Influence of Self-Efficacy on Cancer-Related Fatigue and Health-Related Quality of Life in Young Survivors of Childhood Cancer

Abstract

This study aims to elucidate how self-efficacy influences cancer-related fatigue and health-related quality of life (HRQoL) in young survivors of childhood cancer. Forty-six young survivors (age range, 8–18 years) of childhood cancer who were currently in complete remission completed measures for self-efficacy (Pediatric General Self-Efficacy Scale (PedsSE)), cancer-related fatigue (Cancer-related Fatigue Score (CRFS)), and HRQoL (Pediatric Quality of Life Inventory 4.0 Generic Core Scale, Pediatric Quality of Life Inventory (PedsQL)). Structural relationships between the PedsSE and CRFS or PedsQL, including the effects of potential demographic or clinical confounders, were examined by machine learning random forest algorithms and structural equation modeling. According to the distribution of the PedsQL, six survivors with PedsQL < 70 were determined to have compromised HRQoL (referred to as “low-PedsQL survivors”). The random forest model identified six variables for the prediction of the CRFS, with the PedsSE being the most important, and eight variables for the distinction of low-PedsQL survivors, with the CRFS being the most and the PedsSE the third most important variable. The structural equation model indicated that a direct influence of the PedsSE on the PedsQL was less detectable (β = −0.049), whereas an indirect influence of the PedsSE on the PedsQL via the CRFS was evident (β = 0.333). The model explained 51% of the variation of the CRFS and 28% of the variation of the PedsQL. The PedsSE was strongly correlated with “altered mood” in the subclass of the CRFS (r = −0.470), and “altered mood” was strongly correlated with the PedsQL (r = 0.737). In conclusion, self-efficacy is a major determinant of cancer-related fatigue and influences HRQoL via cancer-related fatigue in survivors of childhood cancer. The main pathway from self-efficacy to HRQoL is thought to be via the emotional aspect of cancer-related fatigue. However, unlike adult survivors of cancer, self-efficacy for young survivors may not contribute much to self-management behaviors that maintain HRQoL.

Posttraumatic growth in children aged 8–18 years with malignancies in China

“…It is possible that self-efficacy allows affected children to increase their sense of control, helps them view traumatic experiences as opportunities for growth. In this study, 93.2% (233/250) of the children had low or medium levels of self-efficacy, significantly lower than Japanese [ 42 ] and Korean [ 43 ]. It is obvious that the self-efficacy level of Chinese children aged 8–18 years with malignancies needs to be improved.…”

The relationship between physical activity, self-efficacy and quality of life in colorectal cancer survivors: a multicenter cross-sectional study

“…However, it is important to consider that certain recreational physical activities often demand a certain level of physical fitness, and an individual's physical fitness is closely related to the severity of their disease. It has also been reported that physical activity has an indirect effect on QoL over time through self-efficacy and health status [38,39]. Whether self-efficacy in CRC survivors is mediated in this way requires further research.…”

Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer‐related fatigue

“…6,11 Self-efficacy, that is, one's confidence in their capability to influence one's fatigue, is also thought to promote adaptive health behaviors and mediate CRF severity. 14,15 As for perpetuating factors, a direct link has been found between worrying and CRF, as worrying is thought to perpetuate CRF through endless pessimistic cognitions focused on physical health. 16,17 Another proposed perpetuating factor of CRF is catastrophizing, which is where one engages in an exaggerated negative evaluation of symptoms and imagines the worst possible outcome.…”

“…Allowing oneself to rest may be another behavioral mechanism promoting adaptive functioning in the face of CRF, as patients often report that they cope with their fatigue by pacing themselves and by balancing activity and rest 6,11 . Self‐efficacy, that is, one's confidence in their capability to influence one's fatigue, is also thought to promote adaptive health behaviors and mediate CRF severity 14,15 …”