Cancer coping self-efficacy mediates the relationship between mental adjustment to cancer and health-related quality of life in persons with cancer

Abstract

Individuals with cancer experience significant levels of distress. Improving health-related quality of life of persons with cancer is a major focus in cancer treatment. This study investigated the mediating role of self-efficacy for coping with cancer in the relationship between mental adjustment to cancer and health-related quality of life among individuals with cancer. Two hundred and fourteen persons with cancer (male = 74, female = 140, mean age = 50.57) were recruited from a University Teaching Hospital, in South-West Nigeria. Participants responded to the measures of psychological responses to cancer (mental adjustment to cancer), self-efficacy for coping with cancer (Cancer Behaviour Inventory [CBI]), and health-related quality of life (Functional Assessment of Cancer Therapy–General). Mediation analysis and structural equation modelling were carried out using IBM AMOS software version 23. Domains of mental adjustment to cancer significantly predicted health-related quality of life, helplessness/hopelessness, and anxious preoccupation had a negative association with health-related quality of life; whereas fighting spirit, cognitive avoidance, and fatalism were positively associated with health-related quality of life. Self-efficacy had a positive association with health-related quality of life. Mediation analysis showed that self-efficacy for coping with cancer partially mediated the association between four domains of mental adjustment to cancer (helplessness/hopelessness, fighting spirit, cognitive avoidance, and fatalism) and health-related quality of life. The findings demonstrated the need for improved coping mechanisms while undergoing cancer treatment. The study has important clinical implications for psycho-oncology practice, particularly with respect to self-efficacy for coping with cancer. Psychosocial therapies aimed at enhancing the self-efficacy of persons with cancer should be incorporated as part of cancer treatment to improve their health-related quality of life.

Keywords

Coping health-related quality of life mental adjustment to cancer self-efficacy

Cancer is a life-threatening illness that is associated with psychological distress and poor health-related quality of life (HRQoL) among patients (Lavdaniti et al., 2019). A report from the World Health Organisation (WHO (2020)) revealed that Nigeria recorded 115,000 new cases of cancer and 41,000 cancer-related deaths in 2019. Stress experienced by people living with life-threatening health conditions, such as cancer, does not only apply to the period of diagnosis of the disease only, but also involves a later struggle with the disease, brought about by the interplay of disease severity, stress of treatment, threat of death, and psychosocial factors, all of which result in current and future stressors (Moye & Rouse, 2014; Rzeszutek & Gruszczyńska, 2018). Persons with cancer experience high levels of anxiety which has been shown to be significantly associated with poorer HRQoL (Fatiregun et al., 2019).

HRQoL is the extent to which disease and its treatment affect a patient’s life functions (Schipper et al., 1996). HRQoL is a multidimensional construct involving physical, emotional, social, and cognitive factors, disease symptoms, and treatment side effects (Leplege & Hunt, 1997). HRQoL is a major consideration in the treatment of persons with cancer because of its usefulness in the effective allocation of health management resources, the monitoring of disease progression, and the evaluation of the most effective and least harmful treatment programmes (Centers for Disease Control and Prevention [CDC], 2020; Hassen et al., 2019). In efforts to adjust to the burden associated with cancer and its treatment, patients are confronted with various coping mechanisms. Lazarus and Folkman (1984) defined coping styles as an individual’s cognitive or behavioural efforts at managing the demands of a stressful situation. Lazarus and Folkman’s (1984) coping theory proposes that when a situation is evaluated as stressful and requires efforts to overcome, coping behaviours are enacted. In line with this theory, Watson et al. (1988) defined mental adjustment to cancer (MAC) as the cognitive and behavioural responses of patients to a cancer diagnosis. Dimensions of MAC include helplessness/hopelessness, anxiety preoccupation, fighting spirit, cognitive avoidance, and fatalism. While helplessness/hopelessness is concerned with demonstrating a pessimistic outlook on the situation and disappointment at any possibility of managing it, anxiety preoccupation refers to ongoing concern about the cancer and consequent feelings of devastation and anxiety. Fighting spirit reflects a belief in a certain degree of disease control and an optimistic outlook for the future. Cognitive avoidance is characterized by minimizing the threat and downplaying the need for personal control, while fatalism refers to passive acceptance of the disease (Watson et al., 1988). Although the effectiveness of psychological responses to cancer used by persons with cancer differs across contexts, effective strategies (e.g., fighting spirit) are typically associated with optimum adaptation, whereas ineffective strategies (e.g., helplessness–hopelessness) are associated with poorer psychosocial outcomes (Boyes et al., 2011; Grassi et al., 2004).

Studies (e.g., Costanzo et al., 2006; Watson et al., 1988) have shown that the dimensions of MAC have been identified as important factors in the HRQoL of persons with cancer. For example, helplessness and anxious preoccupation predicted a decrease in HRQoL (Johansson et al., 2011; Lampic et al., 1994), whereas fighting spirit predicted an increase in HRQoL among persons with cancer (Lampic et al., 1994; Yeung & Lu, 2014). Kugbey et al. (2019) found that helplessness–hopelessness and anxiety preoccupation were negatively associated with HRQoL, while fighting spirit, cognitive avoidance, and fatalism were positively associated with HRQoL. However, inconsistencies still exist on the nature of the association between certain dimensions of MAC and HRQoL. For example, Kugbey et al. (2019) found a positive association between cognitive avoidance and HRQoL, while Costanzo et al. (2006) found a negative association in the cognitive avoidance–HRQoL relationship. Some studies (e.g., Anagnostopoulos et al., 2006; Kang et al., 2008; Lampic et al., 1994) reported that fatalism was positively associated with HRQoL, while other studies (e.g., Bustillo et al., 2015; Gonzales et al., 2016; Yeung & Lu, 2014) reported a negative association between fatalism and HRQoL in persons with cancer. The inconsistent findings on the association between MAC and HRQoL therefore call for further studies.

If MAC is linked to HRQoL, the mechanism of such association is not yet clear. Identifying how MAC is linked to HRQoL would be helpful in understanding the mechanisms implicated in the health and wellbeing of persons with cancer. This could be useful in the development of interventions that could enhance patients’ life functions. We therefore propose that self-efficacy, as a measure of confidence in one’s ability to act, could serve as a mediator between MAC and HRQoL. Bandura (1989) had, in a self-efficacy theory, posited that the greater an individual’s confidence in their ability to execute a course of action, the more likely they would achieve the desired goal. Self-efficacy focusses on the individual’s judgement as to how well they can execute activities necessary to manage or cope with potential challenges (Bandura, 1989). People with higher self-efficacy for coping are better able to engage the resources needed to meet the challenges involved in coping with stressors than individuals with lower self-efficacy (Bandura, 1991). Studies involving persons with cancer indicate that self-efficacy plays an important role in the patients’ ability to cope with stress (Chirico et al., 2017; Cunningham et al., 1991; Merluzzi & Martinez-Sanchez, 1997). Previous studies have shown that persons with cancer who felt more effective in coping, adapted faster (Lev et al., 2007) and experienced better HRQoL than those who felt less confident in their ability to cope (Giese-Davis et al., 1999).

Studies have shown that self-efficacy for coping with cancer was positively associated with HRQoL and less distress (BorjAlilu et al., 2017; Heitzmann et al., 2011; Merluzzi et al., 2001). Shelby et al. (2014) found that higher self-efficacy for coping was associated with increased HRQoL (across functional, emotional, and social well-being dimensions). Chirico et al. (2017) also found that self-efficacy for coping with cancer is positively associated with HRQoL and inversely associated with distress. Among cancer survivors, self-efficacy has been shown to be positively associated with HRQoL (Yeung & Lu, 2014).

Considering the reported research findings on the relationship between MAC, self-efficacy, and HRQoL, it is possible that self-efficacy in relation to coping with cancer could mediate between MAC and HRQoL. No study, to the best of our knowledge, has investigated the mediating influence of self-efficacy in the MAC–HRQoL relationship. Some studies have, however, investigated the mediating role of self-efficacy in the association between psychosocial variables and HRQoL among persons with cancer. For instance, Perez and Smith (2015) found that self-efficacy for coping with cancer mediated the association between intrinsic religiousness and HRQoL among persons with cancer. Adams et al. (2017) also found that self-efficacy mediated the relationships between perceived social constraints and symptoms in long-term breast cancer survivors. The purpose of this study is therefore to investigate whether self-efficacy would mediate the relationship between MAC and HRQOL among persons with cancer.

We hypothesize that: (i) the dimensions of MAC (helplessness/hopelessness, anxiety preoccupation, fighting spirit, cognitive avoidance, and fatalism) will significantly predict HRQoL; (ii) self-efficacy will significantly predict HRQoL; and (iii) self-efficacy will mediate the relationship between the dimensions of MAC (helplessness/hopelessness, anxiety preoccupation, fighting spirit, cognitive avoidance, and fatalism) and HRQoL.

Method

Participants

Participants were 214 persons with cancer; 74 (34.6%) participants identified as male and 140 (65.4%) identified as female. Participants were aged between 18 and 77 years with a mean age of 50.57 (SD = 13.07) and attending oncology treatment in Lagos University Teaching Hospital (LUTH). Participants were included in the study if: (a) they were diagnosed with cancer of any part of their body, (b) they could read and understand English, and (c) they gave their informed consent (by signing the consent form) to participate in the study. Participants were excluded if they did not meet the above criteria or if they had a co-morbid health condition (e.g., hypertension, diabetes, etc.). The majority of the participants were married (81.3%). Other demographic and clinical characteristics of the participants are shown in Table 1.

Table 1.

Demographic and clinical characteristics of study participants.

Characteristics	N	%	Mean	SD
Age	18–77		50.57	13.07
Gender
Male	74	34.6
Female	140	65.4
Marital status
Married	174	81.3
Single	40	18.7
Education
No formal education	7	3.3
Primary education	16	7.5
Secondary	87	40.7
Tertiary	104	48.6
Cancer diagnosis
Breast cancer	80	37.4
Prostate cancer	24	11.2
Colon cancer	17	7.9
Lung cancer	9	4.2
Gynaecologic cancer	36	16.9
Liver cancer	6	2.8
Kidney cancer	5	2.3
Others	37	17.3
Cancer stage
Stage I	33	15.4
Stage II	92	43.0
Stage III	80	37.4
Stage IV	9	4.2
Cancer duration
Less than 1 year	33	15.4
1–5 years	155	72.4
6–10 years	25	11.7
Over 10 years	9	4.2
Treatment type
Chemotherapy
No	85	39.7
Yes	129	60.3
Radiotherapy
No	199	93.3
Yes	15	7.0
Surgery
No	149	69.6
Yes	65	30.4

Instruments

Functional Assessment of Cancer Therapy–General

The Functional Assessment of Cancer Therapy–General (FACT-G) is an instrument developed to assess HRQoL of persons with cancer (Cella et al., 1993). It comprises four subscales: physical well-being (seven items); social/family well-being (seven items); emotional well-being (six items), and functional well-being (seven items). The FACT-G is scored on a 5-point rating scale (0 = not at all; 1 = a little bit; 2 = somewhat; 3 = quite a bit; and 4 = very much). The subscale scores of FACT-G are obtained by summing up the items of each subscale, while the total score for FACT-G is obtained by summing up the four subscale scores. Total scores range from 0 to 108, with higher scores indicating better HRQoL. Although the scale has four dimensions, the composite score for FACT-G may be used to calculate overall HRQoL (Cella et al., 1993). The use of the composite score makes interpretation of the results less complex. The developers reported a Cronbach’s alpha reliability coefficient of .89 for the total score of the FACT-G. Cronbach’s alpha reliability coefficient for the FACT-G subscales ranged between.69 and.82 (Cella et al., 1993). In the present study, the FACT-G yielded a Cronbach’s alpha reliability coefficient of.88, Cronbach’s alpha reliability coefficients of the FACT-G subscales ranged from .74 to .91.

Mini-mental adjustment to cancer

The mini-mental adjustment to cancer (mini-MAC) is a revised 29-item five-domain scale developed to measure psychological responses to cancer (Watson et al., 1994). The domains include: fighting spirit, helplessness/hopelessness, anxious preoccupation, fatalism, and cognitive avoidance. Fighting spirit entails a belief in a certain degree of control over the disease and an optimistic perspective towards the future (e.g., I am determined to beat this disease). Helplessness/hopelessness measures passive responses to the individual’s situation, demonstrating a negative outlook regarding the situation and disbelief in any possibility of controlling it (e.g., I feel that life is hopeless). Anxious preoccupation refers to a constant preoccupation with cancer as being a source of feelings of devastation and anxiety (e.g., I am upset about having cancer). Fatalism entails an attitude of passive acceptance of the disease, which the individual considers impossible to control (e.g., I’ve put myself in the hands of God). Cognitive avoidance entails minimization of the threat and downplaying the need for personal control (e.g., Not thinking about it helps me cope). The items are scored on a 4-point format ranging from 1 (Definitely does not apply to me) to 4 (Definitely applies to me). Higher scores represent higher adjustment. Developers of the mini-MAC reported Cronbach’s alpha coefficients of .87 for the helplessness/hopelessness subscale, .88 for anxious preoccupation, .76 for fighting spirit, .74 for cognitive avoidance, and .62 for fatalism. In the present study, the mini-MAC yielded Cronbach’s alpha coefficients of .86, .84, .72, .88, and .61, respectively, for the helplessness/hopelessness, anxious preoccupation, fighting spirit, cognitive avoidance, and fatalism subscales.

Cancer Behaviour Inventory–Brief

The Cancer Behaviour Inventory–Brief (CBI-B) is a 12-item scale that assesses coping self-efficacy among persons with cancer (Heitzmann et al., 2011). The CBI-B is scored by summing the scores for the 12 items, with higher scores indicating greater coping self-efficacy. Developers reported a minimum Cronbach’s alpha coefficient of .84 among three separate samples. The CBI-B yielded a Cronbach’s alpha coefficient of .93 in the present study.

Procedure

While the patients were waiting to see their doctors, four research assistants approached them and explained the purpose of the study. Participants who agreed to take part in the study were recruited for the study after signing the informed consent form. The three instruments were compiled in a questionnaire format and 230 copies of the questionnaire were distributed. The participants completed the questionnaires before meeting their doctors and returned them to the research assistants. Out of the 230 questionnaires distributed, 214 completed questionnaires, representing a 93.4% return rate, were used for data analysis.

Ethical considerations

This study was approved by the research ethical review board of the LUTH.

Data analysis

We adopted a cross-sectional design in this study. Pearson’s correlation coefficient was used to examine correlations among the demographic and study variables. Mediation analysis and structural equation modelling were carried out using IBM AMOS software version 23. The maximum likelihood estimation was used to maximize the probability that the data were taken from the population. In this study, indirect effects serve as a measure of mediation. The indirect and total effects of the predictor (MAC) and the criterion HRQoL, mediated by self-efficacy for coping with cancer were examined, while the bias-corrected and accelerated 95% confidence intervals (CIs) were computed using 5000 bootstrap samples for indirect effects (Preacher & Hayes, 2008). CIs that do not include a zero value indicate a significant indirect effect. Gender was controlled for in the analysis because of its significant relationship with HRQoL.

Results

Correlational analyses

Table 2 summarizes Pearson’s correlation coefficients among all variables. All the dimensions of MAC correlated with HRQoL as follows: helplessness/hopelessness (r = –.46, p < .001) and anxious preoccupation (r = –.52, p < .001) had a negative relationship with HRQoL while fighting spirit (r = .22, p < .001), cognitive avoidance (r = .33, p < .001), and fatalism (r = .27, p < .001) were positively associated with HRQoL. Self-efficacy for coping had a significant positive relationship with HRQoL.

Table 2.

Mean (M), standard deviation (SD), and zero-order Pearson correlations of mental adjustment, self-efficacy and quality of life.

	Variables	M	SD	1	2	3	4	5	6	7	8	9
1	Gender			1
2	Age	50.57	13.07	−.036	1
3	Helplessness–hopelessness	13.30	4.79	−.018	−.09	1
4	Anxious preoccupation	18.99	4.41	−.031	−.06	.58**	1
5	Fighting spirit	13.61	2.60	−.053	.10	−.16*	.02	1
6	Cognitive avoidance	13.54	2.74	−.012	.12	−.16*	−.07	.52**	1
7	Fatalism	15.89	2.78	−.027	.21**	−.16*	−.12	.51**	.61**	1
8	CBI	71.59	23.26	−.113	.01	−.21**	−.08	.34**	.33**	.28**	1
9	FACT-G	65.46	16.58	.140*	−.10	−.46**	−.52**	.22**	.33**	.27**	.37**	1

Note: ^**p < .01; ^*p < .05; HRQoL = health-related quality of life; CBI = Cancer Behaviour Inventory; FACT-G = Functional Assessment of Cancer Therapy–General.

Structural equation model: self-efficacy for coping with cancer mediates the association between MAC and HRQoL

Figure 2 shows the mediating role of self-efficacy for coping with cancer in the MAC–HRQoL association. The model provided a good fit to the data (χ² = 7.747; df = 7; χ²/df = .356; goodness-of-fit index [GFI] = .990; normed fit index [NFI] = .983; Tucker–Lewis index [TLI] = .995; comparative fit index [CFI] = .998; root mean square error of approximation [RMSEA] = .022).

The bootstrap test of indirect effects confirmed that self-efficacy for coping partially mediated the helplessness/hopelessness–HRQoL association (β = –.058, CI₉₅ = –.105, –.018, p = .040). Self-efficacy for coping did not mediate the anxious preoccupation–HRQoL association (β = –.025, CI₉₅ = –.069, .023, p = .696; see Figure 1). Self-efficacy for coping mediated the association between fighting spirit and HRQoL (β = .111, CI₉₅ = .049, .188, p = .019; see Figure 1). Self-efficacy for coping also partially mediated the relationship between cognitive avoidance and HRQoL (β = .095, CI₉₅ = .046, .159, p = .014; see Figure 1). Self-efficacy for coping partially mediated the fatalism–HRQoL association (β = .091, CI₉₅ = .040, 158, p = .021; see Figure 1).

Figure 1.

Hypothesized model showing the mediating role of self-efficacy for coping with cancer on the relationship between MAC and HRQoL.

With the exception of fighting spirit, all the direct effects of the MAC domains were significant, indicating that there was no evidence of full mediation.

Discussion

We investigated the mediating role of self-efficacy for coping with cancer in the relationship between MAC and HRQoL. In line with the first hypothesis, we found that helplessness/hopelessness and anxious preoccupation had a negative association with HRQoL. Consistent with other studies (Johansson et al., 2011; Kugbey et al., 2019; Lampic et al., 1994), increased helplessness/hopelessness and anxious preoccupation predicted lower HRQoL among persons with cancer. We also found that fighting spirit, cognitive avoidance, and fatalism were positively associated with HRQoL. This is in line with other studies which showed that greater fighting spirit, cognitive avoidance, and fatalism increased HRQoL among persons with cancer (Kugbey et al., 2019). Specifically, fighting spirit has been shown to increase HRQoL and improved outcomes among persons with cancer (Lampic et al., 1994; Yeung & Lu, 2014). The direction of the relationship for cognitive avoidance and fatalism in previous studies appears to be contradictory. For example, while some studies found a positive association between cognitive avoidance and HRQoL (Kugbey et al., 2019), others found a negative association between cognitive avoidance and well-being (Costanzo et al., 2006). This may imply that where therapeutic options for the cure of the disease may not be available, diversion and not worrying about one’s illness, can reduce emotional distress. Distraction has been widely recognized as an emotion-focussed coping mechanism (Lazarus & Folkman, 1984), in that, it redirects attention from negative to positive thoughts. Thus, while some studies (Anagnostopoulos et al., 2006; Grassi et al., 2004; Ho et al., 2003; Kang et al., 2008) found cognitive avoidance to be an indicator of good adjustment, others (Bredal, 2010; Watson et al., 1994) found it to be an indicator of poor adjustment. Fatalism was positively associated with HRQoL. This is in agreement with Kugbey et al. (2019) who found a positive association between fatalism and HRQoL. This suggests that fatalism may be an adaptive coping strategy for persons with cancer in low- and middle-income countries. This may be due to the nature of some of the items in the scale that express a sense of religiosity in the form of dependence on God (e.g., I’ve put myself in the hands of God), which may reduce psychological distress among persons with cancer. Moreover, some researchers have argued that the original fatalism subscale may be measuring other coping functions besides fatalism, such as religion, coping, and faith and that fatalism was positively correlated with spirituality and an active participation in religious practice. This is unsurprising because religiosity has been found to be positively associated with overall HRQoL in persons with cancer (Tarakeshwar et al., 2006). Our study also showed that self-efficacy for coping with cancer was positively associated with HRQoL. This was supported by previous studies (Chirico et al., 2017; Heitzmann et al., 2011; Yeung & Lu, 2014) which found that self-efficacy for coping with cancer was associated with increased HRQoL among persons with cancer. Self-efficacy theory had posited that people with higher self-efficacy are better able to use the resources needed to meet the challenges of dealing with stressors than people with lower self-efficacy (Bandura, 1991). Self-efficacy may have implications for cancer survival, as some studies among cancer survivors have shown its positive effect on HRQoL (Yeung & Lu, 2014). In line with the third hypothesis, self-efficacy for coping with cancer mediated the relationship between MAC and HRQoL across all dimensions, except anxious preoccupation. As shown in Table 3, the mediating role of self-efficacy in the relationship between helplessness/hopelessness, fighting spirit, cognitive avoidance, fatalism, and HRQoL was supported. Specifically (see Figure 2), the findings show that lower helplessness/hopelessness was associated with increased self-efficacy and increased self-efficacy was then associated with better HRQoL. Fighting spirit was associated with increased self-efficacy which was then linked to better HRQoL. Also, higher cognitive avoidance and fatalism was associated with higher self-efficacy, which was then associated with better HRQoL. Thus, the mediating roles of self-efficacy suggest that it is not only the direct input from MAC that is linked to variations in HRQoL, but also the association between MAC and the extent of belief and confidence in coping with cancer. This revealed the importance of self-efficacy in the MAC–HRQoL association among persons with cancer. To our knowledge, our study appears to be the first to investigate this link in a sample of low-to-middle-income countries (LMICs), such as Nigeria.

Table 3.

Summary of the standardized coefficients of the total and indirect effects and relative CIs.

Direct effect	β	SE	95% CI	p
a → DV	−.401	.204	−1.827, –1.022	.001
b → DV	−.504	.202	−2.294, –1.498	.001
c → DV	.112	.431	−.077, 1.621	.074
d → DV	.235	.398	.743, 2.313	.001
e → DV	.184	.396	.128, 311	.001
M→DV	.202	.042	.119, 285	.001
Indirect effect
a → M→ DV	−.058	.023	−.105, –.018	.040
b → M→ DV	−.025	.023	−.069, .023	.696
c → M→ DV	.111	.036	.049, .188	.019
d → M→ DV	.095	.029	.046, .159	.014
e → M→ DV	.091	.030	.040, 158	.021
Total effect
a → M→ DV	−.470	.210	−2.041, –1.213	.001
b → M→ DV	−.530	.218	−2.420, –1.561	.001
c → M→ DV	.233	.426	.640, 2.320	.001
d → M→ DV	.348	.391	1.334, 2.873	.001
e → M→ DV	.302	.398	1.012, 2.582	.001

Note: a = helplessness/hopelessness; b = anxious preoccupation; c = fighting spirit; d = cognitive avoidance; e = fatalism; M = mediator (Cancer Behaviour Inventory); DV = dependent variable (FACT-G).

Figure 2.

Structural equation model testing self-efficacy for coping with cancer as a mediator of the relationship among MAC (helplessness/hopelessness, anxious preoccupation, fighting spirit, cognitive avoidance fatalism, and HRQoL). Standardized coefficients are presented in the diagram. Errors were omitted from the diagram. Non-significant parameters are represented by dashed lines. *p < .05; **p < .01.

The findings of the study are of particular relevance for LMICs, such as Nigeria, where there is a fragile health care system (Chukwuorji & Iorfa, 2020; Nnadozie et al., 2015) with poor health care for persons with cancer and a high number of cancer-related deaths (WHO, 2020). The study highlighted the significance of MAC, which illustrates the importance of psychological adjustments in the HRQoL of persons with cancer. Little or no attention has been paid to the MAC among individuals suffering from cancer in LMICs, such as Nigeria. Exploring this in cancer management can therefore contribute to improving patient health and well-being. Our study further identified the importance of self-efficacy in cancer management. Since the impact of MAC on HRQoL can be explained by self-efficacy, the individual’s confidence in coping with a difficult situation is therefore important in the management of stressful life events, such as cancer. Accordingly, psychotherapy aimed at boosting an individual’s self-efficacy in coping with the disease may help improve HRQoL. This study therefore has implications for psycho-oncology, an emerging field in Nigeria.

Despite the significance of the study findings and important clinical implications, there are some limitations. The use of a cross-sectional design with its inherent weakness in establishing causality is a major limitation in the present study. Future studies may adopt a longitudinal design to make causal inferences. We also relied on self-reported measures which often elicit socially desirable responses from participants. In addition, participants were recruited from only one hospital. This limits the extent to which the findings can be generalized.

Conclusion

We found that self-efficacy for coping with cancer mediated the association between MAC and HRQoL, indicating its relevance in the management of cancer. This study has clinical implications for psycho-oncology practice. We therefore recommend that self-efficacy in persons with cancer should be enhanced given its potential role in managing the MAC and HRQoL. Consequently, psychosocial therapies aimed at self-efficacy for coping with cancer should be incorporated in the care of persons with cancer as it reduces emotional distress and improves HRQoL.

Footnotes

Author Note

Desmond U Onu is now affiliated to Department of Psychology, University of Pretoria, South Africa.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Maria-Chidi Christiana Onyedibe

Desmond U Onu

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