Biopsychosocial Effects of Chemotherapy Among Breast and Cervical Cancer Patients Attending Kenyatta National Hospital Cancer Treatment Center.

Abstract

Cancer is a leading cause of mortality globally and breast and cervical cancers are two of the most common cancers among women. In Kenya, breast and cervical cancers cause the highest cancer related morbidity and mortality among women. Chemotherapy, one of the three modalities of cancer treatment, is associated with biological, psychological and sociological effects. These effects affect patients‟ adherence to treatment and the overall outcome of treatment. In Kenya studies on cancer are few and none has concentrated specifically on the effects of chemotherapy on patients diagnosed with breast and cervical cancer. This study sought to determine the biopsychosocial effects of chemotherapy experienced by patients diagnosed with breast or cervical cancer. This study involved both quantitative and qualitative data collection methods to explore on the effects chemotherapy. Quantitative and qualitative data was collected for a period of 6 weeks in KNH CTC among patients diagnosed with breast or cervical cancer. A questionnaire developed from a modified Rotterdam Symptom Checklist (RSCL) was used to collect quantitative data from 157 systematically sampled participants. In addition two focus group discussions were held involving purposively selected from the study population. Quantitative data was analyzed using SPSS version 23.0. Univariate analysis was conducted and the results presented using frequency and proportions. Bivariate analysis was done using Pearson‟s correlation to determine relationships between categorical variables and p-values of 0.05 or less were considered to have a significant relationship. Descriptive statistics was presented in text, frequency tables and bar graphs. Qualitative data analysis involved clustering together related narrative information then analyzed using thematic analysis. Pretesting of the study tools was done in clinic 23, questions in the questionnaire which were irrelevant were expunged. Permission to conduct the research was obtained from Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UON ERC). The highest percentage (31.2%) of participants fell within the age group of 41-50 years. Most (66.9%) were married and depended on their husbands (45.9%) for social support. Only (22.9%) were in formal employment and majority (73.2%) earned a monthly income of below 20000kshs. Biological effects experienced by participants were anorexia (90.4%), nausea (86.5%), alopecia (79%), and peripheral neuropathy (61.8%). Psychological effects included; body image changes (65.6%), anxiety (79%), low self-esteem (63.1%), loneliness (55.4%) and sadness (51.6%). Sociological effects experienced were; inability to perform their family roles (88.5%), failure to return to return to work (76.3%), financial constraints (82.2%) and isolation (77.7%). Pearson‟s correlation test showed that age, economic status, previous chemotherapy sessions had significant relationships with biological, psychological and sociological effects e.g. aged patients are likely to experience biological effects(r= 0.270) and as patients receive more chemotherapy they are likely to experience psychological (r= 0.510) and sociological effects(r= 0.361) In conclusion, Cancer chemotherapy is associated with biological, psychological and sociological effects. The psychological and sociological effects are aggravated by increased chemotherapy sessions and low monthly income.