Self-efficacy for cancer self-management in the context of COVID-19: a cross-sectional survey study

Abstract

Purpose: For cancer survivors, self-efficacy is needed to manage the disease and the effects of treatment. The COVID-19 pandemic disrupted cancer-related healthcare, which may have impacted self-management self-efficacy. We investigated self-efficacy reported by cancer survivors during COVID-19, including associations with healthcare disruptions, distress, and general health. Methods: Between 2020 and 2021, 1902 individuals aged 18–80 years with a recent cancer diagnosis completed a survey regarding the effects of COVID-19 on healthcare, self-efficacy for managing cancer and social interactions, cancer-related distress, and perceived general health. Linear and logistic models estimated odds ratios and 95% confidence intervals (CIs) between self-efficacy scores, healthcare disruptions, significant distress, and general health. Results: Mean self-efficacy for managing cancer was 7.58 out of 10. Greater self-efficacy was associated with lower odds for distress (OR 0.18 [95% CI 0.13–0.26], quartile 4 vs. 1) and for worse general health (0.05 [0.03–0.09]). Participants with disruptions to cancer-related healthcare had lower self-efficacy for managing cancer compared to those without (6.62 vs. 7.09, respectively, P < 0.001) and higher odds for distress (1.70 [1.36–2.14]), but not worse general health (1.13 [0.39–1.44]). Lower self-efficacy mediated 27% of the association between healthcare disruptions and increased distress (15–47%). Associations with self-efficacy for managing social interactions trended in the same direction. Conclusions: During COVID-19, disruptions to cancer-related healthcare were associated with lower self-efficacy, increased distress, and worse general health. Psychosocial interventions designed to overcome barriers and target self-efficacy may be important for enhancing outcomes among cancer survivors experiencing disruptions in healthcare access.