Resilience and quality of life (QoL) of head and neck cancer and brain tumour survivors in Pakistan: an analytical cross-sectional study protocol

Oral health related quality of life in head and neck cancer survivors within the first year following treatment: a cross-sectional study in Karachi, Pakistan

After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N - 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46-28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p < 0.05). These findings suggest that Quality of Life (QoL) among HNC treated patients is negatively impacted by their poor oral health, post cancer treatment. Therefore, it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.

Latent profiles of resilience and associations with quality of life in head and neck cancer patients undergoing proton and heavy ion therapy

Background

Psychological resilience is the most important psychological protection factor for cancer patients in the face of tumors and treatment. However, few studies have performed meaningful latent profile analyses of resilience to identify unobserved subgroups of head and neck cancer patients.

Purpose

The purpose of this study was to investigate the characteristics of resilience in head and neck cancer patients using latent profile analysis (LPA) to determine the sociodemographic and disease characteristics of each profile. In particular, we examined the association of different resilience profiles with the quality of life of head and neck cancer patients.

Methods

A total of 254 head and neck cancer patients completed a demographic questionnaire, the Resilience Scale Specific to Cancer and the EOTRC QLQ-C3O, used to assess their resilience and quality of life.

Results

LPA identified three distinct profiles based on varying levels of resilience: "low resilience" group (n = 45; 17.72%), "moderate resilience" group (n = 113; 44.49%), and "high resilience" group (n = 96; 37.80%). Gender (χ2 = 6.20; p < 0.01), education level (χ2 = 1,812.59; p < 0.01), treatment regimen (χ2 = 6.32; p < 0.01), tumor stage (χ2 = 3.92; p ≤ 0.05), and initial recurrence (χ2 = 5.13; p < 0.05) were important predictors. High resilience was significantly related to higher quality of life (χ2 = 15.694; p < 0.001).

Conclusions

Head and neck cancer patients' psychological resilience can be categorized as three resilience profiles; those who are female and have a low education level tend to have lower psychological resilience. Low resilience in patients is linked to poor role function and social function, low quality of life, and more severe pain symptoms, highlighting the need to address resilience in patient care for improved wellbeing.

Clinical and psychosocial factors associated with quality of life in patients with head and neck cancer: an analytical cross-sectional study from a lower-middle-income country

INTRODUCTION

The disease course of head and neck (H&N) cancer can severely impair patients' quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan.

METHODS

An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis.

RESULTS

A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34).

CONCLUSION

The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.

Factors influencing resilience in patients with advanced cancer: A cross-sectional study

Background

Advanced cancer and its treatments lead to various detrimental impacts on patients. Resilience is an important ability to adapt to such adversity, but there is limited information about its influencing factors, specifically in patients with advanced cancer.

Objective

This study aimed to examine the influence of social support, depression, anxiety, hope, optimism, spiritual well-being, religious belief, and hardiness on resilience among adults with advanced cancer.

Methods

This cross-sectional research used multi-stage sampling to select 288 participants from a university hospital and three tertiary hospitals in northern Thailand. Data were collected using a demographic data collection form, the Hospital Anxiety and Depression Scale (HADS), the Thai version of the Social Support Questionnaire (SSQ), the Herth Hope Index (HHI), Life Orientation Test-Revised (LOT-R), Buddhist Belief Questionnaire, Health-Related Hardiness Scale (HRHS), and Connor-Davidson Resilience Scale (CD-RISC), from February 2021 to February 2022. Data were analyzed using descriptive statistics, Pearson correlation, and regression analysis.

Results

Depression (r = -0.47, p <0.01) and anxiety (r = -0.39, p <0.01) had a significant negative relationship with resilience. Spiritual well-being (r = 0.74, p <0.01), hope (r = 0.67, p <0.01), religious belief (r = 0.53, p <0.01), optimism (r = 0.40, p <0.01), social support (r = 0.33, p <0.01), and hardiness (r = 0.21, p <0.01) had significant positive relationships with resilience. Only hope (β = 0.29, p <0.01) and spiritual well-being (β = 0.59, p <0.01) together influenced resilience by 64.70%.

Conclusion

Spiritual well-being and hope are crucial to resilience in patients with advanced cancer. Nurses should provide spiritual support to strengthen patients' ability to adapt successfully to life with advanced cancer.

Psychosocial factors influencing quality of life in patients with primary brain tumors in Pakistan: an analytical cross-sectional study

OBJECTIVE

Despite quality of life (QoL) being recognized as an important outcome in neuro-oncology, there is a lack of research from Pakistan where sociocultural differences may influence QoL. This study aimed to measure the QoL in patients with primary brain tumors (PBTs) and assess its association with mental health outcomes and social support.

RESULTS

Our study included a total of 250 patients, with a median age of 42 years (range 33-54 years). The commonest brain tumors were glioma (46.8%) and meningioma (21.2). The mean global QoL of the sample was 75.73 ± 14.9. The majority of patients had high social support (97.6%) and were not depressed (90%) or anxious (91.6%). On multivariable linear regression, global QoL was inversely associated with no or low income (beta coefficients: -8.75 to -11.84), having hypertension (-5.53), currently using a urine catheter (-13.55), having low social support (-28.16) suffering from mild (-15.31) or symptomatic (-23.84) depression, or mild anxiety (-13.22).

Resilience in Lower Grade Glioma Patients

Current data show that resilience is an important factor in cancer patients’ well-being. We aim to explore the resilience of patients with lower grade glioma (LGG) and the potentially influencing factors. We performed a cross-sectional assessment of adult patients with LGG who were enrolled in the LoG-Glio registry. By phone interview, we administered the following measures: Resilience Scale (RS-13), distress thermometer, Montreal Cognitive Assessment Test for visually impaired patients (MoCA-Blind), internalized stigmatization by brain tumor (ISBI), Eastern Cooperative Oncological Group performance status (ECOG), patients’ perspective questionnaire (PPQ) and typical clinical parameters. We calculated correlations and multivariate regression models. Of 74 patients who were assessed, 38% of those showed a low level of resilience. Our results revealed significant correlations of resilience with distress (p < 0.001, −0.49), MOCA (p = 0.003, 0.342), ECOG (p < 0.001, −0.602), stigmatization (p < 0.001, −0.558), pain (p < 0.001, −0.524), and occupation (p = 0.007, 0.329). In multivariate analyses, resilience was negatively associated with elevated ECOG (p = 0.020, β = −0.383) and stigmatization levels (p = 0.008, β = −0.350). Occupation showed a tendency towards a significant association with resilience (p = 0.088, β = −0.254). Overall, low resilience affected more than one third of our cohort. Low functional status is a specific risk factor for low resilience. The relevant influence of stigmatization on resilience is a novel finding for patients suffering from a glioma and should be routinely identified and targeted in clinical routine.

Psychometric properties of the Urdu version of the EORTC QLQ-H&N35 (European organization for research and treatment of cancer head and neck module) quality of life tool

Background

We translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire’s Head and Neck (H&N) Cancer Module (EORTC QLQ-H&N35) and assessed its convergent and discriminant validity by examining correlations of QoL with depression, anxiety, and resilience.

Methods

We translated the EORTC QLQ-H&N35 according to EORTC instructions. Patients at a tertiary care hospital in Pakistan completed a survey consisting of Urdu versions of EORTC QLQ-C30 (core QoL tool), QLQ-H&N35, Hospital Anxiety and Depression Scale, and Wagnild and Young Resilience Scale (RS-14). Content validity, convergent validity, discriminant validity, and reliability (using Cronbach’s alpha) of the EORTC QLQ-H&N35 were assessed.

Results

Our sample comprised 250 patients with H&N cancer, most commonly oral (82%). The Urdu translations were comprehensible for all patients. The Cronbach alpha for QLQ-H&N35 multi-item domains ranged from 0.75 to 0.98 (acceptable to excellent), barring “Senses Problems”, which was less than the generally acceptable level (0.50). The patient-reported content validity index (CVI) scores for relevance and clarity of the Urdu version of the QLQ-H&N35 were 0.93 and 0.92, respectively (both excellent). Our results revealed weak bidirectional correlations of the QLQ-H&N35 with resilience, depression, and anxiety, showing good discriminant validity. A weak-to-moderate but significant negative correlation (r: − 0.185 to − 0.613; p < 0.01) was seen between the QLQ-H&N35 and the global QoL measure of the QLQ-30.

Conclusion

Our Urdu translation of the EORTC QLQ-H&N35 demonstrated validity comparable to previous studies, with good discriminant construct validity when measured against resilience, depression, and anxiety. An issue of concern is the poor internal consistency of the “Senses Problems” domain. Nevertheless, the Urdu translation produced in this study serves as a valid and reliable measure to measure QoL in H&N cancer in clinical or research settings in Pakistan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00900-x.

Translation and validation of the Urdu version of the European organization for research and treatment of cancer core quality of life questionnaire (EORTC QLQ-C30) and brain module (QLQ-BN20) in primary brain tumor patients

Introduction

This study translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (EORTC QLQ-C30) and Brain Module (QLQ-BN20) amongst patients with primary brain tumors (PBT) in Pakistan, and assessed the correlation of QoL with resilience, depression, and anxiety.

Methods

Translation of the EORTC QLQ-C30 and QLQ-BN20 was performed as per EORTC guidelines. A survey comprising of Urdu translations of EORTC QLQ-C30, QLQ-BN20, Wagnild and Young Resilience Scale (RS-14) and Hospital Anxiety and Depression Scale was administered to patients with PBT at a tertiary care hospital in Pakistan. Reliability (via Cronbach alpha), content validity index (CVI) scores, construct validity, and inter-scale correlations were assessed.

Results

Our sample consisted of 250 patients with PBT, most commonly glioma (46.8%) and meningioma (21.2%). All patients were able to understand the Urdu translations. The Cronbach alphas for the QLQ-C30 and the QLQ-BN20 were 0.860 and 0.880, respectively. The CVI scores for clarity and relevance were high for both the EORTC QLQ-C30 (0.98 and 0.96, respectively) and the QLQ-BN20 tool (0.81 and 0.95, respectively). The global QoL domain (EORTC QLQ-C30) showed significant positive correlations with resilience (r = 0.422), and significant negative correlations with depression (r =  − 0.541) and anxiety (r =  − 0.502). Strong inter-scale correlations were observed between physical functioning and insomnia (r =  − 0.690) and role functioning and insomnia (r =  − 0.641).

Conclusion

Our study confirms the Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 as valid clinical tools for the measurement of QoL in primary brain tumors patients within the cultural and socioeconomic context of Pakistan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00354-6.

Quality of life (QoL) is an important facet of well-being for patients with primary brain tumors (PBTs), as these individuals face significant distress during the course of their illness and treatment. It is important to have valid and reliable tools to accurately measure the QoL of patients with PBTs. The EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and its brain tumor-specific module EORTC QLQ-BN20 (EORTC QLQ-Brain Neoplasms 20) are exactly that.

However, the use of the EORTC QLQ-C30 and QLQ-BN20 is limited in Pakistan, where the national language is Urdu, and the majority of patients are of low socioeconomic backgrounds. Since no Urdu translations of the EORTC QLQ-C30 and QLQ-BN20 exist, we aimed to translate and validate these tools to enable their applicability in Pakistan.

The Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 demonstrated good validity amongst patients with PBTs. Thus, our study confirms the EORTC QLQ-C30 and QLQ-BN20 as valuable clinical tools for the measurement of QoL in primary brain tumors patients within the linguistic, cultural and socioeconomic context of Pakistan.

Resilience and its associated factors in head and neck cancer patients in Pakistan: an analytical cross-sectional study

INTRODUCTION

The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan.

METHODS

An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed by Enriched Social Support Instrument (ESSI).

RESULTS

The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. A total of 250 head and neck cancer patients were recruited, 79% of them were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for the covariates in multivariable analysis resilience was associated with severe depression (- 17[- 20.98,-12.93]) or borderline depression (- 4[- 8.41,-0.39]), severe anxiety (- 11 [- 17.88,-4.18]), low social support (- 6[- 9.62,-1.71]), having family members of > 6 in the household (- 2[- 4.31,-0.29), smokeless tobacco users post- treatment (10[5.79, 14.45]), and those who underwent tracheotomy (- 4[- 7.67,-0.21]). There was a significant interaction between education and role in the family (decision maker).

CONCLUSION

In Pakistan, a South Asian LMIC, collectivist culture prevails, family ties are greatly promoted thus resilience and social support is highly prevalent in head and neck cancer patients resulting in lower prevalence of depression and anxiety. Our study highlights that higher resilience is prevalent among small families less than six members, as the welfare of the individual is prioritized over multiple needs of the family. Formal Education and role in household/decision making power are effect modifiers in our study, demonstrating its protective effect on the mental health of head and neck cancer patients. High resilience scores were reported among current smokeless tobacco users as compared to quitters post treatment. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease and its sequel.

Factors Related to Resilience, Anxiety/Depression, and Quality of Life in Patients with Colorectal Cancer Undergoing Chemotherapy in Japan

Objective:

This study clarifies the relationship between resilience and anxiety and depression, quality of life (QOL), and other related factors that influence colorectal cancer patients undergoing chemotherapy.

Methods:

This cross-sectional study focused on outpatients with colorectal cancer undergoing chemotherapy. A questionnaire including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, the MOS 12-item Short-Form Health Survey, and items based on a literature review was administered between August 2019 and August 2020. SPSS version 26 was used for data analysis. Correlation analysis and t-test were applied. In addition, Amos version 26 was used and structural equation modeling was applied to create a causal model.

Results:

A total of 121 participants (94.5%) were included in the study. The goodness of fit (GFI) of the causal model was GFI = 0.94, adjusted GFI = 0.906, comparative fit index = 0.997, and root mean square error of approximation = 0.011. Resilience had a negative effect on anxiety and depression and a positive effect on QOL. Depression had a negative effect on QOL.

Conclusions:

The results of this study indicate that resilience is a predictor of anxiety, depression, and QOL in colorectal cancer patients undergoing chemotherapy. Therefore, I believe that it is important to enhance resilience in order to maintain and improve patients’ mental health and QOL. In addition, since resilience was affected by cancer metastasis and the presence of metastasis was a predictor of resilience, it is a challenge to explore interventions to enhance resilience, especially in patients with metastasis.

Resilience and its associated factors in brain tumor patients in Karachi, Pakistan: An analytical cross-sectional study

OBJECTIVES

This study assessed resilience in brain tumor patients at a tertiary care hospital in Pakistan (a lower middle-income country; LMIC) and explored its relationship with patients' sociodemographic factors, clinical characteristics, social support, and mental health.

METHODS

A cross-sectional survey was conducted amongst adult (≥18 years) patients with brain tumor at the Aga Khan University Hospital, Pakistan. Resilience was assessed by Wagnild and Young's Resilience Scale, and patients' psychosocial characteristics by the Hospital Anxiety and Depression Scale and the Enriched Social Support Instrument.

RESULTS

A total of 250 patients were included (mean age: 44 years; 68% males), with majority (97.6%) having high social support and only 4.4% and 2% having symptomatic depression and anxiety, respectively. On multivariable linear regression adjusted for covariates, lower resilience was associated with not being involved in household decision-making (Adjusted Beta Coefficient: 4.58 [95% Confidence Interval:-7.59, -1.56]), not currently working (-2.80 [-4.61, -0.99]), undergoing multiple neurosurgical interventions such as tumor biopsies or resections (-8.64 [-13.11, -4.16]), receiving chemotherapy (-5.17 [-9.51, -0.83]) or combination adjuvant therapy (-2.91 [-5.14, -0.67]), low social support (-7.77 [-13.73, 1.81]), mild depression (-13.00 [-17.00,-8.99]) or symptomatic depression (-19.79 [-24.69, -14.89]), and mild anxiety (-4.24 [-7.98, -0.50]).

CONCLUSION

Our study highlights the function of familial/household role and working status in mediating resilience, and demonstrates the well-known protective effect of resilience for mental health in brain tumor patients in Pakistan, a South-Asian LMIC. These findings are of clinical relevance with regards to the development of culture-specific evidence-based resilience-building interventions that may help patients with brain tumors to cope with the psychological distress of cancer.

Positive effects of resilience and self-efficacy on World Health Organization Quality of Life Instrument score among caregivers of stroke inpatients in China

AIM

Stroke is one of the major health challenges affecting life expectancy and quality of life around the world. However, there is limited reporting on the status of some caregivers, including Chinese caregivers of stroke inpatients. Limited information is available on evaluations using the World Health Organization Quality of Life Instrument (WHOQOL) and the effects of resilience and self-efficacy on WHOQOL score. Therefore, we conducted research to assess the role of resilience on the WHOQOL and to investigate the role of self-efficacy as a mediator between resilience and WHOQOL score among Chinese caregivers of stroke inpatients.

METHODS

This cross-sectional study to gather data from north-east and south-east China was conducted from June 2019 to October 2019. Over 380 caregivers of stroke inpatients at two general public hospitals were interviewed face-to-face. About 305 caregivers (80.26%) completed the questionnaire, which included the Ego Resilience Scale, the General Self-Efficacy Scale, and the brief version of the WHOQOL and asked about demographic characteristics. This study also examined factors associated with WHOQOL score and used linear regression analysis and structure equation modelling to construct direct and indirect models, respectively.

RESULTS

After adjustment for demographic characteristics, both resilience and self-efficacy were positively associated with all WHOQOL domains. Structure equation modelling revealed that self-efficacy mediated the relationship between resilience and WHOQOL score among caregivers of stroke inpatients.

CONCLUSION

Chinese caregivers of stroke inpatients exhibited good social health but poor physical, psychological, and environmental health. It is necessary for promoting resilience and improving WHOQOL score through the mediating effect of self-efficacy. These results suggest that interventions in health care focused on both enhancing resilience and providing self-efficacy training could effectively improve WHOQOL score.