Association Between Unmet Supportive Care Needs And Quality Of Life Among Patients With Breast Cancer At Kenyatta National Hospital, Kenya

Abstract

Background: Breast cancer patients need support in the management of cancer symptoms, therapy-related adverse effects, educational, psychosocial, spiritual and sexual needs in all aspects of their lives. Provision of supportive care is not always of high significance in developing countries mainly dependent on existing resources. Patients who have cancer of the breast and have more unsatisfied supportive care needs, right from the early phases of treatment, have a poorer quality of life (QOL) and general state of health. This, in the long run, may increase family and community burden, healthcare utilization and expenses. Broad objective: In Kenya, there is no data on the researches which have assessed the Supportive Care Needs (SCNs) and quality of life of patients with breast cancer (PWBC). Hence, this study examined the association between unmet SCNs and QOL among patients with breast cancer receiving care at Kenyatta National Referral Hospital (KNH) of Kenya. Study design and site: The research adopted a descriptive cross-sectional study design using structured questionnaires to collect data at the Cancer Treatment Centre (CTC) of KNH and took eight weeks. Participants and method: The study involved sixty-six (66) participants who have breast cancer, recruited by purposive sampling. The study obtained ethical clearance from the University of Nairobi (UON), and KNH, Ethics and Research Committee (ERC) and participants were consented to participate. The analysis was done using correlation analysis and multivariate linear regression. Results: The study enrolled a total of 66 participants who were all breast cancer patients receiving care at CTC of KNH. Most of the respondents were female 95.5% (n=63), aged between 45-54 years 45.5% (n=30), attained at least secondary education 65.2% (n=39), and were married 75.8% (n=50). Most of the participants were Christians 84.9% (n=56), housewives 33.3% (n=22), earned a monthly income of between 5000 - 29,999 Kenya Shillings 57.6% (n=38) and resided in rural areas 75.8% (n=50). In terms of the patient clinical factors, most of the respondents had been diagnosed between 6 months – 1 year ago, 43.9% (n=29). More than half of the patients were undergoing single therapy 54.5% (n=36). The study established that the unmet psychological needs were the most prevalent 75.2% (mean = 73.1; SD = 63.4) among breast cancer patients. The study also found negative correlations between the overall QOL and unmet needs in all the five domains, which imply that more unmet SCNs predicted poorer QOL of breast cancer (BC) patients at KNH. The regression analysis revealed that the overall QOL was predicted by unmet sexuality needs. Conclusion: Based on the findings of this study, it can be concluded that; The most prevalent unmet needs of breast cancer patients were found in the psychological domain followed by unmet needs in health systems information domain. There was a correlation between unmet supportive care needs and quality of life. More unmet supportive care needs predicted a poorer quality of life of breast cancer patients. Recommendations; Kenyatta national hospital should put particular emphasis on training and recruiting more psychosocial counsellors, Onco-psychologists and oncology nurse specialists besides the existing multidisciplinary team to address the psychological, health system information and sexual needs of patients with breast cancer hence improving their QOL. Further studies should be conducted in Kenya to determine effective methods in managing the supportive care needs of breast cancer patients using bigger study sample sizes.