Nico, Darlene Jasmine G.Panela, Fatima Ruby C.

Pangilinan, Carmela Mariz D. Paras, Ana Concepcion B.

Pasamba, EdmundoSalas, Julie Ann S.

Salayog, Kathereene M.Samama, Sittie Rizza Sambile, Mary Grace

Sancha, Carlo Henry A.

Georgina T. Paredes, M.D., MPH,

Adviser

Quality of Life (QoL) of Filipino Breast Cancer Patients in Various

Treatment Modalities: A Descriptive Study

INTRODUCTION

Worldwide, breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among women.

Malignant neoplasm is the 3rd leading cause of morbidity and mortality in the Philippines and breast cancer ranks 2nd among these malignancies. (DOH, 2007)

26 females out of 100 females and 1 male for every 105 males may be diagnosed with breast cancer in the Philippines. (Philippine Foundation for BREAST Care, Inc. (PFBCI), 2009)

INTRODUCTIONThe primary goal of breast cancer treatment is to assess the stage of the disease and to remove underlying masses within the affected breast/s (American Cancer Society; 2008)

Treatment decisions are based on the optimal modality for the stage and biological characteristics of the cancer, the patient’s age, preferences, and their effects on the quality of life of the patient (American Cancer Society; 2008)

INTRODUCTIONQuality of life is a descriptive term that refers to people’s emotional, social and physical well-being and their ability to function in the ordinary tasks of living.

It is measured using especially designed and tested instruments which quantifies people’s abilities to function in the ordinary tasks of living. (Psychooncology 2008)

QoL measures may therefore help to decide between different treatments, to inform patients about the likely effects of treatments, to monitor the success of treatments from the patient’s perspective, and to plan and coordinate care packages.

More attention to the reduction and management of disease and treatment-related symptoms could improve QoL among women with breast cancer.

External stressors (Ex.: finances, work, etc.) also contribute to the overall diminished quality of life in all treatments.

In the Philippines, there is an ongoing demand for research into the accompanying psychological effects of breast cancer treatments and this study accounts for the effects of chemotherapy, hormonal therapy and combined therapy on the quality of life specifically among Filipino breast cancer patients.

INTRODUCTION

OBJECTIVESDescribe the QoL of breast cancer patients undergoing chemotherapy, hormonal therapy and combination therapy along the following domains:

Physical stateMental/emotional stateStressLife enjoyment andOverall quality of life

To benefit both breast cancer patients and doctors in clinical decision-making, as it will consider the effects of specific therapeutic regimens on the patient’s quality of life.

Enable the family of those afflicted to better understand the effects of the disease on the overall wellbeing of their loved one.

SIGNIFICANCE OF THE STUDY

METHODOLOGYSTUDY DESIGN:

Descriptive Study

TARGET POPULATION: Diagnosed female breast cancer patients

undergoing either hormonal therapy, chemotherapy or combined therapy; treated or still undergoing treatment from different hospitals.

SIZE OF SAMPLE:(n=k2 SD2/d2)n = [(1.96) 2 x 352] / 122 = 33 respondents

METHODOLOGYPre-existing validated 55-item QoL questionaire entitled the “Health,

Wellness and Quality of Life Questionnaire” made by Dr. Terrie Lewine of the Back to Life Wellness Education Center in Philadelphia,

Pennsylvania.

Translated into Filipino by a licensed Filipino teacher who graduated from the Polythechnic University of the Philippines.

14 pre-tested translated questionnaires were administered last November 2008– January 2009 to female breast cancer patients

from Laguna, Nueva Ecija, Rizal and Metro Manila.

Ten 3rd year medical students researchers administered the questionnaires

METHODOLOGYINCLUSION: Diagnosed female breast

cancer patients (within in any stage of the disease) who have undergone or are undergoing either hormonal therapy, chemotherapy or combined therapy.

EXCLUSION:Not dx w/ diseaseMale breast cancer patientsDiagnosed with breast cancer but have not undergone any form of therapy yet.

Researchers coordinated with oncologists of the hospitals

Information gathered via the questionnaire.

36 out of 50 valid and fully-answered questionnaires by the eligible breast cancer patients were used as data for the research.

METHODOLOGY

Breast Cancer patients undergoing Hormonal

Therapy

Breast Cancer patients undergoing Chemotherapy

Breast Cancer patients undergoing Combined/Mixed

Therapy

Physical state

Mental/ emotional state

Stress evaluation

Life enjoyment

Overall Quality of Life

Physical state

Mental/ emotional state

Stress evaluation

Life enjoyment

Overall Quality of Life

Physical state

Mental/ emotional state

Stress evaluation

Life enjoyment

Overall Quality of Life

DATA AND RESULTS

Study population (36): Mean age of 49 years old

22% within hormonal therapy: mean age at 53 years old

50% within chemotherapy: mean age at 50 years old

28% within combined therapy: mean age at 45 years old

DATA AND RESULTS

0

0.5

1

1.5

2

2.5

3

Mode

1 2 3 4 5 6 7 8 9 10

Subtopics

Physical State

Hormonal Therapy

Chemotherapy

Combined Therapy

Respondent Mode Scores - Physical State[1-Physical Pain; 2-Spine Stiffness; 3-Fatigue; 4-Colds and Flu; 5-Headache; 6- Nausea; 7-Menstrual Pain; 8-Allergies; 9-Dizziness; 10-Accidents]

DATA AND RESULTS

0

0.5

1

1.5

2

2.5

3

Mode

1 2 3 4 5 6 7 8 9 10

Subtopics

Mental / Emotional State

Hormonal Therapy

Chemotherapy

Combined Therapy

Respondent Mode Scores – Mental/Emotional State1-How Painful; 2-Negative Feelings; 3-Moodiness; 4-Depression; 5-Worriness; 6-Concentration; 7-Anxiety / Fear; 8-Fidgety; 9-Sleep Problems; 10-Recurring Thoughts / Dreams

DATA AND RESULTS

Respondent Mode Scores – Stress Evaluation[1-Stress; 2-Significant Relationship; 3-Health; 4-Finances; 5-Sex Life; 6-Work; 7-School; 8-General; 9-Emotional; 10-Daily Coping]

DATA AND RESULTS

Respondent Mode Scores – Life Enjoyment[1-Openness; 2-Wellbeing; 3-Positive Feeling; 4-Interest; 5-Feeling of Being Open; 6-Level of Confidence; 7-Level of Compassion; 8-Satisfaction; 9-Feeling of Happiness; 10-Level of Satisfaction With Sex Life; 11-Time Devoted]

DATA AND RESULTS

Respondent Mode Scores – Overall QoL[1-Personal life; 2-Spouse/Significant Other; 3-Romantic Life; 4-Job/Work; 5-Co-workers; 6-The actual work you do; 7-TheA handling of problems in your life; 8-What you are accomplishing in life; 9- The way you look to others; 10-Self-evaluation of appearance; 11-Ability to adjust to change; 12-Life As A Whole; 13-Overall contentment; 14-Extent to which your life has been the way you want it]

DISCUSSIONPHYSICAL STATE:Our results showed physical pain to be the only prevailing trait within all 3 treatments. Nausea was predominantly experienced by the respondents under chemotherapyDizziness was experienced by all treatment groups, more so with combined therapySpine stiffness is mostly manifested by those on hormonal therapyFatigue and presence of colds and flu were more for respondents under chemotherapy.Fatigue was more present in patients under hormonal therapyHeadache results were higher in respondents under hormonal and chemotherapy

DISCUSSIONMENTAL AND EMOTIONAL STATE:

Respondents under hormonal therapy experienced more discomfort.

Negative feelings were more experienced by respondents under hormonal and combined therapy.

Moodiness was common under the three treatment modalities.

DISCUSSION

MENTAL AND EMOTIONAL STATE:

Depression is mostly felt by those on hormonal and combined therapy.

Worriness was seen in patients under chemotherapy and combined therapy as compared to hormonal therapy.

DISCUSSIONMENTAL AND EMOTIONAL STATE:

Difficulty concentrating was mostly experienced by patients under hormonal therapy

Our study showed that anxiety is mostly experienced by those on combined therapy.

Feeling restless or fidgety is occasionally experienced mostly in patients under hormonal therapy as compared to the two treatment modalities.

In our study, respondents under hormonal therapy mostly had sleep problems in contrast to chemotherapy and combined therapy.

DISCUSSION

MENTAL AND EMOTIONAL STATE:

Chemotherapy mostly had recurring thoughts and dreams as compared to combined therapy and hormonal therapy

DISCUSSIONSTRESS EVALUATION:

Our study showed that most patients under chemotherapy and combined therapy NEVER had problems with most of the subtopics under stress while those under hormonal therapy RARELY experienced it.

Family had a positive impact on patients under all therapy which was seen in our results wherein most chemotherapy and combined therapy respondents never had problems with family and most in hormonal therapy rarely encountered it

DISCUSSION

STRESS EVALUATION:

Hormonal therapy rarely dealt with problems regarding their significant others while respondents under chemotherapy and combined therapy never had problems with regard to it.

The respondents under hormonal therapy did not find sexual history applicable to them and those under chemotherapy and combined therapy did not have problems with it.

DISCUSSIONLIFE ENJOYMENT:Chemotherapy patients were more open to guidance of their inner voice/feelings. Hormonal therapy the greatest positive feelings about themselves.

Maintaining a healthy lifestyle was more important for those within hormonal and chemotherapy.

Hormonal therapy patients were the most confident.

Hormonal and chemotherapy patients were equally compassionate and accepting of others. Hormonal and combined therapy had higher feelings of satisfaction, happiness and they devoted more time to do things which they enjoyed.

DISCUSSION

OVERALL QUALITY OF LIFE:

Those within hormonal therapy had the highest scores toward having positive feelings about life as a whole and with regard to how life turned out as they wanted it.

Hormonal therapy group also showed a positive effect on both personal and interrelational factors

Chemotherapy respondents on the other hand had the highest scores only with regard to co-worker relationships.

DISCUSSIONOVERALL QUALITY OF LIFE:

Combined therapy results showed the highest scores of being mostly satisfied in the subsets involving romantic life, work, handling of personal problems, personal accomplishments, how one appears to others, self-evaluation, ability to adjust to change, contentment and life as a whole.

Chemotherapy, despite its adverse drug reactions and supposed effects of psychological distress, showed moderate to high results within this domain

CONCLUSION Physical state: Pain was the prevalent factor causing decreased QoL scores in all treatment modalities.

Mental/emotional state:Increased moodiness was the only constant factor across all treatments. Recurrent thoughts, dreams and negative feelings were high in the chemotherapy group and can be supported by its profound effects on the cognitive functioning of the patient.

Stress was markedly decreased in all three treatments, contradicting prior studies done which show otherwise, especially so in chemotherapy.

Overall QoL showed the highest scores within those in the hormonal therapy group.

LIMITATIONSResults can neither be generalized to breast cancer patients nor to specific ethnic groups across the country

Sample does not represent the whole Philippines based on sampling method employed in the study.

Breast cancer patients who were interested in participating were the only ones who completed the questionnaires

Some of the patients surveyed came from a foundation where treatment is paid for/ subsidized by the foundation itself making the burden of treatment considerably less, hence invariably having an effect on the quality of life.

Quality of life questionnaire was also based from a foreign study of chronic illnesses and neither solely intended for breast cancer patients nor to Filipino respondents.

Lack of budget to cover all the breast cancer patients in the country

RECOMMENDATIONSUse of Filipino culture-based questionnaires

Ask about their spiritual beliefs and the effects of these beliefs in their lives in times of hardships

Be expanded to a larger group that may include culturally diverse groups

Separate investigation is recommended to further evaluate the quality of life of patients on specific stages of breast cancer, especially those with metastatic cancers and the use of QoL as a predictor for survival.

Studies on the QoL of male breast CA patients can also be done

METHODOLOGYSOURCES OF DATA

UERM hospital at the private clinics of different oncologists (Dr. Gracieux Fernando & Dr. Joan Tagorda)UERM OPD-Surgery Department (Dr. Rafael Azares)Manila Doctors Hospital (Dr. Theresa Chauhdry & Dr. Villalon)Eduardo L. Joson Memorial Hospital – Nueva Ecija (Dr. Pamela Panela)Breast Cancer Foundation of East Avenue Medical Center (Mrs. Maria Lourdes V. Cortez & Dr. Elizabeth C. Pineda)