Quality of Life and Social Support in Cancer Patients Undergoing Outpatient Chemotherapy in Turkey
- 1. Department of Nursing, Adnan Menderes Üniversitesi, Turkey
Absract
The aim of the present study was to evaluate the relationship between quality of life and perceived social support in patients undergoing outpatient chemotherapy. The study was designed as descriptive. It was conducted in the oncology outpatient chemotherapy units of one university hospital, in a city west Anatolia, Turkey. There was a correlation between the mean perceived social support score and the mean subscale scores of the Short-Form Health Survey (SF-36) in cancer patients. The mean perceived social support score was positively correlated with physical functioning (p=0.012), physical role functioning (p=0.049), vitality (p=0.009), emotional role functioning (p=0.006), general health perceptions (p=0.008), and mental health subscale scores of the SF-36 (p=0.005).
As the level of perceived social support increased, the quality of life of the cancer patients undergoing outpatient chemotherapy increased.
Keywords
Social support, Quality of life, Cancer, Outpatient chemotherapy
Citation
Güne? Z, Çal???r H (2016) Quality of Life and Social Support in Cancer Patients Undergoing Outpatient Chemotherapy in Turkey. Ann Nurs Pract 3(7): 1070
INTRODUCTION
Cancer is a major health problem adversely affecting physical, psychological, and social aspects of individuals’ lives and impairing the quality of life [1-3]. Social support is one of the most important factors in coping with the psychological and physiological effects of cancer and its therapy [1-3]. Social support, which can be defined as the cumulative support provided by family members, friends, professionals, and members of the same social network, has positive effects on life satisfaction, happiness, as well as physical well-being [1-4]. If a high level of social support is provided under conditions of elevated stress, a reduction is observed in psychological and physiological symptoms [1-6].
Studies conducted on patients with cancer have revealed that social support decreases the psychological problems and hopelessness, while increasing the quality of life [1-7]. A study conducted by Gustavsson-Lilius et al., (2007) reported that women with cancer with higher levels of perceived support from their husbands, had better quality of life, and took a more positive approach to the disease. Fernandes et al. (2014) note that the cancer treatment leads to many situations that may threaten the psychosocial integrity of those affected by the disease.
The current study was designed to determine the relationship between perceived social support and quality of life in patients undergoing outpatient chemotherapy. Since such patients stay at home after the administration of chemotherapy, their requirement for social support increases. It was anticipated that their quality of life would be improved in parallel with perceived social support.
MATERIALS AND METHODS
Research design and sample
The current descriptive and cross-sectional study was conducted on 102 patients, who were admitted to the Practice and Research Hospital of University. Data were collected between October 2007 and April 2009. The inclusion criteria were as follows: having undergone at least one session of chemotherapy. The exclusion criterion was being in the terminal stage of disease.
Data collection tools
Data collection tools used to obtain patient information were as follows: Patient Information Form (age, gender, education, occupation, marital status, financial concerns, and health insurance status, diagnoses, types of assistance with activities of daily living, and duration of chemotherapy), Perceived Social Support from Family Scale, and Short Form (36) Health Survey (SF-36; 20).
Perceived social support from family Scale (PSSFS)
The scale was developed by Procidano and Heler. The Turkish validity and reliability of the scale was performed by Eskin. The total score ranges from a minimum score of “0” to a maximum score of “20”. Higher scores indicate higher social support from the family [8]. The test-retest reliability was calculated to be 0.85 and the Cronbach’s alpha value was 0.73. The scale was utilized in a study conducted on cancer patients by [9].
The short form (36) health survey (SF-36)
The SF-36 consists of 8 subscales. Subscales evaluate health status with scores ranging from 0-100, with “0” indicating worst health status and “100” indicating best health status. The scale was developed to evaluate quality of life by Ware in 1992 [10], translated the SF-36 into the Turkish language and tested its validity and reliability [10,11], reported the Turkish version of the SF-36 was a suitable instrument that could be employed in cancer research in Turkey. The reliability of the scale in cancer was performed P?nar.
Data Collection
Preliminary interviews were conducted with patients, who were admitted to the Practice and Research Hospital of University for outpatient chemotherapy sessions, and these patients were invited to participate in the study. Appointments for home interviews were made with those consenting to participate. Data collection forms were filled by face-to-face interviews at the homes of the patients.
Statistical Analysis
Statistical analysis was conducted using SPSS for Windows (version 15.0; SPSS Inc., Chicago, IL, USA). Normally distributed data were analyzed using the two-tailed Pearson’s correlation test to evaluate the relationship between the eight subscale scores of the SF-36 and perceived social support, while nonnormally distributed data were analyzed using the two-tailed Spearman’s test.
RESULTS
Correlations between the mean perceived social support score and the mean subscale scores of the SF-36 are presented in Table 4. Analyses revealed positive, significant, but very weak correlations between the mean perceived social support score and physical functioning, vitality, and physical role functioning scores. Similarly, weak, positive, and significant correlations were noted between the mean perceived social support score and general health perceptions, emotional role functioning, and mental health scores.
The mean age of the patients was 56.43±12.27 years (range, 19-81 years). Of the patients, 52% were males. The majority of the patients were married. Greater than one-half of the patients were primary school graduates. Approximately one-half of the patients were retired and greater than one-half of the patients complained of financial difficulties. The majority of the patients (n=42) received chemotherapy for 0-2 months, followed by 40 patients receiving outpatient chemotherapy for 3-4 months (Table 1).
It is presented in Table (2) that the mean social support score that the men perceived is significantly higher than the women (M-WU=. 853.0; Asymp Sig= 0.003).
It was found that there was a significant correlation between age and physical functioning subscale score of quality of life, and as age increased, physical functionality decreased. When it was analyzed by gender, quality of life, physical functioning, physical role difficulty, vitality, emotional role difficulty, general health and mental health subscale mean scores of the women were found to be significantly lower than the men. It was determined that the married ones had less emotional role difficulty than the single ones, and the difference was significant. It was found that as the duration of chemotherapy extended, the patients had more social role difficulty, and there was a statistically significant difference, and this statistically significance stemmed from the difference between the ones undergoing chemotherapy for 0-2 months and for 5 months and over. It was found that there was a statistically significant difference between vitality and emotional role difficulty subscale mean scores of the patients according to cancer types, and this statistically significance stemmed from the difference between breast cancer patients and lung cancer patients. Vitality and emotional role difficulty subscale mean scores of the breast cancer patients were found to be significantly lower than the lung cancer patients (Table 3).
Table 1: Sociodemographic and disease-related characteristics of the patients (n=102).
| Descriptive characteristics | |
| Age (years) Mean ± SD (Range) | 56.43±12.27 (19-81) |
| Gender n (%) | |
| Female | 49 (48) |
| Male | 53 (52) |
| Marital status n (%) | |
| Married | 86 (84.3) |
| Single | 16 (15.7) |
| Educational level n (%) | |
| Illiterate | 18 (17.6) |
| Primary | 58 (56.9) |
| High School and University | 26 (25.5) |
| Occupation n (%) | |
| Housewife | 43 (42.2) |
| Government employee | 5 (4.9) |
| Self-employed | 6 (5.8) |
| Retired | 46 (45.1) |
| Student | 2 (2.0) |
| Financial difficulty n (%) | |
| Yes | 54 (52.9) |
| No | 48 (47.1) |
| Duration of chemotherapy n (%) | |
| 0-2 months | 42 (41.2) |
| 3-4 months | 40 (39.2) |
| 5 and over | 20 (19.6) |
| Diagnosis/cancer type n (%) | |
| Lung Ca | 24 (23.5) |
| Digestive Ca | 33 (32.4) |
| Breast Ca | 35 (34.3) |
| **Others | 10 (9.8) |
| Type of chemotherapy n (%) | |
| Alkylating agents | 11 (10.8) |
| Antimetabolites | 19 (18.6) |
| Vinca alkaloids | 11 (10.8) |
| Antimetabolites + Vinca alkaloids | 10 (9.8) |
| Anti-tumor antibiotics + Vinca alkaloids | 16 (15.7) |
| Anti-tumor antibiotics + Alkylating agents | 16 (15.7) |
| Alkylating agents + Antimetabolites | 19 (18.6) |
| Session of chemotherapy Mean ± SD | 3.5 ± 2.31 |
| * One worker was included in the government employee group. **Lymphoma, mesothelioma, reproductive cancers |
|
Table 2: Differences in descriptive characteristics of perceived social support (n=102).
| Descriptive characteristics | |||
| Age | Pearson correlation= -0.077; p= 0.441 |
||
| Gender | Mean rank | Test value, | p |
| Female | 42.41 | MWU= 853.0 | 0.003 |
| Male | 59.91 | ||
| Marital status | |||
| Married | 53.71 | MWU= 498.0 | 0.079 |
| Single | 39.63 | ||
| Educational level | |||
| Illiterate | 39.97 | KW= 3.742 | 0.154 |
| Primary | 55.30 | ||
| High School and university | 51.00 | ||
| Financial difficulty | |||
| Yes | 54.19 | MWU= 1151 | 0.328 |
| No | 48.48 | ||
| Duration of chemotherapy | |||
| 0-2 months | 49.46 | KW= 0.369 | 0.832 |
| 3-4 months | 53.36 | ||
| 5 and over | 52.05 | ||
| Diagnosis/cancer type | |||
| Lung Ca | 61.21 | KW=3.501 | 0.321 |
| Digestive Ca | 49.12 | ||
| Breast Ca | 48.63 | ||
| Others | 46.10 | ||
| Session of chemotherapy | Pearson correlation=0.038; p=0.706 |
||
| Lymphoma, mesothelioma, reproductive cancers | |||
Table 3: Differences in descriptive characteristics of quality of life subscale scores (n=102).
| Descriptive characteristics |
Physical functioning |
Physical functioning |
Bodily pain | General health perceptions |
Vitality | Social functioning |
role functioning |
Mental health |
| Age *r; p value |
0.246;0.013 | -0.044;0.663 | 0.142;0.153 | -0.040;0.692 | 0.010;0.924 | -0.002;0.981 | -0.029;0.776 | 0.029;0.775 |
| Gender n | ||||||||
| Female | 43.43 | 46.55 | 49.97 | 43.54 | 42.60 | 47.80 | 43.98 | 44.86 |
| male | 58.96 | 56.08 | 52.92 | 58.86 | 59.73 | 54.92 | 58.45 | 57.64 |
| MWU; p value | 903; 0.008 | 1056; 0.024 | 1223; 0.607 | 908; 0.009 | 862; 0.003 | 1117; 0.219 | 930; 0.002 | 973; 0.029 |
| Marital status | ||||||||
| Married | 53.60 | 52.94 | 49.62 | 52.34 | 53.06 | 51.95 | 53.78 | 53.12 |
| Single | 40.22 | 43.75 | 61.59 | 49.97 | 43.09 | 49.09 | 39.22 | 42.78 |
| MWU; p value | 507; 0.096 | 2.521;0.112 | 2.317;0.128 | 0.446;0.504 | 1.546;0.214 | 0.128;0.720 | 4.958;0.026 | 1.652;0.199 |
| Educational level | ||||||||
| Illiterate | 44.11 | 50.08 | 49.97 | 40.97 | 47.86 | 57.42 | 46.17 | 47.78 |
| Primary | 54.67 | 51.09 | 54.04 | 55.82 | 55.52 | 53.21 | 50.33 | 53.72 |
| ≥High School | 49.54 | 53.38 | 46.88 | 49.15 | 45.06 | 43.60 | 57.81 | 49.13 |
| KW; p value | 1.911;0.385 | 0.305;0.858 | 1.163;0.559 | 3.686;0.158 | 2.597;0.273 | 2.824;0.244 | 2.817;0.245 | 0.778;0.678 |
| Financial difficulty | ||||||||
| Yes | 46.61 | 51.43 | 47.23 | 47.98 | 48.84 | 49.60 | 48.58 | 47.53 |
| No | 57.00 | 51.58 | 56.30 | 55.46 | 54.49 | 53.64 | 54.78 | 55.97 |
| MWU; p value | 1032;0.076 | 1292;0.970 | 1065; 0.113 | 1106; 0.202 | 1152; 0.334 | 1193; 0.488 | 1138; 0.193 | 1081; 0.150 |
| Duration of chemotherapy | ||||||||
| 0-2 months | 53.58 | 51.54 | 54.13 | 52.35 | 52.24 | 60.10 | 49.90 | 52.33 |
| 3-4 months | 48.94 | 52.65 | 49.05 | 51.65 | 52.36 | 45.43 | 52.19 | 51.63 |
| 5 and over | 52.25 | 49.13 | 50.88 | 49.43 | 48.23 | 45.60 | 53.48 | 49.50 |
| KW; p value | 0.523;0.770 | 0.367;0.832 | 0.645;0.724 | 0.134;0.935 | 0.308;0.857 | 6.148;0.046 | 0.353;0.838 | 0.126;0.936 |
| Diagnosis/cancer type | ||||||||
| Lung Ca | 56.48 | 54.69 | 44.08 | 59.90 | 63.27 | 50.06 | 51.38 | 57.58 |
| Digestive Ca | 56.47 | 56.70 | 56.50 | 54.47 | 53.09 | 54.91 | 59.91 | 56.70 |
| Breast Ca | 42.13 | 46.07 | 51.91 | 44.89 | 40.87 | 47.67 | 42.49 | 42.74 |
| Others** | 55.95 | 45.70 | 51.35 | 54.60 | 55.20 | 57.10 | 55.60 | 50.40 |
| KW; p value | 5.370;0.147 | 5.536;0.136 | 2.578;0.461 | 3.799;0.284 | 8.644;0.034 | 1.468;0.690 | 9.260;0.026 | 5.126;0.163 |
| Session of chemotherapy | ||||||||
| r; p value | 0.009;0.930 | -0.051;0.609 | -0.038;0702 | -0.002;0.988 | 0.016;0.871 | -0.146;0.142 | 0.057;0.569 | -0.049;0.625 |
| Pearson correlation value **Lymphoma, mesothelioma, reproductive cancers | ||||||||
Table 4: Correlations between the perceived social support scores and quality of life subscale scores (n=102)
| Quality of life subscale scores |
Perceived social support score (r) |
p |
| Physical functioning | 0.249* | 0.012a |
| Physical role functioning # | 0.210* | 0.034a |
| Bodily pain | 0.029 | 0.772 |
| General health perceptions | 0.261** | 0.008b |
| Vitality | 0.256* | 0.009b |
| Social functioning | 0.153 | 0.124 |
| Emotional role functioning | 0.278** | 0.005b |
| Mental health | 0.274** | 0.005 b |
| * Very weak correlation; **Weak correlation; a p<0.05; b p<0.01 r=Correlation coefficient; # = Spearman’s correlation | ||
DISCUSSION
Cancer treatment can damage the physical and mental health of patients and reduce their quality of life. Studies have demonstrated an association between increased levels of social support and quality of life [5,6,12]. This is the first study that evaluates quality of life and social support in Turkish cancer patients receiving outpatient chemotherapy.
It was found in some studies that female cancer patients had more emotional problems than male cancer patients, had physical limitations in their life, and their quality of life scores were lower compared to men [20]. Quality of life subscale mean scores of the women were found to be lower than men in our study. Within the scope of these findings, it can be said that gender is an important predictor of quality of life. Salander and Hamberg reported that there were differences in the self-expressions of the women and men diagnosed with cancer, and the men tended to report negative situations more positive, and therefore the women had more psychological problems than men, and quality of life of the women was worse. The reason why the quality of life of the women is worse in every aspect compared to men may be due to the social support perceptions, too. In our study, it is clear that the women perceive less social support from their family compared to men. The social support that the family has given is an important component of quality of life [22].
It was determined that the married ones had less emotional role difficulty than the single ones and the difference between them was significant [18], reported that the single patients receiving chemotherapy faced with more psychological problems than the married patients and that the single patients had less social support than the married patients might have caused this difference [23], stated that the social support provided by the partners was important in sustaining the quality of life. It was found in our study that the single patients perceived less social support compared to the married patients.
It is known that as the duration of chemotherapy extends, social functions of the patients are affected more [23]. It was determined in our study that as the duration of treatment extended, the patients had more social problem. It is thought that as the duration of treatment extends, the patients are forced to deal with more side-effects and their social roles are restricted.
It was found that the patients with breast cancer had more emotional role difficulty than the patients diagnosed with other kinds of cancer. The reason why the women with breast cancer had more role difficulty than the patients with lung cancer can be associated with the cancer’s being directly related to the femininity image [24].
Social support has long been considered a significant contributor to health and well-being [1,3-5,12]. If a high level of social support is provided under conditions of elevated stress a reduction in psychological and physiological symptoms is noted in researches [1-5,6,12,25,26]. A study reported that women with cancer with high levels of perceived support from their husbands had better quality of life, and took a more positive approach to the disease [6,27], reported that as the level of social and emotional support decreased, poor general health, and dissatisfaction with life, as well as physical and psychological problems increased. Another studies established a relationship between social support and the mental components of quality of life cancer patients [1,6,12,25,26]. In the current study, there was a positive correlation between perceived social support scores and general health perceptions, mental health, physical and emotional role subscale scores of the SF-36. Results of this study are consistent with findings reported in the broad literature on social support and better health [3,5,26-28]. This result can be explained that perceived social support from family members has a positive impact on quality of life. On the other hand, the perceived support of significant others, the perception of being cared for or loved and appreciated, can contribute to a positive feeling of health [5].
CONCLUSION
There was a relationship between the mean perceived social support score and the mean subscale scores of the Short-Form Health Survey (SF-36) in cancer patients. Quality of life of cancer patients undergoing outpatient chemotherapy can be increased by increasing social support from family members in home.
