Download Mental/emotional state

Quality of Life (QoL) of Filipino Breast
Cancer Patients in Various Treatment
Modalities: A Descriptive Study
Nico, Darlene Jasmine G.
Panela, Fatima Ruby C.
Pangilinan, Carmela Mariz D.
Paras, Ana Concepcion B.
Pasamba, Edmundo
Salas, Julie Ann S.
Salayog, Kathereene M.
Samama, Sittie Rizza
Sambile, Mary Grace
Sancha, Carlo Henry A.
Georgina T. Paredes, M.D., MPH,
Adviser
INTRODUCTION
 Worldwide, breast cancer is the most frequently diagnosed
life-threatening cancer in women and the leading cause of
cancer death among women.
 Malignant neoplasm is the 3rd leading cause of morbidity
and mortality in the Philippines and breast cancer ranks 2nd
among these malignancies. (DOH, 2007)
 26 females out of 100 females and 1 male for every 105
males may be diagnosed with breast cancer in the
Philippines. (Philippine Foundation for BREAST Care, Inc. (PFBCI), 2009)
INTRODUCTION
The primary goal of breast cancer treatment is to
assess the stage of the disease and to remove underlying
masses within the affected breast/s (American Cancer Society; 2008)
Treatment decisions are based on the optimal modality
for the stage and biological characteristics of the cancer,
the patient’s age, preferences, and their effects on the
quality of life of the patient (American Cancer Society; 2008)
INTRODUCTION
Quality of life is a descriptive term that refers to people’s
emotional, social and physical well-being and their ability to
function in the ordinary tasks of living.
It is measured using especially designed and tested instruments
which quantifies people’s abilities to function in the ordinary tasks
of living. (Psychooncology 2008)
QoL measures may therefore help to decide between different
treatments, to inform patients about the likely effects of
treatments, to monitor the success of treatments from the
patient’s perspective, and to plan and coordinate care packages.
INTRODUCTION
More attention to the reduction and management of disease
and treatment-related symptoms could improve QoL among
women with breast cancer.
External stressors (Ex.: finances, work, etc.) also contribute to
the overall diminished quality of life in all treatments.
 In the Philippines, there is an ongoing demand for research into
the accompanying psychological effects of breast cancer
treatments and this study accounts for the effects of
chemotherapy, hormonal therapy and combined therapy on the
quality of life specifically among Filipino breast cancer patients.
OBJECTIVES
Describe the QoL of breast cancer patients
undergoing chemotherapy, hormonal therapy and
combination therapy along the following domains:
Physical state
Mental/emotional state
Stress
Life enjoyment and
Overall quality of life
SIGNIFICANCE OF THE STUDY
To benefit both breast cancer patients and
doctors in clinical decision-making, as it will
consider the effects of specific therapeutic
regimens on the patient’s quality of life.
Enable the family of those afflicted to better
understand the effects of the disease on the overall
wellbeing of their loved one.
METHODOLOGY
STUDY DESIGN:
Descriptive Study
TARGET POPULATION:
Diagnosed female breast cancer patients
undergoing either hormonal therapy, chemotherapy or
combined therapy; treated or still undergoing treatment
from different hospitals.
SIZE OF SAMPLE:
(n=k2 SD2/d2)
n = [(1.96) 2 x 352] / 122 = 33 respondents
METHODOLOGY
Pre-existing validated 55-item QoL questionaire entitled the “Health, Wellness and
Quality of Life Questionnaire” made by Dr. Terrie Lewine of the Back to Life Wellness
Education Center in Philadelphia, Pennsylvania.
Translated into Filipino by a licensed Filipino teacher who graduated from the
Polythechnic University of the Philippines.
14 pre-tested translated questionnaires were administered last November 2008–
January 2009 to female breast cancer patients from Laguna, Nueva Ecija, Rizal
and Metro Manila.
Ten 3rd year medical students researchers administered the questionnaires
METHODOLOGY
INCLUSION: Diagnosed female breast cancer
patients (within in any stage of the disease) who
have undergone or are undergoing either hormonal
therapy, chemotherapy or combined therapy.
EXCLUSION:
Not dx w/ disease
Male breast cancer patients
Diagnosed with breast
cancer but have not
undergone any form of
therapy yet.
Researchers coordinated with oncologists of the hospitals
Information gathered via the questionnaire.
36 out of 50 valid and fully-answered questionnaires by the eligible breast cancer
patients were used as data for the research.
METHODOLOGY
Breast Cancer patients
undergoing Hormonal
Therapy
Breast Cancer patients
undergoing Chemotherapy
Breast Cancer patients
undergoing Combined/Mixed
Therapy
Physical state
Physical state
Mental/ emotional
state
Mental/ emotional
state
Mental/ emotional
state
Stress evaluation
Stress evaluation
Stress evaluation
Life enjoyment
Life enjoyment
Life enjoyment
Overall Quality of
Life
Overall Quality of
Life
Overall Quality of
Life
Physical state
DATA AND RESULTS
Study population (36): Mean age of 49 years old
22% within hormonal therapy: mean age at 53 years
old
50% within chemotherapy: mean age at 50 years old
28% within combined therapy: mean age at 45 years
old
DATA AND RESULTS
Physical State
3
2.5
2
Mode 1.5
Hormonal Therapy
Chemotherapy
Combined Therapy
1
0.5
0
1
2
3
4
5
6
7
8
9
10
Subtopics
Respondent Mode Scores - Physical State
[1-Physical Pain; 2-Spine Stiffness; 3-Fatigue; 4-Colds and Flu; 5-Headache; 6- Nausea; 7-Menstrual Pain; 8-Allergies;
9-Dizziness; 10-Accidents]
DATA AND RESULTS
Mental / Emotional State
3
2.5
2
Mode 1.5
Hormonal Therapy
Chemotherapy
1
Combined Therapy
0.5
0
1
2
3
4
5
6
7
8
9
10
Subtopics
Respondent Mode Scores – Mental/Emotional State
1-How Painful; 2-Negative Feelings; 3-Moodiness; 4-Depression; 5-Worriness; 6-Concentration; 7-Anxiety / Fear; 8Fidgety; 9-Sleep Problems; 10-Recurring Thoughts / Dreams
DATA AND RESULTS
Respondent Mode Scores – Stress Evaluation
[1-Stress; 2-Significant Relationship; 3-Health; 4-Finances; 5-Sex Life; 6-Work; 7-School; 8-General; 9-Emotional; 10Daily Coping]
DATA AND RESULTS
Respondent Mode Scores – Life Enjoyment
[1-Openness; 2-Wellbeing; 3-Positive Feeling; 4-Interest; 5-Feeling of Being Open; 6-Level of Confidence;
7-Level of Compassion; 8-Satisfaction; 9-Feeling of Happiness; 10-Level of Satisfaction With Sex Life; 11Time Devoted]
DATA AND RESULTS
Respondent Mode Scores – Overall QoL
[1-Personal life; 2-Spouse/Significant Other; 3-Romantic Life; 4-Job/Work; 5-Co-workers; 6-The actual work you do; 7-TheA
handling of problems in your life; 8-What you are accomplishing in life; 9-The way you look to others; 10-Self-evaluation of
appearance; 11-Ability to adjust to change; 12-Life As A Whole; 13-Overall contentment; 14-Extent to which your life has
been the way you want it]
DISCUSSION
PHYSICAL STATE:
Our results showed physical pain to be the only prevailing trait within
all 3 treatments.
Nausea was predominantly experienced by the respondents under
chemotherapy
Dizziness was experienced by all treatment groups, more so with
combined therapy
Spine stiffness is mostly manifested by those on hormonal therapy
Fatigue and presence of colds and flu were more for respondents
under chemotherapy.
Fatigue was more present in patients under hormonal therapy
Headache results were higher in respondents under hormonal and
chemotherapy
DISCUSSION
MENTAL AND EMOTIONAL STATE:
Respondents under hormonal therapy experienced more
discomfort.
Negative feelings were more experienced by respondents under
hormonal and combined therapy.
Moodiness was common under the three treatment
modalities.
DISCUSSION
MENTAL AND EMOTIONAL STATE:
Depression is mostly felt by those on hormonal and
combined therapy.
Worriness was seen in patients under chemotherapy and
combined therapy as compared to hormonal therapy.
DISCUSSION
MENTAL AND EMOTIONAL STATE:
Difficulty concentrating was mostly experienced by patients under
hormonal therapy
Our study showed that anxiety is mostly experienced by those on
combined therapy.
Feeling restless or fidgety is occasionally experienced mostly in patients
under hormonal therapy as compared to the two treatment modalities.
In our study, respondents under hormonal therapy mostly had sleep
problems in contrast to chemotherapy and combined therapy.
DISCUSSION
MENTAL AND EMOTIONAL STATE:
Chemotherapy mostly had recurring thoughts and dreams as
compared to combined therapy and hormonal therapy
DISCUSSION
STRESS EVALUATION:
Our study showed that most patients under chemotherapy and
combined therapy NEVER had problems with most of the subtopics
under stress while those under hormonal therapy RARELY experienced
it.
Family had a positive impact on patients under all therapy which was
seen in our results wherein most chemotherapy and combined therapy
respondents never had problems with family and most in hormonal
therapy rarely encountered it
DISCUSSION
STRESS EVALUATION:
Hormonal therapy rarely dealt with problems regarding their
significant others while respondents under chemotherapy and
combined therapy never had problems with regard to it.
The respondents under hormonal therapy did not find sexual
history applicable to them and those under chemotherapy and
combined therapy did not have problems with it.
DISCUSSION
LIFE ENJOYMENT:
Chemotherapy patients were more open to guidance of their inner
voice/feelings.
Hormonal therapy the greatest positive feelings about themselves.
Maintaining a healthy lifestyle was more important for those within
hormonal and chemotherapy.
Hormonal therapy patients were the most confident.
Hormonal and chemotherapy patients were equally compassionate and
accepting of others.
Hormonal and combined therapy had higher feelings of satisfaction,
happiness and they devoted more time to do things which they enjoyed.
DISCUSSION
OVERALL QUALITY OF LIFE:
Those within hormonal therapy had the highest scores
toward having positive feelings about life as a whole and with
regard to how life turned out as they wanted it.
Hormonal therapy group also showed a positive effect on
both personal and interrelational factors
Chemotherapy respondents on the other hand had the
highest scores only with regard to co-worker relationships.
DISCUSSION
OVERALL QUALITY OF LIFE:
Combined therapy results showed the highest scores of being
mostly satisfied in the subsets involving romantic life, work,
handling of personal problems, personal accomplishments, how one
appears to others, self-evaluation, ability to adjust to change,
contentment and life as a whole.
Chemotherapy, despite its adverse drug reactions and supposed
effects of psychological distress, showed moderate to high results
within this domain
CONCLUSION
Physical state: Pain was the prevalent factor causing decreased QoL scores
in all treatment modalities.
Mental/emotional state:Increased moodiness was the only constant factor
across all treatments. Recurrent thoughts, dreams and negative feelings were
high in the chemotherapy group and can be supported by its profound effects
on the cognitive functioning of the patient.
Stress was markedly decreased in all three treatments, contradicting prior
studies done which show otherwise, especially so in chemotherapy.
Overall QoL showed the highest scores within those in the hormonal
therapy group.
LIMITATIONS
Results can neither be generalized to breast cancer patients nor to specific
ethnic groups across the country
Sample does not represent the whole Philippines based on sampling method
employed in the study.
Breast cancer patients who were interested in participating were the only ones
who completed the questionnaires
Some of the patients surveyed came from a foundation where treatment is paid
for/ subsidized by the foundation itself making the burden of treatment
considerably less, hence invariably having an effect on the quality of life.
Quality of life questionnaire was also based from a foreign study of chronic
illnesses and neither solely intended for breast cancer patients nor to Filipino
respondents.
Lack of budget to cover all the breast cancer patients in the country
RECOMMENDATIONS
Use of Filipino culture-based questionnaires
Ask about their spiritual beliefs and the effects of these beliefs in
their lives in times of hardships
Be expanded to a larger group that may include culturally diverse
groups
Separate investigation is recommended to further evaluate the
quality of life of patients on specific stages of breast cancer,
especially those with metastatic cancers and the use of QoL as a
predictor for survival.
Studies on the QoL of male breast CA patients can also be done
METHODOLOGY
SOURCES OF DATA
UERM hospital at the private clinics of different oncologists
(Dr. Gracieux Fernando & Dr. Joan Tagorda)
UERM OPD-Surgery Department (Dr. Rafael Azares)
Manila Doctors Hospital (Dr. Theresa Chauhdry & Dr.
Villalon)
Eduardo L. Joson Memorial Hospital – Nueva Ecija (Dr.
Pamela Panela)
Breast Cancer Foundation of East Avenue Medical Center
(Mrs. Maria Lourdes V. Cortez & Dr. Elizabeth C. Pineda)