Download AIM The diagnosis of cancer and its management present

THE PSYCHOSOCIOECONOMIC IMPACT OF
HAEMATOLOGICAL MALIGNANCIES
ON THE PATIENTS AND THEIR FAMILIES
Ebenezer Ofori Appah, University of Ghana Medical School, Accra, Ghana.
AIM
The diagnosis of cancer and its management present psychosocial disruptions and economic
challenges. The aim of this study was to assess the psychosocioeconomic impact of
haematological malignancies on patients and their families.
BACKGROUND
 Cancer produces more apprehension and worry than any form of illness. It produces
sudden and sometimes overwhelming challenges for the patient and family.
 Haematological malignancies are usually not restricted to one part of the body, but involve
the whole body affecting the non-visible and somewhat abstract organ systems such as
blood and bone marrow.
 Cancer has been found to be a psychologically debilitating illness. Almost every cancer
patient experiences psychosocial problems of one kind or another. Even after successfully
going through the normal adjustment reactions, they may develop formal mental
disorders1.
 About half of all cancer patients have been reported to be suffering from a mental disorder,
usually an adjustment disorder with depression2. Mental disorders such as depression,
anxiety and delirium occur in a significant percentage of adult cancer patients, particularly
as the disease advances and therapy become more aggressive3.
 In a developing country like Ghana where health care delivery system is faced with
financial and infrastructural challenges, as well as availability of medications, living with
and being managed for cancer is a daunting task for patients and their families.
OBJECTIVES
1. To determine the prevalence of psychological disorders among patients with
haematological malignancies.
2. To asses the social effects of the disease on the quality of life of the patients.
3. To asses the financial burden of the disease and its management on the patients and their
families.
METHODOLOGY
 This was a descriptive study conducted at the Department of Haematology of the Korle-Bu
Teaching Hospital between August and September, 2007. This study site was chosen as it
is the only centre with specialised facilities and personnel for the management of
haematological malignancies serving the southern part of Ghana.
 The respondents were patients diagnosed of haematological malignancies who were
attending the Haematology Day Care of the Department of Haematology.
 The research instrument was a combination of a self-designed questionnaire and the
Hospital Anxiety and Depression Scale (HADS). It is a14-item scale designed to detect
anxiety and depression. It consists of two 7- item subscales measuring depression and
anxiety. A 4-point response scale (from 0 representing absence of symptoms, to 3
representing maximum symptomatology) is used, with possible scores for each subscale
ranging from 0 to 21. Higher scores indicate higher levels of disorder. The clinical
classification scheme used to categorise scores on the HADS had the following cut offs
were: 0–7 = 'noncases'; 8–10 = 'possible case'; 11–21 = 'probable case'. 59 respondents
were selected by systematic sampling.
 The data collected was analysed using the Statistical Package for Social Science (SPSS)
15.0 and Microsoft Excel 2007.
ETHICAL CONSIDERATIONS
 Informed consent of the respondents was sort before they were involved in the study and
they had the right of refusing to take part in the study. Information collected was only used
for this study and the researcher had the only access to information collected.
LIMITATION
 It was presumed that the respondents gave honest answers to the questions asked. This
could however not be certified.
FINDINGS (SEE PAPER FOR MORE DETAIL)
Socioeconomic impact
 The time, resources, strength and money care consumes can have far reaching effects on
the productivity of the individual and caregivers. Frequent hospitalisation and clinic
attendance affects productivity and results in social and economic losses. The patient
thereby became a liability to him/herself, family and friends.
 Three-quarters of the respondents attested that the illness and its management have caused
them and their families some financial difficulties.
 40.7% of them have missed some part of their treatment. This they all attributed to
difficulties with raising funds for the medication.
Psychological impact
 Psychological manifestations were full-blown disorders as depressive disorders, anxiety
disorders, delirium etc. This corresponds to the findings that nearly 90% of the psychiatric
disorders were related to the response to disease or treatment6.
 From the study, males preponderance in probable cases of psychological disorder as
compared to females was not significant (p=0.46). There was no significant difference in
the occurrence of psychological disorders with respect to sex.
 Younger patients were reported to have a higher amount of probable cases of depression
and anxiety than older patients. They had more problems in adapting to the stress of
cancer, because severe illness and the possibility of dying do not fit in their "life-cycle
phase" as at that age.
CONCLUSION
 Reaction to illness has a psychosocial component which affects the pattern of
interrelationships between the ill person and others close to him, particularly family.
 Psychological disorders namely depressive and anxiety disorders are common in patients
with haematological malignancies. The diagnosis and management also results in
significant socioeconomic burden for the patient and the family. Haematological
malignancies are more than just diseases that begin with diagnosis and ends when the
treatment protocol ends