The psychosocial aspects among adult cancer patients attending oncology clinic at moi teaching and referral hospital, Eldoret, Kenya

Abstract

Background: Cancer diagnosis is associated with increased chance of developing psychological, social and psychiatric disorders, which impact on patient’s health state and medical treatment. Psychiatric disorders are experienced by cancer patients at all stages of disease. The number of people diagnosed with cancer is on the increase every year in the developing countries, Kenya being one of them and the burden of cancer continues to grow. Psychological and social issues among adults cancer patients are well documented in the rest of the world, Kenya has a little amount of data in place. A critical part of cancer care is the recognition of the levels of psychological and social problems that present among patients with cancer and determination of the appropriate level of intervention, ranging from brief counselling or psychosocial interventions and social support to medication and specific coping styles. Objectives: The main objective was to determine the psychological and social issues among adult cancer patients seen at the oncology clinic of Moi Teaching and Referral Hospital (MTRH), Eldoret. The Specific objectives were to determine the psychological, social issues that are associated with cancer diagnosis and socio-demographic characteristics and clinical state of the patients diagnosed with cancer. Methodology: This was a cross-sectional and descriptive study. The study participants diagnosed with cancer were enrolled and interviewed using researcher designed socio-demographic and clinical questionnaire and the Mini International Neuropsychiatric Interview for adults (M.I.N.I Plus) instrument. The participants were assessed after informed consent was obtained. Ethical approval was obtained from Institutional Research and Ethics Committee (IREC) Moi Teaching and Referral Hospital (MTRH) Moi University and Ethics and Research Committee Kenyatta National Hospital/ University of Nairobi before conducting the study. Data analysis: There was double entry of data followed by cleaning weekly. Data was entered into Microsoft excel worksheet then exported to Statistical packages for social sciences (SPSS) version 16.0 for analysis to describe each DSM-IV diagnosis of each participant by summing up the ‘yes’ responses that met each criterion for DSM-IV Axis I disorders. Results are presented in form of tables, charts and graphs Result: A total of 138 respondents participated in the study. Majority of the study participants were females at 71.7% (99) whereas males were 28.3% (39). Breast cancer at 34.8% (48) and cervical cancer at 12.3% (17) were the commonest. Most of the participants were in the advanced stages between stage III at 33.3% and IV at 39.1%. Among the participants major depression episode (current, past, with melancholic features) was noted in 42%, 15% and 21.7% respectively. 14.5% had dysthymia current. Suicide risk high, moderate and low risks were 2%, 2.9% and 8% respectively. Panic disorder current without agoraphobia was 2.2%, with agoraphobia 6.5% and agoraphobia without history of panic disorder was 8.7%. Post traumatic stress disorder was 13% social phobia was 7.2%. Obsessive compulsive disorder was 4.3%. Generalised anxiety disorder was 12.3%. Hypomanic episodes was at 5.1%; manic episodes at 7.2%. The less frequent disorders were alcohol and drug dependency/ abuse, Psychotic disorders, Anorexia nervosa and Bulimia nervosa were each affecting less than 1% of the patients. Antisocial personality disorders accounted for only 1.4% amongst the cancer patients. None of the participants had the psychosocial issues documented in the clinical file notes. Only 7.9% (11) reported to have discussed the psychological and social concern with the care givers that is a 92.1% treatment gap. Conclusion: Major Depressive Episode, anxiety disorder, Obsessive compulsive disorder, Posttraumatic stress disorder were the main psychiatric disorders noted. Other disorders that were found among cancer patients at MTRH include antisocial personality, social phobia, and alcohol and drug dependency/abuse. Psychosocial oncology services for patients and families were found to be minimal.