Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: a controlled study

Abdel W Awadalla 1, Jude U Ohaeri, Abdullah Gholoum, Ahmed O A Khalid, Hussein M A Hamad, Anila Jacob

Affiliations

19 June 2007

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doi: 10.1186/1471-2407-7-102

Abstract

Background: Quality of life (QOL) issues are of interest in cancer because effective methods of treatment and detection have led to an increase in the number of long-term survivors. The objectives of the study were: to assess the subjective QOL of stable Sudanese women cancer outpatients and their family caregivers, using the WHO 26-item QOL Instrument; compare with matched general population groups, as well as diabetic and psychiatric patient groups; examine patient-caregiver concordance in ratings; and assess the variables associated with their QOL, with a view to identifying factors that can enhance quality of care.

Methods: Responses of oncology outpatients with breast cancer (117), cervical cancer (46) and ovarian cancer (18) (aged 44.6, SD 11.5) were compared with those of their family caregivers and matched general population groups. Data were analyzed by univariate and multivariate statistics.

Results: The cancer groups had similar QOL domain scores, which were significantly lower than those of their caregivers, but higher than the control group as well as those of psychiatric and diabetic patients studied previously. Patients who were married, with higher education, better employment, and with longer duration of illness had higher QOL. Patients on radiotherapy and their caregivers had higher QOL scores. Correlations between patient's ratings and caregiver impression of patient's QOL were high. Caregiver impression was a significant predictor of patient's and caregiver's QOL. Other predictors for the patient were: currently feeling sick and duration of illness; for the caregiver: feeling sick, relationship to patient, and age.

Conclusion: Cancer patients in stable condition and with psychosocial support can hope to enjoy good QOL with treatment. The findings constitute an evidence base for the country's cancer care program, to boost national health education about prognosis in cancer. Families living with women cancer patients are vulnerable and need support if the patient is recently diagnosed, less educated, single, not formally employed; and the caregiver is female, parent, younger, less educated, unemployed and feels sick. Clinicians need to invest in the education and support of family caregivers. The patient-caregiver dyad should be regarded as a unit for treatment in cancer care.

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References

  1.  
    1. Penson RT, Wenzel LB, Vergote I, Cella D. Quality of life considerations in gynecologic cancer. Int J Gynaecol Obstet. 2006;95:S247–257. doi: 10.1016/S0020-7292(06)60040-4. - DOI - PubMed
  2.  
    1. Vistad I, Fossa SD, Dahl AA. A critical review of patient-related quality of life studies of long-term survivors of cervical cancer. Gynaecol Oncol. 2006;102:563–572. doi: 10.1016/j.ygyno.2006.03.050. - DOI - PubMed
  3.  
    1. Penson R, Cella D, Wenzel L. Quality of life in ovarian cancer. J Reprod Med. 2005;50:407–416. - PubMed
  4.  
    1. Griemel ER, Bjelic-Radisic V, Pfisteter J, Hilpert F, Daghofer F, du Bois A, Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group Randomized study of the Arbeitsgemeinschaft Gynaekologische Onkologie Cancer Study Group comparing quality of life in patients with ovarian cancer treated with cisplatin/paclitaxel versus carboplatin/paclitaxel. J Clin Oncol. 2006;24:579–586. doi: 10.1200/JCO.2005.02.4067. - DOI - PubMed
  5.  
    1. Ferguson RJ, Ahles TA, Saykin AJ, McDonald BC, Furstenberg CT, Cole BF, Mott LA. Cognitive-behavioral management of chemotherapy-related cognitive change. Psychoonclogy. 2006. - PMC - PubMed
  6.  
    1. Taechaboonsermsak P, Kaewkungwal J, Singhasivanon P, Fungladda W, Wilailak S. Causal relationship between health promoting behavior and quality of life in cervical cancer patients undergoing radiotherapy. Southeast Asian J Trop Med Public Health. 2005;36:1568–1575. - PubMed
  7.  
    1. Bloom JR, Stewart SL, Chang S, Banks PJ. Then and now: quality of life of young breast cancer survivors. Psychooncology. 2004;13:147–160. doi: 10.1002/pon.794. - DOI - PubMed
  8.  
    1. Visser MR, van Lanschot JJ, van der Velden J, Kloek JJ, Gouma DJ, Sprangers MA. Quality of life in newly diagnosed cancer patients waiting for surgery is seriously impaired. J Surg Oncol. 2006;93:571–572. doi: 10.1002/jso.20552. - DOI - PubMed
  9.  
    1. Peuckmann V, Ekholm , Rasmussen NK, Moller S, Groenvold M, Christiansen P, Eriksen J, Sjogren P. Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark. Breast Cancer Res Treat. 2006 - PubMed
  10.  
    1. Neyt M, Albrecht J. The long-term evolution of quality of life for disease-free breast cancer survivors: a comparative study in Belgium. J Psychosoc Oncol. 2006;24:89–123. doi: 10.1300/J077v24n03_05. - DOI - PubMed
  11.  
    1. Dorval M, Maunsell E, Deschesnes L, Brisson J, Masse B. Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls. J Clin Oncol. 1998;16:487–494. - PubMed
  12.  
    1. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94:39–49. - PubMed
  13.  
    1. Ganz PA, Lee JJ, Sim M, Polinsky ML, Schag CA. Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer. J Clin Epidemiol. 1992;45:473–485. doi: 10.1016/0895-4356(92)90096-6. - DOI - PubMed
  14.  
    1. Miller BE, Pittman B, Case D, McQuellon RP. Quality of life after treatment for gynecologic malignancies: a pilot study in an outpatient clinic. Gynecol Oncol. 2002;87:178–184. doi: 10.1006/gyno.2002.6812. - DOI - PubMed
  15.  
    1. Arndt V, Stegmaier C, Ziegler H, Brenner H. A population-based study of the impact of specific symptoms on quality of life of women with breast cancer 1 year after diagnosis. Cancer. 2006;107:2496–2503. doi: 10.1002/cncr.22274. - DOI - PubMed
  16.  
    1. Malinovszky KM, Gould A, Foster E, Cameron D, Humphreys A, Crown J, Leonard RC. Anglo-Celtic Co-operative Oncology Group: Quality of life and sexual function after high-dose or conventional chemotherapy for high-risk breast cancer. Br J Cancer. 2006;95:1626–1631. doi: 10.1038/sj.bjc.6603454. - DOI - PMC - PubMed
  17.  
    1. Abayomi J, Kirwan J, Hackett A, Bagnall G. A study to investigate women's experiences of radiation enteritis following radiotherapy for cervical cancer. J Hum Nutr Diet. 2005;18:353–363. doi: 10.1111/j.1365-277X.2005.00633.x. - DOI - PubMed
  18.  
    1. Moore HC. Impact on quality of life of adjuvant therapy for breast cancer. Curr Oncol Rep. 2007;9:42–46. - PubMed
  19.  
    1. Klee MC, King MT, Machin D, Hansen HH. A clinical model for quality of life assessment in cancer patients receiving chemotherapy. Ann Oncol. 2000;11:23–30. doi: 10.1023/A:1008394107982. - DOI - PubMed
  20.  
    1. Northouse L, Templin T, Mood D. Couples' adjustment to breast disease during the first year following diagnosis. J Behav Med. 2001;24:115–136. doi: 10.1023/A:1010772913717. - DOI - PubMed
  21.  
    1. Ferrell B, Ervin K, Smith S, Marek T, Melancon C. Family perspectives of ovarian cancer. Cancer Pract. 2002;10:269–276. doi: 10.1046/j.1523-5394.2002.106001.x. - DOI - PubMed
  22.  
    1. Le T, Leis A, Pahwa P, Wright K, Ali K, Reeder B, Kinderchuck M, Ward K. Quality of life evaluations of ovarian cancer patients during chemotherapy treatment. J Obstet Gynaecol Can. 2004;26:627–631. - PubMed
  23.  
    1. Arora NK, Finney Rutten LJ, Gustafson DH, Moser R, Hawkins RP. Perceived helpfulness and impact of social support provided by family, friends, and health care providers to women newly diagnosed with breast cancer. Psychooncology. 2007;16:474–486. doi: 10.1002/pon.1084. - DOI - PubMed
  24.  
    1. Griemel E, Thiel I, Peintinger F, Cegnar I, Pongratz E. Prospective assessment of quality of life of female cancer patients. Gynecol Oncol. 2002;85:140–147. doi: 10.1006/gyno.2002.6586. - DOI - PubMed
  25.  
    1. Kitrungroter L, Cohen MZ. Quality of life of family caregivers of patients with cancer: a literature review. Oncol Nurs Forum. 2006;33:625–632. doi: 10.1188/06.ONF.625-632. - DOI - PubMed
  26.  
    1. Wilson KG, Chochinov HM, Graham Skirko M, Allard P, Chary S, Gagnon PR, Macmillan K, De Luca M, O'shea F, Kuhl D, Fainsinger RL, Clinch JJ. Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage. 2007;33:118–129. doi: 10.1016/j.jpainsymman.2006.07.016. - DOI - PubMed
  27.  
    1. Holzner B, Kemmler G, Meraner V, Maislinger A, Kopp M, Bodner T, Nguven-Van-Tam D, Zeimet AG, Fleischhacker WW, Sperner-Unterwerger B. Fatigue in ovarian carcinoma patients: a neglected issue? Cancer. 2003;97:1564–1572. doi: 10.1002/cncr.11253. - DOI - PubMed
  28.  
    1. Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Res Treat. 2007. 2007 Jan 3. - PubMed
  29.  
    1. Ohaeri JU, Campbell OB, Ilesanmi AO, Omigbodun AO. The psychosocial burden of caring for some Nigerian women with breast cancer and cervical cancer. Soc Sci Med. 1999;49:1541–1549. doi: 10.1016/S0277-9536(99)00223-3. - DOI - PubMed
  30.  
    1. Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007;56:44–53. doi: 10.1097/00006199-200701000-00006. - DOI - PubMed
  31.  
    1. Mantani T, Saeki T, Inoue S, Okamura H, Daino M, Kataoka T, Yamawaki S. Factors related to anxiety and depression in women with breast cancer and their husbands: role of alexithymia and family functioning. Support Care Cancer. 2007. - PubMed
  32.  
    1. Sun CC, Ramirez PT, Bodurka DC. Quality of life for patients with epithelial ovarian cancer. Nat Clin Pract Oncol. 2007;4:18–29. doi: 10.1038/ncponc0693. - DOI - PubMed
  33.  
    1. Fitch M, Gray RE, Franssen E. Perspectives on living with ovarian cancer: young women's views. Can Oncol Nurs J. 2000;10:101–118. - PubMed
  34.  
    1. Basen-Engquist K, Paskett ED, Buzaglo J, Miller SM, Schover L, Wenzel LB, Bodurka DC. Cervical cancer. Cancer. 2003;98:2009–2014. doi: 10.1002/cncr.11681. - DOI - PubMed
  35.  
    1. Ohaeri JU, Campbell OB, Ilesanmi AO, Ohaeri BM. Psychosocial concerns of Nigerian women with breast and cervical cancer. Psychooncology. 1998;7:494–501. doi: 10.1002/(SICI)1099-1611(199811/12)7:6<494::AID-PON331>3.3.CO;2-N. - DOI - PubMed
  36.  
    1. McQuellon RP, Thaler HT, Cella D, Moore DH. Quality of life outcomes from a randomized trial of cisplatin versus cisplatin plus paclitaxel in advanced cervical cancer: a Gynecologic Oncology Group study. Gynecol Oncol. 2006;101:296–304. doi: 10.1016/j.ygyno.2005.10.039. - DOI - PubMed
  37.  
    1. Saegrow S. Health, quality of life and cancer. International Nurs Rev. 2005;52:233–240. doi: 10.1111/j.1466-7657.2005.00416.x. - DOI - PubMed
  38.  
    1. Janz NK, Mujahid M, Lantz PM, Fagerlin A, Salem B, Morrow M, Deapen D, Katz SJ. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res. 2005;14:1467–1479. doi: 10.1007/s11136-005-0288-6. - DOI - PubMed
  39.  
    1. Le T, Hopkins L, Kee Fung MF. Quality of life assessment during adjuvant and salvage chemotherapy for advanced stage epithelial ovarian cancer. Gynecol Oncol. 2005;98:39–44. doi: 10.1016/j.ygyno.2005.03.040. - DOI - PubMed
  40.  
    1. Chan YM, Ng TY, Ngan HY, Wong LC. Quality of life in women treated with neo-adjuvant chemotherapy for advanced ovarian cancer: a prospective longitudinal study. Gynecol Oncol. 2003;88:9–16. doi: 10.1006/gyno.2002.6849. - DOI - PubMed
  41.  
    1. Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, Eifel P, Bevers TB, Levenback CF, Gershenson DM, Bodurka DC. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005;23:7428–36. doi: 10.1200/JCO.2004.00.3996. - DOI - PubMed
  42.  
    1. Waggoner SE. Cervical cancer. Lancet. 2003;361:2217–2225. doi: 10.1016/S0140-6736(03)13778-6. - DOI - PubMed
  43.  
    1. Amir H, Kwesigabo G, Aziz MR, Kitinya JN. Breast cancer and conservative surgery in sub-Saharan Africa. East Afr Med J. 1996;73:83–87. - PubMed
  44.  
    1. Hamad HMA. Cancer initiatives in Sudan. Annals Oncol. 2006;17:viii 32–viii 36. - PubMed
  45.  
    1. Northouse LL, Mood D, Kershaw T, Schafenacker A, Mellon S, Walker J, Galvin E, Decker V. Quality of life of women with recurrent breast cancer and their family members. J Clin Oncol. 2002;19:4050–4064. doi: 10.1200/JCO.2002.02.054. - DOI - PubMed
  46.  
    1. Raune D, Kuipers E, Bebbington PE. Expressed emotion at first episode-psychosis: investigating a carer appraisal model. Br J Psychiatry. 2004;184:321–326. doi: 10.1192/bjp.184.4.321. - DOI - PubMed
  47.  
    1. Katschnig H. Schizophrenia and quality of life. Acta Psychiatr Scand. 2000:33–37. doi: 10.1034/j.1600-0447.2000.00006.x. - DOI - PubMed
  48.  
    1. Griemel ER, Freidl W. Functioning in daily living and psychological well-being of female cancer patients. J Psychosom Obstet Gynaecol. 2000;21:25–30. - PubMed
  49.  
    1. Eisemann M, Lalos A. Psychosocial determinants of well-being in gynecologic cancer patients. Cancer Nurs. 1999;22:303–306. doi: 10.1097/00002820-199908000-00007. - DOI - PubMed
  50.  
    1. Capelli G, De Vincenzo RI, Addamo A, Bartolozzi F, Braggio N, Scambia G. Which dimensions of health-related quality of life are altered in patients attending the different gynecologic oncologic health care settings? Cancer. 2002;95:2500–2507. doi: 10.1002/cncr.10993. - DOI - PubMed
  51.  
    1. Awadalla AW, Ohaeri JU, Salih AA, Tawfiq AM. Subjective quality of life of community living Sudanese psychiatric patients: comparison with caregivers' impression and control group. Qual Life Res. 2005;14:1855–1867. doi: 10.1007/s11136-005-4328-z. - DOI - PubMed
  52.  
    1. Awadalla AW, Ohaeri JU, Salih AA, Tawfiq AM. Subjective quality of life of family caregivers of community living Sudanese psychiatric patients. Soc Psychiatry Psychiatr Epidemiol. 2005;40:755–763. doi: 10.1007/s00127-005-0947-x. - DOI - PubMed
  53.  
    1. Awadalla AW, Ohaeri JU, Tawfiq AM, Al-Awadi SA. Subjective quality of life of outpatients with diabetes: comparison with family caregivers' impressions and control group. J Natl Med Assoc. 2006;98:737–745. - PMC - PubMed
  54.  
    1. Awadalla AW, Ohaeri JU, Al-Awadi SA, Tawfiq AM. Diabetes mellitus patients' family caregivers' subjective quality of life. J Natl Med Assoc. 2006;98:727–736. - PMC - PubMed
  55.  
    1. Skevington SM, Lotfy M, O' Connell KA, the WHOQOL group The World Health Organization's WHOQOL – Bref quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13:299–310. doi: 10.1023/B:QURE.0000018486.91360.00. - DOI - PubMed
  56.  
    1. Olusina AK, Ohaeri JU. Subjective quality of life of recently discharged Nigerian psychiatric patients. Soc Psychiatry Psychiatr Epidemiol. 2003;38:707–714. doi: 10.1007/s00127-003-0691-7. - DOI - PubMed
  57.  
    1. Ohaeri JU. Perception of the social support role of the extended family network by some Nigerians with schizophrenia and affective disorders. Soc Sci Med. 1998;47:1463–1472. doi: 10.1016/S0277-9536(98)00111-7. - DOI - PubMed
  58.  
    1. Sainfort F, Becker M, Diamond R. Judgments of quality of life of individuals with severe mental disorders: patient self-report versus provider perspectives. Am J Psychiatry. 1996;153:497–502. - PubMed
  59.  
    1. Canada AL, Parker PA, de Moor JS, Basen-Engquist K, Ramondetta LM, Cohen L. Active coping mediates the association between religion/spirituality and quality of life in ovarian cancer. Gynecol Oncol. 2006;101:102–107. doi: 10.1016/j.ygyno.2005.09.045. - DOI - PubMed
  60.  
    1. Odukogbe AA, Adebamowo CA, Ola B, Olayemi O, Oladokun A, Adewole IF, Omigbodun OA, Aimakhu CO, Okunlola MA, Fakulujo O, Oluyemi FA. Ovarian cancer in Ibadan: characteristics and management. J Obstet Gynaecol. 2004;24:294–7. doi: 10.1080/01443610410001660904. - DOI - PubMed
  61.  
    1. Adesunkanmi AR, Lawal OO, Adelusola KA, Durosinmi MA. The severity, outcome and challenges of breast cancer in Nigeria. Breast. 2005;15:399–409. doi: 10.1016/j.breast.2005.06.008. - DOI - PubMed
  62.  
    1. Nair MG. Quality of life in cancer of the cervix patients. Int Clin Psychopharmacol. 2000;15:S47–49. - PubMed
  63.  
    1. Ashin-Giwa KT, Padilla GV, Bohorquez DE, Tejero JS, Garcia M. Understanding the breast cancer experience of Latina women. J Psychosoc Oncol. 2006;24:19–52. doi: 10.1300/J077v24n03_02. - DOI - PubMed
  64.  
    1. Ferrell BR, Smith SL, Juarez G, Melancon C. Meaning and spirituality in ovarian cancer survivors. Oncol Nurs Forum. 2003;30:249–257. - PubMed
  65.  
    1. Wenzel LB, Donnelly JP, Fowler JM, Habbal R, Taylor TH, Aziz N, Cella D. Resilience, reflection, and residual stress in ovarian cancer survivorship: a gynecologic oncology group study. Psychooncology. 2002;11:142–153. doi: 10.1002/pon.567. - DOI - PubMed
  66.  
    1. Stewart DE, Wong F, Duff S, Melancon CH, Cheung AM. "What doesn't kill you makes you stronger": an ovarian cancer survivor survey. Gynecol Oncol. 2001;83:537–542. doi: 10.1006/gyno.2001.6437. - DOI - PubMed
  67.  
    1. Yun YH, Rhee YS, Kang IO, Lee JS, Bang SM, Lee WS, Kim JS, Kim SY, Shin SW, Hong YS. Economic burdens and quality of life of family caregivers of cancer patients. Oncology. 2005;68:107–114. doi: 10.1159/000085703. - DOI - PubMed
  68.  
    1. Zhao H, Kanda K, Liu SJ, Mao XY. Evaluation of quality of life in Chinese patients with gynecological cancer: assessments by patients and nurses. Int J Nurs Pract. 2003;9:40–48. doi: 10.1046/j.1440-172X.2003.00401.x. - DOI - PubMed
  69.  
    1. Goleman D. Social Intelligence: The new science of human relations. Published by Bantam Dell, Random House, New York; 2006. p. 43. (Quoting Daniel Stern: The present moment in psychotherapy and everyday life. New York: W. W Norton, 2004 pg 76)
  70.  
    1. Iacoboni M, Molnar-Szakacs I, Gallese V, Buccino G, Mazziotta JC, Rizzolatti G. Grasping the intentions of others with one's own mirror neuron system. PLoS Biol. 2005;3:e79. doi: 10.1371/journal.pbio.0030079. - DOI - PMC - PubMed
  71.  
    1. Vaddadi KS, Gilleard C, Fryer H. Abuse of carers by relatives with severe mental illness. Int J Soc Psychiatry. 48:149–155. doi: 10.1177/002076402128783208. - DOI - PubMed
  72.  
    1. Ohaeri JU. The burden of caregiving in families with a mental illness: a review of 2002. Curr Opinion Psychiatry. 2003;16:457–465. doi: 10.1097/00001504-200307000-00013. - DOI

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