Status quo of self-management efficacy in patients with endocrine therapy of breast cancer
The total score of the questionnaire on self-management efficacy of endocrine therapy for breast cancer patients was 165.00 points. In this study, the average score of the self-management efficacy of breast cancer endocrine therapy patients was 125.21 points, which was at a medium level and consistent with previous research results [18–19]. Studies have shown that the course of disease will affect the level of self-management efficacy of patients, and the level of self-management efficacy of patients will decrease with the passage of time . Therefore, in this study, patients were divided into 1 year, 2 years, 3 years, 4 years, 5 years and more than 5 years according to the length of endocrine therapy for comparison. However, the results showed that there was no significant difference in the scores of self-management efficacy among patients with different periods of endocrine therapy (p>0.05), which may be due to the good physiological and psychological status of most patients with endocrine therapy in this study, and the adequate family and social support system, which made patients confident to adhere to long-term treatment.
QOL status quo in patients with endocrine therapy of breast cancer of breast cancer
The average score of QOL of breast cancer patients treated with endocrine therapy was 73.29, which was at a medium level, consistent with the results of Montagnese et al. . Among all the dimensions, the score of psychological function was the lowest, which may be related to breast cancer patients' inferiority about the change of their own image, the worry about the disease and treatment, and the symptom confusion caused by endocrine therapy.
Correlation between self-management efficacy and QOL in patients with endocrine therapy of breast cancer
The results of this study showed that there was a positive correlation between self-management efficacy and quality of life (p<0.01), which indicated that the higher the level of self-management efficacy, the better the QOL, which was consistent with previous research results [18, 22–24]. At the same time, the results of this study showed that the self-management efficacy of patients with breast cancer endocrine therapy was positively correlated with the physical function dimension, physiological function dimension, social function dimension and breast cancer-specific module of QOL (p<0.01), which indicated that improving the self-management efficacy of patients with breast cancer endocrine therapy can improve their physical, physiological and social function and other aspects of life quality. However, in the results of this study, the common symptoms and side effects of self-management efficacy and QOL were not related, which may be due to the difference between the symptoms and side effects contained in the dimension of QOL scale for breast cancer patients and the physical symptoms and side effects experienced by breast cancer patients during endocrine therapy. In addition, the life/emotion dimension, disease coping dimension, social/family dimension and compliance behavior dimension of self-management efficacy were positively correlated with the quality of life (p<0.01), which indicated that when the self-management efficacy level of daily life and emotions is high, positive emotions can be improved while negative emotions can be reduced to broaden the patient's thinking-behavior system and establish an effective coping mode [23, 25], so as to better cope with diseases and achieve social and family functions. In addition, breast cancer patients with a strong sense of self-efficacy can face the stress caused by the disease with a more optimistic and positive attitude, actively seek the help of medical staff and the support of family and society, build up confidence in fighting the disease, actively participate in the management of the disease, and reduce the influence of disease and treatment on the overall health and QOL [26–27].
Analysis of influencing factors of QOL in patients with endocrine therapy of breast cancer
In this study, the factors influencing the QOL of patients with breast cancer undergoing endocrine therapy were analyzed by one-way ANOVA, and it found that age, BMI, marital status, monthly family income, the number and types of physical symptoms, fatigue, nausea, insomnia, recurrence and metastasis and self-management efficacy had significant influence on the QOL (p<0.05).
Because single factor analysis can't control the influence of confounding factors and the information obtained from comprehensive analysis, the comparability of data is slightly poor and the results are relatively limited. Multi-factor analysis has the characteristics of high efficiency and reliable results, and through comprehensive analysis, it can eliminate atypical and unrepresentative factors and find out the real factors. Therefore, in order to eliminate the possible interaction among various factors, this study took the QOL as the dependent variable, and meaningful variables in single factor analysis as the independent variable, and carried out multiple stepwise regression analysis to screen the most important influencing factors of the QOL of breast cancer patients undergoing endocrine therapy.
The results showed that the variables entered the regression equation were self-management efficacy, number of physical symptoms, monthly family income, recurrence or metastasis, which jointly predicted the variation of 46.2% of the QOL of patients with breast cancer undergoing endocrine therapy. It was suggested that the higher the self-management efficacy level of breast cancer endocrine therapy patients, the better the QOL, which was consistent with the previous research results [18, 22–24, 28]. Bandura thought self-efficacy can affect human health by influencing individual's physical and mental regulation system, such as influencing individual's health habits and directly controlling individual's physiological aging. Therefore, self-efficacy can make breast cancer patients reach the physiological, psychological and social health state by regulating the physical and mental system, thus affecting their quality of life. Patients with high self-efficacy, when faced with difficulties and challenges, often don't fear difficulties, often can make their ability to solve problems outstandingly, show better self-management ability, better grasp the relevant knowledge and skills of self-management healthy behaviors, adhere to daily life and emotional management, adhere to self-condition monitoring, adhere to correct self-management behaviors and improve their quality of life; on the contrary, patients with low self-efficacy often question their abilities and tend to adopt negative or evasive coping styles when facing diseases, which easily leads to the generation of bad emotions such as anxiety, depression, pessimism, disappointment, etc., which is not conducive to the formation of correct self-management behaviors and new healthy behaviors, and leads to the decline of quality of life [22, 26, 28, 30–31]. Secondly, the number of physical symptoms, family monthly income and whether recurrence or metastasis also enter the regression equation. The fewer physical symptoms, the higher monthly income of family, and the better QOL if there is no recurrence or metastasis [26, 32–35].
To sum up, the self-management efficacy of breast cancer patients undergoing endocrine therapy is the most important factor affecting their QOL. The higher the self-management efficacy level of breast cancer patients, the better their QOL.