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Keywords:

  • cancer;
  • oncology;
  • cognitive functioning;
  • self-efficacy;
  • quality of life;
  • distress

Abstract

Objective

Cognitive problems are commonly reported by hematopoietic stem cell transplant (HSCT) survivors and are associated with poorer physical and mental well-being. It was hypothesized that adverse effects of subjective cognitive impairment occur because cognitive difficulties reduce survivors' confidence that they can manage HSCT-related symptoms—that is, self-efficacy for symptom management.

Methods

Hematopoietic stem cell transplant survivors (n = 245), 9 months to 3 years post-HSCT, completed measures of subjective cognitive functioning, self-efficacy for symptom management, and clinically important outcomes: depressed mood, anxiety, and quality of life. Mediation analyses using bootstrapping were conducted to investigate whether effects of subjective cognitive impairment on these outcomes were mediated by self-efficacy for cognitive, emotional (SE-Emotional), social (SE-Social), and physical (SE-Physical) symptom management.

Results

Self-efficacy mediated relations between subjective cognitive impairment and depressed mood (total indirect effect = −0.0064 and 95% CI −0.0097 to −0.0036), anxiety (total indirect effect = −0.0045, CI −0.0072 to −0.0021), and quality of life (total indirect effect = 0.0952, CI 0.0901 to 0.2642). SE-Emotional was a unique mediator when the outcome was depressed mood and anxiety. SE-Social, SE-Physical, and SE-Emotional were specific mediators when outcome was quality of life.

Conclusions

Findings support the conclusion that subjective cognitive impairment reduces HSCT survivors' confidence in their ability to manage common post-HSCT symptoms, with implications for physical and mental well-being. Interventions that help enhance survivors' self-efficacy, particularly self-efficacy for the management of emotional symptoms, are likely to benefit HSCT survivors who report subjective cognitive impairment. Copyright © 2011 John Wiley & Sons, Ltd.