.Background: Cancer is considered as major public health problem and one of the most common causes of death worldwide. Diagnosis of having a life threatening disease such as cancer has a massive effect on patients’ quality of life (QOL). The World Health Organization (WHO), quality of life (QOL) is defined as individual perception of life, values, objectives, standards, and interests in the framework of culture .Cancer can produce many concerns and problems in daily life that involve the physical, psychological and social problem some subtle and some not at all subtle. An increasingly important issue in oncology is to evaluate quality of life (QOL) in cancer patients. Aim: was to assess the Quality of life concerns among cancer patients at King Abdul-Aziz University Hospital. Design: A descriptive study for all types of cancer adult (male or female) patient, Aged from 18 -70 years old. Setting: Data collected in surgical inpatient wards (male and female), outpatient clinic, gynecology, Radiation unite and day care at King Abdul-Aziz University Hospital (KAUH). Tool: Data collected by using single developed tool (Cancer Survivors Survey of Needs developed tool): to attain the objective of the study consisting of three parts will used to for data collection to achieve the purpose of the study. Data were analyzed by SPSS Version22. Result: It was found that emotional distress was the most common concerns affect on cancer patients with percentage 66.88% more than social concern that was 66.22% and the less concerns was physical concerns 62.15%. There were no significant relationship between cancer patients concerns and quality of life. conclusion: In current study finding was surprising it showed that the most common concerns on cancer patients was the emotional distress more than social and physical concerns. There is no significant relationship between cancer patients concerns and quality of life. this could be due to decrease of sample size , which may shows other significant results.
KEYWORDS: Cancer patients, Quality of life, Physical concerns, Social concerns, Psychological concerns.
Introduction
Cancer is a major public health problem and one of the most common causes of death worldwide (Janbabaei & Fard, 2014).There is significant increasing in the incidence rates each year. Cancer represents a tremendous burden on patients, families and societies. Further on, Cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths(World health organization[WHO], 2012).While, The Saudi Cancer Registry(SCR) estimated that 2010, the total number of cancer incident cases reported to the SCR was 13,706. One out of every two men and one out of every three women will have some type of cancer at some point during their lifetime.
National cancer institution (NCI) defined Cancer as the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in the human body, which is made up of trillions of cells.
The types of cancer vary around the world and there is significant variation in the risk of different cancers by geographic area (Boehringer Ingelheim, GmbH, 2009). The most common types of cancer in men, are lung, prostate, colorectal, stomach, and liver cancer, while among women breast, colorectal, lung, uterine cervix,and stomach cancer(WHO, 2015).
Diagnosis of having a life threatening disease such as cancer has a massive effect on patients’ quality of life (QOL), (Fard & Janbabaei, 2013). Quality of life is very dependent on the stage of the disease and treatment and its an issues for cancer patients which can impact overall patient health (Radiotis et al., 2014). Further on, WHO defined QOL as the individuals’ perception of their position in life in the cultural context and in the value system in which they live, and in relation to their goals, expectations, standards, and concerns. Health related quality of life(HRQOL) covers subjective perceptions of the positive and negative aspects of patient symptoms, including physical effects, emotional aspects and social issues and also the disease symptoms and adverse effects of treatments significantly factors related to patients quality of life. (Lemonnier et al., 2014).
Within the physical domain, the discrimination between disease and treatment effects may become fogginess to the patient, who misinterpret the experience .Psychological wellbeing as separate dimensions, reflecting positive affect as well as negative affect distress. Social issues is poorly understood dimension in most scales (Porock & Palmer, 2004).
Recent studies have dealt with a wide range of cancer patients’ concerns and the association with their QOL. They face varies physical ,psychological ,social and spiritual effects. Therefore, research is needed to better understand the concerns of cancer patients and its effect on their QOL.
The purpose of current study is to assess the concerns of cancer patients and the degree to which these concerns contribute to patients' quality of life. The measurement of QOL for cancer patients become a vital and required part of health outcomes appraisal which can affect the quality of life of these patients and their families (Fard & Janbabaei, 2014)
Conceptual framework
The framework of this study is based on the Wilson and Cleary conceptual model of health-related quality of life (HRQOL) that integrates both biological and psychological aspects of health outcomes. There are five different levels in their model, namely, physiological factors, symptom status, functional health, general health perceptions, and overall quality of life. Their model has been widely applied to different populations, including patients living with cancer Wilson and Cleary’s model is a unique conceptual for adults receiving Long-term therapy and determined the challenge of having cure as the best outcome. Instead, changes in many domains related to aging, weakness, and adopting with the effects of multiple chronic conditions are the focus for measuring change and outcomes. This model has been demonstrated to improve knowledge about the HRQOL of people to coping with long-term health status. (Zubritsk.et.al2015)
Operational definition:
Cancer :refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue.
Concerns :feeling or showing worry or solicitude that which concerns a person with regard to a particular role or situation. QOL: is the individuals’ perception of their position in life in the cultural context and in the value system in which they live, and in relation to their goals, expectations, standards, and concerns.
HRQOL: includes the physical, functional, social and emotional well-being of an individual. is a patient reported outcome usually measured with carefully designed and validated instruments such as questionnaires or semi-structured interview schedules.
Aim of study:
To assesses the concerns of cancer patients and the degree to which these concerns contribute to patients' quality of life.
Study objective:
-To determine the cancer patients' concerns.
-To identify cancer patients Concerns about physical symptoms, psychological ,and social symptoms contribute to their QOL directly or indirectly.
Research question:
What are the quality of life concerns among cancer patients at King Abdul-Aziz University Hospital?
Research methodology
Study design:
A design used to suite the aim of the study was A quantitative descriptive design chosen by researcher to determine the concerns of cancer patients and the degree to which these concerns contribute to patients' quality of life.
Study Setting:
Data collection of this study conducted at KAUH which was one of the teaching hospitals in KSA for training of physician, nurses and dentists under the ministry of health. KAUH is considering as medical landmark, this hospital characterized by having 845 beds capacity and multi nationality staff. The present study was conducted at the following department’s surgical inpatient wards (male and female), outpatient clinic, gynecology, radiotherapy and day care unit.
Study Sample:
This study used a convenient sample which means all available type of cancer patients who were eligible to complete a questionnaire regarding comprehensive concerns about physical and psychological and social aspects related to cancer.
The researcher calculate the sample to set limit for the minimum number of subjects required to get significant result.
Inclusion criteria will be:
-Any adult male or female cancer patients
-Aged from 18- 70 years old or more.
-Patients who are more than 3 months diagnosed with cancer
-patients diagnosed with any of stage of cancer.
Exclusion Criteria:
– Cancer patients with any coexisted disease.
– Inability or unwillingness to provide informed consent.
Sample size:
A convenience sample was taken from the above mentioned setting according to inclusion criteria. The estimated number of newly diagnosed cancer at king Abdul-Aziz university hospital in 2015. The sample size calculated according to Robert Mason equation application which was 280 patients.
Data Collection tool:
The data were collected by using single developer tool (Cancer Survivors Survey of Needs developed tool) These Survey were modified because we think it accommodate best to the social culture status of patients. They were used to measure the three domains of quality of life namely, the physical complains, the daily activities and psychological wellbeing.to attain the objective of the study. It is divided into three parts were used for data collection to achieve the purpose of the study:
Part I; cancer development assessment part; include demographic data of patients including: (age, gender, level of education, occupation nationality, marital status, income, and date of being involved in the study.
Part II: clinical data:
It was included; (cancer diagnosis, years of cancer, types, stages, types of treatment received (surgery, radiation, chemotherapy, hormonal or others), currently received treatment.
Part III :
It was included the quality of life concerns of cancer patients, it includes 3 domains; Physical, Psychological and social aspect.
Scoring system: Within each of these three domains, participants rated specific items using a six-point Likert rating scale from 0 (no level of concern) to 5 (extreme level of concern).
In addition, one question included in the survey tool was designed and studied to measure overall quality of life (QOL) using an 11-point Likert scale from 0 (as bad as it can be) to 10 (as good as it can be).
Validity
The study tool were developed by the researcher after extensive reviewing of relevant literature. The content of developed tool consensus by a panel of experts in the field of medical- surgical nursing faculty at king Abdul-Aziz university to supports the content validity of survey. Comments and suggestions of jury consider and the tool modified.
Reliability of tools
The structured tools developed by researcher were examined by a panel of three medical and critical care nursing experts to determine whether the included items were clear and suitable to achieve the aim of the study.
The reliability of the developed tool was tested by using Cronbach's alpha coefficient test and calculated using SPSS version 22. Reliability coefficient value was 0.820
Pilot study
Survey designed to evaluate the self-reported concerns of cancer survivors will have applied to 10% of total participants before data collection to test the clarity, feasibility, applicability and the ease of implementation for the study tool. Necessary modifications in the tool will be done; patients included in pilot study will be excluded from the study.
Ethical Considerations:
Prior to conducting the study, official permission were obtained from the Faculty of Nursing College after submission of a proposal including explanation of the aim, methods, and the procedure of the study. Additionally, administrative approval was obtained from the hospital for data collection. Then the researcher were informed the participants about the study objective and written consent were taken from each participant before conducting the study.
Confidentiality
The data will not include name or identifying personal data . Information received from the patients will be treated confidentially and privacy will be assured for all participants , each participants will be allocated a code to ensure anonymity of collected data.
Data analysis:
Descriptive statistics will have used for all data including frequency distributions and cross-tabulations. The Statistical Package for Social Science (SPSS version 22) will be used to check, enter and analyze the collected data.
Discussion
The Discussion is to state the researcher interpretations and opinions, explain the implications of the study findings, and make suggestions for future research. Its main function is to answer the questions posed in the Introduction, explain how the results support the answers and, how the answers fit in with existing knowledge on the topic. The Discussion is considered the heart of the paper and usually requires several writing attempts. The current study aimed to assess the quality of life concerns among cancer patients at King Abdul-Aziz University Hospital. To attain this aim, the researcher collected data from the participants through interview questionnaire. The World Health Organization(WHO, 2015) has identified Cancer as a generic term for a large group of diseases that can affect any part of the body. Which can affect overall patients quality of life dependent on the stage of the disease and treatment (Radiotis et al., 2014)
The finding of the current study were presented in three parts (demographic data , clinical data , quality of life concerns of cancer patients)
Demographic data:
In current study , it has been discovered that most of the participants were female but that doesn't mean that most of cancer patients are female as result of our limitation which is randomize sample size. However, the result was in contrast with the Saudi Cancer Registry Report , 2010, which stated that the overall cancer was slightly more in males than in females. Cancer affected 50. 5%males and 49.5% females. The most of age was between 51-70 years old which according to Nathan, A. et al ,(2008) reported that the advancing age is a high risk factor for cancer, with persons over 65 accounting for 60% of newly diagnosed malignancies and 70% of all cancer deaths. Almost of them were non saudi because most of the saudi patients refuse to participate in our study or does not know about their diagnosis of cancer which may be attributed to that the family doesn't like to tell the patient about the cancer because of the enormous affect on the patient if know he /she have a life threatening disease such as cancer. Regarding the martial status in current study most of cases 84.8% were married as well as 90.30% of the participants had emotional concerns about changing relationship with spouse, family and others.
Ayal A. et al (2015) determined that married patients were less likely to present with metastatic disease , more likely to receive definitive therapy and less likely to die as a result of their cancer than unmarried patients.
Cancer type & treatment:
In relation to types of cancer and treatments of the participants the majority of the study group were had breast cancer patients which represented 31.8% than colorectal cancer with 16.7% according to saudi cancer registry(2009) reported that breast cancer ranks the first in female and the colorectal cancer was the first in male and the third in female. Cancer diagnosis and treatment brings patients physiological and psychological distress, economic burden, and social distress which can affect patients’ therapeutic effects, prognosis and life quality (Yan-Mdi et al. ,2013). Most of the participants were receiving treatment currently while 7.1% of them didn’t receive the treatment. The American Cancer Society 2011,reported that most of the cancer patients receiving treatment while rare of the patients do not receiving treatment. In the current study most of participants were undergoing chemotherapy while half of them were undergoing surgical treatment and one third of the cancer cases were undergoing radiation treatment. Which from the researcher view that cancer treatment received by the cancer survivals are differ according to the type of cancer and extend of the disease.
However, according to Brunner&Suddarth’s 2010,reported that surgery used as primary treatment approach for cancer and more than half of cases receiving radiotherapy while chemotherapy consider primarily to treat the systematic disease and may be combined with surgery or radiation therapy (Brunner&Suddarth’s twelve edition, unite 3 ,page 347-352).
Physical concerns:
Regarding to physical concern in current study the researcher found that the result of physical concern of the cancer participants related to fatigability , pain and sleep disturbance was decreased this could be related to limitations of sample size as it was relatively very small sample size. In a recent study ,this finding was in contrast, which reported that physical activities, sleep problems, and increased pain and fatigue are commonly experienced by cancer patients and are associated with significant deterioration in quality of life (Hopko et al., 20116).
Also, in another study conducted by(Karthikeyan et al., 2012)was shown that there were negative correlation between fatigue and QOL in which that fatigue can have an immensely negative impact on patients’ Quality of Life and activities of daily living.
In current the result the researcher found that the sexual and fertility issues was the most common concerns to cancer patients according to physical aspect this is supported by (Ann H, 2013) who reported that fertility and sexual issues was the most physical concern linked to cancer patients and its related to physical changes that occur often during treatment that can contribute to reduced sexual interest and decreased sexual function. However, going through cancer treatment does not mean that cancer patients cannot be intimate. Many people are able to continue their sexual relationships.
Social concerns:
In relation to social concern can effects contribute to emotional distress among cancer patients in this current study showed that no conflict with what had been reported 75.15% of the participant They have concerns of Health insurance ,74.55% Find it difficult to returning to work and 44.55% Suffer from lack of Managing household activities 44.55 and this can lead to substantial social problems, such as the inability to work and reduced income. These effects are magnified in the presence of any social stressors that predate the onset of cancer, such as low income, lack of health insurance, and weak or absent social supports.
as the National Centre for Biotechnology Information (2008) described it in their article. (Boer et al,2008) who reported in their result that the cancer patients’ work ability scores at 6, 12 and 18 months after the re-turn to work improved significantly over time.
Regarding sex men scored higher on work ability than women The result of the study indicated that there is no differences were found between age or education groups. Furthermore, that cancer patients who received chemotherapy or chemotherapy plus radiotherapy and/or surgery consistently showed lower work ability scores. In the comparative study of Gudbergsson et al (2006), who were 2′ 6 years after diagnosis, reported that they had , poorer physical and mental work capacity compared to employed matched controls from the general population so they worried about their returned to work after curative treatment
Emotional concerns
Regarding to emotional concern the most of participants in current study were suffering from changing in relationships with spouse, family and others. From the researcher view this changes may lead patients to feel lonely, isolated and frustrated that lead to the lack of progress and treatment of health state .
This finding was in contrast with Dingley& Roux( 2013) who reported in their result that cancer patients who live with hopefulness, having purpose in life, personal relationships and support from others, and positive and spiritual changes, were associated with positive QOL. While in other study reported that cancer treatment can make for cancer patients feel tired and weak. Yet, many people with a cancer diagnosis find that physical activity helps them feel better. Being active may help them regain strength, control stress and focus on positive way (The LIVE STRONG (2015). However, there less concerns on emotional distress with the participant it the current study, they could managing the stress with percent 48.79% .
Result
It was found that emotional distress was the most common concerns affect on cancer patients with percentage 66.88% more than social concern that was 66.22% and the less concerns was physical concerns 62.15%. There were no significant relationship between cancer patients concerns and quality of life.
Conclusion
In current study finding was surprising it showed that the most common concerns on cancer patients was the emotional distress more than social and physical concerns. There is no significant relationship between cancer patients concerns and quality of life. this could be due to decrease of sample size , which may shows other significant results.
Recommendation
Our recommendations cover different aspects from further research to implementing programs, which include:
‘ Recommendations are offered concerning the appropriate use of these measures in clinical research and directions for future research with all types of cancer patients.
‘ Taking larger sample size from different settings.
‘ Necessary to educate patients and their families about what are the concerns of the cancer and what is its impact on the quality of life for them also how to manage concerns.
‘ We recommend further research about the concerns effect on quality of life in cancer patients on different place to get significant result because our sample size was only limited in KAUH due to limited time.
Limitation
The limitations of this study were both population and sitting related, Including:
‘ Time limitation to obtaining ethical approval, collecting data and analysis of results; were not sufficient for quality research.
‘ Small Sample size (N = 66), which cannot represent the all type of cancer population in KAUH.
‘ The disparities in the number of male patients (N = 22) to female patients (N = 44), which resulted in unclear understanding to the nature of the Concerns in relation to the gender difference.