This retrospective cohort study included 650 patients with primary gastric cancer who were treated at the First Affiliated Hospital of Soochow University between March 2020 and March 2023. All patients had been clinically diagnosed with gastric cancer and met the inclusion criteria outlined below. The demographic characteristics of the study population were as follows: 370 males and 280 females; age range from 28 to 88 years, with a mean age of (56.73 ± 8.56) years. Occupational status: 312 employed, 204 retired, and 134 unemployed; Education level: 222 patients with middle school or lower education, and 428 with high school or higher education. Tumor staging: Stage I (76 patients), Stage II (146 patients), Stage III (291 patients), and Stage IV (137 patients). Type of hospital accommodation: 88 patients in single rooms, 258 in double rooms, and 304 in triple rooms. Length of hospitalization: 442 patients were hospitalized for ≤7 days, 128 for 8–15 days, and 80 for ≥16 days. Time Since Last Chemotherapy/Radiotherapy: 468 patients (72.0%) had ≤4 weeks since their last chemotherapy/radiotherapy, and 182 patients (28.0%) had >4 weeks. Insurance type: 533 patients had medical insurance (180 with urban employee insurance, 148 with urban resident insurance, 205 with new rural cooperative insurance), and 117 were self-paying. Among the enrolled patients, 124 (19.1%) had controlled hypertension, 98 (15.1%) had type 2 diabetes, and 76 (11.7%) had a history of coronary artery disease. These comorbidities were recorded but were not the primary focus of this study.

This study adhered to ethical guidelines and received approval from the Ethics Committee of the First Affiliated Hospital of Soochow University. Informed consent was obtained from all participants prior to enrollment. Statistical analysis revealed no significant differences in the demographic characteristics of the study participants (p > 0.05), ensuring comparability across the groups.

All patients included in the study were diagnosed with primary gastric cancer based on clinical symptoms, auxiliary examinations (such as CT, MRI, and endoscopy), and pathological confirmation. Tumor staging was determined according to the 8th edition of the TNM staging system by the Union for International Cancer Control (UICC). Staging was verified by two independent oncology specialists at the time of patient enrollment.

All statistical analyses were conducted using SPSS 19.0 statistical software.

Continuous variables were expressed as mean ± standard deviation (M ± SD) and analyzed using independent-sample t-tests or t’-tests (when variance heterogeneity was detected).

Multiple-group comparisons were performed using one-way analysis of variance (ANOVA), followed by post-hoc Tukey tests where significant differences were found.

Effect sizes were calculated to assess the magnitude of differences:

Pearson correlation analysis was used to evaluate the relationship between negative emotions (PANAS scores) and sleep quality (PSQI scores): Small (r = 0.10–0.29), Moderate (r = 0.30–0.49), Large (r ≥ 0.50).

Categorical variables were analyzed using chi-square (χ²) tests, where applicable.

A two-tailed p-value of <0.05 was considered statistically significant for all tests.

Among the 650 patients, 533 (82%) exhibited varying degrees of negative emotions, while 117 (18%) reported no significant emotional distress.

Negative emotion scores, as measured by the Positive and Negative Affect Schedule (PANAS), varied significantly based on gender, age, tumor stage, and education level (p < 0.05). Female patients exhibited significantly higher PANAS negative emotion scores (M = 13.12 ± 7.98) than male patients (M = 15.85 ± 8.12, p < 0.05, Cohen’s d = 0.37), indicating a moderate effect size. This difference may be influenced by hormonal variations, coping strategies, and social expectations (Figure 1). Patients aged >60 years had significantly higher PANAS negative emotion scores (M = 30.2 ± 6.7) compared to those aged ≤60 years (Age≤45:M = 17.22 ± 7.43, Age 46–60: M = 14.15 ± 6.29,p < 0.05, η² = 0.09), suggesting a small-to-moderate effect. Advanced-stage gastric cancer patients (Stages III-IV) exhibited significantly higher PANAS negative emotion scores (Stages III:M = 18.12 ± 5.91,Stages IV:M = 23.67 ± 7.01) than early-stage patients (Stages I-II) (Stages I:M = 9.78 ± 5.66,Stages II:M = 12.45 ± 6.44, p < 0.05, η² = 0.15), indicating a moderate-to-large effect. Patients with lower educational attainment reported significantly higher PANAS negative emotion scores (M = 19.87 ± 6.52) than those with higher education levels (M = 13.21 ± 5.79, p < 0.05, Cohen’s d = 0.42), demonstrating a moderate effect size.

A detailed comparison of PANAS scores across different patient subgroups is provided in Table 1.

Among the 650 patients, 560 (86.15%) reported sleep disturbances, while only 90 (13.85%) had normal sleep quality. Definition of Sleep Disturbances: In this study, sleep disturbances were defined as a Pittsburgh Sleep Quality Index (PSQI) score ≥7, while normal sleep quality was defined as a PSQI score <7. This threshold is consistent with established research on clinical sleep assessment. No significant differences in sleep quality scores were observed based on gender, age, tumor stage, or education level (p > 0.05, η² < 0.02 for all comparisons). However, hospital room type was found to significantly impact sleep quality (p < 0.05, η² = 0.12). Patients in single-occupancy rooms reported significantly better sleep quality than those in double- or triple-occupancy rooms (p < 0.05, Cohen’s d = 0.58), indicating a moderate-to-large effect (Figure 2). Effect of Length of Hospital Stay: Further analysis showed that length of hospital stay did not have a statistically significant impact on sleep quality (p > 0.05, η² < 0.02). However, patients hospitalized for ≥16 days exhibited a trend toward poorer sleep quality compared to those hospitalized for ≤7 days, suggesting that prolonged hospitalization may contribute to worsening sleep, though additional factors likely mediate this relationship.

A detailed comparison is provided in Table 2.

Further analysis showed that patients with sleep disturbances (PSQI ≥7) had significantly higher PANAS negative emotion scores (M = 31.5 ± 7.0) than those with normal sleep quality (PSQI <7) (M = 24.7 ± 6.3, p < 0.05, Cohen’s d = 0.58), indicating a moderate-to-large effect size. As illustrated in Figure 3, Pearson correlation analysis indicated a strong positive correlation between negative emotions and sleep quality (r = 0.682, p < 0.05). This finding confirms that higher levels of emotional distress are associated with poorer sleep quality, emphasizing the need for integrated psychological and sleep management interventions in clinical care. However, it is important to note that correlation does not imply causation. While this study confirms a strong association, future longitudinal research is needed to establish whether negative emotions directly contribute to sleep disturbances or whether other confounding factors, such as disease progression and treatment effects, mediate this relationship.

A summary of PANAS score distributions across different patient characteristics is presented in Table 3.

To strengthen our statistical analysis, we have also included an additional table summarizing key statistical findings (Table 4).

The findings of this study indicate that negative emotions, particularly anxiety and depression, are prevalent among gastric cancer patients. Several clinical and demographic factors influence the severity of emotional distress.

First, female patients exhibited significantly higher negative emotion scores than male patients (p < 0.05). This difference may be influenced by a combination of biopsychosocial factors, including hormonal variations, gender-specific coping strategies, and societal expectations (15). Previous studies suggest that women tend to experience greater affective responses to stress and illness, which may contribute to increased negative emotions (15, 16).

Second, older patients (≥70 years) had significantly higher negative emotion scores than younger patients (≤60 years) (p < 0.05). This may be attributed to physical decline, loss of independence, and existential anxiety regarding mortality, which exacerbate emotional distress (17).

Third, advanced-stage gastric cancer patients (Stages III-IV) exhibited significantly higher negative emotion scores than early-stage patients (Stages I-II) (p < 0.05). This is likely due to concerns about prognosis, disease progression, and aggressive treatment regimens (18, 19).

Finally, education level and social support play crucial roles in psychological well-being. Patients with lower educational attainment often exhibit higher anxiety and fear due to limited disease-related knowledge, while stronger social support networks have been associated with reduced psychological distress (20–22).

Sleep disturbances are highly prevalent among gastric cancer patients, with 86.15% of patients in this study reporting impaired sleep quality. This aligns with prior research demonstrating that factors such as cancer-related pain, chemotherapy-induced side effects, and psychological distress contribute to sleep disturbances (23–25).

Although age, gender, and tumor stage did not significantly impact sleep quality in this study (p > 0.05), hospital room type had a statistically significant effect (p < 0.05). Specifically, patients in single-occupancy rooms reported significantly better sleep quality than those in shared rooms (p < 0.05). This finding underscores the importance of hospital environment optimization, as private and quiet spaces may promote better rest and recovery (26–28).

However, hospitalization conditions encompass multiple factors beyond room type, such as ward noise levels, nighttime medical interruptions, and hospital care routines (29, 30). These were not explicitly controlled in this study, necessitating further investigation into their impact on sleep quality.

A key finding of this study is the significant positive correlation between negative emotion scores and sleep quality scores (r = 0.682, p < 0.05), indicating that higher levels of negative emotions are associated with poorer sleep quality.

This relationship can be explained through physiological and psychological mechanisms (31–33). Anxiety and depression activate the body’s stress response system, leading to increased sympathetic nervous activity and elevated secretion of stress hormones (e.g., cortisol and adrenaline), which disrupt sleep architecture (34–36). Additionally, prolonged sleep disturbances exacerbate psychological distress, creating a vicious cycle (37–39).

These findings highlight the bidirectional relationship between negative emotions and sleep disturbances, reinforcing the need for integrated psychological and sleep management interventions (39–41).

While this study establishes a strong correlation between negative emotions and sleep disturbances, several potential confounding factors should be considered:

The findings of this study emphasize the need for a multidisciplinary approach to managing psychological distress and sleep disturbances in gastric cancer patients. Clinical recommendations include:

By addressing these factors, future clinical strategies can enhance both mental well-being and sleep quality, ultimately improving patient outcomes and quality of life.