Cancer Behavior Inventory Research Articles

The Mediating Role of Cancer Self-Efficacy in the Relationship Between Mindfulness and Death Anxiety in Patients with Cancer

Background: Investigating the relationship between mindfulness, cancer self-efficacy, and death anxiety in patients with cancer is crucial for understanding how these factors influence emotional well-being. Insights from such research can guide the development of psychological interventions aimed at enhancing quality of life for cancer patients. Objectives: The primary objective of this study was to explore the relationship between mindfulness and death anxiety in cancer patients, focusing on the mediating role of cancer self-efficacy. Methods: This study employed a descriptive correlational design and utilized structural equation modeling (SEM) to examine the relationships. A convenience sample of 302 cancer patients from Tehran (2023) completed three questionnaires: The Death Anxiety Scale, the Mindfulness Questionnaire, and the Cancer Behavior Inventory. Structural equation modeling was used to evaluate the proposed model, while the bootstrap method assessed the indirect effects. Results: The study found a significant negative relationship between mindfulness and cancer self-efficacy, and between cancer self-efficacy and death anxiety (P < 0.001). There was no direct relationship between mindfulness and death anxiety; however, cancer self-efficacy was found to mediate this relationship (P < 0.001). The model demonstrated a good fit with indices: RMSEA = 0.065, CFI = 0.96, and TLI = 0.95. Conclusions: These findings suggest that mindfulness indirectly reduces death anxiety in cancer patients by enhancing cancer self-efficacy. This highlights the potential effectiveness of mindfulness-based interventions in improving the emotional and psychological health of individuals diagnosed with cancer

Effect of Digital Health Coaching on Self-Efficacy and Patient-Reported Outcomes in Individuals with Acute Myeloid and Chronic Lymphocytic Leukemia: A Pilot Randomized Controlled Trial.

Promotion of self-efficacy can enhance engagement with health care and treatment adherence in patients with cancer. We report the outcomes of a pilot trial of a digital health coach intervention in patients with leukemia with the aim of improving self-efficacy. Adult patients with newly diagnosed acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) were randomized 1:1 to a digital health coach intervention or standard of care. The primary outcome of self-efficacy was measured by the Cancer Behavior Inventory (CBI) score. A total of 147 patients (37 AML, 110 CLL) were enrolled from July 2020 to December 2022. In the AML cohort, there was a mean increase in CBI score of 7.03 in the digital health coaching arm compared to a mean decrease of -3.57 in the control arm at 30 days (p = 0.219). There were no significant associations between the intervention and other patient-reported outcomes for patients with CLL. There were numerical, but not statistically significant increases in self-efficacy metrics in AML patients who received digital health coaching. Although this trial was underpowered due to enrollment limitations during a pandemic, digital health coaching may provide benefit to patients with hematologic malignancy and warrants further investigation.

Relationships Between Socio-behavioral Factors and the Symptoms Among Asian American Breast Cancer Survivors: A Structural Equation Modeling.

Despite increased research on breast cancer survivors, little is known about how socio-behavioral factors influence the symptoms among racial/ethnic minority breast cancer survivors, particularly Asian American breast cancer survivors (AABCS). This study examined the relationship between multiple socio-behavioral factors in AABCS, including attitudes, perceived barriers, and social influences, and their symptom experiences, with an emphasis on the mediating effect of self-efficacy. This secondary analysis used data collected from 195 AABCS women recruited through online and offline communities from January 2017 to June 2020. Study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences; the Cancer Behavior Inventory; and the Memorial Symptom Assessment Scale-Short Form. For structural equation modeling based on Bandura's self-efficacy theory, mediation analysis was performed using SPSS version 26.0 and AMOS 28. The overall fitness of the hypothetical model to the data is acceptable (χ2 = 51.36, P < .001; goodness-of-fit index = 0.95, adjusted goodness-of-fit index = 0.89, comparative fit index = 0.96, Tucker-Lewis index = 0.94, normed fit index = 0.94, and root-mean-square error of approximation index = 0.08). Both attitudes and social influences indirectly influenced symptom distress through self-efficacy (β = -0.054, P = .019, and β = -0.053, P = .017, respectively). Perceived barriers had indirect effects through self-efficacy (β = 0.121, P = .024) and significant direct effects (β = 0.605, P = .003) on symptom distress. Our findings supported that the self-efficacy for coping mediated their symptom experience among AABCS. In addition, there were significant relationships among attitudes, perceived barriers, social influences, and symptom experience. Future theory-driven interventions need to consider self-efficacy and socio-behavioral factors in symptom management among AABCS.

Effectiveness of Comprehensive Intervention Programme on Quality of life, fatigue, self-efficacy, and psychosocial distress among head and neck cancer patients receiving radiotherapy

PurposeThe study aimed at evaluating the Effectiveness of Comprehensive Intervention Programme (CIP) on Quality of life (QOL), fatigue, self-efficacy, and psychosocial distress among Head and Neck Cancer (HNC) patients receiving radiotherapy treatment.MethodsSingle-centre non-RCT time series study was conducted among 134 HNC patients (67 observed, followed by 67 subjected to CIP). FACT- H&N, FACT-F, Cancer Behavior Inventory and psychosocial distress scales were used to assess QOL, fatigue, self-efficacy, and psychosocial distress respectively. CIP was provided to the intervention arm twice a week during the course of radiation therapy along with the standard care; the control arm received only standard care. Data were collected before commencing radiotherapy, and post-test assessments were carried out at the end of radiotherapy treatment, and at 3 and 6 months after completion of radiotherapy.ResultsRepeated measures ANOVA revealed a statistically significant improvement with CIP in QOL (F (1.917) = 454.103, p = 0.001), fatigue (F (2.106) = 183.775, p = 0.001), self-efficacy (F (2.429) = 190.861, p = 0.001), and psychosocial distress (F (2.288) = 290.105, p = 0.001) in the intervention arm.ConclusionThe CIP implemented to address multitude of issues in HNC patients receiving radiotherapy, proved to be effective in reducing the impact of treatment on QOL, fatigue, self-efficacy and psychosocial distress in HNC patients receiving radiotherapy.

Evaluating a shared care pathway intervention for people receiving chemotherapy to reduce post-treatment unplanned hospital presentations: a randomised controlled trial

PurposeThe aim of this randomised controlled trial (RCT) was to explore whether a community nursing intervention for outpatients receiving systemic therapy reduced unplanned hospital presentations and improved physical and psychosocial health outcomes over the first three cycles of treatment compared to a control group receiving standard care.MethodsThe number of and reasons for unplanned presentations were obtained for 170 intervention and 176 control group adult patients with solid tumours starting outpatient chemotherapy. Poisson regression was used to compare the number of presentations between the intervention and control groups. Patients self-completed the Hospital Anxiety and Depression Scale, the Cancer Behavior Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) at the start of the first four cycles. Linear regression techniques were used to compare quality of life outcomes.ResultsThe reduction in unplanned presentations in the intervention group relative to the control group was 12% (95% CI, − 25%, 37%; P = 0.48). At the start of cycle 4, there was no difference in anxiety (difference = 0.47 (95% CI, − 0.28, 1.22; P = 0.22)), depression (difference = 0.57 (95% CI, − 0.18, 1.31; P = 0.13)) or EORTC QLQ-C30 summary score (difference = 0.16 (95% CI, − 2.67, 3.00; P = 0.91)). Scores for self-efficacy as measured by the Cancer Behavior Inventory were higher in the intervention group (difference = 4.3 (95% CI, 0.7, 7.9; P = 0.02)).ConclusionThis RCT did not demonstrate a benefit in reducing unplanned presentations to hospital. The trial identified improved cancer-based self-efficacy in patients receiving the intervention.Trial registrationRegistered at Australian and New Zealand Clinical Trials Registry: ACTRN12614001113640, registered 21/10/2014.

Evidence of validity of the Brazilian version of the Cancer Behavior Inventory - Brief Version.

To analyze the validity evidence of the Brazilian version of the Cancer Behavior Inventory - Brief Version. Methodological study, conducted between November and December 2021, with 140 patients undergoing hospital cancer treatment in João Pessoa, Paraíba, Brazil. Psychometric analyses were performed in the adapted version, using exploratory factor analysis and correlation with correlated constructs. A two-factor and 10-item model was evidenced. The cumulative variance explained about 61% the shared variance of the items. Satisfactory values were observed for the factors in the analyses of composite reliability (0.89 and 0.91, respectively), internal consistency (0.86 and 0.91, respectively) and ORION (0.89 and 0.85, respectively). The expected correlations of self-efficacy with quality of life (convergent) and with anxiety and depression (divergent) were evident. The Brazilian version of the instrument showed evidence of validity, being considered reliable to assess the self-efficacy of patients undergoing cancer treatment.

Evidence of validity of the Brazilian version of the Cancer Behavior Inventory - Brief Version

RESUMO Objetivo: Analisar as evidências de validade da versão brasileira do Cancer Behavior Inventory - Brief Version. Método: Estudo metodológico, realizado entre os meses de novembro e dezembro de 2021, com 140 pacientes em tratamento oncológico hospitalar em João Pessoa, Paraíba, Brasil. Foram realizadas análises psicométricas na versão adaptada, mediante a análise fatorial exploratória e correlação com constructos correlacionados. Resultados: Evidenciou-se um modelo de 2 fatores e 10 itens. A variância acumulada explicou cerca de 61% da variância compartilhada dos itens. Foram observados valores satisfatórios para os fatores nas análises de confiabilidade composta (0,89 e 0,91, respectivamente), consistência interna (0,86 e 0,91, respectivamente) e ORION (0,89 e 0,85, respectivamente). Evidenciaram-se as correlações esperadas da autoeficácia com a qualidade de vida (convergente) e com a ansiedade e depressão (divergente). Conclusão: A versão brasileira do instrumento mostrou evidências de validade, sendo considerada como confiável para avaliar a autoeficácia dos pacientes em tratamento oncológico.

A Machine Learning Model to Predict Patients' Adherence Behavior and a Decision Support System for Patients With Metastatic Breast Cancer: Protocol for a Randomized Controlled Trial.

Adherence to oral anticancer treatments is critical in the disease trajectory of patients with breast cancer. Given the impact of nonadherence on clinical outcomes and the associated economic burden for the health care system, finding ways to increase treatment adherence is particularly relevant. The primary end point is to evaluate the effectiveness of a decision support system (DSS) and a machine learning web application in promoting adherence to oral anticancer treatments among patients with metastatic breast cancer. The secondary end point is to collect a set of new physical, psychological, social, behavioral, and quality of life predictive variables that could be used to refine the preliminary version of the machine learning model to predict patients' adherence behavior. This prospective, randomized controlled study is nested in a large-scale international project named "Enhancing therapy adherence among metastatic breast cancer patients" (Pfizer 65080791), aimed to develop a predictive model of nonadherence and associated DSS and guidelines to foster patients' engagement and therapy adherence. A web-based DSS named TREAT (treatment adherence support) was developed using a patient-driven approach, with 4 sections, that is, Section A: Metastatic Breast Cancer; Section B: Adherence to Cancer Therapies; Section C: Promoting Adherence; and Section D: My Adherence Diary. Moreover, a machine learning-based web application was developed to predict patients' risk factors of adherence to anticancer treatment, specifically pertaining to physical status and comorbid conditions, as well as short and long-term side effects. Overall, 100 patients consecutively admitted at the European Institute of Oncology (IEO) at the Division of Medical Senology will be enrolled; 50 patients with metastatic breast cancer will be exposed to the DSS and machine learning web application for 3 months (experimental group), and 50 patients will not be exposed to the intervention (control group). Each participant will fill a weekly medication diary and a set of standardized self-reports evaluating psychological and quality of life variables (Adherence Attitude Inventory, Beck Depression Inventory-II, Brief Pain Inventory, 13-item Sense of Coherence scale, Brief Italian version of Cancer Behavior Inventory, European Organization for Research and Treatment of Cancer Quality of Life 23-item Breast Cancer-specific Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 8-item Morisky Medication Adherence Scale, State-Trait Anxiety Inventory forms I and II, Big Five Inventory, and visual analogue scales evaluating risk perception). The 3 assessment time points are T0 (baseline), T1 (1 month), T2 (2 months), and T3 (3 months). This study was approved by the IEO ethics committee (R1786/22-IEO 1907). The recruitment process started in May 2023 and is expected to conclude on December 2023. The contribution of machine learning techniques through risk-predictive models integrated into DSS will enable medication adherence by patients with cancer. ClinicalTrials.gov NCT06161181; https://clinicaltrials.gov/study/NCT06161181. DERR1-10.2196/48852.

Evaluating Patient-Reported Outcomes and Wearable Data Among Individuals with Relapsed/Refractory Multiple Myeloma

Background: Digital life coaching (DLC) pairs patients with a certified health coach to identify and achieve wellness-related goals through phone calls and text messages. DLC has been shown to improve physical quality of life in a recent randomized trial of patients with multiple myeloma (MM) undergoing upfront transplantation (Banerjee, BMT 2023). However, transplantation is an acute life disruption that may not necessarily reflect long-term wellness; this is particularly true for patients living with relapsed/refractory (R/R )MM, for which symptom burden and uncertainty may be chronically higher. As such, a new study (clinicaltrials.gov ID: NCT05956457) is under way to explore the feasibility and outcomes of DLC with integrated symptom monitoring (via a wearable activity tracker) to inform a more complete understanding of the patient experience with R/R MM. Endpoints from this study will include symptom burden, health self-efficacy, and financial, physiologic, and psychosocial well-being, and if and how DLC may be used to support this population. Study Design and Methods: For this prospective, non-randomized, quasi-experimental study at the University of Washington, up to 100 individuals will be enrolled. Individuals must meet the following Inclusion criteria: English speaking; aged 18 years and older, R/R MM diagnosis; initiated at least the second line of therapy for MM at time of study enrollment and must have been exposed to at least one proteasome inhibitor (PI) and/or one immunomodulatory drug (IMiD). Individuals will be excluded from participation if they meet any of following criteria: anticipated to have 6 months or less to live, have a serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with participant safety, provision of informed consent, or compliance with study procedures; and those who do not own or have access to a personal smartphone or device allowing for access to text or email Consented individuals will be enrolled in a 3-month DLC coaching program, consisting of weekly calls and up to 4 digital nudges, delivery of content via text or email, each week. The evidence-based coaching curriculum focuses on supporting patient self-management of symptoms; physical, mental, financial, social and sexual health; and nutrition, exercise, and sleep. Patient-reported outcomes (PROs) will be collected at baseline and monthly for 3 months to track progress during both coaching and treatment, and to provide insights into the experience and well-being of participants. PROs include quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 &amp; Quality of Life Questionnaire Multiple Myeloma-20); health self-efficacy (measured with the Cancer Behavior Inventory- Brief); anxiety and depression (Patient Health Questionnaire-4); financial toxicity (Comprehensive Score for Financial Toxicity); and medication adherence (CASE Medication Adherence Index). Physical activity will be captured via wrist-worn activity tracker provided to participants. Descriptive analysis will be conducted for this study. Feasibility for this study is defined as a retention rate greater than or equal to 70%. Retention is defined as individuals who agree to participate in the DLC program and complete the 3 months of engagement post-enrollment. Engagement is defined as the completion of 1 nudge (call, text, or email) per module out of 5 nudge opportunities. Summary statistics, such as frequencies, percentages, means, standard deviations, and ranges, will be used to describe patient demographic and clinical characteristics of the study population. Summary statistics will also be used to describe PRO by assessment time. We will also assess the additional PRO trends over time using linear mixed models (LMMs). Additional models will be created to assess intervention effect while controlling for possible confounding covariates, and the relationship between self-efficacy and other PROs. Implications: Results of this study are anticipated to elucidate (1) if and how DLC may be used to support individuals with R/R MM and (2) clinical and PRO outcomes, including both survey and wearable data, for individuals with R/R MM in a DLC program.

Unraveling the Link between Self-efficacy and self-management in Breast Cancer Patients during the COVID-19 Pandemic: A Cross-sectional Study

Background: The COVID-19 pandemic necessitates that cancer patients take on a more active role in self-managing their illness and adjusting to the altered healthcare resources. To perform self-management behaviors, patients may need an adequate level of self-efficacy. However, little is known about breast cancer patients’ self-efficacy and self-management in pandemic times. Aim: This study aimed to assess the self-efficacy and self-management of breast cancer patients undergoing therapy during the COVID-19 pandemic and identify their associations. Methods: A descriptive-analytical, cross-sectional design was used. One hundred and eight breast cancer patients undergoing treatment were recruited from the National Cancer Center in Indonesia. Participants completed questionnaires that consisted of the Cancer Behavior Inventory, the Depression Anxiety Stress Scale, the Enrichd Social Support Instrument, and the Self-Management Assessment Scale. Data were analyzed using multiple regression. Results: The study found that 45.4% and 42.6% of breast cancer patients under treatment had a low level of self-efficacy and self-management, respectively. Self-efficacy is positively associated with self-management in breast cancer patients (p=0.001) after controlling for various factors, including cancer stage, psychological factors, and social support. The factor most related to self-management is self-efficacy, as measured by the odds ratio (OR), which was 16.713 (95% CI: 4.424-63.137), while the ORs of social support and stage were 4.968 (95% CI: 1.785-13.831) and 0.190 (95% CI: 0.044-0.820), respectively. Conclusion: It can be concluded that self-efficacy is strongly and positively associated with self-management in breast cancer patients undergoing treatment. Therefore, nursing interventions focusing on enhancing patients’ self-efficacy are needed.

Outcomes of a digital health coaching program for individuals with acute myeloid and chronic lymphocytic leukemia.

496 Background: Chronic lymphocytic leukemia (CLL) accounts for ~19,000 and acute myeloid leukemia (AML) accounts for ~20,000 new cases a year, according to SEER data. Individual management and overall survival rates vary by cancer type, each with unique and potentially long-term care needs. Digital interventions continue to expand, connecting with individuals beyond the clinical setting to support health self-efficacy and address overall wellness needs. However, data related to their application for hematologic malignancies is limited. Methods: The aim of this randomized, longitudinal cohort study was to evaluate the effect of a 3-month digital health coaching program on health self-efficacy, measured by the Cancer Behavior Inventory (CBI), and other patient reported outcomes (PROs) among individuals with AML or CLL. We aimed to enroll 500 participants, 250 each with CLL and AML, randomized to either the digital intervention or usual care. PROs were collected at baseline and up to once per month for 3 months via REDCAp. Clinical outcomes were tracked via electronic health record. The change in CBI scores from baseline to 3 months was calculated with 95% confidence intervals. A 2-sample t-test was used to compare change between intervention and control arms. PRO trends over time were analyzed using linear mixed models (LMMs). Results: The study enrolled 147 individuals from July 2020 through December 2022. Thirty-seven were enrolled in the AML group (19 control), and 110 in the CLL group (55 control). The mean change in CBI from baseline to 3 months in the AML control arm was -3.57 (95% CI: -17.30 – 10.15) and in the AML intervention arm was 7.03 (95% CI: -2.67 – 16.74), with higher scores indicating greater efficacy for coping. While not significant, mean change in CBI in the CLL control arm was 1.43 (95% CI: -3.45 – 6.31; p=0.556) and in the CLL intervention arm was 3.46 (95% CI: -1.44 – 8.37; p=0.219). In the CLL group, self-efficacy was associated with improved quality of life (p &lt;0.001); For every unit increase in FACT-LEU-TOI, CBI increased on average by 0.81 units (95% CI: 0.62 – 1.00). Conclusions: Due to limited study enrollment during the COVID-19 pandemic, the study was not powered to detect a difference between groups. Data from the engaged cohort suggest a non-statistically significant trend over time in improvement in health self-efficacy for the participants engaged in digital health coaching. A recent meta-analysis suggests self-efficacy has a strong negative correlation with distress and positive correlation with quality of life and improved self-efficacy may mitigate negative effects of a cancer diagnosis and treatment. Data related to trends in PRO over time within and between AML and CLL cohorts provide further insights into physiologic and psychosocial outcomes for these populations. Clinical trial information: NCT04774744 .

Relationship of Health Literacy and Social Support with Health-Promoting Behaviors in Women with Breast Cancer: Mediating Role of Cancer Self-Efficacy

Background: Women diagnosed with breast cancer experience high levels of psychological disorders ranging from depression, anxiety, maladjustment to the disease, and decreased self-confidence to different emotional disturbances and fears of recurrence and mortality. The present study aimed to investigate the mediating role of cancer self-efficacy in the relationship between health literacy and social support with health-promoting behaviors in women with breast cancer.&#x0D; Methods: In this descriptive-correlational study, the convenience sampling method was employed to select 282 women diagnosed with breast cancer in Ahvaz, Khuzestan Province (Iran) in 2021. The participants were asked to answer the Health-Promoting Lifestyle Profile II (HPLP-II), Iranian Health Literacy Questionnaire, Social Support Survey, and Cancer Behavior Inventory. Path analysis was adopted to analyze data in AMOS software.&#x0D; Results: The results revealed there was a significant relationship between perceived social support with health-promoting behaviors (P=0.004) and cancer self-efficacy (P=0.001) in women with breast cancer. There was a significant relationship between health literacy and cancer self-efficacy in women. According to the results, the mediating role of cancer self-efficacy in the relationship between perceived social support and health literacy with health-promoting behaviors was found to be significant in women with breast cancer (P=0.001).&#x0D; Conclusion: Accordingly, the research model had a desirable fit. The findings of this research showed the effective role of cancer self-efficacy in the outcome of social support and health literacy to increase health-promoting behaviors in women with breast cancer.

A Decision Tree Analysis on Symptom Experience of Asian American Breast Cancer Survivors.

Mainly due to their cultural attitudes toward symptoms and breast cancer, Asian American breast cancer survivors tend to suffer from symptoms and often delay in getting treatments, information, and support. To improve their symptom management, it would be important to determine risk groups among them. Decision tree analyses reportedly help determine risk groups by identifying the characteristics that are directly associated with target health outcomes. Using a decision tree analysis, this study aimed at identifying the characteristics that were closely linked to the symptom experience of Asian American breast cancer survivors. This was a part of a parent randomized controlled trial among Asian American breast cancer survivors. Only the data from 135 women at the pre-test were included. Multiple instruments were used to collect the data: the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the PRQ-2000, the Perceived Isolation Scale, and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using latent profile analysis and decision tree analyses. Two most frequently found profiles included the low symptom experience profile (72.6%) and the high symptom experience profile (27.4%). The high symptom experience profile was predicted by 2 combined characteristics; (a) high psychological needs for help (over 60.00 points), and (b) low psychological needs for help (cut point = 60.00), high perceived barriers (cut point = 1.62), and high social isolation (social support) (cut point = 2.33). These characteristics linked to Asian American breast cancer survivors with high symptom experience need to be considered in future intervention development.

Abstract LB145: The relationship of socio-behavioral factors to the symptom experience of Asian American breast cancer survivors: a structural equation model

Abstract Background: Despite an increasing number of studies among breast cancer survivors, little is known about how socio-behavioral factors influence the symptom experience of racial/ethnic minority breast cancer survivors, especially Asian American breast cancer survivors. The identified socio-behavioral factors could give directions for development of unique intervention components that are tailored to a specific population in needs. Purpose: This study examined the relationship of multiple socio-behavioral factors including attitudes, perceived barriers, social influences, and self-efficacy to the symptom experiences of Asian American breast cancer survivors. Methods: This secondary analysis was conducted using data collected from 195 Asian American female breast cancer survivors. Subjects were recruited from January 2017 to June 2020 through online and offline communities and groups. The study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences (QASPS); the Cancer Behavior Inventory (CBI); and the Memorial Symptom Assessment Scale-Short Form (MSAS-SF). The hypothetical model was built based on Bandura’s self-efficacy theory. Mediation analysis was conducted using structural equation modeling with SPSS version 26.0 and Amos 28. Results: The overall fitness of the hypothetical model to the data was acceptable (χ2=51.36, p&amp;lt;.001, the goodness of fit index [GFI] = .95, adjusted GFI [AGFI] = .89, comparative fit index [CFI] = .96, Tucker-Lewis index [TLI] = .94, normed fit index [NFI] = .94, and root mean square error of approximation [RMSEA] = .08 Attitude and perceived barrier and social influence had a significant direct effect on self-efficacy (direct effect, β = 0.247, p =.003; β = -0.552, p =.003; β = 0.241, p =.002, respectively). Attitudes indirectly influenced symptom distress scores through self-efficacy (β =-0.054, p = .019). Perceived barriers had a significant direct effect (β = 0.605, p=.003), indirect effect (indirect effect, β = 0.121, p =.024), and a total effect on symptom distress scores (total effect, β = 0.726, p =.004). In addition, social influence had an indirect effect on symptom distress scores through self-efficacy (β = -0.053, p = .017) Conclusions: The findings supported that the self-efficacy for coping had a mediating effect on their symptom experience among Asian American breast cancer survivors as well as identified meaningful associations with attitudes, perceived barriers and social influences and symptom experience. Future research and practice should consider socio-behavioral factors, especially self-efficacy, in symptom management of Asian American breast cancer survivors. Acknowledgments: The parent study was funded by the National Institutes of Health (NCI/NINR; 1R01CA203719). Citation Format: Seo Yun Kim, Heejung KIM, Wonshik Chee, Eun-ok Im. The relationship of socio-behavioral factors to the symptom experience of Asian American breast cancer survivors: a structural equation model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB145.

Fear, Anxiety, and Coping Self-efficacy of Individuals With Cancer During COVID-19 and Predictive Risk Factors: A Descriptive and Correlational Study

ObjectivesIn this study, we determined COVID-19-related fear, anxiety, and coping self-efficacy in individuals with cancer and predicted the risk factors of these parameters. Data SourcesA descriptive and correlational study was conducted in a single cancer center with 396 individuals. The data were collected using the Participant Information Form, the Fear of Coronavirus Scale, the Coronavirus Anxiety Scale, and the Cancer Behavior Inventory Short Form. Approximately 94% of individuals had received the COVID-19 vaccine. The boosting effect of the vaccination on self-confidence (β = 0.209), duration of diagnosis (β = 0.219), and perception of mental health (β = 0.284) was associated with fear of COVID-19. Smoking (β = 0.116), vaccination dose (β = 0.139), disease stage (β = 0.101), perception of physical health (β = –0.262), and perception of mental health (β = –0.112) were associated with coping self-efficacy. ConclusionWe found that most individuals did not have anxiety, had a moderate level of fear, and their coping self-efficacy was satisfactory. Implications for Nursing PracticeThe perception of mental health was the common risk factor for fear and coping self-efficacy. Health professionals should be aware of the psychological problems experienced by individuals with cancer, and they should adopt strategies that can increase self-efficacy in coping.

Abstract P4-05-03: Investigating Financial Toxicity among Breast Cancer Patients Diagnosed during the Pandemic: The Role of Cancer Care Disruptions and Social Isolation

Abstract Background: Financial toxicity (FT) is a multi-faceted construct, encompassing material hardship, psychological responses, and coping behaviors. FT adversely impacts patient-reported outcomes by decreasing mental health, affecting health-related quality of life (HRQOL), and deteriorating healthcare adherence. Few studies have assessed the relationship between financial toxicity, distress, coping, self-efficacy, and HRQOL within the context of cancer care disruptions resulting from the pandemic. Methods: In the COVID-19 Breast Cancer Care Survey, 46 women with primary breast cancer were cross-sectionally evaluated for financial hardship (FACIT-COST), distress (Perceived Stress Scale), coping behaviors (Brief COPE), self-efficacy (Cancer Behavior Inventory–Brief) and HRQOL using the Functional Assessment of Cancer Therapy General (FACT-G) measure. Cancer care disruptions were measured with a series of questions investigating the impact of COVID-19 guidelines on access to healthcare services, treatment, and transition to telemedicine. Given the role of informal caregivers for patients’ outcomes, social isolation was additionally included (PROMIS Social Isolation Scale). Descriptive statistics were computed, and bivariate correlations examined. Then, a subsequent regression model investigated predictors of FT in the present sample. Statistical analyses were performed using SAS 9.4 and significance level was set at p&amp;lt; 0.05. Results: Overall, participants were adult (Mage= 46.3±10.9) women diagnosed with early-stage breast cancer (75.61% Stage I/II). Approximately half of the participants were in active treatment (51.2%) and received multiple types of treatment (85.4% surgery; 61% chemotherapy, and 36.5% radiation). Although all participants were insured at time of the study, the mean score of FT was 22.75 (SD=4.10, range: 0-44). Correlation analyses indicated that cancer care disruptions (r= -0.57, p&amp;lt;.001), health-related quality of life (r=-0.51, p=0.0007), coping behaviors (r=-0.33, p=0.037), well-being (r=0.56, p=0.0001), social isolation (r=-0.40, p=0.0096), and psychological distress (r=-0.42, p=0.0064) were significantly correlated with FT. That is, women who reported greater disrupted cancer care delivery, greater difficulties managing the illness, reduced physical and mental health, and those experiencing more social isolation reported worse financial toxicity. Results of the final regression model showed that women who experienced greater COVID19-related cancer care disruptions (β=-2.82, p=0.0013) and isolation (β=-0.44, p=0.0196) from supportive networks were more likely to indicate elevated FT scores. Conclusions: A multidisciplinary and patient-centered FT management approach can be implemented to extend current financial navigation models to address psychosocial and behavioral factors exacerbated by altered care delivery protocols. Citation Format: Chiara Acquati, Tzuan Chen, Isabel Martinez Leal, Shahnjayla Connors, Anastasia Rogova, Mathew Banegas, Grace Smith, Lorraine R. Reitzel, Lorna McNeill. Investigating Financial Toxicity among Breast Cancer Patients Diagnosed during the Pandemic: The Role of Cancer Care Disruptions and Social Isolation [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-05-03.

Low Self-efficacy in Breast Cancer Patients Undergoing Treatment During the COVID-19 Pandemic

Self-efficacy is needed as a basis for action and is defined as a person’s ability to take care of himself in order to achieve the expected results. Breast cancer patients need good self-efficacy to undergo treatment, especially during the COVID-19 pandemic. This study aims to describe the characteristics of breast cancer patients and their relationship with self-efficacy during treatment at the Dharmais Cancer Hospital. The study design used was cross-sectional, involving 107 cancer patients through consecutive sampling. Self-efficacy was assessed using the Cancer Behavior Inventory (CBI) instrument. Data were analyzed using the Chi-square test. The results showed that as many as 69 respondents (64%) had low self-efficacy during the COVID-19 pandemic. The results showed that age (p = 0.008), employment status (p = 0.026), monthly income (p = 0.000), and ward (p = 0.031) had significant relationship to self-efficacy. Self-efficacy describes the optimistic perception of cancer patients being able to overcome their cancer-related stressors. In probable or confirmed cases of COVID-19, most patients will fall into a state of psychological crisis, unstable emotions, rejection, anger, and non-compliance with treatment. Education and counseling regarding self-efficacy are needed in an effort to increase the self-efficacy of breast cancer patients undergoing treatment during the COVID-19 pandemic at Dharmais Cancer Hospital Jakarta.&#x0D; Keywords: self-efficacy, breast cancer, COVID-19

“Letting go” - Relinquishing control of illness outcomes to God and quality of life: Meaning/peace as a mediating mechanism in religious coping with cancer

BackgroundRelinquishing control (RC) of outcomes to God is a long-standing form of religious coping with serious illness. Placing cancer outcomes “in God's hands” has been positively related to coping and quality of life (QOL). However, the mechanisms involved in this relationship have not been established. A serial mediation model [i.e., RC (X)-Meaning/Peace (M1)-Coping Efficacy (M2)-Symptoms, Physical QOL, Functional QOL (Ys)] tested the hypothesis that Meaning/Peace alone and in conjunction with coping would mediate the RC-QOL relationship. Method548 persons with a cancer diagnosis completed the Religious Problem-Solving Scale (RPSS), FACIT-Sp Meaning and Peace Scales, Cancer Behavior Inventory (coping efficacy), and measures of Physical Quality of Life (PQOL), Functional Quality of Life (FQOL) and Symptoms. ResultsAs hypothesized, the single mediation effects of Meaning/Peace were significant [Indirect Effects: PQOL: .23 (95% CI: 0.15, 0.34); FQOL: 0.46 (95% CI: 0.33, 0.61); Symptoms: −0.18 (95% CI: −0.27, −0.10)]. In addition, mediation was confirmed for the serial mediation model (i.e., Meaning/Peace - Coping Efficacy as serial mediators) with significant indirect effects [Indirect Effects: PQOL: 0.37 (95% CI: 0.27, 0.48); FQOL: 0.57 (95% CI: 0.42, 0.72); Symptoms: −0.25 (95% CI: −0.35, −0.17)]. ConclusionsIn the mediation models tested, the RC-QOL and RC-Symptoms relationships were mediated by the confluence of a sense of peace perhaps due to patients' feelings that outcomes were “in God's hands” and a sense of coherence between their current situation and a spiritually-based meaning system. Meaning/Peace was also related to coping efficacy, suggesting that these mediating constructs could be used to inform evidence-based interventions, such as Meaning-Centered therapies, that are sensitive to the belief systems of cancer patients and enhance QOL.

Assessment of socio-relational self-efficacy in breast cancer patients: Italian validation of the social relationship coping efficacy scale (SRCE-I)

BackgroundSocial relationship coping efficacy (SRCE) represents the ability to maintain or enhance social relationships in the context of serious illness. The purpose of the current study was to confirm the factor structure, psychometric properties, and utility of the Italian version of the SRCE scale.Methods181 breast cancer patients completed the SRCE-Italian (SRCE-I), the Cancer Behavior Inventory–Brief/Italian (CBI–B/I), quality of life (QOL) measures (EORTC QLQ-C30; EORTC QLQ-BR23), and the Hospital Anxiety and Depression Scale (HADS).ResultsThe SRCE-I was internally consistent (Cronbach alpha = .95) and factor analysis confirmed that the SRCE-I was a unidimensional construct. In terms of validity, the SRCE-I was correlated with QOL (EORTC QLQ-30, Social Functioning, r = .33, Emotional Functioning, r = .57, and Global Health/Quality of Life; r = .54) and scales of the EORTC QLQ-BR23 (e.g., Future Perspective, r = .38; Breast Symptoms, −.31). SRCE-I was also correlated negatively with the HADS (r = −.72) and positively with the CBI–B/I (r = .79), a measure of coping efficacy (all ps < .001). Mediation analyses confirmed the utility of the SRCE-I scale as a mediating mechanism in enhancing social functioning and QOL.ConclusionsThe SRCE-I is a structurally sound, reliable, and valid measure that assesses the ability to maintain or enhance social support and mitigate the loss of social support. The SRCE-I can be used as a screening measure to assess low efficacy for maintaining social support or as a measure to detect the change in efficacy for enhancing social support in interventions to improve the QOL of patients.

Abstract 5881: The efficacy of a technology-based support program on survivorship experience: Asian American breast cancer survivors

Abstract Purpose: A technology-based intervention without face-to-face interactions could work better for many women from cultures where breast cancer is still a stigmatizing experience. Also, a technology-based intervention could meet the necessity of information and support without time and/or geographical restrictions. The purpose of this study was to test the efficacy of a technology-based support program for Asian American breast cancer survivors (TICAA) in enhancing the women’s breast cancer survivorship experience. Methods: This was a randomized controlled intervention with repeated measures (pretest [Time Point 0; T0], post 1-month [T1], and post 3-months [T2]). A total of 199 Asian American breast cancer survivors were recruited/retained through online and offline settings and included in the data analysis. While the intervention group was requested to use the TICAA and the American Cancer Society (ACS) website on breast cancer for 3 months, the control group was requested to use the ACS website for 3 months. Multiple instruments were used: the Cancer Behavior Inventory (CBI), the Personal Resource Questionnaire (PRQ), the Perceived Isolation Scale (PIS), the Support Care Needs Survey-34 Short Form (SCNS), the Memorial Symptom Assessment Scale-Short Form (MSAS), and the Functional Assessment of Cancer Therapy Scale-Breast Cancer (FACT-B). The data were analyzed using growth curve models, fitted within the framework of mixed effects modeling, and mediation analyses. Results: Within the mixed-effect model, there were significant decreases in the needs for help scores (SCNS scores) from T0 to T2 (β = -3.0236, p = .005) and the symptom distress scores (MSAS scores) from T0 to T1 and T2 (β = -2.8131, p &amp;lt; .001; β = -3.0356, p &amp;lt; .001). Yet, the change over time in the quality-of-life scores (FACT-B scores) was not statistically significant although the fixed effect of time was significant (β = -1.0476, p = .004). All the theory-based mediators (attitudes, self-efficacy, perceived barriers, and social influences) had statistically significant mediating impact on all outcome variables (needs for help, symptom distress, and quality-of-life; all p &amp;lt; .001), but there were differences in the mediating effects among different individual outcome variables. Conclusions: The findings supported the efficacy of the technology-based program in reducing the need for help and symptoms of Asian American breast cancer survivors. Further studies are needed on the differences in the effects of theory-based mediators on different outcome variables. Citation Format: Eun-Ok Im, Wonshik Chee, Sudeshna Paul, TICAA Research Team. The efficacy of a technology-based support program on survivorship experience: Asian American breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5881.