Assessment of the quality of life of breast cancer patients after one year of treatment

Nội dung text: Assessment of the quality of life of breast cancer patients after one year of treatment

1. Hue Central Hospital Original Research ASSESSMENT OF THE QUALITY OF LIFE OF BREAST CANCER PATIENTS AFTER ONE YEAR OF TREATMENT Hoang Ngoc Tu1, Le Quang Quan1, Nguyen Thi Kim Tien1, Ho Xuan Dung1* DOI: 10.38103/jcmhch.2021.72.13 ABSTRACT Introduction: Breast cancer is the most commonly diagnosed malignancy and the leading cause of death among women worldwide. The incidence of breast cancer is on the rise in developing countries. Breast cancer patients not only experience physical pain from treatment but may also face mental crises, impaired social function, and impaired quality of life. However, there are not many studies on the quality of life (QoL) of post - treatment breast cancer patients. Therefore, we carried out the study “assessment the quality of life of breast cancer patients after one year of treatment” with aims to evaluate the quality of life of breast cancer patients after one year of treatment using the scales EQ-5D-5L and QLQ-BR23 and to find out related factors to the quality of life of these subjects. Methods: A cross - sectional study was conducted on 100 breast cancer patients after one year of treatment at the Hue University of Medicine and Pharmacy Hospital to examine the quality of life using the scales EQ-5D-5L and QLQ-BR23 and to detect the associated factors. Results: The mean quality of life score of breast cancer patients after one year of treatment on the EQ- 5D-5L scale was 0.6436 ± 0.2098. By QLQ-BR23, the quality of life score on function was 74.75 ± 20.78 while the score on symptoms was 28.80 ± 12.79. The quality of life from both scales was found to be statistically significant related to social work participation, self - reported health, risk of depression, anxiety, and stress. Conclusions: The quality of life of breast cancer patients in the study was at a moderate level. This suggests more supports to be done continuously after long - term post - diagnosing especially psychological and social aspects for these subjects. Keywords: Quality of life, breast cancer, EQ-5D-5L, QLQ-BR23, post-treatment. I. INTRODUCTION Breast cancer is the most common malignancy Today, medicine has made many advances in and is one of the leading causes of death among the early diagnosis and treatment of breast cancer women in many countries around the world. to help prolong life, but after treatment, patients According to GLOBOCAN 2020, there were nearly often face a lot of difficult problems. They not 2.3 million new cases of breast cancer worldwide, only experience physical pain due to the treatment accounting for 11.7 % of all cancers [1]. In Vietnam, consequences but also can face mental crises, there are more than21,000 new cases per year and it psychological effects, impaired social functioning, is the fourth cause of death by cancer [2]. leading to reducedquality of life [3]. 1University of Medicine and Pharmacy, Hue University - Received: 23/9/2021; Revised: 15/10/2021; - Accepted: 13/11/2021 - Corresponding author: Ho Xuan Dung - Email: xuandung59@gmail.com; Phone: 0982558945 Journal of Clinical Medicine - No. 72/2021 71
2. Assessment of the quality of life of breast cancer patients afterBệnh oneviện year Trung of treatmentương Huế According to the study “Assessment of quality and QLQ - BR23 scales. of life of female breast cancer patients treated at - The EQ-5D-5L toolkit has been standardized Thu Duc District Hospital” by Pham Dinh Hoang and applied in Vietnam with Cronbach’s alpha = 0.8. using the QLQ-BR23 scale, the quality of life score The EQ-5D-5L Toolkit evaluates the quality of life in in functional areas was 56.3 points, the symptom five dimensions: mobility, self - care, usual activities, field was 16.7. Thus, the quality of life in patients pain/discomfort, anxiety/depression, with 5 levels. was not high [4]. Quality of life and its assessment Degree (1 = no problem to 5 = extreme problem). are still relatively new concepts in the treatment and The compilation of five assessments in 5 different care of breast cancer patients in our country. aspects can give the subject’s health status [5]. Currently, at Hue University of Medicine and - The QLQ Toolkit - BR23 has been authorized. Pharmacy Hospital, there have been several studies The Vietnamese version of the questionnaire, the on breast cancer, but most of them focused on the data analysis manual, and the reference data sheet aspects of treatment effectiveness, survival time, were sent via email by EORTC. The questions are side effects of chemotherapy, etc without many measured in 4 accending levels from 1 = “None” studies on the quality of life of breast cancer patients to 4 = “Very much”. Converted linearly to a 100 after treatment. From the above issues, we carried - point scale according to the guidelines of the out the study “Assessment of the quality of life of EORTC quality of life study group [6]. breast cancer patients after one year of treatment” + Raw score (RS) is the average score of with aims: To evaluate the quality of life of breast questions with the same problem. RS = (Q1 + Q2 cancer patients after one year of treatment at Hue + + Qn)/n University of Medicine and Pharmacy Hospital and + Normalized score is a raw score calculated on to identify some correlative factors of the quality of a scale of 100: life of breast cancer patients. • Functional scales: Score = (1 - (RS -1)/3) x 100 • Symptom scales: Score = ((RS -1)/3) x 100 II. MATERIALS AND METHODS • Financial score: Score = ((RS -1)/3) x 100 2.1. Subjects and methods • Global health status/QoL: Score = ((RS -1)/6) A cross - sectional study was conducted on 100 x 100 breast cancer patients after more than one year • Global health status and function problems: of treatment at the hospital of Hue University of The higher the score, the better the function, which Medicine and Pharmacy byconvenientsampling indicates good health. method. The patients were explained about their • Symptom and financial problems: The higher disease by their doctor and voluntarily participate the score, the more severe the symptoms, inferring in the study. to bad health and financial problems. 2.2. Data collection and studytools The research subjects have fully explained Data were collected by direct interview with the purpose, confidentiality of the study, the time breast cancer patients based on a set of questions required to complete a questionnaire, and they designed with 3 parts: voluntarily decided to participate in the study or Part 1: General information about research not. Participants were interviewed directlyfor the subjects data collection. Part 2: Quality of life assessment scale EQ-5D- 2.3. Data analysis 5L and QLQ-BR23 Using Epidata 3.1 software for data input and Part 3: Some factors related to the quality of life SPSS 20.0 software for data analysis. The results Quality of life was assessed using the EQ-5D-5L were described by frequency tables, ratios, and linear 72 Journal of Clinical Medicine - No. 72/2021
3. Hue Central Hospital regression models to determine some correlative factors. III. RESULTS 2.4. Ethical issues 3.1. Characteristics of research subjects Patients were fully explained and voluntarily One hundred breast cancer patients were in our participate in the study. They can refuse at any study group aged from 31 to 80 with a mean age of time during the interview. All information was 52.5 ± 9.82. Their characteristics were demonstrated kept confidential, anonymously, and only used for in table 1 about ethnicity, religion, educational level, research purposes. occupation, and marital status. Table 1: Demographic features of the study population Variable Frequency (n) Percentage (%) Kinh 96 96 Ethnicity Others 4 4 None 46 46 Religion Buddhism 49 49 Christian 5 5 Illiteracy 2 2 Can read and write 18 18 Education level Primary school 32 32 Secondary school 30 30 High school 11 11 Post high school 7 7 Married 74 74 Single 2 2 Phân nhóm BMI Separated/Divorced 2 2 Widow 22 22 Live alone 6 6 GDS - 15 Live with family 94 94 The subjects were dominantly Kinh people, accounting for 96%. Buddhist was the most common religion with 49%. Non - religious participants accounted for 46%. Patients were mainly at a lower level of education of which 82% were noted below high school level. The rate of widow/single/separated/divorced accounted for 26%. Most of the subjects lived with their families (94%). 3.2. Quality of life by EQ-5D-5L và QLQ-BR23 aspects of the EQ-5D-5L scale were demonstrated The mean score of QoL by EQ-5D-5L of breast in Figure 1 including mobility, self - care, usual cancer patients after 1 year of treatment at Hue activities, pain/discomfort, and anxiety/depression. University of Medicine and Pharmacy Hospital And the quality of life according to the QLQ-BR23 was 0.6436 (standard deviation: 0.2098). The five scale was shown in Table 2. Journal of Clinical Medicine - No. 72/2021 73
4. Assessment of the quality of life of breast cancer patients afterBệnh one viện year Trung of treatmentương Huế Figure 1: Five aspects of EQ-5D-5L scale of breast cancer patients after 1 year of treatment In the three aspects of mobility, self - care, In the other 2 aspects of pain/discomfort and usual activities, less severe levels of difficulty and anxiety/depression, the moderate problem were noted at a high percentage, of which slightly was reported at the top level with 41% and 40% difficulty level was at the highest rate. respectively. Table 2: Quality of life according to the QLQ-BR23 scale Average SD Functional scales Body image 62.17 21.56 Sexual functioning 31.67 36.51 Sexual enjoyment 30.00 34.97 Future perspective 36.00 34.71 Overall functional score 74.75 20.78 Symptom scales/items Systemic therapy side effects 37.38 13.82 Arm symptoms 23.78 21.54 Breast symptoms 15.42 15.56 Overall symptom score 28.80 12.79 The QoL score of functions according to QLQ- 12.79, highest score was found in systemic therapy BR23 was 74.75 ± 20.78 including the highest side effects at 37.38. score of body image at 62.17. The QoL score on The linear regression model was used to analyze symptoms according to QLQ-BR23 was 28.80 ± the association of QoL by QLQ BR23 & EQ-5D-5L 74 Journal of Clinical Medicine - No. 72/2021
5. Hue Central Hospital and several factors. The QoL by QLQ-BR23 and its presented in table 5. Exercising, participation in correlated factors were presented in Tables 3 and 4. social activities were common correlated factors to The QoL by EQ-5D-5L and its related factors were QoL measured by either EQ-5D-5L or QLQ-BR23. Table 3: Linear regression model between functional score of QoL according to the QLQ BR23 scale and several related factors Regression Characteristics 95% confidence interval P coefficient B Constant 147.647 119.039 176.256 < 0.001 Marital status (vs married) Widow/single/divorce/separated - 1.200 - 9.743 7.342 0.781 Chronic disease (compared to no disease) Yes - 17.351 - 24.792 - 9.910 < 0.001 Self-assessment of health status (compared to well-being) Unwell - 2.446 - 9.978 5.085 0.520 Exercising (vs doing exercise) No - 11.768 - 20.120 - 3.417 0.006 Participation in social work (vs participation) No participation - 13.720 - 22.104 - 5.336 0.002 Meeting family, relatives, neighbors (vs meeting) No - 1.306 - 8.471 5.859 0.718 Chronic diseases, not exercising, not participating in social work activities were factors that reduce the functional score of QoL Table 4: Linear regression model between The QoL score on symptoms according to the QLQ BR23 and some related factors Regression Characteristics 95% confidence interval P coefficient B Constant - 35.86 - 54.923 - 16.248 < 0.001 Depression (compared to no risk) At risk 1.679 - 3.115 6.473 0.488 Anxiety (vs no risk) At risk 7.784 3.098 12.470 0.001 Stress (vs no risk) At risk 8.920 4,588 13.251 < 0.001 Acute symptoms (vs asymptomatic) Symptomatic 1.310 - 2.686 5.305 0.517 Chronic disease (vs no comorbidity) Co - morbidity 4.475 0.204 8.746 0.040 Journal of Clinical Medicine - No. 72/2021 75
6. Assessment of the quality of life of breast cancer patients afterBệnh one viện year Trung of treatmentương Huế Self - assessment of health status (compared to well - being) Unwell 4.318 0.208 8.429 0.040 Exercising (vs exercise) None 4.608 0.252 8.963 0.038 Participation in social work (vs participation) None 4.366 0.037 8.695 0.048 Living situation (compared to living with family) Live alone 5.161 - 2.374 12.696 0.177 Patients with co - morbidity, at risk of anxiety, at risk of stress, not exercising, not participating in social work activities, self - assessing their poor health status were factors that increase symptom scores of quality of life. Table 5: Linear regression model between The QoL score according to the EQ-5D-5L and some related factors Regression Characteristics 95% confidence interval P coefficient B Constant 1.777 1.331 2.222 < 0.001 Self - assessment of health status (compared to well - being) Unwell - 0.130 - 0.202 - 0.059 < 0.001 Participation in social work (vs participation) None - 0.120 - 0.186 - 0.055 < 0.001 Marital status (vs living with husband) Widow/single/divorce/separated - 0.129 - 0.215 - 0.043 0.004 Depression (compared to the no - risk group) At risk - 0.111 - 0.185 - 0.037 0.004 Living situation (compared to living with family) To live alone - 0.041 - 0.189 0.107 0.584 Stress (compared to the no - risk group) At risk - 0.075 - 0.151 0.001 0.054 Chronic disease (vs no comorbidity) Co - morbidity - 0.051 - 0.126 0.023 0.172 Exercising (versus exercise) None - 0.079 - 0.156 - 0.001 0.047 Not exercising, risk of depression, no participation in social work activities, unwell at self-assess of their health status, widow/single/separated/divorced was associated to the reduction of functional score of quality of life. 76 Journal of Clinical Medicine - No. 72/2021
7. Hue Central Hospital IV. DISCUSSION cancer treatment is aimed at providing the best The quality of life in breast cancer patients after possible chance of recovery, the best treatments still more than one year of treatment at Hue University induce side effects even long-term ones. Therefore, of Medicine and Pharmacy Hospital was 0.6436, the problem of persisting symptoms after treatment similar to the study by Mathias Lidgren at Karolinska is unavoidable. Solna University Hospital (0.696) [7]. According to Through linear regression analysis, exercise figure 1, patients were more difficult in two aspects: improves the quality of life of breast cancer patients pain/discomfort (82%), and anxiety/depression (83%). on the QLQ-BR23 and EQ-5D-5L scales. A study Compared with the Ethiopian QoL study of breast in 2016 by Fatemeh Shobeiri in Iran showed that cancer patients using the EQ-5D-5L scale, the two exercise intervention was positively associated most common problems were also pain/discomfort with both functional and symptomatic aspects of (54.7%) and anxiety/depression (40.3%) [8]. The quality of life. At the same time, research by Thais similarity in these two issues may be due to physical R. S. Paulo in Brazil in 2019 also demonstrated pain and side effects of the treatment, and their the benefits of an exercise program to improve worries about their health. However, there was a the quality of life of breast cancer patients[10]. In difference in the pain/discomfort level between contrast, sedentary behavior was associated with the two studies, specifically, the Vietnamese have poorer quality of life in breast cancer patients [11]. a higher level of pain/discomfort. It may come from Physical activity and exercise contribute to reducing the difference in disease stage, method of treatment, the risk of breast cancer progression and recurrence human characteristics between Asia and Africa, and the and reducing breast cancer mortality [3]. Our results different interviewing time during or after the treatment. were consistent with studies and evidence on the For the quality of life according to the QLQ- effects of exercise on the quality of life of breast BR23 scale, the functional score was 74.75 ± 20.78 cancer patients. including body image was 62.17; sexual function In addition, breast cancer patients who did not was 31.67; sexual enjoyment was 30.00; future participate in social work activities have a lower perspective was 36.00. Our study results were quality of life than those who did. Patients who similar to the author Pham Dinh Hoang in Ho Chi self - assessed their health at an unhealthy level Minh City in 2019 and the study of Selamawit have a lower quality of life than those who self - Gebrehiwot Sibhat in 2019 [4]. It may be explained evaluate at the healthy level on the QLQ-BR23 that patients diagnosed with breast cancer suffer and EQ-5D-5L scales. Research by Doan Vuong from many psychological and physical problems. Diem Khanh in Hue in 2016 also showed that During the treatment, most patients just want to when participating in social work activities such as focus on the treatment and to get recovery quickly, going to church, going to pagodas, participating in so they don’t care so much about other issues such clubs, unions, and associations, the quality of life as sex. The sexual health of breast cancer patients on both physical and mental aspects was better than is much worse than that of patients without breast those who did not [12]. Participating in social work cancer [9]. Furthermore, women with breast cancer activities allows them to exchange, chat and share, not only have to deal with the shock of their which will contribute to reducing stress, anxiety, appearance but also to cope with the fear of being and sadness about the disease. Therefore, patients ignored by their partner and losing their femininity. who participate in these activities can improve The QoL on symptom score according to QLQ- their health leading to higher quality of life scores BR23 was 28.80 ± 12.79: for systemic side effects than those who do not participate. It can be seen was 37.38 points, brachial symptoms were 23.78 that, when the patient feels unwell, not only the points, breast symptoms were 15, 42 points. Though physical health causes (from the effects of breast Journal of Clinical Medicine - No. 72/2021 77
8. Assessment of the quality of life of breast cancer patients afterBệnh one viện year Trung of treatmentương Huế cancer symptoms and accompanying diseases) but Therefore, the group of widowed/single/divorced/ also affects the mental and psychological health of separated breast cancer patients had a lower quality the patient. This makes the patient more worried, of life than the group of breast cancer patients living thinking more about health and disease. Therefore, with their husbands. affecting the quality of life in a negative direction. Additionally, when multivariate linear analysis Chronic disease is an important determinant of quality of life score on the EQ-5D-5L scale of quality of life. The results of our study also found that the group of breast cancer patients at showed that patients with comorbidities have a risk of depression had a lower quality of life score reduced quality of life score compared to those than the group without risk depression. On the who did not have comorbidity. According to the QLQ-BR23 scale, an association between anxiety, results of a study by Daniel Sat-Muñoz in Mexico stress, and QoL score on symptoms was found. in 2011, it was found that breast cancer patients Breast cancer patients may experience anxiety with comorbidities were affected by side effects and depression due to coping with pain, treatment of breast cancer treatment higher than patients regimens, financial burdens, and disruption to work without comorbidities [13]. Similarly, Juan Xia’s and life for themselves and their families. Research study in China in 2018 also found that the group by Pham Minh Khue in Hai Phong in 2020 found of patients with chronic diseases had a higher an association between depression and quality of symptom score of quality of life leading to lower life in lung cancer patients on the same EQ-5D- QoL [14]. Thus, patients are not only affected by 5L scale [15]. Research by Akel, R in the US in breast cancer but also by their chronic diseases, 2017, depression, anxiety, and stress are factors which degrade the patient’s health and at the that adversely affect the quality of life of breast same time aggravate both QoL on symptoms and cancer patients [16]. Therefore, early detection and functions of breast cancer according to the QLQ- intervention of depression, anxiety, and stress can BR23 scale. help improve the quality of life for patients. Widow/singleness/divorce/separation was negatively associated with aspects of psychological health, V. CONCLUSION social relationships, and quality of life [7]. In The quality of life of breast cancer patients contrast, the group of married breast cancer patients according to the QLQ-BR23 and EQ-5D-5L scales living with their husbands was found to have a was at an average level. There was a statistically better quality of life than the group of single/ significant correlation between doing exercise, divorced/widowed breast cancer patients. This can social work participation, self - assessment of health, be explained by the spiritual and emotional support risk of depression, anxiety, stress, and quality of life and the husband’s role in life and health care. of study subjects. REFERENCES 1. Sung H., Ferlay J., Siegel R.L., et al. (2021). 3. Shobeiri, F., Masoumi, S. Z., Nikravesh, A., Global Cancer Statistics 2020: GLOBOCAN Moghadam, R. H., & Karami, M. (2016). The Estimates of Incidence and Mortality Worldwide impact of aerobic exercise on quality of life for 36 Cancers in 185 Countries. CA Cancer J in women with breast cancer: a randomized Clin, 71(3), 209-249 controlled trial. Journal of research in health 2. IARC (2020). Globocan. < sciences, 16(3), 127. today/data/factsheets/populations/704-viet- 4. Hoàng, P.Đ, Quỳnh, Đ.V, Thắng, V.V (2019), nam-fact-sheets.pdf “Đánh giá chất lượng cuộc sống của bệnh nhân 78 Journal of Clinical Medicine - No. 72/2021
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