Journal List > Korean J Adult Nurs > v.28(4) > 1076404

Seo and Lim: The Effects of Fatigue and Distress on Self-efficacy among Breast Cancer Survivors

Abstract

Purpose

The purpose of this study was to describe the impact of fatigue and distress on self-efficacy among breast cancer survivors and to provide a base for development of nursing intervention strategy to improve self-efficacy.

Methods

A descriptive research design was used. The subjects were 158 patients who were either being treated or were receiving follow-up care at a university breast center in D City from May 30 to August 30, 2014. Structured questionnaires, Revised Piper Fatigue Scale, Distress Thermometer, and Self-Efficacy Scale for Self-Management of Breast Cancer were used to measure fatigue, distress, and self-efficacy. Data were analyzed using t-test, ANOVA, Pearson's correlation coefficients, and multiple regressions.

Results

The mean scores of fatigue, distress, and self-efficacy were 3.83, 4.31, and 3.77, respectively. There were significant differences among participants in terms of educational background, current treatment methods, perceived health status, economic burden for fatigue and perceived health status for distress. Self-efficacy was impacted by age, educational background, marital status, average monthly income, perceived health status, and medical expenses. Fatigue, age, and the burden on medical expense had the most impact on self-efficacy, accounting for 17% of the variance.

Conclusion

Fatigue should be managed to improve self-efficacy of breast cancer survivors. Therefore, nursing programs designed to decrease fatigue may be helpful.

REFERENCES

1.Korea Breast Cancer Society. 2014 breast cancer white paper [Internet]. Seoul: Korea Breast Cancer Society;2014. [cited 2014 July 1]. Available from:. http://www.kbcs.or.kr/journal/file/2014_Breast_Cancer_Facts_and_Figures_updated.pdf.
2.Lee SJ., Chon SJ., Roh YS., Park YM. Change in the sensation of the arms, the range of motion in the shoulders and depression in breast cancer patients. Journal of Korean Academy of Community Health Nursing. 2008. 19(3):398–407.
3.Burgess C., Cornelius V., Love S., Graham J., Richards M., Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. British Medical Journal. 2005. 330(7493):702–6. http://dx.doi.org/10.1136/bmj.38343.670868.D3.
crossref
4.Lev EL., Daley KM., Conner NE., Reith M., Fernandez C., Owen SV. An intervention to increase quality of life and self-care self-efficacy and decrease symptoms in breast cancer patients. Scholarly Inquiry for Nursing Practice. 2001. 15(3):277–94.
5.Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychological Review. 1977. 84(2):191–215.
crossref
6.Rottmann N., Dalton SO., Christensen J., Frederiksen K., Johansen C. Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Quality of Life Research. 2010. 19(6):827–36.
crossref
7.Zhang Y., Kwekkeboom K., Petrini M. Uncertainty, self-efficacy, and self-care behavior in. patients with breast cancer undergoing chemotherapy in China. Cancer Nursing. 2014 Forthcoming.
8.Haas BK. Fatigue, self-efficacy, physical activity, and quality of life in women with breast cancer. Cancer Nursing. 2011. 34(4):322–34. http://dx.doi.org/10.1097/NCC.0b013e3181f9a300.
crossref
9.Hoffman AJ., von Eye A., Gift AG., Given BA., Given CW., Ro-thert M. The development and testing of an instrument for perceived self-efficacy for fatigue self-management. Cancer Nursing. 2011. 34(3):167–75. http://dx.doi.org/10.1097/NCC.0b013e31820f4ed1.
crossref
10.Mosher CE., DuHamel KN., Egert J., Smith MY. Self-efficacy for coping with cancer in a multiethnic sample of breast cancer patients: associations with barriers to pain management and distress. Clinical Journal of Pain. 2010. 26(3):227–34. http://dx.doi.org/10.1097/AJP.0b013e3181bed0e3.
crossref
11.Kim SH., Son BH., Hwang SY., Han W., Yang JH., Lee S, et al. Fatigue and depression in disease-free breast cancer survivors: prevalence, correlates, and association with quality of life. Journal of Pain and Symptom Management. 2008. 35(6):644–55. http://dx.doi.org/10.1016/j.jpainsymman.2007.08.012.
crossref
12.National Cancer Institute. Psychosocial distress [internet]. Rockville: National cancer institute;2014. [cited 2014 November 4]. Available from:. http://www.cancer.gov/cancertopics/pdq/supportivecare/adjustment/HealthProfessional/page6.
13.Kwon EJ., Yi MS. Distress and quality of life in breast cancer survivors in Korea. Asian Oncology Nursing. 2012. 12(4):289–96. http://dx.doi.org/10.5388/aon.2012.12.4.289.
crossref
14.Mullan F. Seasons of survival: reflections of a physician with cancer. New England Journal of Medicine. 1985. 313(4):270–3.
crossref
15.Card IC. National coalition for cancer survivorship perspective. group V: resources for care. Cancer. 1993. 71(10):3244.
crossref
16.Piper BF., Dibble SL., Dodd MJ., Weiss MC., Slaughter RE., Paul SM. The revised piper fatigue scale: psychometric evaluation in women with breast cancer. Oncology Nursing Forum. 1998. 25(4):677–84.
17.Piper BF., Lindsey AM., Dodd MJ. Fatigue mechanisms in cancer patients: developing nursing theory. Oncology Nursing Forum. 1987. 14(6):17–23.
18.Lee EH. Construct validity of the revised piper fatigue scale in Korean women with breast cancer. Journal of Korean Academy of Nursing. 1999. 29(3):485–93.
crossref
19.National Comprehensive Cancer Network. Clinical practice guidelines in oncology: distress management [internet]. Washington, D.C.: National Comprehensive Cancer Network;2014. [cited 2014 November 7]. Available from:. http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf.
20.Kim JH. National Cancer Center, Ministry for health, welfare and family Affairs of Korea. Development of recommendations for distress management toward improvement of quality of life in cancer patients. Final Research Report. Seoul: Ministry for health, welfare and family Affairs of Korea;2009. May. Report No: 0830690-1.
21.Lee R., Kim SH., Lee KS., Seo MK. Development and validation of self-efficacy scale for self-management of breast cancer (SES SM-B). Journal of Korean Academy of Nursing. 2012. 42(3):385–95. http://dx.doi.org/10.4040/jkan.2012.42.3.385.
22.Kwon YW. Factors related to fatigue in breast cancer patients receiving chemotherapy. Journal of Korean Academy of Adult Nursing. 2005. 17(2):310–19.
23.Park JH. Patterns and related factors of fatigue during radiotherapy in patients with breast cancer. Journal of Korean Academic Society of Adult Nursing. 2003. 15(1):33–44.
24.Jung MS. A Study on radiation-treated cancer patient's symptom distresses and fatigue symptoms. [master's thesis]. Seoul: Hanyang University;2007.
25.Lee KS., Lee R., Kim DM., Kim SH. The effects of a comprehensive education program on knowledge, self-efficacy, and coping style among newly diagnosed patients with breast cancer. Asian Oncology Nursing. 2012. 12(1):35–43. http://dx.doi.org/10.5388/aon.2012.12.1.35.
crossref
26.Yang KS. The structural equation model on resilience of breast cancer patients receiving chemotherapy. [dissertation]. Seoul: Ewha Womans University;2014. p. 1–133.
27.Kim SK. Relationships between self-efficacy, self-care behavior and quality of life in patients with hematologic malignancy. [master's thesis]. Busan: Kosin University;2013.
28.Lee YS. Psychosocial experience in post-mastectomy women. Korean Journal of Social Welfare. 2007. 59(3):99–124.
29.Linda HE., Jannelle MT. Putting evidence into practice improving oncology patient outcomes. Pittsburgh: Oncology Nursing Society;2012.

Table 1.
General and Clinical Characteristics of Participants (N=158)
Characteristics Categories n (%) or M±SD
Age (year)   49.8±9.4
≤40 22 (13.9)
41~50 64 (40.5)
51~60 55 (34.8)
≥61 17 (10.8)
Educational level ≤Junior high school 32 (20.3)
≥High school 126 (79.7)
Residence area Metropolitan city 105 (66.5)
Small and medium-sized 31 (19.6)
cities  
Town 22 (13.9)
Marital status Unmarried 15 (9.5)
Married 129 (81.6)
Divorce, separate, bereave 14 (8.9)
Occupation Homemaker 100 (63.3)
Self-employed 11 (7.0)
Specialized job, office job 26 (16.5)
Salaried worker 9 (5.7)
Other 12 (7.5)
Religion Yes 115 (72.8)
No 43 (27.2)
Monthly household income (10,000 won) <100 19 (12.0)
100~199 31 (19.6)
200~299 41 (25.9)
≥300 67 (42.5)
Time since diagnosis was made (month)   13.11±5.80
6~12 73 (46.2)
13~18 51 (32.3)
19~24 34 (21.5)
Current treatment modality Chemotherapy radiation 27 (17.1)
therapy  
Others, follow up 131 (82.9)
Perceived health condition Good 126 (79.7)
Not good 32 (20.3)
Medical expense payer Own 66 (41.8)
Spouse 76 (48.1)
Others 16 (10.1)
Economic burden High 52 (32.9)
Moderate 76 (48.1)
Low 30 (19.0)
Cancer pain level Mild 142 (89.9)
Severe 16 (10.1)

CRT=chemotherapy radiation therapy

Table 2.
Degree of Fatigue, Distress, and Self-efficacy (N=158)
Variables M±SD
Total fatigue score 3.83±2.11
   Behavioral severity 3.89±2.23
   Affective meaning 3.75±2.34
   Sensory 3.89±2.52
   Cognition/mood 3.78±2.29
Distress score 4.31±2.32
Total self-efficacy score 3.77±0.53
   Coping with psycho-informational demand d 3.96±0.71
   Management of side effects 3.44±0.72
   Maintenance of healthy lifestyle 3.79±0.67
   Therapeutic compliance 4.59±0.53
   Sexual life 3.12±1.15
Table 3.
Differences in Fatigue, Distress, and Self-efficacy by Participants' Characteristics (N=158)
Characteristics Categories Fatigue Distress Self-efficacy
M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Age (year) ≤40a 3.81±1.90 1.75 4.55±1.99 0.70 3.96±0.44 4.56
41~50b 3.45±2.01 (.160) 4.05±2.35 (.556) 3.88±0.52 (.004)
51~60c 4.32±2.30   4.60±2.39   3.60±0.55 a, b>c
≥61d 3.68±1.88   4.06±2.44   3.64±0.43  
Educational level ≤Junior high school 4.57±2.04 2.26 4.50±2.30 0.52 3.56±0.55 -2.60
≥High school 3.64±2.09 (.025) 4.26±2.34 (.606) 3.82±0.51 (.010)
Residence area Metropolitan city 3.70±1.98 .81 4.42±2.37 0.52 3.82±0.54 1.95
Small & medium-sized city 3.89±2.55 (.449) 3.94±2.08 (.598) 3.73±0.54 (.146)
Countryside 4.33±2.05   4.32±2.46   3.58±0.42  
Marital status Singlea 4.13±2.50 2.24 4.47±2.50 0.52 3.77±0.34 3.64
Marriedb 3.68±1.99 (.110) 4.36±2.34 (.597) 3.81±0.55 (.028)
Divorce, separate, bereavec 4.87±2.51   3.71±2.02   3.41±0.33 b>c
Occupation Housewife 4.03±2.12 1.71 4.25±2.36 0.92 3.75±0.57 0.35
Self-employed 3.10±2.12 (.151) 4.82±2.75 (.454) 3.72±0.41 (.841)
Professionals 3.31±1.97   4.23±1.99   3.87±0.44  
Service 4.80±2.11   5.44±2.55   3.67±0.51  
Other 3.23±2.02   3.67±2.15   3.79±0.45  
Religion Yes 4.30±2.35 0.05 4.30±2.35 0.05 3.76±0.53 0.17
No 4.33±2.28 (.959) 4.33±2.28 (.959) 3.78±0.53 (.866)
Monthly household income (10,000 won) <100a 4.15±2.42 2.09 4.21±2.39 2.57 3.47±0.37 4.18
100~199b 4.52±1.74 (.104) 5.26±2.05 (.056) 3.66±0.36 (.007)
200~299c 3.79±2.09   4.34±2.45   3.77±0.57 a<d
≥300d 3.43±2.13   3.88±2.27   3.90±0.57  
Time since diagnosis was made (month) 6~12 4.10±2.09 1.16 4.55±2.24 0.90 3.74±0.56 0.18
13~18 3.65±2.17 (.316) 3.98±2.42 (.411) 3.79±0.59 (.832)
19~24 3.51±2.04   4.29±2.36   3.79±0.33  
Current treatment modality Chemotherapy radiation 4.63±1.73 2.19 4.41±2.15 0.24 3.64±0.53 -1.35
therapy   (.030)   (.812)   (.179)
Others, follow up 3.66±0.53   4.29±2.36   3.79±0.53  
Perceived health condition Good 4.00±2.24 -3.44 4.00±2.24 -3.44 3.83±0.53 3.20
Not good 5.53±2.29 (.001) 5.53±2.29 (.001) 3.51±0.45 (.002)
Medical expense payer Owna 4.21±2.28 2.33 4.53±2.17 0.81 3.74±0.49 3.81
Spouseb 3.46±1.95 (.100) 4.07±2.37 (.447) 3.85±0.56 (.024)
Othersc 3.99±1.87   4.56±2.73   3.47±0.38 b>c
Economic burden Higha 4.32±2.19 3.16 4.60±2.44 1.43 3.63±0.55 2.97
Moderateb 3.41±1.91 (.045) 3.99±2.13 (.243) 3.86±0.53 (.054)
Lowc 4.02±2.30 a>b 4.63±2.55   3.77±0.43  
Cancer pain level Mild 4.19±2.28 -1.31 4.19±2.28 -1.80 3.79±0.52 1.69
Severe 5.22±2.49 (.192) 5.38±2.53 (.090) 3.56±0.55 (.092)

Scheffé test.

Table 4.
Correlation among Fatigue, Distress, and Self efficacy (N=158
Variables Fatigue Distress Self-efficacy
r (p) r (p) r (p)
Fatigue 1    
Distress .56 (<.001) 1  
Self-efficacy -.33 (<.001) -.28 (<.001) 1
Table 5.
Influencing Factors on Self-efficacy of the Breast Cancer Survivors (N=158)
Step Variables Adjusted R2 F p B SE β t p
Step 1 Fatigue .11 19.60 <.001 -.08 .02 -.33 -4.43 <.001
Step 2 Fatigue .15 15.15 <.001 -.08 .02 -.33 -4.43 <.001
  Age       -.01 .01 -.23 -3.10 .002
Step 3 Fatigue .17 12.00 <.001 -.08 .02 -.32 -4.37 <.001
  Age       -.01 .01 -.20 -2.76 .006
  One million won       -.26 .12 -.16 -2.20 .028

Monthly household income.

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