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Oman Medical Journal 2009, Volume 24, Issue 3, July 2009

Quality of Life in Cancer Patients undergoing Chemotherapy

Ali Dehkordi,1 M. Saeed Heydarnejad,2 Daryoush Fatehi3

Introduction

According to the World Health Organization (WHO), quality

o lie (QoL) is dened as individual perception o lie, values,

objectives, standards, and interests in the ramework o culture.QoL is increasingly being used as a primary outcome measure

in studies to evaluate the eectiveness o treatment.1-4 Patients

generally instead o measuring lipoprotein level, blood pressure,

and the electrocardiogram, make decisions about their health

care by means o QoL which estimates the eects on outcomes

important to themselves.5

An increasingly important issue in oncology is to evaluate

QoL in cancer patients.6 Te cancer-specic QoL is related to

all stages o the disease.7,8 In act, or all types o cancer patients

general QoL instruments can be used to assess the overall impact

o patients’ health status on their QoL, however hand cancer-

specic instruments assess the impact o a specic cancer on QoL.6

In some cancer diseases (glioma or instance), QoL has become

an important endpoint or treatments comparison in randomized

controlled trials so that in these patients clinical studies increasingly

incorporate QoL as the endpoint.9

Te main problems acing long-term cancer survivors are

related to social/emotional support, health habits, spiritual/

philosophical view o lie, and body image concerns.10-13 Many

studies have shown good or adequate overall QoL in these cancer

patients. However, among long-term survivors, psychosocial issues

and physical symptoms such as pain and lymphedema, particularly

the adverse eects o systemic adjuvant therapy (chemotherapy) on

QoL still persist.11-14 Te aim o this study is to evaluate the QoL

in cancer patients with solid tumors at dierent chemotherapy

cycles.

Methods

A total o 200 cancer patients were included in this present analysis.

Te study was conducted in ehran hospital. Beore taking part in

the study, subjects lled out a QoL questionnaire, and a ormal

consent was obtained rom all o them. Following Chen et al. 2008,

i the ollowing criteria met by the patients, then they were invited

to participate: (1) diagnosed with solid tumors, (2) planning toreceive chemotherapy, (3) no history o other chronic disease such

as diabetic or heart disease, and (4) aged 18 years or older.15 With

some modication, the European Organization or Research and

reatment o Cancer QoL Questionnaire (EORC QLQ-C30)

was used to measure QoL in the patients. Te test consisted o 56

questions and was arranged into ve domains (able 1): (a) physical,

role, cognitive, emotional, and social unctioning demographic

data as well as cancer/treatment inormation (b) patient’s general

conditions (c) patient’s physical activities (d) social status and

occupational unction and (e) sleep pattern.

Abstract

Objectives: Te objective o this study is to describe the qualityo lie (QoL) in cancer patients with solid tumors and at dierent

chemotherapy (C) cycles.

Methods: A total o 200 cancer patients were included. With

some modication, the European Organization or Research and

reatment o Cancer QoL Questionnaire (EORC QLQ-C30)

was used to measure QoL in the student patients.

Results: Tere was no correlation between the QoL and variables

such as age, sex, marital status, duration o disease, economic

conditions, and occupational unction. Furthermore, no

correlation was ound between QoL and the patients’ educational

level (literate or illiterate). Nevertheless, a signicant dierence

was ound between the level o QoL in patients with ≤ 2 C

cycles and/or with 3-5 cycles (p< 0.001).

Conclusion: Tis study suggests that encouraging cancer patientsto complete a C course plays an important role in the treatment

outcome and the QoL in cancer patients undergoing C.

From the 1Nursing Faculty, Shakrekord Medical University, Shakrekord, Iran2Department of Biology, Shahrekord University, Sharekord, Iran 3Dept. of Medical

& Surgical Nursing, Shahrekord University of Medical Sciences, Shahrekord, Iran.

Received: 21 April 2009

Accepted: 15 May 2009

Address correspondence and reprint request to: Dr. Saeed Heydarnejad, Department

of Biology, Shahrekord University, Shahrekord, Iran.E-mail: [email protected]

Dehkordi A, et al. OMJ. 24, 204-207 (2009); doi:10.5001/omj.2009.40




Table 1: Te Scores used to evaluate QoL in Cancer Patients

undergoing C (N=200).ScoresDomain

FavorableFairlyfavorable

Nonfavorable

85-11554-8423-53Patients general conditions

38-5526-3711-25Physical activities

52-7033-5114-32Social status & Occupationalunction

28-4017-278-16Sleep pattern

207-280131-20656-130Quality o lie

With the aid o a nurse and/or a medical student, thequestionnaires were lled out during interview. Each question had

Quality of Life in Cancer... Dehkordi et al.

an equal value and the QoL was quantied as the sum o the scoresor all domains. Te scores were classied into three categories,namely; avorable, airly avorable, and avorable. Te higher scoreson this scale represent a better QoL. Te χ2 test was used to ndthe correlation o the clinical variables and QoL scores using theSPSS sotware (version 14). Te level o signicance was set at p <0.05 or all tests.

Results

Demographic and cancer/treatment inormation o the 200patients are presented in table 2. Te majority o patients (54.5%)were male, aged 18-75 years, with a mean age o 46.2 (650%),unmarried (44%), primary school graduates (65%), and hadinsufcient income (79.5%). GI (gastrointestinal) cancer at stageIII was the most common cancer, accounting or 35-40% in all thepatients.

Table 2: Demographic and Cancer/reatment in Cancer Patients undergoing C (N=200)

ValueVariableValueVariable

35%GI systemCancer type

46.15Mean age

65%Other systems54.5%maleGender

6.5%I

Cancer stage

45.5%emale

31%II44%yesMarital status

35.5%III56%no

27%IV65%yesEducation85%yes

Knowledge about disease35%no

15%no46.5%yesJob position

91%yesDisease acceptance

53.5%no

9%no20.5%yesSufcient income

61.5%year 1<Extent o disease

79.5%no

39.5%≤ year 116%yesSupport by charity organizations

27.5%≥ 2

Number o CT sessions

%48no

41.5%3-597%yesHealth insurance

31%6 ≥3%no

Most o the patients (85%) were aware o their disease. Findings about QoL in the rest o our domains are depicted in table 3. Temost common problems in regard to this category were: ear about uture (29%), thinking about the disease and its consequences (26.5%),

impatience (24%), and depression (17.5%). Te QoL was airly avorable in majority (66%) o the patients. Tere was no correlation

between the QoL and variables such as age, sex, marital status, duration o disease, economic conditions, and occupational unction.

Furthermore, no correlation was ound between QoL and the patients’ educational level (literate or illiterate).

Table 3: Frequency and Percentages o Cases in Dierent Domains regarding QoL in Cancer Patients undergoing C (N=200)

Number of patientsDomains

FavorableFairly favorableNon favorable

(54%) 108(45%) 90(1%) 2Patients general conditions

(22.5%) 45(74.5%) 149(3%) 6Physical activities

(78.5%) 157(19.5%) 39(2%) 4Social status & Occupational function(58%) 116(28.5%) 57(13.5%) 27Sleep pattern

(23%) 46(66%) 132(11%) 22Quality of life





QoL are perhaps the main objectives o medical care, this study

showed that improvement o QoL in cancer patient can be carried

out by means o C.10

In act, improving QoL is as important asthe survival benet that a pharmacological treatment may provide.

However, this is not always the case. For example, Nemati et al.

reported that the level o QoL in patients with leukemia was 87.5%

lower than that in the control group.21 Te dierences may be

due to dierent patients’ population (sample size or patient age),

or cancer types. Te current study selected patients (aged ≥ 18

years) with various solid tumors while Nemati et al sampled 40

adolescence patients (aged < 18 years) with leukemia. 21

In this study, the majority o the patients (68%) who had

completed 3 or more cycles o C reported a airly avorable or

avorable level o QoL (able 4). Tis may show that QoL is directlyrelated to cancer treatment procedure, i.e. C. Likewise, except

or a small group (13.3%) o the patients reported that their sleep

pattern was not avorable, the others had good QoL. Tis implies

that C can lead to the better sleep pattern in cancer patients. Te

results are consistent with other studies. For instance, Chen et al.

ound that QoL in lung cancer patients during the ourth cycles

o C improved slightly over the baseline values; the patients

perceived more sleep disturbances during the early cycles o C.15

Similar results have been ound in patients suering rom advanced

cancer by Mystakidou and rom breast cancer by Fortner.2,22

Te ndings o the present study showed that there was no

correlation between QoL and age, gender, social status, marriage,

and job. Similar results have been reported by Nematollahi,

Vedat et al. and Rustøen studies.25,16,2 Furthermore, there was no

correlation between the extent o the disease and QoL. In contrast,

Rustøen and Holzner in two separate studies ound that the extent

to which QoL o cancer patients depends on the time elapsed since

initial treatment; with an increase in the extent o the disease, a

decrease in the QoL was observed. Te dierence may be due to

the duration o the disease; the extent o the disease, in 87% o the

patients rom the current study was less than two years whilst itwas more than 2 years in Rustøenand Holzner studies. 25.26

Conclusion

Cancer is an important health issue inuencing QoL. An

appropriate treatment which may provide care to the cancer patients

is C. Te obtained results here indicate a strong correlation

between QoL and number o C cycles in cancer patients. Since

C is social ly stigmatized in some countries e.g. Iran, encouraging

patients to complete a C course may play an important role in the

treatment outcome and the QoL o cancer patients.

Te relationship between QoL and the number o C cycles

is demonstrated in able 4. As shown, majority (66%) o the

patients had airly avorable QoL. A strong correlation was oundbetween QoL and number o C cycles. Nevertheless, a signicant

dierence was ound between the level o QoL in patients with ≤ 2

C cycles and/or with 3-5 cycles (p< 0.001). Tis was also the case

or the level o QoL in patients with ≥ 6 cycles (p< 0.001).

Table 4: Frequency o C Cycles regarding QoL in Cancer patients

undergoing C (N=200); In Each Case p<0.001

SumQuality of life

Number of CT cycles favorable

fairlyfavorable

Non-favorable

(27.5%) 55(16.4%) 9(67.2%) 37(16.4%) 9≤2

(41.5%) 83(13.3%) 11(77.1%) 64(9.6%) 83-5

(31%) 62(41.9%) 26(50%) 31(8.1%) 56 ≤

(100%) 200(23%) 46(66%) 132(11%) 22otal

Discussion

QoL reers to “global well-being,” including physical, emotional,

mental, social, and behavioral components. In the last ew years, a

number o inormative and valid QoL tools have become available

to measure health-related QoL.

6

Te most widely applicableinstrument to measure the QoL in cancer patients is the EORC

QLQ-C30. Using this method, the current study assessed the QoL

in cancer patients undergoing C. Several studies also support

these ndings on the inuence o C on good or adequate QoL

among the cancer patients undergoing C.

For instance, Nematollahi showed in patients suering rom

lymphatic tumors that there was a positive correlation between C

and QoL. Likewise, the QoL o Arican American women with

breast cancer was ound to be relatively high; cancer recurrence

and metastasis to the lymphatic glands had signicant eect on the

QoL.17 It has also been shown that C had a measurable adverseeect on QoL in women with node-positive operable breast

cancer.18 Te results rom this current study indicate that C may

improve the QoL in cancer patients.

Currently, QoL has been introduced as an endpoint or

treatment comparisons in many cancer types, particularly in

advanced stages.19 QoL also, as an early indicator o disease

progression could help the physician in daily practice to closely

monitor the patients.20 QoL may be considered to be the eect o

an illness and its treatment as perceived by patients and is modied

by actors such as impairments, unctional stress, perceptions and

social opportunities.3, 4

As reducing mortality and ensuring optimal health-related




Acknowledgements

Te authors would like to thank the sta members o radiation

oncology departments in ehran University o Medical Sciences.

We also appreciate Dr. K. Shaei or her psychological consults

and Mr. A. Mehrban or his statistical consults

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