Abstract

Breast cancer is a serious, stressful and life-threatening disease. Breast cancer survivors increasingly experience long-term side effects that influence their quality of life (Wonghongkul, Dechaprom , Phumivichuvate & Losawatkul,2006).This descriptive study was conducted on the health related quality of life of women with breast cancer and those without cancer at the university of Nigeria Teaching Hospital Ituku/Ozalla Enugu. Five objectives and four hypothesis were generated to guide the study. The study was carried out at the oncology and surgical unit of the University of Nigerian Teaching Hospital Ituku /Ozalla Enugu. A sample size of 230 women made up of 115 women with breast cancer and 115 women without breast cancer was selected using the purposive sampling technique. The WHO Quality of life BREF (WHOQOL-BREF) questionnaire was used as the instrument for data collection in addition to six demographic data questions added by the researcher. The questionnaire was administered with the help of four trained research assistants. Data generated was analyzed using descriptive and inferential statistics. Finding revealed that the HRQoL scores of women with breast cancer were lower than that of the women without cancer in the three domains of life. The women with breast cancer had the highest mean score (22) in the physical domain, followed by the psychological domain score (20) and the lowest mean score (10) in the social domain just like the women without cancer who had the highest mean score (27) in the physical domain, followed by the psychological domain score (23) and the lowest mean score(11) in the social domain but the overall quality of life scores of the women with out breast cancer was higher with a mean and standard deviation score of 4.23±0.7 than that of those with breast cancer group with a mean and standard deviation score of 3.50±1.01. In the comparison between HRQoL scores of women with breast cancer and those without breast cancer in the different domains, there was a significant difference in this comparison in the physical and psychological domains(t=-7.285,df 228, p<0.05 and t=-5.223,df 228, p<0.05) respectively. but not in the social domain  (t-1.720, df 228, P>0.05).These could be related poor attitude of nurses and poorly equiped cancer treatment centers. There was also a significant relationship between the HRQoL of the two groups in the demographic variables of age, and occupation but no significant relation in educational status and marital status for the two groups. Based on these findings the researcher concluded that breast cancer impact negatively on the HRQoL of women and nursing has a key role in the improvement of the HRQoL of women in the different domain of life and so recommended that breast cancer patients should be handled with special care and by special type of nurses (Oncology Nurses) who will appreciate their condition and better equipment of cancer treatment centers for better HRQoL.

CHAPTER ONE

Introduction

Background to the Study

Cancer is a term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymphatic system. (National Cancer Institute, 2008). Cancer can involve any tissue of the body and have many different forms in each body area. Most cancers are named for the type of cell or organ in which they start.

Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Breast cancer is the commonest cancer in women and the most common cancer in Nigeria (Jayisemi, Sofela, Rufai, 2007). Although breast cancer is the most common type of cancer in women, the frequency does not equate mortality.  Breast cancer accounts for 40% of cancers in women and is responsible for about 16% of all cancer related deaths in Nigeria (Obinna, 2012). The burden of breast cancer is increasing in both developed and developing countries. Despite the rising incidence of breast cancer, mortality from the disease has declined recently in some countries, including the United States, United Kingdom and Nigeria (WHO, 2006) due to recent advances in diagnosis and treatment of cancer which have led to an increase in cancer survival. There is a greater emphasis now on the quality beside quantity of survival. However little is known about the quality of life (QOL) of survivors.

Breast cancer is a serious, stressful and life-threatening disease. It is assumed that the diagnosis of cancer evokes far greater distress than many other diseases, regardless of prognosis. Thousands of women are treated each year for breast cancer.  After the diagnosis of breast cancer, the women are faced with the diagnosis, personal interpretation of cancer, physical effects of the disease, long and short term side effects of the treatment regimes and the reaction of family and friends and all these affect the overall quality of life of the woman with breast cancer. Cancer treatment changes a woman’s total quality of life and those who survive are left with little or nothing to enjoy about life as they are often and always faced with psychological, physical and social difficulties such as pains, nausea, vomiting, insomnia and lethargy, including stress, anxiety and depression. All these affect the overall quality of life of women with breast cancer. (Lerman, Jarski, Rea, Gellish and Vicini,2011).

Quality of life (QOL) is a multidimensional concept which is defined as a person’s view of life, and with her satisfaction and pleasure with life (Arriba, 2010). Quality of life is the perceived quality of an individual’s daily life, that is, an assessment of their well being or lack of it. Quality of life includes the emotional, social, and physical aspects of the individual’s life. (Centre for Disease Control (CDC) 2014). Health-Related Quality of Life (HRQOL) is an individual’s satisfaction or happiness with the domains of life in so far as they affect or are affected by health. (American Thoracic Society, 2007). In health care, health-related quality of life (HRQOL) is an assessment of how an individuals’ well being may be affected over time by a disease, disability or disorder. Health-Related Quality of life typically involves the assessment of several dimensions/domains: physical well being, psychological well-being, social well-being, and spiritual well-being. For cancer patients, all these aspects of life are influenced. Breast cancer survivors increasingly experience long-term side effects that influence their quality of life (Wonghongkul, Dechaprom, Phumivichuvate and Losawatkul, 2006).

Although health-related quality of life can be affected positively or negatively by the outcome of treatment, there is always something the nursing team can do to improve it. Nurses can only provide effective and comprehensive nursing care to patients with breast cancer and their families if they understand these patients’ experiences in every area of their lives, hence the need for this study. 

Statement of the Problem

Breast cancer has a lot of burden on the health-related quality of life of the individual as well as the society at large. The population of women with breast cancer is growing with breast cancer accounting for 40% of cancers among Nigerian women (Obinna, 2012). Women with breast cancer are at risk of poor health-related quality of life outcomes due to a number of reasons such as ignorance of the larger proportion of the populace on the causes and preventive measures and treatment options, late presentation  and diagnosis at the hospitals, lack of facilities or ill equipped hospitals, (most cancer treatment centers in Nigeria lack modern diagnostic equipment).Also there is lack or insufficient manpower resulting to poor attention to patients’ experiences during diagnosis and treatment, high cost of treatment and fewer screening and treatment centers and all these have impact on the woman and will likely affect her quality of life.

The researcher during her hospital stay in the female surgical ward of the University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, witnessed how women with breast cancer experienced physiological pains, psychological distress for fear of approaching death, abandonment by friends and relations due to financial burden and feelings of hopelessness especially following the diagnosis and treatment. These situations are sometimes worsened by the side effects of treatment regimen and these women are usually faced with the challenges that affect their quality of life.

The foregoing prompted the interest of the researcher to compare the quality of life of these women at the University of Nigeria Teaching Hospital Ituku/Ozalla with those of other women without cancers since the hospital is a referral centre and handles referral cases from the    South East zone of Nigeria and beyond and so handles most breast cancer cases in the south east region. 

Purpose of the Study

This study was carried out to assess the health-related quality of life of women with breast cancer at UNTH Ituku/Ozalla and compare it with that of those without cancer in the different domains of life namely: physical, psychological and social.

 Objectives

This research study was conducted to:

1. Assess the health-related quality of life of women with breast cancer and that of women with no breast cancer in the three domains- physical, psychological and social domains of life.
2. Compare the health-related quality of life scores of women with breast cancer and women with no breast cancer in the physical domain of life.
3. Compare the health-related quality of life scores of women with breast cancer and women with no breast cancer in the psychological domain of life.
4. Compare the health-related quality of life scores of women with breast cancer and women with no breast cancer in the social domain of life.
5. Determine the relationship between demographic characteristics e g. age, marital status, occupation and quality of life scores of women with breast cancer and those of women with no breast cancer.

 

Research hypothesis

1. There is no significant difference in the health-related quality of life scores of women with breast cancer and those with no cancers in the physical domain of life.
2. There is no significant difference in the health-related quality of life scores of women with breast cancer and those with no cancers in the psychological domain

of life.

3. There is no significant difference in the health-related quality of life scores of women with breast cancer and those with no cancers in the social domain of life.
4. There is no significant relationship between demographic characteristics and quality of life scores of women with breast cancer and that of women without breast cancer. 

Research Questions

1. What are the health-related quality of life scores of women with breast cancer and that of women without breast cancer in the three domains- physical, psychological and social domains of life?
2. What are the differences in the health-related quality of life scores of women with breast cancer and women without breast cancer in the physical domain of life?
3. What are the differences in the health-related quality of life scores of women with breast cancer and women without breast cancer in the psychological domain of

life?

4. What are the differences in the health-related quality of life scores of women with breast cancer and women without breast cancer in the social domain of life?
5. What is the relationship between the health-related quality of life of women with breast cancer and those without breast cancer and demographic variables-age, marital status educational status and occupation.

Significance of the study

The findings from the present study revealed the health-related quality of life of women with breast cancer. Assessing the health-related quality of life of women with breast cancer was important as health-related quality of life is now considered an important endpoint in cancer management. Assessing the health-related quality of life in breast cancer patients could contribute to improved treatment and could even be as prognostic as medical factor as they can even indicate the directions needed for more efficient nursing care of women with breast cancer.

The findings of this study if published and made available could inform nurses when planning and caring for breast cancer patients for more efficient care in order to gain a better quality of life for these women. Better quality of life of these women may reduce the physical, psychological, and social burden of the condition on these women; there by improving the overall health-related quality of life of their families and the society at large.

It will also build on the existing nursing literature on this issue and will serve as a reference point for further studies.

 

Scope of the study

The present study was delimited to women with breast cancer attending the surgical out patient clinic and oncology clinic as well as those admitted in the female surgical ward and the oncology ward of the University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Enugu state, Nigeria and the control was taken from women with no breast cancer who attend the surgical out patient clinic of the same hospital.

 

Operational Definition of Terms

1. Health-related quality of life (HRQOL) – refers to the assessment of an individual’s perceived state of well being as may be affected over time by a disease, disability or disorder (breast cancer) in the different domains of life such as perceived feelings of comfort, satisfaction, etc. In this study, it will be measured based on the scores obtained on the World Health Organization Quality of life instrument. (WHOQOL BREF).
2. Women with breast cancer – refers to women aged 20 years and above with the cancer of the breast admitted in the female surgical or oncology ward or attending surgical out patient clinic of the University of Nigeria Teaching Hospital Ituku/Ozalla.
3. Women with no cancers – refers to women who are aged 20 years and above who have never been diagnosed of any form of cancer or other chronic diseases such as arthritis, hypertension, diabetes, etc. who attend the surgical out patient clinic of the same hospital.
4. Physical domain of health-related quality of life – refers to a patients’ perceived state of physical wellbeing such as feelings of pains, ability to get up, eat, drink and take care of personal hygiene and other activities of daily living without help from others.
5. Psychological domain of health-related quality of life – refers to a patients’ perceived state of psychological wellbeing such as feelings of anxiety, depression, security, self acceptance, satisfaction with support persons, and leisure.
6. Social domain of health-related quality of life – refers to a patients’ perceived state of social wellbeing such as relationships with others, satisfaction with finance, treatment, etc.