How important it is to feel self-efficacious – an exploratory analysis of pediatric and adolescent childhood cancer survivors during long-term follow-up care

Objectives While improved survival rates among pediatric cancer patients are a significant success, the intensive treatments required can lead to treatment-related late effects, psychosocial burden, and reduced health-related quality of life (HRQoL). Therefore, this paper examined the HRQoL of survivors with regard to gender-specific differences and explored the associations between health literacy (HL), self-efficacy (SE) and HRQoL using an exploratory approach.Methods Quantitative data of n = 58 childhood cancer survivors between 11 and 18 years were analyzed using a mediation model. All participants had completed cancer treatment and were in follow-up care. The mean age at diagnosis was 5 years. The majority of participants had been diagnosed with leukemia (55%), while the remaining participants had lymphomas, brain tumors, or other types of tumors. We assessed survivors HRQoL using the KINDL-R, a validated pediatric quality of life measure. To measure HL and SE, we used self-developed items, with SE defined as confidence in managing one’s own health.Results No significant gender-specific differences were found between the survivors with regard to their HRQoL (t(55) = 1.65, p = 0.11). The mediation analysis revealed that SE fully mediated the relationship between HL and HRQoL. The direct effect of HL on HRQoL was not significant (β = −0.06, p = 0.715), while the indirect effect through SE was significant (β = −0.26, p = 0.024). According to the squares of multiple correlation coefficients, this model explained 31% of the variation in HRQoL and 18.2% of the variation in SE.Conclusions Our findings suggest that SE has a potentially important role, being positively associated with HRQoL and acting as a key mediator in the relationship between HL and HRQoL in childhood cancer survivors. Given the modest sample size and preliminary nature of this study, we recommend that future research further investigate SE’s mediating role in larger cohorts. Screening for low SE and the development of SE-targeted interventions may be promising strategies to support survivors’ abilities and promote autonomous health care, but these should be considered as exploratory suggestions pending further validation.