The impact of psychosocial factors on diet compliance in breast cancer patients undergoing chemotherapy

Authors

DOI:

https://doi.org/10.53713/nhsj.v5i4.558

Keywords:

breast cancer, chemotherapy, psychosocial, diet

Abstract

Diet adherence in breast cancer patients impacts their physical condition and quality of life. Psychosocial factors play a role in diet adherence in breast cancer patients, but the exact influence of each factor is still unclear. This study aims to investigate the impact of various psychosocial factors on dietary adherence among breast cancer patients undergoing chemotherapy. The research used a cross-sectional design with 98 respondents selected through simple random sampling. The dependent variable is diet adherence, and the independent variables are psychosocial factors (knowledge, motivation, coping, distress, spirituality, and social support). Data were collected using a questionnaire and analyzed both descriptively and inferentially (using multiple linear regression). The research results show that most respondents are aged 46–55 years (35.7%), have an elementary school education (41.8%), are housewives (51%), are married (84.7%), and have undergone their third chemotherapy visit (24.5%). Respondents have moderate knowledge, coping, and distress (51%, 56%, 55%), while also exhibiting high motivation, spirituality, and social support (71%, 75%, 78%). However, diet adherence is reported as low and high (34.7%, 34.7%). The analysis results indicate that psychosocial factors have a significant simultaneous influence on dietary adherence, accounting for 29.1% of the variance (F = 7.649; p < 0.000; R² = 0.291). However, partially, motivation and spirituality have a significant influence on dietary adherence (t = 2.726, p = 0.008 and t = 4.978, p = 0.000). The study concludes that psychosocial factors, including motivation and spirituality, are important components that influence dietary adherence in breast cancer patients undergoing chemotherapy. Therefore, efforts to improve dietary adherence in breast cancer patients should consider the patients' motivation and spirituality to enhance chemotherapy outcomes and quality of life.

References

Ahmed, H.S., Kundu, S., Shams, M.J., Hossain, A.F.M.A., & Rahman, M.M. (2021). Presenting features of locally advanced breast cancer: a cross-sectional study. Bangabandhu Sheikh Mujib Medical University Journal, 14(4), 148-151. https://doi.org/10.3329/bsmmuj.v14i4.56615

Anuk, D., Tuncer, S.B., Özkan, M., & Yazıcı, H. (2024). Factors associated with psychological distress during genetic counseling in high-risk women with breast cancer in Turkey. Supportive Care in Cancer, 32(6), 359. https://doi.org/10.1007/s00520-024-08573-5

Ben-Artzi, T.J., Baziliansky, S., & Cohen, M. (2024). The associations of emotion regulation, self-compassion, and perceived lifestyle discrepancy with breast cancer survivors’ healthy lifestyle maintenance. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-024-01656-6

Berger, E., Gelot, A., Fournier, A., Dossus, L., Boutron-Ruault, M.-C., Severi, G., Castagné, R., & Delpierre, C. (2024). Educational level and characteristics of invasive breast cancer: findings from a French prospective cohort. Cancer Causes and Control, 35(8), 1151-1163. https://doi.org/10.1007/s10552-024-01873-5

Caillot-Ranjeva, S., Segrestan-Crouzet, C., Gourlain, S., Bergua, V., & Rascle, N. (2021). Relationship between marital adjustment and mental health in couples facing breast cancer. Psycho-Oncologie, 15(1), 27-32. https://doi.org/10.3166/pson-2021-0150

Campos, A. A. L., Bustamante-Teixeira, M. T., Ervilha, R. R., Fayer, V. A., Cintra, J. R. D., Freitas, R. M., Almeida, D. P., & Guerra, M. R. (2024). Quality of life of women who underwent breast cancer treatment relative to sociodemographic, behavioral, and clinical factors. Einstein (São Paulo), 22, eAO0585. https://doi.org/10.31744/einstein_journal/2024ao0585

Chandraprasad, M. S., Dey, A., & Swamy, M. K. (2022). Introduction to cancer and treatment approaches. In Paclitaxel (pp. 1–27). Academic Press. https://doi.org/10.1016/B978-0-323-90951-8.00010-2

Chen, B., Luo, T., Cai, Q., Pan, F., Liang, D., & Hu, Y. (2022). Effect of psychological intervention-assisted comfort nursing based on PERMA model on stress and psychological changes of patients after breast cancer surgery. Computational and Mathematical Methods in Medicine, 1853754. https://doi.org/10.1155/2022/1853754

Das, O., Pradhan, I., Chatterjee, R., & Dash, S. R. (2022). A computational approach to assess breast cancer risk in relation with lifestyle factors. Smart Innovation, Systems and Technologies, 271, 367–376. https://doi.org/10.1007/978-981-16-8739-6_34

Falcão, C. S. V., Catrib, A. M. F., Brasil, C. C. P., Batista, P. M. S., Sousa, I. C., & Melo, J. C. (2022). Netnographic research on the importance of spirituality and religiosity after the diagnosis of breast cancer. New Trends in Qualitative Research, 13, e705. https://doi.org/10.36367/ntqr.13.2022.e705

Farahani, A. S., Ashrafizadeh, H., Akbari, M. E., Motefakker, S., Khademi, F., Ebrahimloyi, S., Karami, M., Moghimian, R., Razmara, R., Abreu, W., & Rassouli, M. (2022). The mediating role of spiritual health in adherence to treatment in patients with cancer. International Journal of Cancer Management, 15(5), e127820. https://doi.org/10.5812/ijcm-127820

Folorunso, S. A., Abiodun, O. O., Abdus-Salam, A. A., & Wuraola, F. O. (2023). Evaluation of side effects and compliance to chemotherapy in breast cancer patients at a Nigerian tertiary hospital. ecancermedicalscience, 17, 1537. https://doi.org/10.3332/ecancer.2023.1537

Forster, M., Deal, A. M., Page, A., Vohra, S., Wardell, A. C., Pak, J., Lund, J. L., Nyrop, K. A., & Muss, H. B. (2024). Dose delay, dose reduction, and early treatment discontinuation in Black and White women receiving chemotherapy for nonmetastatic breast cancer. The Oncologist, 29(10), e1246–e1259. https://doi.org/10.1093/oncolo/oyae150

Fujimoto, T., & Okamura, H. (2021). The influence of coping types on post-traumatic growth in patients with primary breast cancer. Japanese Journal of Clinical Oncology, 51(1), 85–91. https://doi.org/10.1093/jjco/hyaa159

González-Lamuño, D., Sánchez-Pintos, P., Andrade, F., Couce, M. L., & Aldámiz-Echevarría, L. (2021). Treatment adherence in tyrosinemia type 1 patients. Orphanet Journal of Rare Diseases, 16(1), 256. https://doi.org/10.1186/s13023-021-01879-1

Gozzi, E., La Manna, A. R., Rossi, L., Piroli, S., Colonna, M., Ulgiati, M. A., … Ricci, F. (2022). What hides beneath the scar: Sexuality and breast cancer—What women do not say: A single-center study. Clinica Terapeutica, 173(4), 242–246. https://doi.org/10.7417/ct.2022.2443

Hakim, M. A., & Aristawati, N. V. (2023). Mengukur depresi, kecemasan, dan stres pada kelompok dewasa awal di Indonesia: Uji validitas dan reliabilitas konstruk DASS-21. Jurnal Psikologi Ulayat, 10(2), 232–250. https://doi.org/10.24854/jpu553

Hamby, S., Grych, J. H., & Banyard, V. (2013). Life Paths Research Measurement Packet: Coping Scale. Life Paths Research Program. https://doi.org/10.13140/RG.2.1.3094.0001

Helgesen, E. H., Ulevåg, R., Solheim, T. S., Thronæs, M., Jakobsen, G., Løhre, E. T., … Vagnildhaug, O. M. (2024). Appetite loss in patients with advanced cancer treated at an acute palliative care unit. Current Oncology, 31(10), 6061–6072. https://doi.org/10.3390/curroncol31100452

Hutajulu, S. H., Aresy, S., Astari, Y. K., Wiranata, J. A., Puspitaningtyas, H., Sulistyoningrum, D. C., … Hardianti, M. S. (2025). Severe deficiency of vitamin D and anthracycline–taxane regimen are associated with cachexia following breast cancer chemotherapy. Asian Pacific Journal of Cancer Prevention, 26(1), 189–197. https://doi.org/10.31557/apjcp.2025.26.1.189

Juwita, A. P., Mita, M., & Maulana, M. (2019). The conformity of the spiritual assessment scale with the spirituality well-being scale as assessment tools for patients' spirituality level in Yarsi Hospital inpatient ward Pontianak. ProNers, 4(1). https://doi.org/10.26418/jpn.v4i1.34512

Khazi, F., Angolkar, M., Kumari, S., & Patil, B. R. (2024). Assessment of quality of life among breast cancer patients undergoing different treatment modalities at tertiary hospitals in North Karnataka, India. Clinical Epidemiology and Global Health, 28, 101675. https://doi.org/10.1016/j.cegh.2024.101675

Kiew, S. J., Majid, H. A., & Mohd Taib, N. A. (2022). A qualitative exploration of dietary behaviour of Malaysian breast cancer survivors. European Journal of Cancer Care, 31(1), e13530. https://doi.org/10.1111/ecc.13530

Laksmita, O. D., Chung, M. H., Liao, Y. M., & Chang, P. C. (2020). Multidimensional scale of perceived social support in Indonesian adolescent disaster survivors: A psychometric evaluation. PLoS ONE, 15(3). https://doi.org/10.1371/journal.pone.0229958

Leão, D. C. M. R., Pereira, E. R., Silva, R. M. C. R. A., Rocha, R. C. N. P., Cruz-Quintana, F., & García-Caro, M. P. (2022). Spirituality and emotional experience with a diagnosis of breast cancer: A scoping review. Cancer Nursing, 45(3), 224–235. https://doi.org/10.1097/NCC.0000000000000936

Leena Nesamani, S., Nirmala Sugirtha Rajini, S., Josphine, M. S., & Jacinth Salome, J. (2021). Deep learning-based mammogram classification for breast cancer diagnosis using multi-level support vector machine. Lecture Notes in Electrical Engineering, 700, 371–383. https://doi.org/10.1007/978-981-15-8221-9_35

Lestari, H. S. A., Sukartini, T., & Nihayati, H. E. (2023). Spiritual well-being in breast cancer patients. Pediomaternal Nursing Journal, 9(1), 26–30. https://doi.org/10.20473/pmnj.v9i1.42247

Li, H., Liu, C., Ke, S., Cui, L., Sun, M., Bian, Y., Song, Y., & Lu, Q. (2025). The effect of symptom distress on medication adherence in patients with breast cancer undergoing endocrine therapy: A moderated mediation model. Asia-Pacific Journal of Oncology Nursing, 12, Article 100701. https://doi.org/10.1016/j.apjon.2025.100701

Liu, H.-M., Ma, L.-L., Li, C., Cao, B., Jiang, Y., Han, L., Xu, R., Lin, J., & Zhang, D. (2022). The molecular mechanism of chronic stress affecting the occurrence and development of breast cancer and potential drug therapy. Translational Oncology, 15(1), Article 101281. https://doi.org/10.1016/j.tranon.2021.101281

Lope, V., Guerrero-Zotano, Á., Fernández de Larrea-Baz, N., Antolín, S., Benavent Viñuales, M., Bermejo, B., … Pollán, M. (2024). Cross-sectional and longitudinal associations of adherence to WCRF/AICR cancer prevention recommendations with health-related quality of life in breast cancer survivors: Health-EpiGEICAM study. Journal of Nutrition, Health and Aging, 28(8), Article 100312. https://doi.org/10.1016/j.jnha.2024.100312

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3). https://doi.org/10.1016/0005-7967(94)00075-U

Manouchehri, E., Taghipour, A., Ebadi, A., Homaei Shandiz, F., & Latifnejad Roudsarii, R. (2022). How do I deal with breast cancer? A qualitative inquiry into the coping strategies of Iranian women survivors. BMC Women’s Health, 22(1), Article 284. https://doi.org/10.1186/s12905-022-01865-0

Mantzorou, M., Tolia, M., Poultsidi, A., Vasios, G. K., Papandreou, D., Theocharis, S., … Giaginis, C. (2022). Adherence to Mediterranean diet and nutritional status in women with breast cancer: Impact on disease progression and recurrence-free survival. Current Oncology, 29(10), 7482–7497. https://doi.org/10.3390/curroncol29100589

Maramara, T., Matos, M. C., Ardila, S., Phantana-angkool, A., & Henry, D. (2024). Minimizing breast cancer risk with diet and exercise. Current Breast Cancer Reports, 16(1), 45–52. https://doi.org/10.1007/s12609-024-00524-7

Marín-Chollom, A. M., Rillamas-Sun, E., Koch, P. A., Contento, I. R., Gaffney, A. O., Ulanday, K. T., … Greenlee, H. (2024). Social support, diet, and physical activity among Latina/Hispanic women breast cancer survivors. Journal of Immigrant and Minority Health, 26(6), 1053–1061. https://doi.org/10.1007/s10903-024-01614-5

Mate, Y., & Somai, N. (2021). Hybrid feature selection and Bayesian optimization with machine learning for breast cancer prediction. 2021 7th International Conference on Advanced Computing and Communication Systems (ICACCS), 612–619. https://doi.org/10.1109/ICACCS51430.2021.9441914

Muellers, K. A., Soukas, C., Zeidman, R., Pantaleon, K., Harris, Y. T., Wisnivesky, J. P., & Lin, J. J. (2024). Cancer beliefs and diet self-management among cancer survivors with comorbid diabetes. Journal of Cancer Survivorship, 18(3), 900–906. https://doi.org/10.1007/s11764-023-01340-1

Muzayyana, A., & Aini, Q. (2024). Bibliometric analysis of the Health Belief Model in healthcare workers: Trends, insights, and future directions. Journal of Angiotherapy, 8(5), Article 9698. https://doi.org/10.25163/angiotherapy.859698

Nita, I., Nitipir, C., Toma, S. A., Limbau, A. M., Pirvu, E., Badarau, I. A., … Manolescu, L. S. C. (2022). Level of education, background, and clinical stage as prognostic factors in early and locally advanced breast cancer: A Romanian experience. Medicine and Pharmacy Reports, 95(1), 31–39. https://doi.org/10.15386/mpr-1988

Öcal, D. Ş., & Ceyhan, A. A. (2021). The disease process experiences of women diagnosed with breast cancer in the psychosocial context. Turkish Psychological Counseling and Guidance Journal, 11(62), 333–351. https://doi.org/10.17066/tpdrd.1001704

Padmasini, N., Sairam, V. A., Kapoor, S., & Nithila, J. (2025). Application of artificial intelligence in breast cancer diagnostics: A review. Artificial Intelligence in Medicine and Healthcare, 150–171. https://doi.org/10.1201/9781003508595-9

Paloutzian, R. F., & Ellison, C. W. (1991). Manual for the Spiritual Well-Being Scale. Life Advance.

Pangestuti, R. D., Armini, N. K. A., & Dewi, L. C. (2021). Self-structured breast cancer awareness among female adolescents. Pediomaternal Nursing Journal, 7(1), 1. https://doi.org/10.20473/pmnj.v7i1.20431

Pedersini, R., Di Mauro, P., Zamparini, M., Bosio, S., Zanini, B., Amoroso, V., … Berruti, A. (2022). Taste alterations do not affect change in food habits and body weight in breast cancer patients. In Vivo, 36(4), 1860–1867. https://doi.org/10.21873/invivo.12904

Pelletier, L. G., Tuson, K. M., & Haddad, N. K. (1997). Client motivation for therapy scale: A measure of intrinsic motivation, extrinsic motivation, and amotivation for therapy. Journal of Personality Assessment, 68(2), 414–435. https://doi.org/10.1207/s15327752jpa6802_11

Pereira, M., Moreira, C. S., Nogueira-Silva, C., Izdebski, P., & Pereira, M. G. (2021). Breast cancer post-surgical impact on women’s quality of life during chemotherapy treatment: A structural equation modeling approach. European Journal of Cancer Care, 30(1), Article e13349. https://doi.org/10.1111/ecc.13349

Primanda, Y., Kritpracha, C., & Thaniwattananon, P. (2011). Dietary behaviors among patients with type 2 diabetes mellitus in Yogyakarta, Indonesia. Nurse Media Journal of Nursing, 1(2), 211–223. https://doi.org/10.14710/nmjn.v1i2.975

Punzalan, M. G.-R. H., Tioleco, P. B., & Chua, N. S. (2023). The effects of spirituality on the quality of life among cancer patients receiving outpatient chemotherapy. Philippine Journal of Internal Medicine, 62(1), 255–261. https://doi.org/10.54476/ioer-imrj/716261

Putri, G. N., Mutu Manikam, N. R., Andayani, D. E., Trismiyanti, & Halim, L. (2023). Successful nutritional therapy at home for a patient with invasive breast carcinoma: A case report. Asia-Pacific Journal of Oncology Nursing, 10, Article 100250. https://doi.org/10.1016/j.apjon.2023.100250

Rondhianto, R., Ridla, A. Z., & Budi, F. A. K. S. (2023). Analysis of psychosocial factors affecting dietary behavior among people with type 2 diabetes mellitus in Indonesia. Jurnal Keperawatan Soedirman, 18(3), 122–128. https://doi.org/10.20884/1.jks.2023.18.3.6488

Sanati, V., Sohouli, M. H., Dareini, H., Esmailzadeh, A., Sajadian, A.-S., Raji Lahiji, M., … Zarrati, M. (2023). The association between dietary patterns and chemotherapy side effects in patients with breast cancer. Nutrition and Cancer, 75(3), 948–959. https://doi.org/10.1080/01635581.2023.2173552

Schmalenberger, M., Spees, C., Bittoni, A. M., & Krok-Schoen, J. L. (2022). Association of dietary quality, inflammatory markers, and physical functioning among older female cancer survivors. Nutrition and Cancer, 74(2), 496–504. https://doi.org/10.1080/01635581.2021.1892157

Sebri, V., Durosini, I., Mazzoni, D., & Pravettoni, G. (2022). Breast cancer survivors’ motivation to participate in a tailored physical and psychological intervention: A qualitative thematic analysis. Behavioral Sciences, 12(8). https://doi.org/10.3390/bs12080271

Sharma, R., Sharma, S., Dhiman, A., Singh, S. P., Thakur, S., Garg, V. K., … Kashyap, D. (2025). Global epidemiological status of breast cancer burden: Potential reduction strategies and preventive measures. In Cancer of the Breast: Epidemiology, Diagnostics and Treatment (pp. 1–10). https://doi.org/10.1016/B978-0-443-24838-2.00001-X

Sriati, A., Rahayuwati, L., Komariah, M., Hendrawati, Amira, I., Senjaya, S., … Widianti, E. (2021). The balance of spiritual and nutritional needs improves well-being of cancer patients during chemotherapy. Open Access Macedonian Journal of Medical Sciences, 9(T6), 138–142. https://doi.org/10.3889/oamjms.2021.7321

Subih, H. S., Al-Shwaiyat, E. A., Al-Bayyari, N., Obeidat, B. S., Abu-Farsakh, F., & Bawadi, H. (2023). Dietary intake is associated with psychological status among cancer patients receiving chemotherapy. Nutrients, 15(24), Article 5087. https://doi.org/10.3390/nu15245087

Tang, H., Wang, R., Liu, W., Xiao, H., Jing, H., Song, F., … Shang, L. (2023). The influence of nutrition literacy, self-care self-efficacy and social support on dietary practices among breast cancer patients undergoing chemotherapy: A multicentre study. European Journal of Oncology Nursing, 64, Article 102344. https://doi.org/10.1016/j.ejon.2023.102344

Tang, H., Wang, R., Yan, P., Zhang, W., Yang, F., Guo, S., … Shang, L. (2023). Dietary behavior and its association with nutrition literacy and dietary attitude in breast cancer patients treated with chemotherapy. Patient Preference and Adherence, 17, 1407–1419. https://doi.org/10.2147/PPA.S413542

Tang, J. W. C., Lam, W. W. T., Kwong, A., Ma, A. S. Y., & Fielding, R. (2022). Dietary decision-making in Chinese breast cancer survivors: A qualitative study. Patient Education and Counseling, 105(2), 460–465. https://doi.org/10.1016/j.pec.2021.05.017

Terfa, Y. B., Aliyu, S. A., Reta, E. Y., Germossa, G. N., & Akuma, A. O. (2021). What women know about breast cancer: The case of Ethiopia. Nursing Practice Today, 8(2), 113–122. https://doi.org/10.18502/npt.v8i2.5122

Tippannavar, S. S., Yashwanth, S. D., Gayathri, S., & Madappa, E. A. (2023). Early detection of breast cancer using versatile techniques: A review. Journal of Innovative Image Processing, 5(3), 270–289. https://doi.org/10.36548/jiip.2023.3.004

Trabulo, C., Lopes, J., da Silva Dias, D., Gramaça, J., Fernandes, I., Gameiro, R., … Ravasco, P. (2022). Assessment of nutritional status of oncology patients at hospital admission: A Portuguese real-world study. Frontiers in Nutrition, 9. https://doi.org/10.3389/fnut.2022.972525

Trestini, I., Sperduti, I., Caldart, A., Bonaiuto, C., Fiorio, E., Parolin, V., … Carbognin, L. (2021). Evidence-based tailored nutrition education improves adherence to dietary guidelines, anthropometry, and metabolic biomarkers in early-stage breast cancer patients. Breast, 60, 6–14. https://doi.org/10.1016/j.breast.2021.08.008

Urtiga, L. M. P. C., Lins, G. A. N., Slongo, A., Ventura, A. L. F., Cabral, A. K. G. D., Parente, L. B., … Fernandes, T. G. (2023). Spirituality and religiosity: Influence on cancer therapy and well-being. Revista Bioética, 30(4), 883–891. https://doi.org/10.1590/1983-80422022304578PT

Wang, F., Simon, M. S., Kroenke, C. H., Krok-Schoen, J., Jung, S. Y., Chlebowski, R., … Luo, J. (2024). Social support, social strain, stressful life events and mortality among postmenopausal women with breast cancer. Psycho-Oncology, 33(11), Article e70013. https://doi.org/10.1002/pon.70013

Xia, J., Yu, J., Qu, L., Lv, L., Zhu, W., Meng, X., … Luo, Y. (2024). Nutritional inequality and comorbid chronic disease among breast cancer survivors in China. Nutrients, 16(23), Article 4031. https://doi.org/10.3390/nu16234031

Xu, P., Xu, R., Yang, Q., & Zhu, H. (2022). Effect of intensive psychological care on patients with benign breast lumps after mammotome-assisted tumor resection. Evidence-Based Complementary and Alternative Medicine, 2022, Article 9054266. https://doi.org/10.1155/2022/9054266

Xu, W., Li, A., Yackel, H. D., Sarta, M. L., Salner, A., & Judge, M. P. (2024). Dietary consumption patterns in breast cancer survivors: Pilot evaluation of diet, supplements and clinical factors. European Journal of Oncology Nursing, 72, Article 102678. https://doi.org/10.1016/j.ejon.2024.102678

Yuan, R., Zhang, C., Li, Q., Ji, M., & He, N. (2021). The impact of marital status on stage at diagnosis and survival of female patients with breast and gynecologic cancers: A meta-analysis. Gynecologic Oncology, 162(3), 778–787. https://doi.org/10.1016/j.ygyno.2021.06.008

Zaviazkina, N. V., & Nefedova, T. Mousa. (2024). Wiadomości Lekarskie, 77(9), 1704–1711. https://doi.org/10.36740/wlek/192138

Downloads

Published

2025-12-04

How to Cite

Rondhianto, Murtaqib, and Muhammad Wahdha. “The Impact of Psychosocial Factors on Diet Compliance in Breast Cancer Patients Undergoing Chemotherapy ”. Nursing and Health Sciences Journal (NHSJ) 5, no. 4 (December 4, 2025): 523–541. Accessed January 9, 2026. https://nhs-journal.com/index.php/nhs/article/view/558.

Citation Check