±0.88) with a Cronbach’s alpha of 0.923. The higher score for support from friends compared to other sources highlights the prominent role of friends in providing support in this group.

The results, presented in Table 3, highlight the relationship between demographic and clinical variables and psychological capital scores. To assess these associations, a univariate regression analysis was initially conducted for each independent variable. At this stage, each variable was individually entered into the model, and its significance level (P-value) was evaluated. Variables with a significance level of less than 0.2 in the univariate analysis were selected as candidates for inclusion in the multiple regression model. In the second stage, these variables were simultaneously entered into the multiple regression model to evaluate the independent effects of each variable in the presence of others. Unstandardized coefficients, along with their standard errors (SE), were calculated for each variable in the multiple model to determine their impact and significance. Only variables with a significance level of less than 0.05 in the multiple model were considered associated with and influential on psychological capital scores. This approach helps identify factors that independently and collectively affect psychological capital scores.

Table 3.

Results of Simple and Multiple Linear Regression Analyses for Predicting Psychological Capital Score

Model	Univariate Model			Multiple Model
Variable	Unstandardized Coefficients		P	Unstandardized Coefficients
	B	SE		B	SE	P
Sex=Male	0	–	–
Sex=Female	−3.525	4.179	0.401
Age	0.076	0.152	0.618
Marriage=Single	0	–	–
Marriage=Married	−4.605	5.699	0.421
Sufficiency.income=have	0	–	–
Sufficiency.income=Not have	2.683	4.134	0.518
Duration.of.illness	−0.115	0.166	0.488
Frequency.of.hospitalization	−0.287	0.213	0.182	−0.261	0.210	0.217
Education=Illiterate	0	–	–	0	–	–
Education=R & W	−11.383	7.547	0.134	−12.546	7.418	0.094
Education= Highschool	−13.681	6.961	0.052	−16.320	6.938	0.020
Education=Diploma	−15.711	7.323	0.034	−17.124	7.178	0.019
Education=Bsc.	−15.267	7.950	0.057	−21.739	8.213	0.009
Education=Msc. or PhD	−18.933	14.382	0.191	−23.721	14.164	0.097
Job=Homeworker or Retired	0	–	–	0	–	–
Job=Unemployed	2.564	5.242	0.626
Job=Part-time	9.487	5.450	0.084	12.800	5.357	0.019
Job=Full-time	−0.960	7.224	0.895

Notes: Bold P-values indicate statistical significance (p < 0.05). Dependent Variable: psychological.capital.

Abbreviations: SE, Standard Errors; B, Unstandardized Coefficient; P, P-value.

The linear regression analysis revealed that education level and employment status significantly influenced psychological capital scores among elderly patients with gastrointestinal cancers. In the multiple model, it was found that higher education levels were associated with lower psychological capital scores, particularly in groups with middle school education (B = −16.32, P = 0.020), high school diplomas (B = −17.12, P = 0.019), and bachelor’s degrees (B = −21.74, P = 0.009). Additionally, part-time workers scored higher on psychological capital compared to retirees or homemakers (B = 12.80, P = 0.019). Other variables, including the number of hospitalizations and income sufficiency, did not show significant associations with psychological capital. These findings highlight the importance of considering educational and occupational characteristics when designing support programs to enhance the psychological capital of patients.

The results, detailed in Table 4, describe the relationships between independent variables and the total perceived social support score (MSPSS). In this analysis, a univariate regression model was initially performed for each independent variable separately to evaluate its association with MSPSS. Variables with a significance level (P-value) less than 0.2 were selected for inclusion in the multiple regression model. In other words, only variables deemed significant in the univariate analysis were entered into the multiple model to assess their combined effects on perceived social support. In the second stage, a multiple regression model was performed, including all variables found to be significant in the univariate analysis. Unstandardized coefficients, along with their standard errors (SE), were calculated for each variable in the multiple model, and their significance levels (P-values) were evaluated. The results showed that only certain variables, such as employment status (part-time workers), had a significant association with perceived social support scores (P = 0.029). Other variables, such as age, marital status, income, duration of illness, and education level, did not exhibit significant effects on perceived social support. This approach facilitates an understanding of the independent and combined influences of demographic and clinical variables on perceived social support scores.

Table 4.

Results of Simple and Multiple Linear Regression Analyses for Predicting Perceived Social Support Score

Model	Univariate Model			Multiple Model
Variable	Unstandardized Coefficients		P	Unstandardized Coefficients
	B	SE		B	SE	P
Sex=Male	0	–	–
Sex=Female	0.004	0.132	0.977
Age	0.001	0.005	0.931
Marriage=Single	0	–	–
Marriage=Married	0.043	0.180	0.810
Sufficiency.income=have	0	–	–
Sufficiency.income=Not have	−0.086	0.130	0.508
Duration.of.illness	−0.10	0.005	0.049	−0.007	0.006	0.229
Frequency.of.hospitalization	−0.009	0.007	0.165	−0.003	0.008	0.678
Education=Illiterate	0	–	–
Education=R & W	−0.094	0.240	0.695
Education=Highschool	0.001	0.221	1.0
Education=Diploma	0.009	0.231	0.969
Education=Bsc.	0.310	0.253	0.222
Education=Msc. or PhD	−0.250	0.457	0.585
Job=Homeworker or Retired	0	–	–
Job=Unemployed	−0.030	0.163	0.853
Job=Part-time	0.368	0.170	0.032	0.350	0.159	0.029
Job=Full-time	−0.059	0.225	0.794

Notes: Bold P-values indicate statistical significance (p < 0.05). Dependent Variable: Multidimensional Perceived Social Support.

Abbreviations: SE, Standard Errors; B, Unstandardized Coefficient; P, P-value.

The Pearson correlation results, presented in Table 5, showed that psychological capital is significantly correlated with other factors. Specifically, a very strong positive correlation was observed between psychological capital and hope (r = 0.941, P < 0.01), resilience (r = 0.923, P < 0.01), and self-efficacy (r = 0.886, P < 0.01). Additionally, psychological capital was significantly correlated with perceived social support from various sources, including family support (r = 0.358, P < 0.01), support from friends (r = 0.184, P < 0.05), and support from others (r = 0.386, P < 0.01). Among the dimensions of perceived social support, the highest correlations were found with family support (r = 0.771, P < 0.01) and support from others (r = 0.831, P < 0.01). Moreover, significant correlations were also found between social support and other dimensions of psychological capital, including resilience, hope, and optimism. These results indicate a strong positive relationship between psychological capital and perceived social support in elderly patients with gastrointestinal cancers.

Table 5.

Pearson Correlation Between the Scores of the Two Questionnaires

Factors	Psychological.capital	Self.Efficacy	Hope	Resilience	Optimism
MSPSS	0.380**	0.333**	0.307**	0.343**	0.353**
Family support	0.358**	0.249**	0.278**	0.358**	0.413**
Friends support	0.184*	0.133	0.177*	0.137	0.174
Others support	0.386**	0.428**	0.296**	0.355**	0.288**

Notes: **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).

Discussion

The increasing prevalence of cancer in recent years and its impacts on the physical, psychological, and social aspects of life have made cancer a major health problem of the century.¹¹ By causing extensive damage to patients across individual, familial, social, and spiritual dimensions, cancer poses a threat to both physical and mental health.³² The present study examined the relationship between perceived social support and psychological capital among elderly patients with gastrointestinal cancers of the esophagus and stomach.

Social support, as a critical psychological resource, plays a decisive role in empowering cancer patients to cope with feelings of insecurity, anxiety, and reduced quality of life. Previous evidence has shown that social support is associated with reducmortality, improvements in quality of life, and better psychological outcomes.^33–35 In this study, the level of perceived social support among elderly patients was evaluated as relatively low, compatible with similar studies.^36,37 Since the participants were in the early stages of cancer and, due to lack of awareness and social biases prevalent in society, experienced less social support, and also because patients face an initial shock response to their diagnosis, their perception and awareness of social support tend to be lower. In Forsythe’s study, perceived social support among cancer survivors was higher and more tangible.³⁸

In the current study, support received from friends scored higher than from other sources, such as family and spouse, with family support being the lowest. However, studies by Yan reviewed support from family as scoring higher.³⁹ This discrepancy may indicate an increasing role of friendship networks in recent years, possibly due to the proliferation of online networks and decreasing traditional family communications, especially among patients who do not receive sufficient family support. Many patients, due to the specific conditions of their illness and particular support needs, sought support primarily from friends when family or medical staff were unable to provide adequate assistance. On the other hand, social support is generally more effective when received from individuals sharing similar values, characteristics, or stressors with the recipient.

According to the findings of Bou-Samra’s study, education level and employment status were identified as predictors of perceived social support. In the present study as well, individuals with higher education levels and those who were employed part-time reported higher levels of social support. The association between perceived social support and education could be explained by the fact that literate individuals are more successful in establishing social connections and identifying sources of support, thereby having greater access to these resources.^39–41 Additionally, married individuals and those living with their spouses reported the highest levels of perceived social support, consistent with similar studies.³⁶ Previous research also indicated a direct relationship between perceived social support and socioeconomic status.^42,43 Furthermore, studies on the elderly have shown that those with better social support often have private housing, live with a spouse, and have fewer hospital visits, which was statistically significant.^43,44 The role of economic and social conditions, such as having stable housing, cannot be overlooked when considering levels of social support received. Generally, better economic conditions tend to be associated with higher and more comprehensive social support and services, partly because many healthcare services are insurance-based and system payments are dependent on economic circumstances.

Psychological capital is one of the indicators of positive psychology, characterized by features such as belief in one’s abilities to achieve success, perseverance in pursuing goals, creating positive self-beliefs, and resilience in facing problems.⁴⁵ In this study, at the specific time of assessment, the patients exhibited a moderate current level of components such as hope, self-efficacy, resilience, and optimism. Hope and resilience, being the stronger dimensions, had a more significant impact on the patients.

Self-efficacy is another component of psychological capital and refers to a person’s belief in their ability to perform and achieve desired outcomes, especially in challenging circumstances. In cancer patients, high self-efficacy is connected to better treatment adherence, stronger problem-solving skills, and greater psychological coping.⁴⁶ In our study, on one hand efficacy had a slightly lower mean score compared to hope and resilience, on the another hand it still showed a significant positive correlation with perceived social support. This shows that patients who perceive themselves as supported may feel more confident in managing their illness, making decisions, and keeping autonomy.

Optimism, defined as the general expectation that good things will happen, plays a protective role in coping with sickness. Previous research suggests that optimistic people tend to experience less distress and are more likely to engage in adaptive behaviors during treatment.⁴⁷ The moderate scores of optimism in our participants suggest a cautious current outlook, that possibly reflects their immediate, state-dependent awareness of the chronic and potentially life-threatening nature of their condition. Nevertheless, its positive correlation with social support and psychological capital confirms its role as a buffer against emotional distress. Improving optimism through supportive interventions and cognitive restructuring strategies could therefore strengthen patients’ overall psychological capital.

According to research, cancer patients generally possess a moderate level of resilience,⁴⁸ and higher resilience is associated with better recovery outcomes.³⁷ Resilience is a dynamic process. Oncologists can help individuals use resilience strategies to successfully navigate the challenges of their illness.⁴⁹

Studies suggest that perceived social support is positively and significantly related to self-efficacy among patients, and also plays an indirect role in adapting to cancer. Part of the effect of perceived social support on adaptation occurs through increasing self-efficacy.^50–52 The diagnosis of illness in individuals with perceived social support creates less stress, and social relationships act as a buffer against stressful events. When patients feel valued, this can, in turn, enhance their sense of self-efficacy. Overall, self-efficacy mediates the relationship between social support and adaptation to cancer, meaning that social support increases self-efficacy, which subsequently aids in improving adaptation to the disease.

Strengthening hope encourages patients to adopt a more positive attitude towards treatment and to exhibit greater resilience in facing the challenges of illness.²⁴ Previous studies have also reported an inverse relationship between depression and stress with social support, indicating that lower levels of social support are associated with higher depression and stress in cancer patients.⁴⁰ Additionally, patients with higher social support have reported better psychological outcomes, emphasizing the importance of strengthening support networks in care planning.

Education level and employment status significantly influence psychological capital scores among elderly patients with gastrointestinal cancers. In the multivariate model, higher education levels were associated with decreased scores of psychological capitals, which is consistent with previous research,⁴⁰ but contrary to Kyriazidou’s findings.³⁶ Although this may seem contradictory, it can be attributed to increased awareness of disease risks, exposure to complex medical information, and higher expectations regarding treatment in individuals with higher education. More educated individuals may experience greater anxiety due to a deeper understanding of their clinical condition, which may negatively impact their positive perception of their psychological abilities. Furthermore, part-time workers reported higher scores in psychological capital compared to housewives or retirees. This could be related to work engagement and occupational involvement, and aligns with studies indicating that hope is the strongest component of psychological capital, positively related to work engagement and job performance, and inversely related to burnout.⁵³

The study’s findings demonstrated a significant positive relationship between concurrently measured psychological capital and perceived social support. In other words, at this stage of their illness, as perceived social support increases, psychological capital tends to be higher on average. Therefore, incorporating psychological and supportive programs aimed at enhancing these components, alongside medical treatments, could improve the quality of life for cancer patients and increase treatment effectiveness. This comprehensive approach not only helps patients cope with their illness but also allows them to experience a higher quality of life even in difficult circumstances. Additionally, studies suggest that increasing social support in elderly individuals can reduce intrusive thoughts, which consequently can positively impact their quality of life and psychological resources.⁵⁴

The generalizability of this study’s findings may be limited by its specific context. The study was conducted Iran, with a sample of older adults with non-metastatic esophageal or gastric cancer, which may reflect unique cultural, social, and healthcare system characteristics. For instance, the prominence of friend-based social support may be influenced by urban social networks in Tehran, which may differ from rural settings or other cultural contexts where family support is more dominant. Future studies in diverse settings and with broader cancer populations are needed to confirm the generalizability of these findings.

Limitations

The cross-sectional design and single time-point assessment, our findings provide a valuable but snapshot view of the patients’ psychological status. Therefore, these results are unlikely to represent a transformative advance in causality; rather, they serve as crucial hypothesis-generating data. These findings provide a solid foundational framework that can inform and guide future longitudinal or interventional studies aimed at exploring these dynamics over the complex trajectory of oncology care.

Conclusion

At the specific time of assessment, this cross-sectional study highlights a positive interrelation between concurrently measured social support and psychological capital among older adults with non-metastatic esophageal or gastric cancer. The findings indicate that social connections and continued engagement in meaningful activities, such as part-time work, appear to be associated with current levels of psychological resilience and hope. However, these psychological resources should be viewed as potentially transient states rather than enduring traits. Furthermore, while these findings provide preliminary insights, they should be interpreted cautiously regarding direct clinical implications due to the single time-point nature of the data. Future research should further explore the potential association between different sources of social support, with an emphasis on friendships and specific components of psychological capital, using longitudinal or interventional designs to establish causality and to robustly inform supportive care strategies.

Funding Statement

The authors received no specific funding for this work.

Data Sharing Statement

All data related to this study will be available upon request by contacting the corresponding author.

Ethical Declaration and Consent for Participation

This study was approved by the Institutional Review Board of Tehran University of Medical Sciences (Approval number: IR.TUMS.FNM.REC.1402.170). Participants were thoroughly informed face-to-face, and written informed consent was obtained by providing the questionnaire. The study was conducted in accordance with local laws, the Helsinki Declaration, and the ethical guidelines for medical and biological research involving human subjects in Japan.

Disclosure

The authors report no conflicts of interest in this work.