DOI: https://doi.org/10.14710/nmjn.v16i2.77151

Path Analysis Modeling of Impaired Well-being in Advanced Cancer Patients Undergoing Chemotherapy

Thidarat Khamboon orcid scopus  -  Department of Nursing, Division of Adult Nursing, Faculty of Nursing, Naresuan University, Thailand
*Intira Pakanta  -  Department of Nursing, Division of Adult Nursing, Faculty of Nursing, Naresuan University, Thailand
Open Access Copyright (c) 2026 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Well-being is an overall indicator of an individual’s health status. Psychological and somatic symptoms may negatively impact patients undergoing chemotherapy for advanced cancer. Previous studies have identified cancer-related symptoms and psychosocial factors associated with impaired well-being but have not fully explored the factor structure of the whole spectrum of impaired well-being or assessed the causal effects of those factors on impaired well-being.

Purpose: This study aimed to develop and test a path model of the relationships between unpleasant symptoms and impaired well-being among patients undergoing chemotherapy for advanced cancer.

Methods: A cross-sectional secondary analysis was conducted among 500 patients with advanced cancer who received treatment at a tertiary care hospital in the lower northern region of Thailand. Data included personal and clinical information and the Edmonton Symptom Assessment System (ESAS), which assessed the severity of cancer-related symptoms, including pain, anxiety, nausea, shortness of breath, drowsiness, tiredness, depression, and loss of appetite. Impaired well-being was measured using the ESAS well-being item, ranging from 0 (best well-being) to 10 (worst possible well-being). Path analysis was used to examine the relationships between symptoms and impaired well-being.

Results: The final path model demonstrated a good fit to the data and explained 22.1% of the variance in impaired well-being (R² = .221). Loss of appetite had the strongest total effect on impaired well-being (β = 0.72, p < .001). Loss of appetite (β = 0.71, p < .001), depression (β = 0.31, p < .001), and shortness of breath (β = 0.21, p < .001) had significant direct effects on impaired well-being. Anxiety, nausea, shortness of breath, pain, tiredness, and loss of appetite had indirect effects on impaired well-being.

Conclusion: The study provides an explanatory model of the relationships between symptoms and impaired well-being in patients undergoing chemotherapy for advanced cancer. The findings highlight the importance of comprehensive symptom assessment and management and may help nurses design interventions that address both direct and indirect symptom pathways.

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Keywords: Advanced cancer; chemotherapy; impaired well-being; path analysis
Funding: Faculty of Nursing, Naresuan University

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