Journal of Nursing & Patient Care

Research Article, J Nurs Patient Care Vol: 1 Issue: 2

Assessment of Quality of Life of Patients Undergoing Oncology Treatment

Adriane Cristina Bernat Kolankiewicz*, Gerli Elenise Gehrke Herr, Marli Maria Loro, Evelise Moraes Berlezi, Joseila Sonego Gomes
Regional University of the Northwest of Rio Grande do Sul State, Brazil
Corresponding author : Adriane Cristina Bernat Kolankiewicz, Nurse, PhD
Professor, Undergraduate Nursing course, Graduate Program in Comprehensive Health Care of the Regional University of the Northwest of Rio Grande do Sul State, Ijui, Rio Grande do Sul, Brazil
Tel: 55 3332-0622 - (55) 9681 – 6030
E-mail: [email protected]
Received: November 28, 2016 Accepted: December 23, 2016 Published: December 30, 2016
Citation: Kolankiewicz ACB, Herr GEG, Loro MM, Berlezi EM, Gomes JS (2017) Assessment of Quality of Life of Patients Undergoing Oncology Treatment. J Nurs Patient Care 1:2.

Abstract

Objective: To assess the quality of life of cancer patients undergoing chemotherapy assisted in a High Complexity Centre for Cancer Treatment in Southern Brazil.
Method: cross-sectional, descriptive study conducted at a High Complexity Centre for Cancer Treatment in Southern Brazil. Authors used a sociodemographic clinical questionnaire and the European Organization for Research and Treatment of Cancer and the Quality of Life Core - 30 - Questionnare. For data analysis, authors used the Statistical Package for Social Sciences (SPSS) for Windows, version 18.0.
Results: participants were 437 patients whose mean age was 57.46 ± 13.26 years. There was prevalence of women (60%), married people (68.6%), with incomplete primary education (63.8%) and with income of 01-02 minimum wages (60.2%). The Quality of Life Core -30-Questionnare showed that the most affected domains were role performance, emotional function and symptoms of “fatigue”, “pain” and “insomnia”. The overall quality of life reached satisfactory score and financial deficiency was also indicated by patients with an average of 27.05.
Conclusion: quality of life is affected by chemotherapy treatment for its potential to cause symptoms and change the daily life of individuals. Health professionals need to provide care taking into consideration the individual as an indivisible whole.

Keywords: Neoplasias; Quality of life; Chemotherapy

Keywords

Neoplasias; Quality of life; Chemotherapy

Introduction

Neoplasias are chronic pathologies with multiple causes and gave became a public health problem worldwide. The World Health Organization (WHO) estimates that in 2030 the incidence of neoplasias will be 21.4 million new cases and 13.2 million deaths worldwide [1].
There have been scientific and technological advances for the treatment of cancer in the last decade, which includes surgery, radiotherapy (RT), chemotherapy (CT) and target therapies or the combination of therapies. However, this is still a dreaded disease and linked to death. Faced with the diagnosis of cancer, the individual experiences feelings such as anger, grief and low self-esteem. Besides, there are physical changes resulting from the weakening of the body by the evolution of the disease and also from the adverse effects of the treatment, especially chemotherapy; also, psychological and physical changes directly affect the quality of life of the individual.
Chemotherapy has intense repercussions on the organism and can cause different adverse events because drugs still do not have selective action and act on cells with alterations and also on the normal cells, especially those of fast division and the hematopoietic and germinative tissue, the hair follicle lining of the gastrointestinal system [2], causing neurotoxicity and cell death. Despite increasing survival, CT influences negatively the quality of life of individuals due to its toxic effects.
At the present time, models of definitions and concepts of healthrelated QoL have been applied to cancer patients [3]. The term Health- Related Quality of Life is evidenced in the literature as a synonym of Perceived Health Status and its main objective is to verify how much the disease or the chronic state, besides its symptoms, has interfered in the daily quality of life of an individual. Validated instruments have been used to measure and explore symptoms and effects of the disease, as well as to assess QoL during treatment, referred to as “health-related QoL instruments” [4,5].
In this epidemiological and theoretical context, the objective of this study was to assess the quality of life of oncology patients undergoing chemotherapy at a High Complexity Centre for Cancer Treatment (CACON) in Southern Brazil.

Materials and Methods

This is a cross-sectional, descriptive, prospective study linked to the institutional research project “Quality of life of cancer patients assisted in a High Complexity Centre for the Cancer Treatment (CACON)” of the Regional University of the Northwest of Rio Grande do Sul State - UNIJUI.
The study population included individuals aged 18 years or older, from both genders, diagnosed with cancer and assisted in a CACON, in the southern region of Brazil. Patients undergoing treatment for head and neck cancer, participants of clinical research protocols and those not able to respond to data collection instruments were excluded.
For this study, only patients undergoing CT were selected, from the third cycle, totaling 437 participants. Data collection was carried out by means of documentary analysis, interview and application of the European Organization for Research and Treatment of Cancer 30- Item Quality of Life Questionnaire (EORTC QLQ-C30), version 3.0, in Portuguese, translated and validated to the Portuguese language. Its use is authorized by the European Organization for Research and Treatment of Cancer (EORTC).
The QLQ-C30 instrument contains thirty items divided into domains: Global Health Status; Functional Scales; Scales of Symptoms. Items 1 to 28 of the questionnaire are presented in a four-point Likert scale, in which answers are given as: no at all, a little, quite a bit, and very much. Items 29 and 30 are presented in a seven-point Likert scale, in which one corresponds to very poor and seven corresponds to excellent [6].
The Statistical Package for Social Sciences (SPSS)® 20.0 was used for data analysis. Researchers used descriptive statistics tools, measures of central tendency and dispersion for the treatment of quantitative variables and relative and absolute frequencies for qualitative variables. The mean and standard deviation were calculated for descriptive analysis of the data. The development of the study met the national and international norms of ethics in research involving human beings, approved by the Research Ethics Committee (CEP) of the Regional University of the Northwest of Rio Grande do Sul State under the opinion number 275/2010.

Results

The mean age of study participants was 57.46 ± 13.26 years; the minimum age was 21 and the maximum was 88 years. Most participants were females (60%), married (68.6%), had low schooling (63.8%) and income from one to two minimum wages (60.2%).
Table 1 shows the descriptive statistics of the dimensions evaluated by the QoL evaluation questionnaire. It is observed that the average obtained in the general score of the questionnaire was 71.98 points, considered as a satisfactory quality of life. On the functional scales: cognitive, social and physical functioning, scores were equal to or greater than 70 points. For the function of role performance and emotional function, scores were lower than 70 points; participants felt tense, worried, angry angry/or depressed. The symptom scales found the lowest scores; fatigue was the most present symptom with repercussions on QoL; followed by pain, insomnia, constipation, lack of appetite, nausea and dyspnea.
Table 1: Descriptive statistics of the QoL score of patients undergoing CT treatment at a High Complexity Centre for Cancer Treatment in Southern Brazil, 2011.

Discussion

With the emergence of increasingly effective chemotherapy treatments, the survival rates for oncology patients have improved significantly. On the other hand, the effects of the treatment and the symptoms of the disease impair the QoL of patients, which has led researchers and health professionals to identify the affected domains, and, consequently, to plan interventions.
Regarding the sociodemographic characteristics of the population, the average age of the participants was 57.46 years, with a predominance of females; the highest percentage was from married women, with incomplete primary education and income of 01 to 02 minimum wages. In a study of QoL of patients with breast and intestinal cancer, the mean age was 55.5 years with a prevalence of married women with low level of schooling (66.6%) [7]. The findings regarding low schooling may justify patients’ lack of knowledge about cancer risk factors, the delay in the search for specialized treatment services, and difficulties in understanding about prevention factors [8].
Another study of QoL and breast cancer identified that more than 80% of a total of 110 patients belonged to the middle and lower classes [9], which is in line with the present study. In addition, a study that analyzed the QoL of patients with other types of neoplasias corroborates with the result of this study when affirming that the majority of the patients had incomplete primary education [10].
Patients with low socioeconomic level and low schooling require from health professional more attention in the educational processes, with adjustment of the language to the level of their understanding, mainly in the therapeutic offerings aimed at the prevention and early detection of the diagnosis.
The QoL results evidenced by the EORTC QLQ C30 instrument, presented in Table 1, make it possible to characterize the QoL of patients during the CT treatment. When considering the global health scale, it is perceived that participants consider their overall health as satisfactory, by attributing a value of 71.98. A similar result was found in a study, that used the same instrument, and in the evaluation after three months of CT treatment no statistically significant difference was found, which shows that the cancer patients studied consider their health condition as satisfactory [7].
The Social Function is also an independent factor associated with the Global Health Status/Quality of Life. Positive social function may contribute to the improvement of QoL in situations in which patients feel stigmatized by the disease [11]. In this study, it was evidenced that among the items on the functional scale, the role performance is the function that most affects QoL, which may be related to the difficulty of performing work or leisure activities [12].
When analyzing the results of the other items in the Functional Scale, it was observed that the function role performance, followed by the emotional function, had lower means, indicating that patients felt irritated, tense, depressed, worried and with difficulty in performing tasks, such as feeding and getting dressed. The best results were found in social function and cognitive function, which shows that physical condition and treatment interfere little in family life and social activities, and that these patients present little difficulty in concentration and memory [12].
The QLQ-C30 instrument was specially created to characterize the symptoms presented by cancer patients. The scale of symptoms, presented in Table 1, shows that fatigue, pain and insomnia were the symptoms with higher scores than the others.
Fatigue was the main cause of impact in the QoL life of these patients. It is defined as persistent and subjective feeling of tiredness, related to the disease or its treatment that interferes with the usual activities [13]. The occurrence of fatigue is expected in CT treatment, as studies show that the sensation of fatigue is experienced by 72% to 95% of all patients during and after treatment [14]. Another study showed that 40% to 80% of patients suffered significant fatigue before, during or even after chemotherapy [15]. In addition, this symptom correlates with a worsening of the QoL of these patients [16].
Cancer-Related Fatigue (CRF) is usually the most common, distressing and untreatable symptom experienced by patients. They report this is the most important and stressful symptom related to the disease and its treatment and that it interferes in life. It is a strong and independent predictor of the decrease in personal satisfaction and QoL. Many factors are related to the occurrence or worsening of this symptom, such as having cancer in an advanced stage, association of treatments, being female, low level of education, working regularly and living without a partner, besides being depressed and having restriction to develop daily activities [17].
Anemia is among the most common causes of fatigue; it is frequent among patients with cancer under treatment and has a higher prevalence during CT cycles [18].
Pain was also a frequent symptom reported by the investigated population. In a survey of 75 cancer patients, 35 reported having pain, and the sensory pain was the most frequent. However, the greater the intensity, the greater the prevalence of the affective pain, which is identified as being greater in patients with neoplasia than those without neoplasia [19]. In view of this evidence, it is important to have a qualified evaluation of pain to provide an adequate clinical management.
Insomnia is frequent in the population affected by cancer. In Brazil, a study shows the frequency of 25% to 37% in cancer patients, with a higher percentage among those with breast cancer. The study points out that the prevalence of insomnia, whether in hospitalization or during treatment or after, can vary from 23% to 80% [20].
Still regarding sleep quality, it can be greatly impaired by hospital routines. In advanced stages of the disease, tumor invasion can cause severe pain, which can lead to difficulty in sleeping [21]. Research with 50 women in post-treatment of breast cancer showed that, when compared with healthy volunteers, those with cancer had more complaints and nocturnal awakenings. Understanding the nature and consequences of insomnia in this population is fundamental for the planning of interventions aimed at improving sleep and QoL [22,23].
Regarding financial difficulty, the scores were significant, which is related to the fact that the majority of patients are not able to remain in work activities during the oncological treatment, either due to physical difficulties or due to treatment. Consequently, this difficulty has a negative impact on QoL, since it limits the purchasing power and, at times, brings difficulties regarding basic living and housing.

Conclusion

This study evaluated the QoL of cancer patients undergoing CT treatment attended at a CACON in the southern region of Brazil. The mean QoL measured by the QLQ-C30 instrument for our sample was 71.98, which is considered satisfactory.
In spite of all the scientifically proven benefits of CT for patients diagnosed with cancer, the negative impact on QoL can be observed in the results of this study, which evaluated in isolation the domains of role performance, emotional function, fatigue, pain and insomnia; all were affected and presented worsening of QoL.
Results also showed that the lower the education level and income, the greater the probability of the late diagnosis of this population, because they tend to be less informed about the disease and its risk factors, as they have less access to information. Therefore, it is fundamental to know the socioeconomic profile of cancer patients, with an expanded and differentiated view, by assisting and studying them, because it is believed that in the populations of patients with more vulnerable socioeconomic conditions the difficulties may have even more serious consequences on the outcome of the disease.
The results of this research corroborate with data found in the literature, in which the improvement in patients’ QoL may occur inasmuch as health professionals adopt methods to prevent side effects of the treatment, thus avoiding and controlling these effects. Health professionals must also adhere to effective complementary treatments that may help patients to better cope with the disease and treatment. However, the results of this study should be interpreted with caution, since the sample size is small, and it cannot be generalized for all the population under chemotherapy treatment.

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