Symptom Experiences and Effect on Functional Status among BreastCancer Women Receiving Chemotherapy

INTRODUCTION

Breast cancer is the top cancer in women both in the developed and the developing world. The incidence of breast cancer is increasing in the developing world due to increase life expectancy, increase urbanization and adoption of western lifestyles. Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control. Cancer patients often experience multiple symptoms, and symptoms seldom occur in isolation in patients with advanced cancer. Cancer patients have been reported to experience an average of 11–13 concurrent symptoms. Symptoms may be a result of the disease itself or of the associated treatment. They may considerably affect the patient’s sense of wellbeing and his or her physical and social functions. However, most clinical studies in symptom research have focused largely on the treatment of individual symptoms. This focus has undoubtedly led to some advances in the understanding of particular symptoms, but patients seldom present with a single symptom which may perhaps explain why treating one symptom may not necessarily improve quality of life. The co-occurring symptoms that cancer patients often experience may or may not be interrelated. Although a continuing focus on single-symptom research is crucial, it is equally important that symptom management research begin to evaluate multiple symptoms in crosssectional and longitudinal study designs. In addition, research needs to more closely examine the relationships between multiple symptoms, specific interventions, and patient outcomes.¹ Breast cancer and its treatment is an emerging issue in Ethiopia. Identifying the patients experiences of symptoms receiving chemotherapy is an important indicator of treatment effectiveness. Though, the chemotherapy treatment causes many side effects among the patients during their treatment, some of them are manageable. Some side effects and symptoms will their functional status and quality of life. This study explain the symptoms experienced by the women receiving chemotherapy and identifies their effect on the functional status of their life activities. There by, this study helps to identify the common symptoms and provides knowledge to implement symptomatic management and control.

Objectives

•  To determine the symptom experiences of women
•  To identify the effect on functional status of life activities 
• To associate the relationship between symptoms and functional status of women 

METHODOLOGY

The study was conducted by using descriptive research study design in Hawassa Referral health facilities from Mar 2017 to May 2017. The data were collected in the given duration of study period and the sample were selected based on the enrollment for chemotherapy treatment. Before data collection ethical clearance letter was obtained from Hawassa University institutional review board office. One hundred fifty sample were recruited by using Purposive sampling technique and the data were collected using a structured questionnaire including patient information, symptom experience questionnaire and EGOC Functional status Questionnaire were used. The analysis were made by using SPSS version 20.0. The study was funded by the NORAD project with the amount of 20,000 NOK (50,000 ETB).

RESULTS

I. Demographic Characteristics of Breast Cancer Women:

The majority of the breast cancer women 56 (37.3%) were seen in the age group of 31-40 years followed by 40(26.7%) were in the age group of more than 51years. With regard to religion, majority of the breast cancer women 66(44%) were believing in Orthodox and 53(35.3%) of breast cancer women belonged to Oromo culture in their ethnicity. Focusing on educational status of the respondents, majority 57(38%) of the breast cancer women had primary education, followed by 39(26%) did not have any formal education. Majority 108(72%) were married and 84(56%) are from urban residencies. The mean monthly income of the respondent and their family was + 7084.2 in Ethiopian birr. Majority of the breast cancer women 70(46.7%) were working for the government and 110(73.3%) of the breast cancer women are living with their spouse and children in the home. With regard to duration of the illness, majority of the breast cancer women 108(72%) were diagnosed within last 4 years and 98(65.3%) of the women had surgery for their breast and were receiving chemotherapy. Majority 146(97.3%) of the breast cancer womenwere having care giver and 132(88%) of the respondents were identified with presence of additional illness like DVT, DM, Pneumonia. 

II. Findings on Prevalence of Symptoms

In this study, the symptomatic status was identified among the breast cancer women receiving chemotherapy who were experiencing symptoms and categorized into asymptomatic and symptomatic with their percentages. The results were depicted in the table.1 

II. Findings on Level of Functional Status

In this study, majority of the breast cancer women 55(36%) were asymptomatic with regard to their functional status and 46(30.7%) of them were symptomatic but completely ambulatory, 16(10.7%) were spending their time more than fifty percent time in the bed and 13(8.7%) were spending less than fifty percent of their time in bed. Only 20(13.3%) of the breast cancer women were found completely bedbound. Level of functional status showed that, 101(67.3%) were independent and need very little assistance to perform the activities followed by 49(32.7%) were dependent for their activities.(Table 2)

III. Association between the demographic variables and level of functional status:  

Chi-square analysis was generated to show the association between the demographic variables and the level of functional status of breast cancer women receiving chemotherapy. Among the demographic variables computed, type of treatment (X² =23.79, P=0.000) and the duration of treatment (X² =28.77, P=0.000) have shown significance with level of functional status. Among the symptoms computed majority of the symptoms have shown significant association with the level of functional status except symptoms like changes in weight, presence of drymouth, vomiting, presence of diarrhea and bleeding. 

DISCUSSION

Patients can experience gradual change in their functional status due to the adverse effects of treatment especially chemotherapy. They will experience different symptoms throughout their treatment process in different levels like mild, moderate and severe. Sometimes, patients may not have any difficulty while receiving the chemotherapy and they may identify the changes in their functional status or performance status later on after completion of chemotherapy cycles. In this study, out of 30symptoms assessed, majority of the symptoms have shown significant relationship with level of functional status of women. Changes in sleep pattern, fatigue, pain, feeling sad or depression have shown significant impact on performance status of the patients. This study finding supports the findings of Marylin J. Dodd2. Present study findings also strengthens the conclusion of winne.K,3 study on symptom clusters and their effect on the quality of life of women. 

A positive association was identified between the symptoms of changes in memory(X² =57.3, p=0.000), changes in activity (X² =40.00,p=0.000) changes in mood (X² =46.21, p=0.000) and the level of functional status of women. These findings summarize the findings of bender and Catherine study. In this study, it was noted that, a cluster of symptoms such as changes in sleep patterns, changes in appetite, fatigue and changes in memory had shown significant effect on the performance or functional status of women receiving chemotherapy, irrespective of their duration of illness, type of treatment received or undergoing duration of treatment and presence of other co-morbid illnesses.

A second cluster of symptoms were also manifested including pain & feeling drowsy among the respondents which had shown significant changes in the functional status of women. All these symptom clusters were significant at P<0.01. The first cluster of symptoms (Sleep changes, appetite changes, fatigue, memory changes) explains the similarity with the study conducted by MJ.Dodd and Christine in 2004.4

CONCLUSION

Underassessment and lack of investigation may not identify the gaps of treatment strategies to facilitate better patient outcomes. Nurses need to impart knowledge and sound skills of assessments in identifying or assessing the symptoms regularly and continuously when the patient enrolls for treatment will help in planning of better treatment strategies for patients. Effective interventions should be planned for identified symptom clusters.