Health Related Quality of Life of Cancer Patients in Ethiopia

Health-related quality of life among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: a health facility-based cross-sectional study

BACKGROUND

Morbidity and mortality rates from chronic non-communicable diseases (CNCDs) are increasing globally. In Ghana, CNCDs account for 43% of all deaths. We examined the Health-Related Quality of Life (HRQoL) and associated factors among adults living with CNCDs in the Ho Municipality.

METHODS

This was a health facility-based descriptive cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of Ghana. The study adopted the EQ-5D-5L instrument and the Ugandan value set to compute respondents' HRQoL index. Quantile regression models were used in analysing the data with STATA v17.0 at 95% Confidence Intervals, and statistical significance set at p < 0.05.

RESULTS

63.7% of our respondents reported having a problem across the five dimensions of the EQ-5D-5L. The most problems were reported in the dimensions "Anxiety/Depression" (94.4%) and "Pain/Discomfort" (91.4%). Divorced/separated respondents (aOR=-0.52, 95% CI=-0.71, -0.33) and those living with comorbidities (aOR=-0.95, 95% CI=-0.15, -0.04,) were less likely to report high index for HRQoL. However, respondents diagnosed with CKD (aOR = 0.26, 95% CI = 0.10, 0.42), diabetes (aOR = 0.28, 95% CI = 0.11, 0.45), hypertension (aOR = 0.35, 95% CI = 0.19, 0.50) and stroke (aOR = 0.26, 95% CI = 0.11, 0.40) were more likely to report higher index than those diagnosed with cancer.

CONCLUSION

Our study revealed elevated proportions of reported problems in the "Anxiety/Depression" and "Pain/Discomfort" dimensions, indicating noteworthy concerns in these areas of HRQoL. The prevalent issues reported across HRQoL dimensions are cause for concern, posing potential exacerbation of health conditions. We advocate for collaborative efforts from the Ministry of Health, Ghana Health Service, and relevant stakeholders to scrutinize and implement interventions targeting social and psychological factors. These efforts should specifically address contributors to diminished health-related quality of life, particularly among less educated, divorced, and comorbid individuals.

Health-related quality of life among patients with esophageal, gastric, and colorectal cancer at Kenyatta National Hospital

BACKGROUND

Despite the advancement of modern treatment approaches, several studies indicated a diminished health-related quality of life (HRQoL) in patients with gastrointestinal cancer. However, there is insufficient data about the HRQoL of gastrointestinal cancer patients in Kenya.

AIMS

The study aimed to investigate HRQoL and its determinants in gastrointestinal cancer patients at Kenyatta National Hospital.

METHODS

A cross-sectional study was employed among 160 esophageal, 103 gastric, and 96 colorectal cancer patients. The patient list, identified by unique hospital identification numbers, was obtained from records. Eligibility was assessed based on predetermined criteria, and the hospital identification numbers were reshuffled. Study participants were then randomly selected daily during the data collection period. Data were collected using a researcher-administered European Organization for Research and Treatment of Cancer quality of life questionnaire. The data entry and analysis were carried out using Statistical Package for the Social Sciences 26.0 statistical software. A bivariate and multivariate binary logistic regression analysis was employed to investigate determinants of HRQoL at a 0.05 level of significance.

RESULTS

Most esophageal (N = 118, 73.7%), gastric (N = 75, 72.8%), and colorectal (N = 72, 75%) cancer patients had poor overall HRQoL. In the social (p = .04) and cognitive (p = .02) domain of HRQoL, esophageal cancer patients had a significantly lower mean score as compared to gastric cancer patients. Colorectal cancer patients had the highest mean score in physical functioning (p = .01) as compared with gastric cancer patients. Nonetheless, gastric cancer patients had the highest mean score in emotional functioning domains of quality of life as compared to esophageal (p = .04) and colorectal (p < .001) cancer patients The study revealed a low mean HRQoL score in the majority of the symptom domains of quality of life. A statistically significant difference in all domains of HRQoL was not observed in various treatment modalities of gastrointestinal cancer. Advanced-stage (stages III and IV) and co-morbidities were significant determinants of poor HRQoL.

CONCLUSIONS

The overall HRQoL of gastrointestinal cancer patients was poor. Advanced-stage cancer and co-morbidities were significant determinants of poor HRQoL. Therefore, intensification of routine monitoring of the disease and the treatments should be actively implemented to improve the HRQoL.

Longitudinal analysis of quality of life in primary lung cancer patients with chlamydia pneumoniae infection: a time-to-deterioration model

BACKGROUND

Chlamydia pneumoniae (Cpn) IgG and IgA has been strongly linked to lung cancer, but its impact on patients' quality of life remains unclear. Our objective was to investigate the relationship between pre-treatment Cpn IgG and IgA and time to deterioration (TTD) of the HRQoL in patients with primary lung cancer.

METHODS

A prospective hospital-based study was conducted from June 2017 to December 2018, enrolling 82 patients with primary lung cancer admitted to the First Affiliated Hospital of Fujian Medical University for questionnaire surveys. Cpn IgG and IgA was detected by microimmunofluorescence method. HRQoL was assessed at baseline and during follow-up using the EORTC Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30) and EORTC Quality of Life Questionnaire-Lung Cancer (EORTC QLQ-LC13). HRQoL scores were calculated using the QoLR package, and TTD events were determined (minimum clinically significant difference = 5 points). Cox regression analysis was used to evaluate the effect of Cpn IgG and IgA on HRQoL.

RESULTS

We investigated the relationship between Cpn IgG and IgA and quality of life in patients with primary lung cancer. The study was found that 75.61% of cases were Cpn IgG + and 45.12% were Cpn IgA + . Cpn IgA + IgG + was 41.46%. For EORTC QLQ-C30, Physical function (PF) and Pain (PA) TTD events on the functional scale and Symptom scale were the most common during follow-up. After adjusting for gender and smoking status, Pre-treatment Cpn IgA + was found to signifcantly delay TTD of Physical functioning(HR = 0.539, 95% CI: 0.291-0.996, P = 0.048). In addition, Cpn IgG + before treatment significantly delayed TTD in Emotional functioning (HR = 0.310, 95% CI: 0.115-0.836, P = 0.021). For EORTC QLQ-LC13, deterioration of dyspnea (LC-DY) was the most common event. However, Cpn IgG and IgA before treatment had no effect on the TTD of EORTC QLQ-LC13 items.

CONCLUSIONS

According to EORTC QLQ-C30 and EORTC QLQ-LC13, Cpn IgA delayed TTD in Physical functioning and Cpn IgG delayed TTD in Emotional functioning.

Quality of life and associated factors among patients with cancer receiving chemotherapy at Dessie Comprehensive Specialized Hospital, North-East Ethiopia: a cross-sectional study

Background

Cancer is a major public health problem around the world. Cancer by itself and its treatment modalities affect the quality of life (QoL) of patients with it. However, there were a paucity of studies about the QoL of patients receiving chemotherapeutic treatment in Ethiopia. This study was aimed at addressing such a gap. Accordingly, we investigated QoL and associated factors among cancer patients receiving chemotherapy at Dessie Comprehensive Specialized Hospital (DCSH), North East Ethiopia, in 2023.

Methods

We employed a cross-sectional study from April 1 to May 30, 2023. The data was collected using the European Organization for Research and Treatment of Cancer Core QoL Questionnaire, version 3.0 (EORTC QLQ-C30). The data was entered and cleaned using EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 27 for analysis. The association between the dependent and independent variables was determined using Odds Ratios (ORs) at a p value < 0.05 with a 95% CI.

Results

Data was collected from 394 patients. Their mean summary QoL score was 36.3 ± 9.0. About 39.3% demonstrated a good QoL summary score, whereas 60.7% were impacted by symptoms. A good functional QoL score was observed in 42.6% of the participants. About 54.8% and 31.7% reported good overall health status and good overall QoL, respectively. The most impacted functional domain was social functioning, affecting 64.5% of participants. The most common symptom was diarrhea, affecting 65.5% of the participants. Secondary school education level (Adjusted Odds Ratio-AOR = 3.16, 95% CI: 1.14-8.81), diploma and above education level (AOR = 4.90, 95% CI: 1.29-18.62), and urban residency (AOR = 1.74, 95% CI: 1.07-2.82) had a significant positive association with QoL, while being a civil servant (AOR = 0.13, 95% CI: 0.04-0.49), having stage III cancer (AOR = 0.14, 95% CI: 0.05-0.39), and stage IV cancer (AOR = 0.16, 95% 0.06-0.44) had a significant negative association with it.

Conclusion

The QoL for cancer patients undergoing chemotherapy was significantly low and associated with their level of education, occupational status, area of residence, and stage of cancer. Incorporating psychosocial support is thus crucial in their treatment plans.

Determinants of unmet physical and psychological supportive care needs among adult cancer patients in Southern Ethiopia

OBJECTIVE

The main objective of this study was to assess the prevalence of unmet physical and psychological supportive care needs and associated factors among adult patients with cancer in Southern Ethiopia.

METHODS

A cross-sectional study was conducted among 321 patients with cancer from 20 June 2022 to 5 August 2022 at Hawassa University Comprehensive Specialized Hospital oncology centre. Simple random sampling technique was used to recruit participants. Data were entered into Epi-Data V.4.6 and were exported to SPSS V.26 for analysis. Logistic regression model was used to describe the association between dependent and independent variables.

RESULT

The mean age of the study participants was 45±14.27. The prevalence of unmet physical and psychological supportive care needs was 47.3% and 71.1%, respectively. Rural residence ((adjusted OR, AOR 2.73; 95% CI (1.27 to 5.83)) and late-stage cancer ((AOR 2.95; 95% CI 1.02 to 8.52) were factors significantly associated with unmet physical supportive care need. Coexisting illness was associated with both unmet physical and psychological supportive care needs (AOR 2.73; 95% CI 1.27 to 5.83) and (AOR 2.71; 95% CI 1.16 to 6.33), respectively.

CONCLUSION

Nearly half of the study participants had an unmet physical supportive care need while greater than two-thirds had unmet psychological supportive care need. Residence and late-stage cancer were factors significantly associated with physical unmet supportive care need while coexisting illness was associated with both unmet physical and psychological supportive care needs. Hence, supportive care for patients with cancer should be given an emphasis and incorporated into the cancer treatment protocol.

Cross-cultural adaptation and psychometric properties of the Indonesian version for quality of life among breast cancer patients

Background

Breast cancer is one of the most important health problems worldwide. Quality of life (QoL) is an important indicator to evaluate symptoms in cancer patients, including those with breast cancer. Culturally suitable, valid, reliable, and appropriate instruments to measure the QoL of breast cancer patients are needed, which is still rare in Indonesia. This study aimed to translate the EORTC QLQ-BR45 instrument into Indonesian and evaluate its psychometrics.

Methods

A cross-sectional study was performed on 635 patients conveniently selected from the oncology department in referral hospital. The first phase of this study involved translation of the existing EORTC QLQ-BR45 into Indonesian, and in the second phase, we evaluated its psychometric properties. Construct validity was evaluated using confirmatory factor analysis (CFA). Criterion validity was examined according to the association between disease stage and Karnofsky Performance Scale (KPS).

Results

A total of 635 (99.00%) completed the EORTC QLQ-BR45 successfully. The instrument indicated good readability and high content validity. All Cronbach's alpha coefficients were satisfactory (overall value, 0.87). For construct validity, patients with KPS ≥80% did better than those with KPS ≤70% as did two multi-item scales in functional scales (body image and breast satisfaction) and five multi-item scales in symptom scales (systemic therapy side effects, endocrine therapy, and arm, breast, and endocrine sexual symptoms). Body image score of late-stage patients was significantly higher. CFA indicated that the nine-factor structure of the Indonesian EORTC QLQ-BR45 was a good fit for the data.

Conclusion

The Indonesian EORTC QLQ-BR45 questionnaire is reliable and valid with good psychometric properties, thus can be used for breast cancer patients in Indonesia.

The effect of peer support psychoeducation based on experiential learning on self-care demands among breast cancer patients with post-chemotherapy

Background

Breast cancer patients with post-chemotherapy had self-care deficit problems. The patient is unable to perform activities of daily living which can decrease the quality of life. One of the factors that affected self-care deficit among breast cancer patients was inadequate information. This study aimed to determine the effects of peer support psychoeducation based on experiential learning on the self-care demand.

Design and methods

This study used a quasi-experimental design with pretest and posttest. The independent variable of the study was the application of peer support psychoeducation based on experiential learning and the dependent variable was the self-care demand. The inclusion criteria in this study were breast cancer patients with post-chemotherapy. The exclusion criteria in this study were patients who were unconscious. We selected the experimental and control group randomly. The total sample in this study was 60 people, 30 respondents for the experiment group and 30 respondents for the control group. Peer support psychoeducation based on experiential learning was developed from Wauchope's psychoeducational theory, Orem's self-care, and David Kolb's experiential learning. We used a self-report questionnaire to measure self-care demand. Data were analyzed using Wilcoxon signed rank and Mann-Whitney U tests.

Results

Peer support psychoeducation based on experiential learning has a significant effect on self-care demand, namely ADL (p = 0.002), pain management (p = 0.002), nutritional management (p = 0.000), and rest and sleep (p = 0.000).

Conclusion

Psychoeducation based on experiential learning was recommended for nursing care or physician to increase self-care demand.

Quality of Life among Ethiopian Cancer Patients: A Systematic Review of Literatures

Background

Assessment of quality of life (QoL) in cancer patients can provide an overall picture of the patient's adaptation to the disease and maintain long-term health and well-being. Determining the QoL in cancer patients could help with better care and could be as prognostic as medical factors and the survival benefit that pharmacological treatment could provide. The main objective of this review was to determine the prevalence of QoL among Ethiopian adult cancer patients.

Methods

A systematic review was conducted using the "Preferred Reporting Results of Systematic Reviews and Meta-Analyses" guidelines. Databases such as PubMed/Medline, CINAHL, AMED, Embase, the Cochrane Library, ScienceDirect, World Health Organization's Hinari portal, and African Journals Online databases were searched from January 2022 to June 2022. Google, Google Scholar, and university repositories were used to access unpublished studies. Two reviewers independently screened the data using a standardized data extraction format and appraised their quality using the Newcastle-Ottawa Scale.

Results

In this review, 10 studies were included. The prevalence of poor QoL ranged from 52 to 89.6. The physical, role, social, and emotional functioning were the most affected domains of QoL and have been significantly associated with QoL. Financial difficulty was the most important predictor of QoL among Ethiopian cancer patients. Pain, dyspnea, nausea, vomiting, and poor appetite were also reported as predictors of QoL. Low income, lower educational status, unmarried status, underweight, anxiety, and depression, advanced stage of cancer, patients with ≤2 cycles of chemotherapy, and the presence of comorbid diseases were significantly correlated with QoL.

Conclusions

The QoL of an Ethiopian cancer patient was low. Quality of life assessments, appropriate symptom management, integration of psycho-oncology care, and providing economic support shall be considered to improve their QoL.

Quality of Life of Cancer Patients during Chemotherapy in Indonesia: A Comparison of EORTC QLQ-C30 and EQ-5D-5L, Based on Patients' Characteristics

One of the important outcomes to define the success of cancer treatment is the health-related quality of life (HRQoL) that can be measured using generic and/or specific instruments. Our study aims to define the cancer patients' HRQoL in some hospitals in Indonesia as measured by the European Organization for Research and Treatment for Cancer (EORTC QLQ-C30) and the EQ-5D-5L, to define the differences of cancer patients' HRQoL referring to patients' characteristics, and to explore determinants of cancer patients' HRQoL. We recruited 451 cancer patients using a cross-sectional design in two referral hospitals in Central Java, Indonesia, using the purposive sampling technique. All subjects, recruited from July 2020 to October 2021, met the inclusion criteria, namely, adult patients diagnosed with cancers in all stages who willingly participated in the study. The Indonesian value set was used to obtain the EQ-5D-5L index score. We further analyzed the data based on cancer stages and compared two questionnaires using independent t test. We highlighted that most of the cancer patients are female (69.4%), young (86%), and at advanced stages of cancer (54.1%). The physical and role functions and global health status of the cancer patients are poor, and the most severe symptom is fatigue. Moreover, most of them experience severe pain and perform daily activities with difficulties. Some patients' characteristics show significant influences on the HRQoL domains in both questionnaires (p < 0.05). Interestingly, both of the questionnaires have shown significant correlations between similar domains and revealed the poor HRQoL of advanced cancer patients (p < 0.05). Our study finds that cancer patients still have poor HRQoL in some domains. We suggest to the health providers that they apply education and psychological intervention to increase their HRQoL.

Quality of Life and Associated Factors Among Adult Cancer Patients Undergoing Chemotherapy Treatment at Amhara National, Regional State, Ethiopia, 2021

Background

In cancer, quality of life (QoL) is an important patient-reported metric; evaluating how patients feel physically and emotionally while fighting the disease could lead to better treatment. Despite its therapeutic effects, chemotherapy treatment causes a plethora of side effects that can affect QoL. Factors affecting the QoL of cancer patients undergoing chemotherapy treatment in Ethiopia have not been thoroughly investigated. As a result, this study assesses QoL and associated characteristics among adult cancer patients receiving chemotherapy at Amhara Region, Ethiopia in 2021.

Martials and Methods

From February 15 to May 15, 2021, an institutional based cross-sectional study was done in Amhara region. Three hundred fourteen patients were included in the study. The data was gathered using Amharic version of European organization for research and treatment of cancer quality of life questionnaire (EORTC QLQ C-30) through a face-to-face interview. Epi Data 4.6 was used to enter the data, which was then exported to SPSS version 23 for statistical analysis. Multivariable logistic regression analysis was used to determine the relationship between independent and dependent variables. The statistical significance was determined by a p-value of less than .05.

Result

Cancer patients in Amhara Region had a 44.32 average QoL. Emotional functioning AOR 1.01 (1.0-1.04), social functioning AOR 1.02 (1.01-1.03), nausea and vomiting AOR 0.95 (0.93-0.98), pain AOR 0.95 (0.93-0.98), financial difficulty 0.97 (0.95-0.99), education AOR 4.3 (1.49-12.32), underweight AOR 0.45 (0.24-0.84),  > 5th cycle of chemotherapy AOR 4 (1.78-9.11), stage IV cancer AOR 0.21 (0.06-0.71), comorbidity AOR 0.28 (0.14-0.57), anxiety AOR 0.32 (0.12-0.84), and depression AOR 0.29 (0.13-0.63) were all significantly associated with QoL in multivariable logistic regression.

Conclusion

Adult cancer patients receiving chemotherapy in the Amhara region had a poor QoL. Emotional functioning, social functioning, nausea and vomiting, pain, financial difficulty, education, body mass index, cancer stage, chemotherapy cycle, comorbidity, anxiety, and depression all had association with QoL. To improve the QoL of cancer patients, QoL assessments, proper symptom management, nutritional support, and integration of psycho-oncology treatment should be considered.

Quality of life of patients with rare cancer: a comparison with patients with colorectal cancer and the association with disease trajectory-related factors

PURPOSE

Differences in quality of life (QoL) between patients with rare and common cancer might be explained by the specific challenges patients with rare cancer face during their disease trajectory, but research is scarce. This study aimed to (1) assess the difference in QoL between patients with rare and common cancer (i.e. colorectal cancer (CRC)) and (2) examine the association between disease trajectory-related factors and QoL in patients with rare cancer.

METHODS

Cross-sectional data were collected among adults with rare cancer by a nationwide online survey in the Netherlands. For comparison with patients with CRC, data from the Prospective Dutch Colorectal Cancer (PLCRC) cohort were used. Associations were assessed by linear regression analyses.

RESULTS

Data from 1525 patients with rare cancer and 1047 patients with CRC were analysed. Having a rare cancer was significantly associated with a lower QoL compared to having CRC (p < 0.001). Disease trajectory-related factors significantly associated with QoL in patients with rare cancer were time until diagnosis, misdiagnoses, information on best treatment options, information on late and/or long-term effects, and both satisfaction with physician and specialized nurse care (all: p < 0.05).

CONCLUSION

Patients with rare cancers have a lower self-reported QoL than patients with CRC, and several disease trajectory-related factors are associated with QoL in patients with rare cancer.

IMPLICATIONS FOR CANCER SURVIVORS

To improve QoL of patients with rare cancer, appropriate guidance and support by healthcare professionals throughout the disease trajectory are needed, as well as early diagnosis and proper referral to centres of expertise.

Health-related quality of life and associated factors among cancer patients in Ethiopia: Systematic review and meta-analysis

INTRODUCTION

Cancer is the main cause of morbidity and mortality in every part of the world, regardless of human development. Cancer patients exhibit a wide range of signs and symptoms. Being diagnosed with cancer has a variety of consequences that can affect one's quality of life. The term "health-related quality of life" refers to a multidimensional concept that encompasses a person's whole health. The availability of data on the prevalence of poor quality of life among cancer patients in Ethiopia is critical in order to focus on early detection and enhance cancer treatment strategies. In Ethiopia, however, there is a scarcity of information. As a result, the aim of this study was to determine the pooled estimated prevalence of quality of life among cancer patients in Ethiopia.

MATERIALS AND METHODS

This systematic review and meta-analysis were searched through MEDLINE, Pub Med, Cochrane Library, and Google Scholar by using different search terms on the prevalence of health-related quality of life of cancer patients and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal of studies. The analysis was done using STATA 14 software. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. The funnel plot and Egger's test were used to show the publication bias. The pooled prevalence of health-related quality of life of cancer with a 95% confidence interval was presented using forest plots.

RESULTS

A total of 12 studies with 3, 479 participants were included in this review and the overall pooled estimates mean score of health-related quality of life among cancer patients in Ethiopia was 57.91(44.55, 71.27, I2 = 98.8%, p≤0.001). Average monthly income (AOR:3.70;95%CI:1.31,6.10), Stage of cancer (AOR:4.92;95% CI:2.96,6.87), Physical functioning(AOR:4.11;95%CI:1.53,6.69), Social functioning(AOR:3.91;95% CI:1.68,6.14) were significantly associated with quality of life. Subgroup meta-analysis of health-related quality of life of cancer patients in Ethiopia done by region showed that a higher in Addis Ababa 83.64(78.69, 88.60), and lower in SNNP region16.22 (11.73, 20.71), and subgroup analysis done based on the type of cancer showed that higher prevalence of health-related quality of life among cancer patients was breast cancer 83.64(78.69, 88.60).

CONCLUSION

This review showed that the overall health related quality of life was above an average. Furthermore, average monthly income, cancer stage, physical, and social functioning were all significant determinants in cancer patients' QOL.as a result, this review suggests that quality of life evaluation be incorporated into a patient's treatment routine, with a focus on linked components and domains, as it is a critical tool for avoiding and combating the effects of cancer and considerably improving overall health. In general, more research is needed to discover crucial determining elements utilizing more robust study designs.

Predictors of unmet supportive care needs of adult cancer patients in Ethiopia

OBJECTIVE

Cancer is a global public health issue that continues to increase because of aging and adoption of cancer-causing behaviours. In Ethiopia, cancer belongs to the second most common non-communicable disease. Cancer patients face a range of unmet needs in multiple aspects of their lives. Supportive care is defined as essential care that helps patients to cope with cancer. This study aims to assess the predictors of unmet supportive care needs in adult cancer patients in Ethiopia.

METHODS

Institution-based cross-sectional study was done from February to March 2019 in adult cancer patients. Three hundred seventy-one patients were interviewed using convenience sampling. Supportive care needs were used as outcome variables, dichotomized as 'no need' and 'unmet needs'. Variables with a p-value of <0.2 were candidates for multivariable logistic regression.

RESULTS

From 371 patients, 69.8% were females with a mean age of 47 years; the commonest type of cancer was gynaecological cancer. Information about diagnosis, stage of cancer, time since diagnosis, age, wealth index, employment status, gender, type of treatment, history of recurrence, type of cancer and information about diagnosis modified by the source of information were predictors of unmet supportive care needs.

CONCLUSIONS

The study emphasised the importance of considering sociodemographic, clinical and information-related factors when dealing with cancer patients. Programmes, guidelines and services that focus on supportive care needs should be established and/or implemented.

Quality of life among cancer patients at Queen Elizabeth and Kamuzu Central Hospitals in Malawi: a cross-sectional double-center study

Introduction

Many cancer patients experience psychosocial challenges that affect quality of life during the trajectory of their disease process. We aimed at estimating quality of life among cancer patients at two major tertiary hospitals in Malawi.

Methods

The study was conducted among 398 cancer patients using semi-structured questionnaire. Quality of life was measured using EQ-5D-3L instrument.

Results

Mean age was 45 years ± 12.77. Pain (44%) was the most prevalent problem experienced by cancer patients. About 23% had worst imaginable health status on the subjective visual analogues scale. Attending cancer services at QECH (AOR= 0.29, 95% CI: 0.17-0.54, p<0.001) and having normal weight (AOR=0.25, 95% CI: 0.08-0.74, p = 0.012), were associated with improved quality of life. A history of ever taken alcohol (AOR= 2.36, 95% CI: 1.02-5.44, p = 0.045) and multiple disease comorbidities (AOR= 3.78, 95% CI: 1.08-13.12, p = 0.037) were associated with poor quality of life.

Conclusion

Loss of earning, pain, marital strife, sexual dysfunction, were among the common psychosocial challenges experienced. History of ever taken alcohol and multiple comorbidities were associated with poor quality of life. There is need to integrate psychosocial solutions for cancer patients to improve their quality of life and outcomes.

The Experiences of Cervical Cancer Patients During Follow-Up Care in Ethiopia: A Qualitative Study

Purpose

The purpose of the study was to explore the experiences among cervical cancer patients during follow-up care.

Patients and Methods

A qualitative study was conducted with purposively selected cervical cancer patients receiving follow-up treatment at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Data were collected using semi-structured interviews and analyzed via thematic analysis.

Results

The results obtained in this study indicated that women experienced a variety of physical and psychosocial difficulties in the context of cervical cancer care. The data analysis resulted in five themes. Women have undergone difficulties indicated as lack of satisfaction with the health care experience, dealing with treatment side effects, struggle in work and daily life, having stress, disruption in social relationships, and financial difficulties incurred because of their illness and treatment.

Conclusion

This study highlights that cervical cancer patient’s experience is the outcome of a complex interplay by personal, clinical, psychological, and social spheres. Thus, interdisciplinary approach between health and psychosocial professionals is needed during follow-up care in order to help women experience better psychosocial adjustment.

Quality of Life and Its Associated Factors Among Cancer Patients Receiving Chemotherapy at Oncology Hospitals in Vietnam After the Third Wave of the COVID-19 Pandemic

Purpose

This study aimed to evaluate the health-related quality of life (HRQOL) of cancer patients receiving chemotherapy and identify associated factors affecting the HRQOL after the third wave of the COVID-19 pandemic in Vietnam.

Patients and Methods

Patients with solid cancers receiving chemotherapy at two oncology hospitals in Vietnam during April and May 2021 were included. The European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire version 3 was used to measure the HRQOL. Three questions were asked to explore patients’ concern levels about contracting COVID-19, delaying chemotherapy, or not controlling cancer well. One question was used to explore whether patients were concerned about cancer progression or COVID-19 infection more, or equally, or had no concern about both. Multiple regression models were conducted to examine factors associated with the global health status (GHS) score.

Results

Of 270 included patients, mean (Standard deviation [SD]) GHS was 56.7 (20.8). Among the functional statuses, social functioning (SF) had the lowest score of 63.6 (29.2). The symptoms with the highest means were insomnia and fatigue, obtaining the score of 38.5 (31.7) and 37.3 (29.2), respectively. The mean of financial difficulties was 54.1 (32.2). In univariate analysis, high concerns about contracting COVID-19, delaying chemotherapy, not controlling cancer well, or more concern about either cancer or COVID-19 over the other were associated with worse GHS, physical functioning, emotional functioning, and SF. In multivariate analysis, those concerns and no income were significantly related to lower GHS scores besides the non-modifiable factors, such as female gender and some cancer types.

Conclusion

Patients at the high concern levels, or with more concern about either cancer or COVID-19 over the other had poorer HRQOL. Interventions to address the concerns are required to improve their HRQOL, particularly for women, those without income, or with some specific cancers.

Incidence Trends and Survival Prediction of Malignant Skin Cancer: A SEER-Based Study

Purpose

Methods

Results

Conclusion

Anxiety and Depression in Patients with Breast Cancer: A Cross-sectional Study

BACKROUND: The early management for distress, depression, and anxiety in breast cancer patients can help improves quality of life that adherence patients to cancer treatment. AIM: This study aimed to describe the prevalence and risk factors of anxiety and depression symptomatology of breast cancer patients in the inpatients and outpatient settings. METHODS: This study used a research and development study design. The study was conducted in at the University Clinical Center of Kosovo the Medical Oncology Clinic in Pristina from August to October 2021. The total sample in this study consisted of 50 female breast cancer patients diagnosed at least 6 months before the date of assessment, aged 18 and above, able to communicate in Albanian, signed an informed consent form, negative history of other malignancies, and absence of any temporary acute illness affecting psychological well-being while filling the questionnaire. Questionnaire used in our study is Hospital Anxiety and Depression Scale for assessing anxiety and depression in breast cancer patients. RESULTS: For anxiety score, some of them were caseness level with 82%, while 26% of study participants were in borderline, 6% in caseness, and some of them were in normal level from 68% on the depression score. The patients feel tense or wound up with 44% Mean/SD (14.67 ± 6.02), about feeling afraid that something terrible will happen and patients may have this feel Mean/SD (13 ± 1.66). Over half of them had the feeling of fear as if something awful is about to happen Mean/SD (11.33 ± 4.03) and that the feeling of fear as if they had “butterflies” in the stomach of 62% had the feeling sometimes, beautiful often, and very often Mean/SD (10.33 ± 4.92). CONCLUSION: The results indicate that it is very important to measure the level of anxiety and depression in women with breast cancer, which are two common mental disorders in breast cancer.

Factors influencing the occurrence of electrolyte disorders in cancer patients

Objective:

The objective of this study was to determine the magnitude of electrolyte disorders and influencing factors among cancer patients in Southwest Ethiopia.

Methods:

Facility-based cross-sectional study was conducted in Jimma Medical Center (JMC). Eighty-four cancer patients admitted to JMC were recruited for this study. A structured questionnaire and serum electrolyte measurements were used for data collection. Bivariate and multiple logistic regression was employed to determine the association between electrolyte disorders and associated factors among admitted cancer patients. P value ⩽ 0.05 was used as a cut point to declare statistical significance.

Result:

The overall prevalence of electrolyte disorders was 60.7%. The presence or absence of comorbid diseases, age, body mass index (BMI), nutritional status, and current prescribed medication use were associated with electrolyte disorders. Younger patients had lower odds for electrolyte disorders (odds ratio (OR) = 0.128 (P value = 0.05) and OR = 0.08 (P value = 0.033)) for the first and the second quartile, respectively. Underweight patients had a threefold likelihood to develop electrolyte disorders (OR = 3.13 (P value = 0.043)) than having normal BMI. Compared with those in need of nutritional intervention, patients not in need of nutritional intervention had lower odds for the disorders (OR = 0.109 (P value = 0.006)). Medication had increased the likelihood of electrolyte disorders by 5.5 times than with no medication (P value = 0.023). Those who had comorbid disease had 10 times likely to develop electrolyte disorders than those who did not have comorbid diseases (P value = 0.004).

Conclusion:

Electrolyte disorders were prevalent in cancer patients. Age, BMI, nutritional condition, comorbid disease, and prescribed drugs were the predictors of electrolyte disorders in cancer patients. Authors recommend routine screening of electrolyte disorders in cancer patients and special emphasis on controlling and managing risk factors.

Factors associated with unmet supportive care needs of oncology patients at Dessie Referral Hospital, 2020

BACKGROUND

Assessment of supportive care needs for cancer patients and identifying factors affecting these needs is important for the implementation of supportive care programmes, as the burden of cancer is increasing in Ethiopia.

OBJECTIVE

To determine the prevalence and associated factors of unmet supportive care needs of cancer patients at Dessie Referral Hospital, Dessie, South Wollo, North East Ethiopia, 2020.

METHODS

A cross-sectional study design was implemented among 405 cancer patients from February to 30 July 2020, at Dessie Referral Hospital. The data were collected using a validated supportive care needs survey questionnaire through face to face interview and data extraction tools. Both descriptive and inferential statistics were used and bi-variable and multivariable logistic regressions were used to describe the association between dependent and independent variables. Thus, a p-value of less than 0.05 was considered statistically significant.

RESULT

From the total 405 participants, 275 (67.5%) were females with a mean age of (mean ± standard deviation) 48.6 ± 15.4 years. Unmet supportive care needs were higher among psychological needs (81.0%, 95% (confidence interval) CI = 77.0-84.9) and physical needs (74.6%, 95% CI = 70.1-79.0). Old age was associated with unmet physical and psychological needs domain than young age (adjusted odds ratio (AOR) = 1.03; 95% CI: 1.01-1.06), (AOR = 1.06; 95% CI: 1.03-1.09), respectively. High household income was significantly associated with health information needs (AOR = 2.22; 95% CI: 1.33-13.93), remission status (AOR = 0.37; 95% CI: 0.22-0.62) was associated with patient/supportive care needs, late stage cancer was also significantly associated with physical, psychological and health information needs of patients (AOR = 2.19; 95% CI: 1.18-4.06), (AOR = 2.3; 95% CI: 1.18-4.57) and (AOR = 2:95%; CI: 1.03-3.86), respectively. Besides, source of information had a statistically significant association with psychological, health information and patient care needs domain (AOR = 2.61; 95% CI: 1.15-5.93), (AOR = 3.1; 95% CI: 1.65-5.82) and (AOR = 2.2; 95% CI: 1.25-3.87), respectively.

CONCLUSION AND RECOMMENDATION

This study shows that the prevalence of unmet supportive care needs in cancer patients is high in each domain. Age, income, cancer stage, cancer site, treatment option, time since diagnosis and sources of information were associated across one or more unmet supportive care needs domains. Therefore, the government and health professionals should work together to improve the unmet needs of cancer patients.

Study Protocol of CBT-AP Trial: A Randomized Controlled Trial of Cognitive Behavioral Therapy Integrated with Activity Pacing for Fatigued Breast Cancer Patients Undergoing Chemotherapy

PURPOSE

This paper reports the methodology for undertaking a randomized controlled trial to assess the combined effect of cognitive behavioral therapy (CBT) and activity pacing on fatigue experienced by breast cancer patients undergoing chemotherapy.

METHOD

Fifty-eight patients experiencing severe fatigue will be randomized to a CBT group or usual care group. The intervention will be given for 6 sessions by a trained oncology nurse. Primary and secondary outcome measures will be assessed at baseline, the sixth week of intervention and at the third month post intervention. The primary outcome measure is fatigue (Brief Fatigue Inventory) and secondary outcome measures include depression (Patient Health Questionnaire) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire). The protocol is designed using the SPIRIT guidelines which is one of the EQUATOR checklists.

DISCUSSION

This is the first RCT that will determine the efficacy of CBT by integrating with activity pacing to reduce fatigue among breast cancer patients receiving chemotherapy. The intervention design is novel in addressing multiple precipitating and perpetuating factors of fatigue and integrated with activity pacing in CBT.

CONCLUSION

If the intervention is effective, this therapeutic approach can be incorporated into a routine health care for breast cancer patients receiving chemotherapy.

TRIAL REGISTRATION

The study have been registered in Pan-African Clinical Trial Registry (website) on August 24, 2020. The trial registration number is PACTR202008881026130.

The Impact of AC and AC-T Chemotherapy's Toxicities on Quality of Life Among Women with Breast Cancer in Ethiopia: A Prospective Patient-Reported Outcomes Study

PURPOSE

The study aimed to evaluate the quality of life patterns and the effects of AC and AC-T chemotherapy's toxicities on QoL among Ethiopian women with breast cancer.

METHODS

QoL was measured at baseline and at every end of two cycles, for the median of 8 cycles among 146 breast cancer women on AC and AC-T chemotherapy, using EORTC QLQ-C30 and BR23 instruments. The effect of QoL score, socio-demographic, and clinical variables at baseline were adjusted for the effect of chemotherapy's toxicities on QoL.

RESULTS

Overall QoL, all functional scales (except cognitive functioning, body image, future perspectives, and sexual functioning) and symptom scales (except dyspnea, insomnia, pain score, arm, and breast symptoms) of EORTC QLQ-C30 and BR23 deteriorated significantly both clinically and statistically, in particular, during the first two cycles of chemotherapy. After the end of cycle 2 or 4, except for cognitive, social functioning, and financial difficulties of the patients, almost all other QoL dimensions were improved towards pretreatment score by the end of cycle 8. In addition to age, educational status, and tumor stage, the Global Health Status (-10.55≤B≤-7.71, P≤0.013), and the functional scales (-25.320≤B≤-6.351, P≤0.033) of EORTC QLQ-C30 and BR23 were significantly affected at least by one of the AC and AC-T chemotherapy's toxicity such as grade≥2 fatigue, dysgeusia, constipation, dry mouth, vomiting, oral mucositis, skin hyperpigmentation and/or peripheral neuropathy than their lower grade. Grade≥2 fatigue, dysgeusia, oral mucositis, constipation, peripheral neuropathy, anemia arthralgia/myalgia, dry mouth, diarrhea, constipation, and/or skin hyperpigmentation were positively predicted for the deterioration of symptoms scale of EORTC QLQ-C30 and BR23 (4.819≤B≤26.451, P≤0.043).

CONCLUSION

Quality of life among Ethiopian breast cancer patients on AC and AC-T regimens significantly deteriorated particularly during the first two cycles of chemotherapy. In addition to the age, tumor stage and educational status of the patients, grade≥2 fatigue, dysgeusia, constipation, oral mucositis, dry mouth, peripheral neuropathy, and skin hyperpigmentation due to AC and AC-T chemotherapy were frequently associated with deterioration of different scales/items QoL. Hence, devising different strategies to improve the deteriorated QoL due to chemotherapy's toxicities particularly during the first two cycles has paramount importance.

The Hospital Anxiety and Depression Scale (HADS) applied to Ethiopian cancer patients

Psychological distress is a common problem associated with cancer. The main objective of the present study was to test the Hospital Anxiety and Depression Scale (HADS) in a sample of Ethiopian cancer patients and to compare the results with those obtained from a sample in Germany. Data were collected from 256 cancer patients who visited the University of Gondar Hospital between January 2019 and June 2019 using the HADS, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30), and the Multidimensional Fatigue Inventory MFI-20. The reliability of the HADS was good, with Cronbach's α coefficients of 0.86 (anxiety), 0.85 (depression), and 0.91 (total scale). The Ethiopian cancer patients were more anxious (M = 7.9) and more depressed (M = 9.3) than the German patients (M = 6.8 for anxiety and M = 5.5 for depression). Only a weak level of measurement invariance was detected between the Ethiopian and the German sample. In the Ethiopian sample, anxiety and depression were associated with tumor stage (high levels in stage 4) and treatment (high levels for patients not receiving surgery and chemotherapy). Both anxiety and depression were significantly associated with all of the EORTC QLQ-C30 and MFI-20 scales. The HADS proved to be applicable for use with Ethiopian cancer patients. The high level of anxiety and depression present in that group indicates a need for psychosocial care.

Economic Burden and Predictors of Cost Variability Among Adult Cancer Patients at Comprehensive Specialized Hospitals in West Amhara, Northwest Ethiopia, 2019

Background

Cancer is the second leading cause of death in the world and accounts for 5.8% of deaths in Ethiopia. High out-of-pocket payment for the cost of illness of cancer could be linked to the low adherence to cancer treatment. This study aimed to assess the economic burden and predictors of cost variability among adult cancer patients at comprehensive specialized hospitals in West Amhara, Northwest Ethiopia.

Methods

An institutional-based cross-sectional study was conducted from January to February 2019 at the University of Gondar and Felege Hiwot hospitals. The cost of illness of cancer was estimated using a bottom-up micro-costing approach. Direct costs of illness of cancer were measured by calculating out-of-pocket expenditure. The indirect costs were estimated using human capital model approach. Multiple linear regression was used to identify the predictors for the log-transformed data. Unstandardized β-coefficient with 95% CI and p-value < 0.05 were used to declare factors associated with cost of illness of cancer.

Results

The mean cost of cancer illness among adult patients was US$ 1103.7 ±33.2, and median cost was US$ 951.0 with IQR of 822.1. Factors such as urban residents (β = 0.147; 95% CI: 0.047, 0.246), distance (β = 0.0007; 95% CI: 0.0002, 0.001), married (β = 0.125; 95% CI: 0.037, 0.212), higher education (β = 0.318; 95% CI: 0.202, 0.435), buying drugs at private facilities (β = 0.134; 95% CI: 0.026, 0.243), richest households (β = 0.320; 95% CI: 0.143, 0.496) and frequent cycles of chemotherapy (β = 0.093; 95% CI: 0.061, 0.125) were positively associated with cost, while being female patients (β = −0.144; 95% CI: − 0.210, − 0.018) were negatively associated.

Conclusion

The cost of illness of cancer was high. The government, therefore, should expand health insurance and invest an additional budget to safeguard patients from financial catastrophic shock.

Drug therapy problems and health related quality of life among patients with colorectal cancer in a Kenyan tertiary health facility

BACKGROUND

Colorectal cancer is the third most common form of cancer in males and the second in females globally. The ill-health due to cancer and use of multiple therapies may result in drug related problems and also affect the health-related quality of life of the patients.

OBJECTIVE

To characterize drug therapy problems and health-related quality of life among patients with colorectal cancer at Kenyatta National Hospital.Methodology: A descriptive prospective cross-sectional study design was used and simple random sampling utilized to select seventy- one participants. The participants were interviewed and their responses captured using World Health Organisation Quality of Life-BREF and a structured questionnaire. The data were analysed using STATA version 15.0. Data was summarized using descriptive statistic such as mean, range and standard deviation. Association between variables was determined using linear regression model at 0.05% level of significance. Ethical approval was granted by the relevant authorities to conduct the study.

RESULTS

Patients were predominantly females (52.1%), had a mean age of 55.9± 14.4 years. The main drug therapy problems were adverse drug reactions (45.1%). Approximately two thirds (67.6%) of the participants complained of gastrointestinal problems followed by cardiovascular diseases (29.6%). Quality of life assessment indicated that psychological health had the highest score at 60.5%. On linear regression analysis, the presence of anemia (p = 0.021), coverage (p = 0.038), and cardiovascular problems (p = 0.034) were significantly associated with the overall health-related quality of life.

CONCLUSION

The health-related quality of life was is dependent on several patient related factors. Interventions regarding prevention of drug therapy problems should be considered alongside other measures used to manage colorectal cancer.

Quality of life among Ethiopian cancer patients

PURPOSE

Cancer is of increasing prevalence in less-developed countries. However, research on the patients' quality of life (QoL) in these countries is very limited. The aim of this study was to examine QoL of cancer patients in Africa.

METHOD

A sample of 256 cancer patients treated in an Ethiopian hospital was examined with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, the Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale. A group of 1664 German cancer patients served as a comparison group.

RESULTS

Most of the scales of the EORTC QLQ-C30 showed acceptable reliability in the Ethiopian sample. Compared with the German cancer patients, the Ethiopian patients showed lower QoL in most dimensions, especially in financial difficulties, physical functioning, pain, and appetite loss (effect sizes between 0.52 and 0.75). Illiteracy, tumor stage, and treatment (surgery and chemotherapy) were associated with QoL in the Ethiopian sample. QoL was strongly correlated with fatigue, anxiety, and depression.

CONCLUSION

The EORTC QLQ-C30 is a suitable instrument for measuring QoL in Ethiopia. The detriments in QoL in the Ethiopian patients indicate specific cancer care needs for the patients in a developing country.

Quality of Life Among Breast Cancer Patients Attending Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center

BACKGROUND

Breast cancer affects the overall quality of life (QOL) among its survivors. Limited evidence is available about the QOL among cases. Therefore, this study was intended to assess the quality of life of breast cancer patients attending the cancer treatment center at Hawassa University Comprehensive Specialized Hospital, Hawassa, southern Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among breast cancer patients attending cancer treatment at the Hawassa University Comprehensive Specialized Hospital between April and June, 2019. All breast cancer patients attending treatment the center were included in the study by universal sampling. Data were collected using a structured questionnaire containing demographic data, patient clinical factors and Quality of Life Instrument (WHOQOL)-BREF version 3.0. The collected data were entered into EpiData software version 3.1 and analyzed using SPSS Version 20.0. Descriptive statistics were presented in tables.

RESULTS

A total of 259 respondents with a mean age of (SD) 44.89 (12.56) participated in study. The mean score of overall global health scale was 75.3 (SD±17.1) with the mean health satisfaction was 12.43 (SD±3.98). The highest mean score was observed in environmental domain, 93.31 (SD±19.76), despite social domain being very low, 36.69 (SD±7.62). Most of the participants were highly satisfied with the health care service that was provided, with a mean score of 16.1 (SD±3.1). In contrast, the majority of study participants were disappointed with the need for any medical treatment, body appearance, luxurious activities, and sexual life, with mean scores of 8.93 (SD±3.68), 8.74 (SD±4.26), 9.1 (SD±4.22), and 8.1 (SD±4.14), respectively.

CONCLUSION

Breast cancer patients in southern Ethiopia suffered from poor social and psychological support that, in turn, highly affected their life value. Therefore, due attention should be given to enhance social and psychological support for breast cancer patients as a whole.

Quality of life of cancer patients living in Trinidad and Tobago

PURPOSE

To determine quality of life (QoL) of cancer patients in The Republic of Trinidad and Tobago using the European Organization for Research and Treatment of Cancer Care Quality of Life Instrument (EORTC QLQ-C30) and examine relationships between QoL and socioeconomic and medical variables.

METHOD

A cross-sectional study, consisting of 480 cancer patients being managed at the National Radiotherapy Centre, was conducted. One-way, multiple analysis of variance (MANOVA) with post hoc testing was used to analyze relationships between socioeconomic and medical variables and scales on the EORTC QLQ-C30. Stepwise linear regression was used to evaluate which independent variables contributed to the global QoL and function scores.

RESULTS

Participants were of mean age 64.1 ± 12.1 years (males) and 56.7 ± 16.6 years (females). Mean values for global QoL and function scales were below 75. Persons in younger age groups had significantly better physical and cognitive function scores (p < 0.05). Males had higher emotional function scores than females (p < 0.05). Persons with higher income and education had better scores on all function scales, except social, and less symptoms (p < 0.05). Persons receiving chemotherapy had more nausea/vomiting, appetite loss, and constipation (p < 0.05).

CONCLUSION

Age, income, education, and cancer treatment were factors most associated with scores on the EORTC QLQ-C30. Further research is required in this population to examine these variables in more depth and explore methods to improve QoL of cancer patients in this population.