Self-advocacy in cancer care has historically been studied almost exclusively in women, particularly those with breast and gynecologic cancers, where validated measurement tools and intervention programs were first developed. The concept, formally defined through concept analysis work by Hagan and Donovan, encompasses the ability to gain knowledge about one’s illness, communicate one’s values and preferences to others involved in care, and exercise control over treatment decisions and daily living. Whether these same dimensions apply to men — and how they manifest in a cancer type that disproportionately affects males — has remained largely unexplored until now. The research team, led by Yushuo Niu and Yingying Li under the supervision of Xiaohong Hou, set out to fill this gap by examining self-advocacy in a population where the disease burden is substantial and where gender-specific psychosocial dynamics may shape coping in unique ways.

Liver cancer represents one of the most significant global health challenges, with epidemiological data indicating substantial geographic disparities in incidence and mortality. The disease is considerably more common in men than in women, a pattern documented across temporal trends in China and worldwide. In China specifically, where the current study was conducted, national clinical guidelines for primary liver cancer diagnosis and treatment were updated in 2024, reflecting both the scale of the problem and the evolving nature of clinical management. Against this backdrop, understanding how male patients navigate the psychosocial dimensions of their illness — beyond the surgical and pharmacological interventions — becomes increasingly relevant to comprehensive cancer care.

The study enrolled 207 male patients with liver cancer between August 2024 and June 2025. Each participant completed a battery of standardized instruments: a general information questionnaire capturing demographic and clinical characteristics, the Fear of Progression Questionnaire-Short Form measuring anxiety about disease advancement, the Family Hardiness Index assessing family resilience, the Cognitive Emotion Regulation Questionnaire-Short evaluating the strategies patients use to process emotional distress, and the Self-Advocacy in Cancer Survivorship scale quantifying the core construct of interest. The researchers then applied latent profile analysis, a statistical technique that identifies hidden subgroups within a population based on patterns of responses across multiple dimensions, to classify patients according to their self-advocacy characteristics.

Latent profile analysis differs from conventional approaches that simply average scores across a population. Instead of treating self-advocacy as a single continuous variable, the method searches for natural clusters — groups of patients whose response patterns across the various dimensions of self-advocacy resemble each other more than they resemble those of other patients. This approach, grounded in the work of Nylund, Asparouhov, and Muthén on deciding the number of classes in latent class analysis, allows researchers to capture the genuine heterogeneity that exists in how patients engage with their own care. The technique has been increasingly applied in oncology research to identify subgroups that might benefit from different intervention strategies, and the current study represents the first application of this methodology to self-advocacy in male liver cancer patients.

The analysis revealed three distinct self-advocacy profiles among the 207 participants. The largest subgroup, comprising 55.56 percent of patients, was labeled the comprehensive-multidimensional strengths group, characterized by relatively strong performance across all dimensions of self-advocacy. The second subgroup, accounting for 25.60 percent, was the balanced-low interaction group, showing uniformly low levels across the self-advocacy dimensions. The third and smallest subgroup, representing 18.84 percent, was the imbalanced-low decision-high interaction group, displaying an uneven pattern in which decision-making capacity was low while interpersonal interaction remained relatively high. This finding demonstrates that self-advocacy in male liver cancer patients is genuinely heterogeneous, presenting in three categorically different configurations rather than along a single continuum.

To understand what factors distinguish these subgroups, the researchers employed multiple logistic regression analysis, examining whether demographic characteristics, fear of progression, family resilience, and cognitive emotion regulation were associated with subgroup membership. The results showed that place of residence, fear of progression, and cognitive emotion regulation were all statistically significant factors associated with self-advocacy profile membership. However, family resilience did not show a statistically significant association in this study. This pattern of findings suggests that the psychological characteristics of individual patients — particularly how anxious they feel about disease progression and how they cognitively process emotional distress — are more closely tied to their self-advocacy configuration than the collective strength of their family unit.

The association between fear of progression and self-advocacy is particularly noteworthy from a clinical perspective. Fear of progression, a well-documented phenomenon in oncology, refers to anxiety about the disease advancing, treatment failing, or the future becoming uncertain. Prior research has established that fear of progression is prevalent across cancer types and can influence information-seeking behavior, emotional coping, and quality of life. The current findings suggest that this anxiety may also shape how actively patients engage in advocating for themselves. Similarly, cognitive emotion regulation — the mental strategies patients deploy to manage emotional distress — emerged as a significant factor, consistent with broader research linking emotion regulation strategies to psychological outcomes in cancer populations. Patients who rely on adaptive cognitive strategies may be better positioned to engage in the knowledge-seeking, communication, and decision-making behaviors that constitute self-advocacy.

The finding that place of residence was associated with self-advocacy profile membership adds a social dimension to the picture. Urban-rural differences in healthcare access, health literacy, and family support structures have been documented in Chinese healthcare research, and the current study suggests these disparities may extend to the psychosocial realm of self-advocacy. Patients from different residential contexts may face different barriers to engaging actively in their care, whether through limited access to information resources, different cultural norms around patient-clinician communication, or varying levels of exposure to patient education programs. This finding aligns with broader concerns about healthcare equity and suggests that residential context should be considered when designing support interventions.

The absence of a statistically significant association between family resilience and self-advocacy is perhaps the most unexpected finding of the study. Family resilience, measured through the Family Hardiness Index, refers to the collective capacity of a family unit to withstand stress and adapt to challenges. Prior meta-analytic work has established associations between family resilience and mental health outcomes, and systematic reviews have identified family resilience as a key factor in cancer treatment. The current finding does not necessarily mean that family dynamics are irrelevant to self-advocacy in male liver cancer patients, but it does suggest that, in this population, individual psychological characteristics may be more proximal determinants of self-advocacy behavior than family-level resources. This distinction carries practical implications for intervention design, pointing toward individually targeted psychological support rather than family-centered approaches as the primary avenue for enhancing self-advocacy in this population.

The study’s conclusions carry direct relevance for clinical practice. The researchers argue that healthcare providers should pay attention to the psychosocial characteristics of male liver cancer patients and implement targeted support and guidance to enhance self-advocacy and adaptive coping. Rather than applying a uniform intervention to all patients, the three-profile framework suggests that different subgroups may benefit from different approaches. Patients in the balanced-low interaction group, for instance, may need foundational support in building basic self-advocacy skills across all dimensions, while those in the imbalanced-low decision-high interaction group may benefit most from targeted decision-making training that builds on their existing interpersonal strengths. The comprehensive-multidimensional strengths group, already demonstrating strong self-advocacy, may require maintenance strategies rather than intensive intervention.

This research represents the first systematic examination of self-advocacy characteristics in male liver cancer patients and provides a reference for developing individualized, precise nursing interventions. The findings underscore that self-advocacy is not a fixed trait but a set of behaviors that varies meaningfully across patients and is shaped by identifiable psychological and social factors. As cancer care increasingly recognizes the importance of patient engagement and shared decision-making, understanding the heterogeneous configurations of self-advocacy — and the factors that influence them — becomes essential to designing support programs that meet patients where they are. The study opens a pathway for future research to examine whether targeted interventions based on these profiles can improve not only self-advocacy itself but also the broader psychosocial and clinical outcomes that matter to male patients navigating liver cancer.

Subject of Research: Latent profiles of self-advocacy and their relationship with fear of progression, family resilience, and cognitive emotion regulation among male patients with liver cancer

Article Title: Latent profiles of self-advocacy and their relationship with fear of progression, family resilience, and cognitive emotion regulation among male patients with liver cancer

Article References: Niu, Y., Li, Y., Li, C., Zhao, R., Zhang, Q., & Hou, X. (2026). Latent profiles of self-advocacy and their relationship with fear of progression, family resilience, and cognitive emotion regulation among male patients with liver cancer. Supportive Care in Cancer, 34(9), Article 909. https://doi.org/10.1007/s00520-026-11160-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11160-5

Keywords: self-advocacy, liver cancer, fear of progression, cognitive emotion regulation, family resilience, latent profile analysis, oncology nursing, supportive care, Latent, profiles, relationship, fear