We assessed quality of life of cancer patients in palliative care in four domains (Physical health, psychological health, social relationship and environmental health). We also assessed individual’s overall perception to quality of life (QoL) and satisfaction with their health. Our participants were predominately female 102 (64.6%) and cervical cancer was the commonest cancer followed by Kaposi’s sarcoma. This is consistent with reports that indicate that women are more affected by cancer in Malawi compared to males, with cervical cancer being the most cancer and Kaposi’s sarcoma is still prevalent despite availability of free Anti-reoviral Therapy (ART)(23–25). Intensification of cervical cancer prevention (through HPV vaccination), screening and prompt management will reduce the burden of cervical cancer and those who will need palliative care services. The commonest form of Kaposi’s sarcoma in our setting is associated with HIV infection therefore, controlling HIV disease through prompt initiation of ART and good compliance will mitigate burden and aggressiveness of the disease.
We also found that only 54 (34.2%) of cancers had confirmed laboratory diagnosis which implies that majority of patients were clinically diagnosed. Much as some cancers such as Kaposi’s sarcoma may be diagnosed clinically in our set up, low numbers of confirmed cases are not surprising like other low-income countries, Malawi has limited pathological and hematological services (10). Limited diagnostic capacity delays diagnosis and prompt treatment reducing chances of curative intent hence patients end up in palliative care. Therefore, there is need to address inadequacies with regards to diagnostic capacity for early treatment.
The study identified several factors influencing patients' quality of life, including education, treatment types such as chemotherapy and morphine, and the duration of cancer diagnosis.
The positive correlation between education levels and the environmental domain emphasizes the potential role of education in fostering a more supportive and conducive living environment for patients hence good quality of life. Other studies have demonstrated that low educational level was associated with decreased disease awareness, late screening, and late-stage diagnosis which leads to poor prognosis and low score of QoL (12). Similar studies have reported that better overall quality of life was associated with higher level of education (16, 19).
The study also found that those who received palliative chemotherapy had high score on quality of life. Palliative chemotherapy likely alleviated their symptoms hence better quality of life. A systematic review conducted by Qan’ir et al, on quality of life among cancer patients revealed that patients who received chemotherapy and radiotherapy had better quality of life (19). Therefore, it is important to integrate palliative and oncology services so that some patient may benefit from palliative chemotherapy. We had only one patient who underwent radiotherapy which is not surprising since radiotherapy is currently not offered in Malawi.
Pain is a major complaint of most of the patients in palliative care (26). Pain management is an integral concept in the practice of palliative care, so as to improve physical health. Our study found that those who were on opioids (morphine) had better quality of life. Therefore, issues of reluctance to give opioids, regulatory restrictions to prescribe and supply chain need to be addressed to optimise physical health.
Some studies have demonstrated that female gender is associated with better QoL (19). However, in our study gender was not related to QoL which is similar to other studies (16).
In this study age, occupation, marital status, duration in palliative were not associated with overall QoL and satisfaction. This is contrary to findings of other studies including one conducted in Kenya among 120 cancer patients in palliative care which demonstrated that QoL scores were significantly higher among older age-groups, formally employed and married participants (12, 16). This discrepancy may be attributed to potential variations in factor interactions across age, occupation, marital status and duration in palliative care which may require data set large enough to derive definitive conclusions. Our study also found there was no significant association between religion and QoL which is similar to A study which was conducted in Kenya (16). But other studies have reported that religious affiliation is associated with religious wellbeing which is significantly related to QoL among palliative care patients (27). This implies that spiritual activities such as prayer, meditation, reading spiritual scriptures are beneficial to individuals’ quality of life. Our study population was predominately Christians 155 (98,1%), likewise majority of participants in Kenya were Christian which may have contributed to inconsistency of findings with other studies (16).
Limitation of study
While the study contributes to the understanding of the quality of life of cancer patients in palliative care in the context of Northern Malawi, the findings should be interpreted within the limitations of the study's scope, including the cross-sectional design. These limitations warrant caution when generalizing the findings to broader populations and emphasize the need for further research, including longitudinal studies, to elucidate the long-term effects of various interventions on patients' quality of life.