Analysis of factors influencing of supportive care needs in chemotherapy interval breast cancer patients based on a structural equation model: a cross-sectional study

In recent years, although there have been studies on the supportive care needs (SCNs) of breast cancer patients, there have been no studies on the factors affecting the supportive care needs of breast cancer patients during the chemotherapy interval. Guided by the supportive care framework, this study aimed to analyze the factors influencing SCNs in chemotherapy interval breast cancer patients. Study design: This is a cross-sectional study. Participants: 286 female adult breast cancer patients who met the inclusion criteria in the department of Breast Surgery of a tumor hospital in Zhejiang, China, were selected by convenience sampling. Inclusion criteria: first diagnosis of breast cancer in pathology and clinical stage I-IIIA; postoperative adjuvant chemotherapy and have passed at least one chemotherapy interval; older than 18 years old; able to communicate normally; and willing to participate in this study. Exclusion criteria: tumor recurrence; unaware of the disease; mental illness; suicidal tendency. Analysis: Primary outcomes: SCNs and symptom burden, social support and anxiety, depression. Sample size: This study included 286 cases. Statistical tests: Spearman correlation analysis was used to explore the correlation between SCNs and symptom burden, social support, anxiety and depression; constructing a structural equation model of SCNs' influencing factors, and to analyze the pathways and effects of different influencing factors on SCNs. Structural equation modeling (SEM) was performed using maximum likelihood estimation. Ethics approval: The study was approved by the Medical Ethics Committee of a tumor hospital in Zhejiang Province (No. IRB-2020-408). Participants' overall SCNs score was 76.16 (SD=21.06). Among the five dimensions of SCNs, the highest and lowest scoring dimensions were physical and daily living needs 2.77 (SD=0.72) and sexual needs 1.36 (SD=0.75). The constructed structural equation models fit well (χ 2 /df =2.359<3;RMSEA= 0.071<0.08), symptom severity and symptom distress to life had direct and indirect effects on SCNs, with total effect values of 0.545 and 0.481 (P<0.001), respectively; social support and anxiety had a direct effect on SCNs, with effect values of -0.338 and 0.667 (P<0.001), respectively, and depression had an indirect effect on SCNs with an effect value of 0.380 (P<0.001). This study showed that SCNs in chemotherapy interval breast cancer patients were at a high level, confirming the direct or indirect effects of symptom burden, social support, depression and anxiety on SCNs in chemotherapy interval breast cancer patients, and providing a reference for future interventions by caregivers to intervene in SCNs in chemotherapy interval breast cancer patients. Limitations: In this study, only breast cancer patients in the breast surgery department of a tumor hospital in Zhejiang were selected as survey subjects, which resulted in a limited scope of the study and a small sample size. Secondly, there is no assessment tool specifically for the needs of chemotherapy interval breast cancer patients. No.