The function of fatigue and illness perceptions as mediators between self-efficacy and health-related quality of life during the first year after surgery in persons treated for colorectal cancer

Aims and objectives: To measure changes in health-related quality of life, two dimensions of illness perceptions (i.e., consequences and emotional representations), fatigue and self-efficacy in persons treated for colorectal cancer during the first year after surgical treatment, and to study how fatigue, illness perceptions and self-efficacy measured at 3 months affect health-related quality of life at 12 months postsurgery. Background: There are fluctuations in health-related quality of life during the first year after treatment for colorectal cancer, and fatigue may negatively influence health-related quality of life. Illness perceptions (consequences and emotional representations) and self-efficacy have been shown to be associated with health-related quality of life in other cancer diagnoses. Concerning colorectal cancer, there is a lack of knowledge concerning how illness perceptions and self-efficacy change during recovery, and how these variables and fatigue at 3 months relate to health-related quality of life at 12 months. Design: A prospective longitudinal design. Methods: Thirty-nine persons surgically treated for colorectal cancer, of whom 17 had a colostomy, participated. Health-related quality of life, fatigue, illness perceptions and self-efficacy were assessed using QLQ-C30, the Revised Illness Perception Questionnaire and the Maintain Function Scale. Descriptive and analytical statistics were used. Results: No changes were reported in levels of health-related quality of life, fatigue or illness perceptions. Self-efficacy was lower at 12 months compared to 3 months. Fatigue and one dimension of illness perceptions mediated the effect of self-efficacy at 3 months on health-related quality of life at 12 months. Conclusion: Persons treated for colorectal cancer who have lower self-efficacy 3 months postsurgery are inclined to have more negative illness perceptions concerning emotions and to experience more fatigue. Relevance to clinical practice: Nurses need to support persons with fatigue and negative illness perceptions concerning emotions and to bolster their self-efficacy, that is carry out follow-up consultations focusing on illness management, symptoms, emotions and information on ways to increase self-efficacy.