ArticleQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation2026
Factors associated with self-care engagement among oesophageal and gastric cancer survivors: a population-based cross-sectional study.
Article in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSurvivors of oesophageal and gastric cancer frequently experience persistent symptoms and functional limitations that affect their health-related quality of life (HRQL). Although self-care is increasingly recognised as a central component of survivorship care, little is known about what determines self-care engagement or whether engagement is associated with better HRQL. This study examined the sociodemographic and healthcare-related variables associated with self-care engagement and explored its association with global quality of life (QOL) in a nationwide cohort.
methodsA cross-sectional survey was conducted among individuals diagnosed with oesophageal or gastric cancer in Sweden between 2021 and 2023. Participants completed the EORTC QLQ-C30 and a study-specific questionnaire assessing symptoms and self-care. Self-care engagement was operationalised as the ratio of self-care strategies used to the number of symptoms experienced and categorised into no, moderate, and high. Factors associated with self-care engagement were analysed using multinomial logistic regression, and the association between self-care engagement and global QOL was assessed using linear regression, adjusting for sociodemographic and clinical confounders.
resultsOf the 432 respondents, 422 reported at least one symptom and were included in the self-care analysis. One-third of the participants reported no self-care engagement, whereas two-thirds reported moderate or high engagement. Across all models, university education was the strongest and only consistent variable associated with self-care engagement (high vs. no self-care engagement: odds ratio 2.83, 95% confidence interval 1.48-5.42). Neither assignment of a designated contact nurse nor proximity to the treating hospital was associated with self-care engagement. Participants with high self-care engagement had substantially better global QOL than those with moderate or no self-care engagement, with mean differences exceeding 10 points on a 0-100 scale. Global QOL did not differ between the moderate and no self-care groups.
conclusionsSelf-care engagement varies widely among oesophageal and gastric cancer survivors and appears to be influenced by educational level. High self-care engagement is associated with clinically meaningful improvements in global QOL, whereas no or moderate self-care appears insufficient to confer benefits. These findings suggest an equity gap in survivorship care, and future research should explore the development of structured and accessible interventions to enhance self-care capabilities among patients with lower educational attainment.
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