|Year : 2020 | Volume
| Issue : 1 | Page : 53-58
Quality of life of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia
Sultan Mohammed Alshehri1, Abdulrhman Faeq Alzamil1, Rayan Ibrahim Alturki1, Humoud Auoad Alhoraim1, Riyadh Ali Alghamdi1, Mohammed Salman Almutairi1, Emad Mohammad Masuadi2, Abdullah Mohammed Algarni3
1 King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministryc of National Guard Health Affairs, Riyadh, Saudi Arabia
2 Department of Medical Education, Research Unit, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
3 Section Head of Palliative Medicine, Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
|Date of Submission||30-Jun-2019|
|Date of Decision||07-Sep-2019|
|Date of Acceptance||27-Sep-2019|
|Date of Web Publication||06-Jan-2020|
Sultan Mohammed Alshehri
King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh
Source of Support: None, Conflict of Interest: None
Introduction: Measurement of quality of life (QoL) can be an important tool for the comprehensive care of the patients. This study was designed to assess the QoL of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia, and examined its association with sociodemographic variables and also identified the worst type of cancer. Materials and Methods: This cross-sectional study involved 178 participants who met the selection criteria: adult Saudi patients (≥18 years) who had been diagnosed with cancer, were documented in the health care system, and were cognitively able to answer the questionnaire. Those who underwent any surgical, hormonal, radiation, or chemotherapy within 2 weeks were excluded from the study. Patients are recruited by nonprobability convenience sampling between December 20, 2017, and January 1, 2018. Data were obtained using an Arabic version of the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ)-C30 developed, translated, and validated by the EORTC. QLQ-C30 measures three domains: functional, symptoms, and global QoL. Results: The younger (≤29 years) the patients, the better their global QoL. Women had a trend to score worse in all domains but only statistically significant in dyspnea (P < 0.05). Furthermore, patients with high school education and higher exhibited better physical function (PF) than illiterate patients. Multivariate analysis revealed gastric cancer as the most distressing cancer in terms of global QoL (P < 0.01), whereas patients with hematologic and genitourinary cancers trended high scores but insignificant. Moreover, patients with Stage I–II disease had better scores for PF, role function, social function, and anorexia compared with Stage III–IV disease. Conclusion: The QoL of cancer patients is a useful barometer of their overall health. It can also indicate the impact of different types of cancer on QoL. Sociodemographic variables, such as age, gender, level of education, diagnosis, and stage, can affect the QoL of cancer patients.
Keywords: Cancer, oncology, patients, quality of life, Riyadh, Saudi Arabia
|How to cite this article:|
Alshehri SM, Alzamil AF, Alturki RI, Alhoraim HA, Alghamdi RA, Almutairi MS, Masuadi EM, Algarni AM. Quality of life of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia. J Nat Sci Med 2020;3:53-8
|How to cite this URL:|
Alshehri SM, Alzamil AF, Alturki RI, Alhoraim HA, Alghamdi RA, Almutairi MS, Masuadi EM, Algarni AM. Quality of life of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia. J Nat Sci Med [serial online] 2020 [cited 2020 Jan 19];3:53-8. Available from: http://www.jnsmonline.org/text.asp?2020/3/1/53/275171
| Introduction|| |
Cancer is one of the leading causes of death worldwide. It is a disease of abnormal cell growth that can arise in many different parts of the body. The Cancer Research UK reported 18 million new cases of cancer globally in 2018 and 9.6 million mortalities. In Saudi Arabia, based on the latest report by the Saudi Cancer Registry, the number of reported cases of cancer in 2013 was 15,653; of these patients, 75% were Saudis. Riyadh had the highest incidence, with 3279 patients. Cancer was more common among women than men, with a ratio of 120:100. Breast, colorectal, and thyroid cancers were the most common types of cancer.
The treatment of cancer is a long process with many adverse effects on patients' physical and psychologic health. Thus, providing the patient with a comprehensive medical care throughout the disease course is important for the success of the treatment plan.
Quality of life (QoL) is considered an index of the efficacy of care., In fact, many studies have shown that QoL can be as useful as a pharmaceutical treatment for determining a prognosis.,, A study conducted in 2010 reviewed the QoL of patients newly diagnosed with non-small cell lung cancer and received early palliative treatment. It concluded that patients who received early palliative care had a better survival rate and QoL than those who received standard care.
The World Health Organization defines health as “A state of complete physical, mental, and social well-being and not merely the absence of disease.” In other words, the effect of health care is not limited to the clinical status of the disease, but it also includes patients' well-being, which can be assessed by measuring their QoL. Health-related QoL is a concept that encompasses multiple dimensions. It comprises patients' physical, psychologic, and social well-being. The assessment of QoL can be used to improve the quality of care provided by palliative care centers.,
The King Abdulaziz Medical City (KAMC) in Riaydh is one of the largest tertiary medical care centers in Saudi Arabia, with a bed capacity of 1501. In a study conducted at the KAMC involved 438 patients with different types of cancer, physical activity and duration of cancer were found to have an influence on patients' QoL. In another study that was conducted in multiple hospitals involved 106 patients revealed being unemployed or not educated significantly affect the QoL of patients with cancer, especially in functionality. However, this finding was observed on colorectal cancer patients. Furthermore, in another study involving 130 patients, most of whom were women (79%), emotional status was found to be more important than physical function (PF) in determining patients' satisfaction and QoL. This suggests that there is a relationship between the QoL of patients with cancer and sociodemographic variables such as gender, marital status, level of education, and comorbidities. This article aimed to assess the QoL of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia, and to examine the association with sociodemographic variables and identify the worst type of cancer. The primary objective is to assess the QoL of cancer and its associations with sociodemographic variables such as age, gender, marital and occupational status, level of education, diagnosis, and stage of cancer. The secondary objective is to compare the QoL between patients with different types of cancer.
| Materials and Methods|| |
This cross-sectional study took place at the outpatient clinics of the oncology department. The participants were selected by nonprobability convenience sampling from patients who met the selection criteria and consented to take part in the study. Adult Saudi patients (≥18 years of age) who had been diagnosed with cancer, were documented in the health care system, and were cognitively able to answer the questionnaire were eligible to participate in this study. Patients who had received active treatment in the preceding 2 weeks, including chemotherapy, radiotherapy, surgery, or hormonal therapy, were excluded from the study. The expected QoL scores ranged from 30 to 126, with a range of 96 and a standard deviation of 24. With a margin of error of three points and a confidence level of 95%, the required sample size was 199 according to PiFace software. We collected sociodemographic data on age, gender, and marital status. In addition, we categorized patients' occupational status as “unemployed,” “employed,” or “merchant.” We defined patients' educational level as “illiterate,” “primary school,” “middle school,” “high school,” or “posthigh school.” Regarding diagnosis, patients were categorized as “hepatocellular carcinoma,” “colorectal cancer,” “breast cancer,” “lung cancer,” “pancreatic cancer,” “gastric cancer,” “genitourinary cancer,” “gynecologic cancer,” or “hematologic cancer,” which included “leukemia,” “lymphoma,” “multiple myeloma,” or “myelofibrosis.” Stage was divided into “I–II” or “III–IV.”
Quality of Life Questionnaire
Data were collected using an Arabic version of a self-administered questionnaire developed by the European Organisation for Research and Treatment of Cancer (EORTC). The average time required to complete the questionnaire was 11 min. The questionnaire, termed the QoL Questionnaire (QLQ)-C30, was specifically designed to measure the QoL of patients with cancer. It has been translated and validated in over than 100 languages and used in >3000 studies worldwide., The Arabic language was one of the valid and reliable translations of the EORTC QLQ-C30. The QLQ-C30 consists of 30 questions comprising functional, symptom, and global QoL questions. The functional questions are subdivided into five domains: PF (Questions 1–5); role function (RF; Questions 6 and 7); emotional function (Questions 21–24); cognitive function (Questions 20 and 25); and social function (SF; Questions 26 and 27). The symptom questions consist of 13 questions on the following topics: fatigue (FA; Questions 10, 12, and 18); nausea and vomiting (NV; Questions 14 and 15); pain (PA; Questions 9 and 19); dyspnea (DY; Question 8); insomnia (SL; Question 11); anorexia (AP; Question 13); constipation (Question 16); diarrhea (DI; Question 17); and financial difficulty (Question 28). There are also two global health status questions (global QoL; Questions 29 and 30). All questions were scored as follows: 1 (not at all); 2 (a little); 3 (quite a bit); and 4 (very much). The exception was “global QoL,” which was scored from 1 (very poor) to 7 (excellent). The questionnaire was scored from 0 to 100 based on the responses of the patients.
The process of scoring the questionnaire (QLQ-C30) involved raw score estimation: the average score of each patient for the items that contribute to the scale was calculated, and then, a linear transformation was applied to standardize the raw score so that it ranged from 0 to 100. It was difficult to interpret the data, so the mean for each subdomain was reported. Higher scores for function and QoL questions indicated a better response, whereas higher scores for symptom-related questions indicated a worse response. The scoring process was conducted according to the QLQ-C30 scoring manual provided by the EORTC.
The data were collected by the research team between December 20, 2017, and January 1, 2018, using the self-administered questionnaire. A sheet addressing sociodemographic characteristics was provided to the patients simultaneously. The questionnaire was distributed to 202 patients in the waiting areas of the outpatient clinics during their follow-up appointments. The questionnaires were filled in by the patients themselves. Those who were illiterate received help from the research team or from their families/companions to answer the questionnaire.
The data collected were analyzed using the SPSS software package (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, version 25.0. Armonk, NY, USA: IBM Corp.). Means and standard deviation were used for quantitative data, whereas percentages and frequencies were used for categorical data. The t-test, analysis of variance, Tukey's test, and multivariate analysis were used where appropriate to assess the effects of sociodemographic variables on QoL scores. A test was considered significant if P < 0.050.
Approval to conduct this study was obtained on December 14, 2017, from the Institutional Review Board of the research center (reference number: RYD-17-419812-186638). Furthermore, written informed consent form stating the nature and purpose of the study was obtained beforehand by each participant.
| Results|| |
Of 202 possible participants, 24 (12%) were excluded for the following reasons: refusal to participate (2); incomplete questionnaire (9); and failure to return the questionnaire (7). In addition, six participants did not meet the selection criteria for the following reasons: nationality other than Saudi (1); below 18 years of age (1); and received active treatment within preceding 2 weeks (4). Thus, the sample size was reduced to 178 participants, with a response rate of 88%. The sample consists of 86 (48.3%) men and 92 (51.7%) women, with a combined mean age of 56.3 years.
There were no missing values. All questionnaires were completed fully by the participants, who provided all information for the sociodemographic sheet and EORTC QLQ-C30 questionnaire.
Most of the participants were married. Regarding gender distribution, there were slightly more women than men. Of the three age groups, patients aged ≥60 years were the most numerous, whereas patients aged ≤29 years were the least abundant. Majority of the participants were illiterate. Moreover, the majority of the participants were unemployed, whereas merchants were the least numerous. In terms of diagnoses, the largest number of the participants had hematologic cancers (n = 43; 24.2%), followed by colorectal cancer (n = 36; 20.2%), and breast cancer (n = 29; 16.3%). Regarding staging, the participants were designated as Stages I–II (n = 73; 41%) or Stages III–IV (n = 105; 59%).
Age and gender
The youngest age group (≤29 years) scored significantly higher in the PF scale than the other two age groups (P < 0.05). In addition to scoring significantly better in the fatigue, pain, and insomnia, the multivariate analysis revealed that the global QoL indicators are increased in the youngest age group. Regarding gender, men tended to score better in most of the scales, but this was only statistically significant for the dyspnea item [Table 1] and [Table 2].
|Table 1: The age, gender, and stage variables for the participantsf responses in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and domains|
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|Table 2: The multivariate analysis for the participantsf responses in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and domains|
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Social status, occupation, and education
The scores of married participants were consistently higher than those of single participants in all functional scales but without statistical significance. No significant difference or relationship was found between QoL and occupational status; however, the opposite was true for educational level. Patients with a high school or posthigh school education scored significantly higher in the PF scale than illiterate patients (P < 0.05).
Diagnosis and staging
No significant difference was found in functional scale although patients with gynecologic and genitourinary cancers trended to score higher. In the symptom scales, there were no trends for scores or significant differences except for the nausea\vomiting scale, in which patients with gastric cancer scored significantly worse than other cancers. Regarding global QoL, patients with hematologic and genitourinary cancers scored the highest, whereas patients with gastric cancer scored the lowest, and the multivariate analysis revealed that gastric cancer has the worst cancer indicators. Moreover, patients with Stage I–II disease had better scores in all EORTC QLQ-C30 scales and items compared to patients with Stage III–IV but only statistically significant in the PF, RF, SF, and anorexia scales [Table 1], [Table 2] and [Figure 1].
|Figure 1: The mean values for the participants' responses in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 global quality of life domain distributed in diagnosis are presented. Note: Higher score means better quality of life|
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| Discussion|| |
In this study, the assessment of health-related QoL of patients with cancer and the association with sociodemographic characteristics were done. In addition, a comparison of the QoL between patients with different types of cancer was investigated. It is found that age, gender, level of education, diagnosis, and stage can affect the QoL of patients with cancer.
The response rate of 88% is good, considering that the study was conducted on the general population. Furthermore, the distribution and spectrum of cancer types in this study correspond with those presented in the 2014 Cancer Incidence Report of the Saudi Cancer Registry. The results according to age, gender, and sociodemographic characteristics are consistent with those of two previous studies conducted in Saudi Arabia that share the same aim and use the same questionnaire, confirming the reliability and utility of the EORTC QLQ-C30 for measuring the QoL of patients with cancer., Moreover, the tendency of women to score lower than men in the QoL scale corresponds with a previous large-scale study conducted in Sweden, which further supports the reliability of the EORTC QLQ-C30.
Age is a prominent factor in determining the QoL of cancer patients. Multivariate analysis proves that the older the patients, the worse their global QoL. The oldest age group (≥60 years) exhibited a tendency to score lowest in functional domains, and among the functional scales, the oldest age group scored the lowest in PF scales. This is to be expected when considering the normal age-related physical changes. This finding confirms the results of a previous study conducted in the same setting. This suggests that health-care delivery to elderly population diagnosed with cancer is an area in need of improvement. This article aimed to highlight the factors that affect the QoL of patients with cancer, so finding solutions is beyond the scope of this article. Functional status is a broad field, so ideally there must be further investigations for specific factors that deteriorate the functional status to create solutions.
In addition, patients with a high school education and above scored better than illiterate patients. This may be attributable to the poor education on general health information that individuals receive throughout their school years. This finding supports the assertions of Ahmed et al. in that people with university degree have better PF. It also confirms the finding of Almutairi et al. in highlighting the positive effect of educational level on the QoL although the study was specified to colorectal cancer only. This issue connects to the foundation of any human being. We believe that this problem can be overcome by providing a sufficient time for this group of patients with the physicians for good listening and thorough explanation about the nature of the disease and encouraging any inquiries. Oddly, financial difficulties were not a significant problem to the patients that might be attributed to the virtue of governmental support with free of charge medical services that alleviate some of the burdens from patients with cancer.
Regarding the comparison of different types of cancer, gastric cancer is the worst cancer. The trend for low QoL indicators in this cancer is not new. Different studies have pointed to this problem and put the blame on the psychologic burden and surgical intervention to treat this cancer in early stages. It may also be due to the critical nature of the organ, its importance, involvement in daily life activities, and the usual symptoms that are present with this cancer such as nausea and vomiting. However, this steep decline in QoL usually lasts for 5 years only, after that the indicators return to comparable level for that before surgery. In this regard, more studies are encouraged to establish better-relieving methods in improving the QoL of patients with gastric cancer.
This study has some limitations. First, the study measured statistical significance but did not examine clinical significance. Second, the study's design provided only a snapshot of the QoL of patients with cancer at that time. In light of these limitations, we recommend measuring the clinical significance and long-term assessment of the QoL of patients with cancer to obtain more accurate results.
Finally, to the best of our knowledge, this is the largest study to compare the QoL with this amount of different types of cancer in the region. Hence, this study provides valuable data for the comparison of various groups of patients with cancer and may even help in future intervention.
| Conclusion|| |
All in all, the health-related QoL of patients with cancer is a useful barometer of their overall health. It can also indicate the impact of different types of cancer on QoL. Sociodemographic variables, such as age, gender, level of education, diagnosis, and stage, can affect the QoL of patients with cancer.
Financial support and sponsorship
This study was supported by the King Abdullah International Medical Research Center for language editing service from eScienta.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]