Supportive Care in Cancer

, Volume 27, Issue 2, pp 547–555 | Cite as

Knowledge, fatigue, and cognitive factors as predictors of lymphoedema risk-reduction behaviours in women with cancer

  • Miyako TsuchiyaEmail author
  • Mariko Masujima
  • Tomoyasu Kato
  • Shun-ichi Ikeda
  • Chikako Shimizu
  • Takayuki Kinoshita
  • Sho Shiino
  • Makiko Suzuki
  • Miki Mori
  • Miyako Takahashi
Original Article



To identify social–cognitive factors predicting lymphoedema risk-reduction behaviours (hereafter, self-care) after discharge among patients in Japan with breast or gynaecological cancers, using the extended model of the theory of planned behaviour.


A cross-sectional questionnaire study was conducted in an oncology hospital. Items measured were (1) knowledge about self-care; (2) the Cancer Fatigue Scale; (3) social–cognitive factors in the theory of planned behaviour (attitudes, subjective norms, and perceived behavioural control); (4) self-care (limb hygiene, observation, articular movement, recommended risk-reduction behaviours in daily life, and diet and weight control); and (5) demographics. Of 202 respondents, 147 who had not been diagnosed with lymphoedema were eligible for statistical analysis (65.3% with gynaecological cancer, 34.7% with breast cancer).


Structural equation modelling was used to examine a hypothesised model based on the theory of planned behaviour. The results revealed that a longer time since surgery, higher levels of fatigue, less knowledge, higher expected efficacy of self-care, and lower perceived behavioural control directly and significantly predicted less self-care behaviour.


Besides education about self-care behaviour, levels of fatigue and perceived behavioural control should be taken into account to encourage female patients with cancer to perform self-care after discharge. Continuous psycho-educational programmes after discharge may help to facilitate self-care behaviours among long-term female cancer survivors.


Breast cancer Gynaecological cancer Lymphoedema Predictive factors Self-care Social–cognitive factors 



We thank all patients who participated in this study.


This study was funded by the Foundation for Promotion of Cancer Research in Japan and in part by the National Cancer Center Research and Development Fund (28-A-23).

Compliance with ethical standards

Conflict of interest

Chikako Shimizu reports personal consultancy fee from Eizai and Pfizer, and grants from Pfizer, Chugai, MSD and Eli Lilly, outside the submitted work. Miyako Tsuchiya, Mariko Masujima, Tomoyasu Kato, Shun-ichi Ikeda, Takayuki Kinoshita, Sho Shiino, Makiko Suzuki, Miki Mori, and Miyako Takahashi have nothing to declare.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Miyako Tsuchiya
    • 1
  • Mariko Masujima
    • 2
  • Tomoyasu Kato
    • 3
  • Shun-ichi Ikeda
    • 3
  • Chikako Shimizu
    • 4
  • Takayuki Kinoshita
    • 5
  • Sho Shiino
    • 5
  • Makiko Suzuki
    • 6
  • Miki Mori
    • 7
  • Miyako Takahashi
    • 1
  1. 1.Division of Cancer Survivorship Research, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
  2. 2.Graduate School of NursingChiba UniversityChibaJapan
  3. 3.Gynaecology DivisionNational Cancer Center HospitalTokyoJapan
  4. 4.Breast and Medical Oncology DivisionNational Cancer Center HospitalTokyoJapan
  5. 5.Division of Breast SurgeryNational Cancer Center HospitalTokyoJapan
  6. 6.Department of NursingNational Cancer Center HospitalTokyoJapan
  7. 7.Saitama Prefectural UniversitySaitamaJapan

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