Patient-Reported Self-Efficacy, Anxiety, and Health-Related Quality of Life During Chemotherapy: Results From a Longitudinal Study.

PURPOSE/OBJECTIVES: To explore changes over time in self-efficacy and the predictive ability of changes in state anxiety and health-related quality of life during chemotherapy.
. DESIGN: Secondary analysis of a longitudinal dataset derived from a larger, multicenter study.
. SETTING: Outpatient oncology clinics across eight general hospitals in England, Scotland, and Northern Ireland.
. SAMPLE: 137 patients scheduled to receive adjuvant chemotherapy for breast or colorectal cancer.
. METHODS: At the beginning of each of six chemotherapy cycles, participants completed the Strategies Used by People to Promote Health questionnaire, the State-Trait Anxiety Inventory, and the Functional Assessment of Cancer Therapy-Breast or -Colorectal questionnaire. Multilevel model analysis was used to analyze longitudinal data, adjusted for demographic and clinical variables.
. MAIN RESEARCH VARIABLES: Self-efficacy, anxiety, and health-related quality of life.
. FINDINGS: No significant time effects were found for patients' overall perceived self-efficacy or self-efficacy parameters. A trend toward greater self-efficacy was evident as chemotherapy progressed. Self-efficacy was significantly associated with decreased state anxiety throughout chemotherapy. Increases in overall self-efficacy and perceived ability to maintain a positive attitude were significantly associated with over-time increases in physical, emotional, and functional well-being, as well as with fewer cancer-related concerns.
. CONCLUSIONS: Findings highlight the importance of clinical assessments throughout treatment that focus on patients' perceived self-efficacy as a positive regulator of mood and well-being. 
. IMPLICATIONS FOR NURSING: The current study suggests self-efficacy enhancement should be a key component of psycho-behavioral programs designed to support patients with cancer throughout chemotherapy.

Trajectories and predictors of state and trait anxiety in patients receiving chemotherapy for breast and colorectal cancer: Results from a longitudinal study.

PURPOSE: To examine the trajectories and predictors of state and trait anxiety in patients undergoing chemotherapy for breast or colorectal cancer. METHODS: Secondary analysis of data collected as part of a large multi-site longitudinal study. Patients with breast or colorectal cancer completed validated scales assessing their state and trait anxiety levels (State-Trait Anxiety Inventory) and symptom burden (Rotterdam Symptom Checklist) at the beginning of each chemotherapy cycle. Longitudinal mixed model analyses were performed to test changes of trait and state anxiety over time and the predictive value of symptom burden and patients' demographic (age, gender) and clinical characteristics (cancer type, stage, comorbidities, ECOG performance status). RESULTS: Data from 137 patients with breast (60%) or colorectal cancer (40%) were analysed. Linear time effects were found for both state (χ2 = 46.3 [df = 3]; p < 0.001) and trait anxiety (χ2 = 17.708 [df = 3]; p = 0.001), with anxiety levels being higher at baseline and gradually decreasing over the course of chemotherapy. Symptom burden (ß = 0.21; SD = 0.06; p = 0.001) predicted state anxiety throughout treatment, but this effect disappeared when accounting for trait anxiety scores before the start of chemotherapy (ß = 0.85; SD = 0.05; p < 0.001). Patients' baseline trait anxiety was the only significant predictor of anxiety throughout treatment. CONCLUSIONS: Changes in the generally stable characteristic of trait anxiety indicate the profoundly life-altering nature of chemotherapy. The time point before the start of chemotherapy was identified as the most anxiety-provoking, calling for interventions to be delivered as early as possible in the treatment trajectory. Patients with high trait anxiety and symptom burden may benefit from additional support.