title: The influence of demographics, psychological factors and self-efficacy on symptom distress in colorectal cancer patients undergoing post-surgical adjuvant chemotherapy.
abstract: OBJECTIVE
  To explore the influence of self-efficacy and demographic, disease-related, and psychological factors on symptom distress among Chinese colorectal cancer patients receiving postoperative adjuvant chemotherapy.
  
  
  METHODS
  Two-hundred and fifty-two colorectal cancer patients who had undergone postoperative adjuvant chemotherapy completed Chinese versions of M. D. Anderson Symptom Inventory (MDASI-GI), Stanford Inventory of Cancer Patient Adjustment (SICPA), and Hospital Anxiety and Depression Scale (HADS). Associations between patients' self-efficacy and demographic, disease-related, psychological factors and symptom distress were examined.
  
  
  RESULTS
  Patients' overall symptom distress level was mild; MDASI median subscale scores showed mild symptom severity and symptom interference. Anxiety and depression were positively associated with symptom distress. Multivariable analysis showed that more severe symptoms were associated with age ≥60 years, female gender, suburban residence, body mass index <18.5, and stage III cancer. Age ≥60 years, female gender, marital status of single or divorced, and suburban residence were associated with greater symptom interference with daily activities. Greater self-efficacy was associated with milder symptoms severity and less symptom interference with daily life. After adjusting for confounders, patients with higher SICPA scores had less symptom distress.
  
  
  CONCLUSIONS
  Self-efficacy is strongly associated with reduced symptom severity and symptom interference with daily life in CRC patients. Symptom severity is associated with age >60 years, female gender, body mass index <18.5, suburban residence and stage III disease. Nurse-administered self-efficacy interventions may help to improve self-efficacy and reduce symptom distress.
authors.affiliation: School of Nursing, Sun Yat-sen University, Guangzhou 510080, China. Electronic address: zhmfen@mail.sysu.edu.cn.
authors.forename: Mei-fen
authors.initials: MF
authors.lastname: Zhang
authors.affiliation: Department of Nursing, Cancer Center of Sun Yat-sen University, Guangzhou 510275, China.
authors.forename: Mei-chun
authors.initials: MC
authors.lastname: Zheng
authors.affiliation: Department of Nursing, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.
authors.forename: Wei-yan
authors.initials: WY
authors.lastname: Liu
authors.affiliation: Department of Nursing, Cancer Center of Sun Yat-sen University, Guangzhou 510275, China.
authors.forename: Yong-shan
authors.initials: YS
authors.lastname: Wen
authors.affiliation: Department of Nursing, Cancer Center of Sun Yat-sen University, Guangzhou 510275, China.
authors.forename: Xiao-dan
authors.initials: XD
authors.lastname: Wu
authors.affiliation: Department of Nursing, Cancer Center of Sun Yat-sen University, Guangzhou 510275, China.
authors.forename: Qian-wen
authors.initials: QW
authors.lastname: Liu
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D002681:China; D015179:Colorectal Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020377:Self Efficacy; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment
keywords: Anxiety; Chemotherapy; Colorectal cancer; Depression; Self-efficacy; Symptom distress