dc.description.abstract | Background
Gynaecologic and breast malignancies are certainly the commonest forms of
cancers in women in Kenya. For a long time the focus has been on clinical
management of cancers but now Quality of Life (QOL) is emerging as an important
health outcome which require
s to be incorporated in the holistic management of
patients. There are very few African studies
that have investigated
QOL issues.
Objectives
This study set out to determine the quality of life issues of women with
gynaecological and breast cancer
;
and est
ablish the roles of an oral interview and
that of an established QOL instrument
–
Functional Assessment of Cancer Therapy
(FACT), in assessing the QOL of the women in the Kenyan setting.
Study Area
The study was carried out at the two national teaching
and referral hospitals in
Kenya, Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital
(MTRH)
, three Provincial Hospitals and four Hospices during 200
6
-
200
8
.
Study Design
This study was
a cross
-
sectional survey
conducted using a quantitat
ive and
qualitative design
.
Materials and Methods
Two assessment tools were administered to
p
articipants aged 18 years and above,
with
a documented histological diagnosis of gynaecological or breast cancer.A
n
interview was conducted with each patient
prio
r to administration of the
validated
Functional Assessment of Cancer Therapy (FACT)
questionnaire
. In addition a
n
interview guide was used to gather narrated information from patients‟
experiences
.
Data analysis was conducted using SPSS version 19.
Associations between patient characteristics and cancer diagnosis, and its staging were
examined using cross tabulations. Multinomial regressions were used to identify
significant association between patient characteristics and cancer diagnosis.
The
qualit
y of life issues were identified by calculating the percentage of patients giving
each of the five possible Likert scale ratings. A multivariable regression model was
then run for each quality of life issue.
Deductive analysis based on HRQoL domains
was us
ed to identify themes describing patient perception of QOL.
Results
Out of the 27 QOL issues in the FACT
-
G tool, 14 were important issues for Kenyan
patients.
The leading quality of life issues among the 39
4
patients with breast and
gynaecologic cancers in
Kenya are:
worrying that condition will get worse (93.9%),
lack of satisfaction with sexual life (84.1%), losing hope (83.7%), worry about
dying (83.1%), lack of fulfilment in work (77.7%) and feeling nervous (77.4%).
The issues in the emotional domain we
re most affected by cancer.
Overall quality
of life (FACT
-
G) was influenced by type of cancer and treatment modality
(p <
0.05)
. In comparison to FACT
-
G, which reported
that
emotional wellbeing
issues
were the leading QOL issues, content analysis of patie
nt narratives identified
functional and physical issues including pain as important issues
and
de
ductive
analysis
showed that
p
atients perceived the term quality of life as having three
interrelated components: preserving pre
-
diagnosis capacities,
a
personal
or
individualised
meaning, and effects of cancer.
In addition,
spirituality and positive
living
were identified
as important factors in Kenyan patients‟ QOL
.
Conclusions and Recommendations
The leading quality of life issues among Kenyan women are
in the emotional
domain and these can be remedied by nursing intervention including providing
holistic patient care and emphasising the psycho
-
social support
of
patientscounselling and patient education
.
The FACT
-
G tool captures general QOL issue
s
but the qualitative analysis showed that future studies need to incorporate the
positive living and spiritual issues which were important factors in Kenyan female
cancer patients‟ narratives. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |