The mean age of patients was 46.1 ± 13.1 years, with values ranging from 18–73 years. Majority of the patients were female 92 (76.7%) and married 69 (57.5%). The most frequent occurring cancers were breast 50 (41.7%) and urogenital 39 (32.5%) cancers (Table 1). Urogenital cancers including cervical, prostrate and urethral cancers. Thirteen (10.8%) were at stage 1 of their disease, 14 (11.7%) at stage 2, 13 (10.8%) at stage 3, 5 (4.2%) at stage 4 and 75 (62.5%) were not aware of their cancer stage. Majority of the patients had children 105 (87.5%) and 21 (17.5%) had other comorbidities (Table 1).
Table 1
Socio-demographic characteristics of patients
S/N
|
|
|
Frequency
|
Percentage
|
1
|
Gender
|
Female
|
92
|
76.7
|
Male
|
28
|
23.3
|
2
|
Age category
|
18–30
|
14
|
11.7
|
31–50
|
56
|
46.7
|
> 50
|
50
|
41.7
|
3
|
Marital status
|
Single
|
41
|
32.4
|
Married
|
69
|
57.5
|
Widowed/divorced
|
10
|
8.3
|
4
|
Level of education
|
Primary
|
23
|
19.2
|
Secondary
|
56
|
46.7
|
Tertiary
|
39
|
32.5
|
None
|
2
|
1.7
|
5
|
Employment status
|
Employed
|
71
|
59.2
|
Unemployed
|
42
|
35.0
|
Retired
|
7
|
5.8
|
6
|
Monthly income
|
< 178.70$
|
20
|
16.7
|
178.70$-893.52$
|
26
|
21.7
|
> 893.52$
|
5
|
4.2
|
Nothing
|
40
|
33.3
|
Varies
|
12
|
10.0
|
Unanswered
|
17
|
14.2
|
7
|
Location of cancer
|
Breast
|
50
|
41.7
|
Head and neck
|
19
|
15.8
|
Urogenital
|
39
|
32.5
|
Gastrointestinal
|
6
|
5.0
|
Others
|
6
|
5.0
|
8
|
Mode of treatment
|
Radiotherapy
|
15
|
12.5
|
Radiotherapy/Chemotherapy
|
27
|
22.5
|
Radiotherapy/Surgery
|
6
|
5.0
|
Radiotherapy/Chemotherapy/Surgery
|
25
|
20.8
|
Chemotherapy
|
23
|
19.2
|
Chemotherapy/Surgery
|
12
|
10.0
|
Surgery
|
3
|
2.5
|
None
|
9
|
6.7
|
For psychosocial distress, the mean distress level was 4.5 ± 2.7 with values ranging from 0 to 10. Majority of the patients 83 (69.2%) had significant clinical distress as they had a score of ≥ 4 (cut off), while 37(30.8%) were below the cut off score. The most reported problems by patients were; insurance/finance 87 (72.5%), fatigue 83 (69.2%), transport 73 (60.8%), work/school 69 (57.5%), loss of interest in usual activities 67 (55.8%), worry 62 (51.7%), sleep 62 (51.7%), pain 58 (48.3%), appearance 55 (45.8%), waiting time 53 (44.2%) and child care 51 (42.5%).
The mean anxiety score was 7.7 ± 3.6 with scores ranging from 0–17. Fifty-nine (50.0%) patients had mild, 32 (27.1%) had moderate and 27(22.9%) had severe anxiety symptoms. Thus 59 (50.0%) of the patients had scores in the moderate to severe category. On the depression scale, the mean score was 7.6 ± 4.1 with scores ranging from 0–19. Sixty-two (52.5%) had mild, 29(24.6%) had moderate and 27(22.9%) had severe depression symptoms. Thus 56 (47.5%) of the patients had scores in the moderate to severe category. The mean of the overall scale was 15.4 ± 6.7 with scores ranging from 3–32. Majority of the patients 67(56.8%) had an overall score above the cut off score ≥ 15, while 51(43.2%) were below the cut off score.
The mean score for the general health status (quality of life) was 52.4 ± 21.3 out of 100, and values ranged from 0-100. On the functional scale, cognitive, physical and emotional functioning had the highest mean scores 78.9 ± 23.0, 73.4 ± 23.5 and 72.9 ± 23.6 respectively out of 100. Cognitive functioning, concerned the presence of difficulty to remember things and concentrate on things like reading or watching television. Physical functioning concerned difficulty doing strenuous activities, taking long walks, taking short walks, need to stay in bed or a chair and need with toileting activities. Emotional functioning concerned feeling tensed, worried, irritable and depressed. Social functioning had the lowest mean value 49.0 ± 38.0, which concerned family life and social activities. On the symptom scale, financial difficulties had the highest mean score 69.2 ± 36.4, followed by fatigue 39.1 ± 26.3 (Table 2).
Table 2
Mean and standard deviation of EORTC QLQ-C30
S/N
|
Domain
|
Mean
|
SD
|
Minimum
|
Maximum
|
Global health status
|
1
|
Global health status/QOL
|
52.4
|
21.3
|
0
|
100
|
Functional scale
|
2
|
Physical functioning
|
73.4
|
23.4
|
7
|
100
|
3
|
Role functioning
|
59.6
|
37.9
|
0
|
100
|
4
|
Emotional functioning
|
72.9
|
23.6
|
0
|
100
|
5
|
Cognitive functioning
|
78.9
|
23.0
|
0
|
100
|
6
|
Social functioning
|
49.0
|
38.0
|
0
|
100
|
Symptom scale
|
7
|
Fatigue
|
39.1
|
26.3
|
0
|
100
|
8
|
Nausea and vomiting
|
12.9
|
20.2
|
0
|
100
|
9
|
Pain
|
36.8
|
35.4
|
0
|
100
|
10
|
Dyspnoea
|
17.8
|
25.2
|
0
|
100
|
11
|
Insomnia
|
34.4
|
37.9
|
0
|
100
|
12
|
Appetite loss
|
21.7
|
31.9
|
0
|
100
|
13
|
Constipation
|
16.9
|
28.0
|
0
|
100
|
14
|
Diarrhoea
|
6.1
|
15.6
|
0
|
67
|
15
|
Financial difficulties
|
69.2
|
36.4
|
0
|
100
|
* EORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 30, SD: Standard Deviation, QOL: Quality of Life. |
Upon analysis with one-way ANOVA to identify associations between distress levels and the various domains of quality of life, the following were identified (Table 3); Anxiety was found to have a strong association with emotional functioning, where P < 0.0001. Also, a statistical significant association was found between anxiety quality of life, where P < 0.05. On the symptom scale, it was statistically associated with pain, insomnia and financial difficulties, where P < 0.05.
Depression was seen to a have a strong statistical relationship with quality of life, where P < 0.0001. On the functional scale, depression was associated with physical, role, emotional and social functioning where P < 0.05. On the symptom scale, there was a statistically significant relationship between depression and fatigue, dyspnoea and insomnia where P < 0.05.
As concerns emotional distress, a strong statistically significant association was found with quality of life, emotional functioning and pain, where P < 0.0001. Also, it was associated with fatigue, insomnia, loss of appetite and constipation, where P < 0.05.
For psychosocial distress, a strong statistical association was found between with quality of life and fatigue, where P < 0.0001. Psychosocial distress was also associated with all aspects on the functional scale, insomnia and financial difficulties, where P < 0.05.
Table 3
Factors Associated With Quality Of Life of Patients
S/N
|
Domain
|
HADS (A)
|
HADS (D)
|
HADS (overall)
|
Psychosocial distress
|
F
|
P
|
F
|
P
|
F
|
P
|
F
|
P
|
Global health status
|
1
|
Global health status/QOL
|
1.985
|
0.021
|
3.212
|
0.000
|
3.226
|
0.000
|
4.060
|
0.000
|
Functional scale
|
2
|
Physical functioning
|
1.104
|
0.362
|
2.712
|
0.001
|
1.570
|
0.060
|
3.100
|
0.002
|
3
|
Role functioning
|
1.613
|
0.079
|
2.317
|
0.004
|
1.098
|
0.360
|
2.529
|
0.009
|
4
|
Emotional functioning
|
5.511
|
0.000
|
2.079
|
0.011
|
2.702
|
0.000
|
3.000
|
0.002
|
5
|
Cognitive functioning
|
1.278
|
0.226
|
1.531
|
0.092
|
1.060
|
0.404
|
2.722
|
0.005
|
6
|
Social functioning
|
1.450
|
0.134
|
1.860
|
0.026
|
1.482
|
0.087
|
2.739
|
0.005
|
Symptom scale
|
7
|
Fatigue
|
1.515
|
0.109
|
1.855
|
0.027
|
2.150
|
0.004
|
4.040
|
0.000
|
8
|
Nausea and vomiting
|
1.238
|
0.253
|
1.518
|
0.096
|
1.473
|
0.090
|
1.210
|
0.293
|
9
|
Pain
|
2.162
|
0.011
|
1.671
|
0.055
|
2.884
|
0.000
|
1.294
|
0.243
|
10
|
Dyspnoea
|
0.536
|
0.922
|
2.030
|
0.013
|
1.182
|
0.275
|
2.909
|
0.003
|
11
|
Insomnia
|
1.892
|
0.030
|
1.913
|
0.021
|
2.281
|
0.002
|
2.610
|
0.007
|
12
|
Appetite loss
|
1.377
|
0.169
|
1.081
|
0.382
|
2.447
|
0.001
|
1.359
|
0.209
|
13
|
Constipation
|
1.484
|
0.121
|
0.473
|
0.968
|
1.750
|
0.027
|
0.657
|
0.576
|
14
|
Diarrhoea
|
1.092
|
0.373
|
0.663
|
0.846
|
0.878
|
0.639
|
1.158
|
0.327
|
15
|
Financial difficulties
|
2.094
|
0.014
|
1.673
|
0.054
|
1.000
|
0.478
|
1.960
|
0.045
|
*HADS: Hospital Anxiety and Depression Scale, QOL: Quality of Life. |
There was a strong significant negative correlation between quality of life and psychosocial distress, depression and emotional distress, where P < 0.0001. Also, there was a significant negative correlation between anxiety and quality of life, where P < 0.05 (Table 4). Thus, as psychosocial distress, anxiety, depression and emotional distress increase, the quality of life of patients reduces. Given that higher scores on the quality of life scale indicate better quality of life and lower scores, poor quality of life. Thus, there is sufficient evidence to support the claim that psychosocial and emotional distress have a negative impact on the quality of life of patients. Also, correlating psychosocial distress and emotional distress, there was a strong positive correlation with P < 0.0001 (Table 4). Thus as emotional distress in patients’ increases emotional distress too increases, providing additional support to the impact of psychosocial distress on the health of patients.
Table 4
Correlation between Psychosocial and Emotional Distress and Quality Of Life
S/N
|
Comparison
|
Correlation coefficient (r)
|
P value
|
Patients
|
|
1
|
DT vs. EORTC QLQ-C30
|
-0.374**
|
0.000
|
2
|
Anxiety vs. EORTC QLQ-C30
|
-0.289**
|
0.002
|
3
|
Depression vs. EORTC QLQ-C30
|
-0.472**
|
0.000
|
4
|
HADS (overall) vs. EORTC QLQ-C30
|
-0.448**
|
0.000
|
5
|
DT vs. HADS (overall)
|
0.519**
|
0.000
|
*DT: Distress Thermometer, EORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 30, HADS: Hospital Anxiety and Depression Scale. |