Determinants of self-management among gastrointestinal cancer patients undergoing chemotherapy: a structural equation...

Gastrointestinal cancers represent a significant global health burden, particularly in East Asia where incidence and mortality rates remain high. Although chemotherapy is a primary treatment strategy, its adverse effects often undermine treatment adherence and patient well-being. This study aimed to examine the psychosocial determinants of self-management behaviors in gastrointestinal cancer patients undergoing chemotherapy by applying a structural equation modeling (SEM) approach.

A cross-sectional study was conducted among 753 gastrointestinal cancer patients receiving chemotherapy at eight tertiary hospitals in China. Participants completed validated instruments assessing self-management behaviors, self-efficacy, medical coping strategies, perceived social support, and psychological distress. Structural equation modeling was used to investigate the direct, indirect, and mediating effects among the variables.

The SEM analysis revealed that self-efficacy had both a direct and indirect positive effect on self-management behaviors, mediated by adaptive coping strategies. Perceived social support was significantly associated with increased self-efficacy and adaptive coping, while psychological distress negatively influenced self-management, primarily through reduced self-efficacy and increased maladaptive coping. The final model demonstrated good fit indices (CFI = 0.950, TLI = 0.933, RMSEA = 0.065), supporting the hypothesized relationships.

Self-management in gastrointestinal cancer patients undergoing chemotherapy is influenced by a complex interplay of psychosocial factors. Interventions that target self-efficacy enhancement, encourage adaptive coping, and strengthen social support systems may be critical to improving treatment adherence and patient outcomes.