Objective To understand the current situation of symptom-related life distress in patients with esophageal malignant tumors, and to analyze the mediating role of cancer health literacy and self-disclosure in the chain of fear of cancer progression on symptom-related life distress in patients with esophageal malignant tumors.

Methods A total of 150 patients with malignant esophageal tumors were selected as the study subjects. The Chronic Disease Patients' Health Literacy Scale, the Distress Disclosure Index, the Short Form Fear of Progression Questionnaire, and the Symptom Distress Scale were used for assessment. Correlations between cancer health literacy, self-representation, fear of cancer recurrence, and symptomatic life distress were analyzed using Pearson analysis, and structural equation modeling was constructed and chain mediation tests were performed using Amos software.

Results The health literacy score of 150 patients with esophageal malignant tumors was (67.06 ± 8.38) points, the self-disclosure score was (37.65 ± 5.42) points, the fear of cancer progression score was (40.37 ± 5.28) points, and the symptom life distress score was (61.24 ± 5.58) point. There was a negative correlation between symptoms and life distress of patients with esophageal malignant tumors, health literacy, and self-disclosure, and a positive correlation between the fear of cancer progression (P ＜ 0.05); there was a positive correlation between the fear of cancer progression, health literacy, and self-disclosure. There is a negative correlation (P ＜ 0.05); there is a positive correlation between health literacy and self-disclosure (P ＜ 0.05). The chain mediation of health literacy and self-expression between fear of cancer progression and symptomatic life distress was established with a total indirect effect of 49.86%, with 20.06% mediated by health literacy, 21.82% mediated by self-expression, and 7.98% mediated by the chain of health literacy-self-expression.

Conclusions The chain mediating role of health literacy and self-representation between fear of cancer progression and symptomatic life distress is established, confirming that fear of cancer progression can indirectly influence symptomatic life distress in patients with esophageal malignancy by moderating health literacy and self-representation.