Supportive care needs and quality of life of patients with gynecological cancer undergoing therapy

Abstract

Objective

To identify the relationship of unmet supportive care needs with quality of life of patients with gynecological cancer undergoing therapy.

Method

This study used a cross-sectional design. A total of 153 patients with gynecological cancer undergoing therapy were recruited using consecutive sampling methods. The participants completed the questionnaire of Supportive Care Needs Survey to identify their supportive care needs, EORTC-QLQ 30 to assess their general quality of life, and EORTC-QLQ-CX 24 or - OV 28 to determine cancer-specific quality of life in cervical cancer and ovarian cancer, respectively.

Results

Most of the participants (96.1%) reported their unmet needs of supportive care predominantly in the physical domain (80.4%). Unmet supportive care needs were found to be statistically significantly related to quality of life in the global health, functional, and symptom domains (p value 1 = 0.003, p value 2 = <0.001, and p value 3= 0.001; r1 = -0.235, r2 = 0.306, and r3 = 0.268, respectively).

Conclusions

Patients with gynecological cancer needs various supportive care during treatment. These supportive care needs should be identified early at the time of diagnosis and continued throughout the disease and treatment trajectory to the survivorship point. Otherwise, unmet supportive care needs may lead to a low quality of life.

Introduction

Gynecological cancer remains one of the most prevalent cancers in women. According to the data released by Globocan in 2012, cervical cancer and ovarian cancer are the two gynecological cancers with the highest occurrence in Indonesia. The incidence rates of cervical cancer and ovarian cancer are 17.3 and 8.4, respectively, among 100,000 women per year¹.

The effects of cancer pathology and its treatments are so poignant and multidimensional that supportive care is highly needed. For example, impaired physical function is usually associated with symptoms of distress, both of which may bring issues on daily activities and eventually result in unmet supportive care needs². This seemingly vicious cycle should be anticipated by the early identification of supportive care needs in cancer patients, so that the quality of life (QOL) of cancer patients would be improved.

Supportive care needs refer to the management of cancer symptoms and side effects, empowering of patients’ adaptability and coping, optimization of understanding and information on decision making, and minimizing of body deficiencies³. Supportive care needs are broad in dimension, ranging from physical to sexual⁴.

QOL is an important goal in the treatment of cancer. Concerns about the physical, psychological, body image disturbance, and symptoms that can cause distress should be anticipated to improve the QOL of cancer patients. A previous study in Indonesia found that the QOL of cancer patients decreased after chemotherapy⁵. Improving the QOL of cancer patients during treatment improves their adherence to cancer care and treatment and strengthens their ability to overcome cancer-related symptoms or complaints⁶.

To reach the QOL at its most favorable level, strong supportive care service is the key^2,6. Quality nursing care should meet this aim not only to address the accompanying symptoms of cancer and its treatments but also to increase patient satisfaction.

The identification of supportive care support for cancer patients undergoing chemotherapy remains an uncommon practice in Indonesia. Supportive care service mostly addresses cancer survivors and overlooks those currently suffering from cancer^7,8. To encourage action in providing supportive care for gynecological cancer patients during therapy, more solid evidence is needed to examine how supportive care needs relates to the QOL of gynecological cancer patients undergoing therapy, thus explaining the objective of this study. In this article, we present a part of a large study with emphasis on the association between supportive care needs and QOL.

Method

This work was a cross-sectional correlation study. The sample comprised 153 patients with cervical cancer and ovarian cancer undergoing treatment at two central hospitals in Jakarta, Indonesia, from May to June 2016. The respondents were selected through the consecutive sampling method. The number of the sample was calculated using the cross-sectional sample size formula⁹, with the standard deviation taken from a prior relevant study¹⁰.

We used Supportive Care Needs Survey (SCNS-SF34) to measure the need for supportive services. This questionnaire consists of 34 question items under five domains: physical, psychological, supportive care, health system and information, and sexuality¹¹. This tool had a validity score of 0.302-0.792 and a reliability score of 0.933. The QOL was measured using the European Organization of Research and Treatment of Cancer Quality of Life Q-C30 (EORTC QLQ-30), Quality of Life Questionnaire Module Cervical Cancer (EORTC QLQ-CX 24), and Quality of Life Questionnaire ovary Cancer Module (EORTC QLQ-OV28). These instruments underwent forward translation from English to Bahasa Indonesia by an academic language center and an expert panel review. All questionnaires were piloted for validity and reliability testing among 30 respondents in a different setting.

Ethical approval was granted by the Institutional Review Board of Faculty of Nursing, Universitas Indonesia, and Dharmais Cancer Hospital. We adhered to ethical principles, including the right to self-determination, anonymity and confidentiality, and protection from discomfort and harm.

Results

The demographic characteristics of the respondents are presented in Table 1. The table shows that most respondents were 55 years and below, worked as housewives, and were of a low socioeconomic status, as shown in their family income rate. More than half of the respondents were diagnosed with stages I and II cervical cancer, with less than a year of cancer treatment.

Table 1.

Characteristics of the respondents (n = 153).

Variable	n (%)
Age
≤ 55 years	118 (77.1)
> 55 years	35 (22.9)
Education
Basic education (elementary, junior high school)	108 (70.9)
Higher education (senior high school, college)	45 (29.1)
Occupation
Housewife	126 (82.4)
Employee	27 (17.6)
Income
< minimum family income rate	93 (60.8)
≥ minimum family income rate	60 (39.2)
Cycle of chemotherapy
1-weekly	52 (40.6)
3-weekly	76 (59.4)
Cancer type
Cervical cancer	99 (64.7)
Ovarian cancer	54 (35.3)
Cancer stage
Early stage (stage I and II)	104 (68)
End-stage (stage III and IV)	49 (32)
Time of therapy
≤ 1 year	141 (92.2)
> 1 year	12 (7.8)
Therapy type
Single	95 (62.1)
Combination	58 (37.9)

The unmet supportive care needs of the respondents are summarized in Table 2. The highest unmet need was identified as the physical domain (80.4%) and the lowest was sexuality.

Table 2.

Unmet supportive care needs (n = 153).

Variable	n (%)
Supportive care needs
No need	6 (3.9)
Unmet need	147 (96.1)
Physical and daily living
No need	30 (19.6)
Unmet need	123 (80.4)
Psychological
No need	43 (28.1)
Unmet need	110 (71.9)
Patient care and support
No need	39 (25.5)
Unmet need	114 (74.5)
Health system and information
No need	45 (29.4)
Unmet need	108 (70.6)
Sexuality
No need	99 (64.7)
Unmet need	54 (35.3)

Table 3 presents the bivariate analysis that determines the relationship between the need for supportive services and the QOL of gynecological cancer patients undergoing therapy.

Table 3.

Relationship between the need for supportive services and quality of life (n = 153).

Variable	Analysis
	Mean (SD)	p value (correlation coefficient)
Global quality of life
General health status	67.65 (19.02)	0.003 (−0.235)
Functional	73.89 (14.99)	< 0.001^* (0.306)
Physical function	63.83 (21.93)
Function role	59.91 (24.22)
Emotional function	83.60 (15.86)
Cognitive function	88.34 (18.54)
Social function	76.47 (20.73)
Symptom	28.89 (15.06)	< 0.001^* (0.268)
Fatigue	44.59 (19.41)
Nausea and vomiting	23.31 (23.90)
Pain	39.32 (25.84)
Difficulty in breathing	17.43 (24.80)
Insomnia	46.62 (37.33)
Loss of appetite	43.36 (29.14)
Constipation	21.13 (36.42)
Diarrhea	71.24 (23.89)
Financial difficulties	16.99 (21.67)
Quality of life: cervical cancer
Functional	79.50 (14.15)	0.162 (−0.142)
Self-image	68.33 (41.69)
Sexual activity	66.67 (27.21)
Sexual pleasure	50.00 (19.24)
Sexual function	93.75 (4.16)
Symptom	34.55 (10.44)	0.669 (0.043)
Experienced symptoms	36.26 (7.42)
Lymphedema	8.33 (16.67)
Peripheral neuropathy	58.33 (41.94)
Menopause symptoms	23.56 (27.46)
Sexual anxiety	75.00 (16.67)
Quality of life: ovarian cancer
Functional	79.69 (10.25)	0.895 (−0.018)
Self-image	79.32 (17.11)
Sexuality	93.82 (17.22)
Behavior to treatment	69.75 (16.64)
Symptom	27.29 (9.7)	0.587 (0.076)
Digestive symptoms	21.87 (11.46)
Peripheral neuropathy	36.62 (22.59)
Menopause symptoms	19.44 (15.77)
Other chemotherapy effects	25.18 (13.37)
Hair loss	44.44 (28.22)

SD, standard deviation.

*

p value < 0.05.

Discussion

The results of this study indicate a relationship between unmet supportive care needs and the global QOL in the domains of global health, functional, and symptoms in patients with gynecological cancer undergoing chemotherapy. Conversely, no significant association was found when the QOL was measured specifically against cervical cancer and ovarian cancer QOL. A consistent result was reported by a previous study assessing a similar hypothesis in a different cancer population¹². The present study affirms the previous finding that patients with more unmet supportive care needs are more likely to have lower QOL.

The QOL of cervical cancer patients is affected by general health status and good relationships between the patients and healthcare professionals¹³. Cervical cancer patients receiving chemotherapy may experience a number of side effects, such as pain, fatigue, nausea, vomiting, and poor appetite, and they affect the QOL of these patients¹⁴. Poor management of the treatment's side effects and inadequate self-care negatively affect the QOL of patients^6,15. Increasing the QOL of cancer patients during therapy increases patient compliance with the treatment and contributes to their self-efficacy⁶.

Similar to patients with cervical cancer, ovarian cancer patients also struggle with their interrelated physical and emotional changes, such as anxiety or depression, which may deteriorate their QOL. Simultaneous interactions worsen the existing symptoms and lead to other symptoms¹⁶.

In this study, unmet supportive care needs in the physical domain were found to be strongly related to the QOL of the patients. This finding is consistent with that of Effendy et al⁷, who found that physical problems constituted the most dominant unmet need in Indonesian patients with advanced cancer. An earlier study among Chinese patients also showed a similar result¹⁷. The physical symptoms commonly experienced by cancer patients undergoing therapy include decreased appetite, change in the taste of food, hair loss, nausea, vomiting, and fatigue¹⁸. Patients need support to cope with these physical symptoms to improve their condition and QOL.

Psychological health status also contributes to the QOL of patients undergoing treatment for cervical cancer¹⁹. In their study on supportive care needs, psychosocial status, and QOL of survivors of gynecological cancers, Hodgkinson et al. found that psychological distress is a predictor of unmet supportive care needs and low QOL²⁰. Therefore, cancer patients undergoing therapy need emotional support to cope with their anxiety, sadness, and fear during the process of diagnosis and treatment²¹. Patients need reassurance and motivation to remain optimistic throughout their cancer experience¹⁸.

Conflicts of interest

None declared.

Acknowledgement

This study was funded by the Directorate of the Research and Community Service, Universitas Indonesia.