Department of Nursing, School of Health Science, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan.
Department of Pediatrics, Akita University Hospital, Akita 010-8543, Japan.
Int J Environ Res Public Health. 2022 Jan 27;19(3):1467. doi: 10.3390/ijerph19031467.
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.
本研究旨在阐明自我效能感如何影响儿童癌症幸存者的癌症相关疲劳和健康相关生活质量（HRQoL）。46 名处于完全缓解期的儿童癌症年轻幸存者（年龄 8-18 岁）完成了自我效能感（儿科一般自我效能感量表（PedsSE））、癌症相关疲劳（癌症相关疲劳评分（CRFS））和 HRQoL（儿科生活质量量表 4.0 通用核心量表、儿科生活质量量表（PedsQL））的测量。通过机器学习随机森林算法和结构方程模型，考察了 PedsSE 与 CRFS 或 PedsQL 之间的结构关系，包括潜在的人口统计学或临床混杂因素的影响。根据 PedsQL 的分布，确定了 6 名 PedsQL<70 的幸存者存在 HRQoL 受损（称为“低 PedsQL 幸存者”）。随机森林模型确定了预测 CRFS 的六个变量，其中 PedsSE 最重要，区分低 PedsQL 幸存者的八个变量，其中 CRFS 最重要，PedsSE 第三重要。结构方程模型表明，PedsSE 对 PedsQL 的直接影响较难察觉（β=-0.049），而 PedsSE 通过 CRFS 对 PedsQL 的间接影响则很明显（β=0.333）。该模型解释了 CRFS 变化的 51%和 PedsQL 变化的 28%。PedsSE 与 CRFS 子类的“情绪改变”高度相关（r=-0.470），“情绪改变”与 PedsQL 高度相关（r=0.737）。总之，自我效能感是儿童癌症幸存者癌症相关疲劳和 HRQoL 的主要决定因素，通过癌症相关疲劳对 HRQoL 产生影响。从自我效能感到 HRQoL 的主要途径被认为是通过癌症相关疲劳的情绪方面。然而，与成年癌症幸存者不同，自我效能感对年轻幸存者的自我管理行为可能没有多大贡献，这些行为可以维持 HRQoL。
