Assessment of the quality of life issues of women with gynaecological and breast cancers in Kenya

Abstract

Background Gynaecologic and breast malignancies are certainly the commonest forms of cancers in women in Kenya. For a long time the focus has been on clinical management of cancers but now Quality of Life (QOL) is emerging as an important health outcome which require s to be incorporated in the holistic management of patients. There are very few African studies that have investigated QOL issues. Objectives This study set out to determine the quality of life issues of women with gynaecological and breast cancer ; and est ablish the roles of an oral interview and that of an established QOL instrument – Functional Assessment of Cancer Therapy (FACT), in assessing the QOL of the women in the Kenyan setting. Study Area The study was carried out at the two national teaching and referral hospitals in Kenya, Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) , three Provincial Hospitals and four Hospices during 200 6 - 200 8 . Study Design This study was a cross - sectional survey conducted using a quantitat ive and qualitative design . Materials and Methods Two assessment tools were administered to p articipants aged 18 years and above, with a documented histological diagnosis of gynaecological or breast cancer.A n interview was conducted with each patient prio r to administration of the validated Functional Assessment of Cancer Therapy (FACT) questionnaire . In addition a n interview guide was used to gather narrated information from patients‟ experiences . Data analysis was conducted using SPSS version 19. Associations between patient characteristics and cancer diagnosis, and its staging were examined using cross tabulations. Multinomial regressions were used to identify significant association between patient characteristics and cancer diagnosis. The qualit y of life issues were identified by calculating the percentage of patients giving each of the five possible Likert scale ratings. A multivariable regression model was then run for each quality of life issue. Deductive analysis based on HRQoL domains was us ed to identify themes describing patient perception of QOL. Results Out of the 27 QOL issues in the FACT - G tool, 14 were important issues for Kenyan patients. The leading quality of life issues among the 39 4 patients with breast and gynaecologic cancers in Kenya are: worrying that condition will get worse (93.9%), lack of satisfaction with sexual life (84.1%), losing hope (83.7%), worry about dying (83.1%), lack of fulfilment in work (77.7%) and feeling nervous (77.4%). The issues in the emotional domain we re most affected by cancer. Overall quality of life (FACT - G) was influenced by type of cancer and treatment modality (p < 0.05) . In comparison to FACT - G, which reported that emotional wellbeing issues were the leading QOL issues, content analysis of patie nt narratives identified functional and physical issues including pain as important issues and de ductive analysis showed that p atients perceived the term quality of life as having three interrelated components: preserving pre - diagnosis capacities, a personal or individualised meaning, and effects of cancer. In addition, spirituality and positive living were identified as important factors in Kenyan patients‟ QOL . Conclusions and Recommendations The leading quality of life issues among Kenyan women are in the emotional domain and these can be remedied by nursing intervention including providing holistic patient care and emphasising the psycho - social support of patientscounselling and patient education . The FACT - G tool captures general QOL issue s but the qualitative analysis showed that future studies need to incorporate the positive living and spiritual issues which were important factors in Kenyan female cancer patients‟ narratives.