Coping Strategies and Its Effect on the Quality of Life of Cancer Patients Attending Federal Teaching Hospital Ido- Ekiti
CHAPTER ONE
OBJECTIVES OF THE STUDY
GENERAL OBJECTIVES
This study was aimed at determining the coping strategies and its effects on the quality of life of cancer patients attending Federal Teaching Hospital, Ido Ekiti.
SPECIFIC OBJECTIVES
The specific objectives are to:
- Assess the coping strategies used by cancer patient
- Examine the effect of the coping attitudes adopted by patients on the quality of life
- Investigate the relationship between coping styles and quality of life in cancer patients as well as those receiving chemotherapy and radiotherapy
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
This chapter focuses on the coping strategies adopted by patients with cancer and how it affects their quality of life based on different findings across the various studies conducted previously.
CANCER; AN OVERVIEW
Definition
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body (National Cancer Institute 2014). They form a subset of neoplasms and a neoplasm or tumor is a group of cells that have gone through unregulated growth and will frequently form a mass or lump which may spread out to the body (American Cancer Society). Not all neoplasm is cancerous for example benign tumors do not spread to other part of the body (National Cancer Institute, 2014). Signs and symptoms may include the presence of lump, abnormal bleeding, prolonged cough, weight loss and a change in bowel movements. While these symptoms may indicate cancer, they may have other causes. Factors that influence the occurrence of cancer may include the presence of certain infections, exposure to ionizing radiation and environmental pollutants. It has been observed that 22% of cancer death is caused by the use of tobacco (WHO 2014) and another 10% is due to obesity, poor diet, lack of physical activity and drinking alcohol. In the developing world nearly 20% of cancers are due to infections such as hepatitis B, hepatitis C and human papillomavirus (HPV),(WHO 2014). Generally, most genetic changes are involved before cancer develops (WHO 2014). Approximately 5-10% of cancers are due to inherited genetic defects from one‟s parents (American Cancer Society, 2013). Cancer can be detected by certain signs and symptoms or by screening tests (WHO 2014). It is then usually further investigated by medical imaging and confirmed by biopsy (American Cancer Society 2014). Most cancer can be prevented by avoiding smoking and alcohol, maintaining a healthy weight, eating enough vegetables, fruits and whole grains, taking vaccines against certain infectious diseases, abstaining from the intake of too much processed and red meat, and avoiding too much exposure to sunlight (Kushi, Byers, Doyle, Bandera, McCullough, McTiernan, Gansler, Andrews, Thun, 2012).
Types of cancer
A cancer or neoplasm can either be benign or malignant, with represents a new growth.
Benign neoplasms: Are well differentiated tumors that resemble the tissues of origin but have lost the ability to control cell proliferation. They grow by expansion, are enclosed in a fibrous capsule, and do not cause death unless their location is such that it interrupts vital body functions (Porth, Matfin, 2009).
Malignant neoplasms: Are less well differentiated tumors that have lost the ability to control both cell proliferation and differentiation. They grow in a disorganised and uncontrolled manner to invade surrounding tissues, have cells that break loose and travel to distant sites to form metastases, and inevitably cause suffering and death unless their growth can be controlled through treatment ((Porth, Matfin, 2009).
Etiology of cancer
About 90–95% cases of cancer are due to environmental factors and the remaining 5–10% are due to inherited genetics (Anand, Kunnumakkara, Sundaram, Harikumar, Tharakan, Lai, Sung, Aggarwal, 2008). Environmental factors as used by cancer researchers, means any cause that is not genetically inherited such as one‟s lifestyle, economic and behavioural factors and not merely pollution (Kravchenko, Akushevich, Manton, 2009). Common environmental factors that contribute to cancer death include diet and obesity (30-35%), tobacco (25-30%), infections (15-20%), stress, lack of physical activity, radiation (both ionizing and non-ionizing, approximately 10%) and environmental pollutants (Anand, et al 2008). It is generally impossible to prove what caused a particular cancer because the various causes do not have specific fingerprints.
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
This chapter focuses on the methodology used in conducting this study. It highlights the study design, the setting on which it was conducted, the target population and the sampling technique used in selecting study participants. It is also aimed at providing an overview on the instrument of data collection, the validity and reliability of the instrument, the data collection method, analytical method as well as ethical consideration.
RESEARCH DESIGN
A descriptive quantitative study will be used as the research design which is aimed at identifying the coping strategies and its effects on the quality of life of cancer patients who have been diagnosed and are receiving treatment in Federal Teaching Hospital Ido-ekiti.
STUDY SETTING
The study will be conducted in Federal Teaching Hospital, Ido-Ekiti. The following clinics/ department will be used for the study; cancer registry, outpatient clinic, obstetrics and gynaecology department, surgical wards both male and female wards.
Federal Teaching Hospital Ido Ekiti.
Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria (FETHI), formerly known as Federal Medical Centre, was commissioned as a hospital in July, 1998 by the Federal Government. Federal medical Centre was upgraded to Federal Teaching Hospital by the Federal Government in September, 2014. It is located in Ido-Osi Local Government Area, Ekiti State. The federal Teaching Hospital Ido Ekiti is a 280 bedded tertiary institution comprising of 24 functional wards with other ancillary units such as radiology department, laboratory and pharmacy. It has about 53 consultants and numerous nurses registered there and at least a total of 6 nurses per unit of the hospital. The hospital has a family medicine department, the obstetrics and gynaecology department, the accident and emergency unit, the cardiac centre, the renal centre, the male and female medical wards as well as the male and female surgical wards. Also, there is the main theatre, the ear, nose and throat department, the neurology department, the physiotherapy unit, the mental health unit, the children’s ward and the NHIS building.
CHAPTER FOUR
ANALYSIS OF DATA
INTRODUCTION
This chapter deals with the presentation, analysis, and interpretation of data gathered in the course of the study. This analysis is a descriptive type. It involves the use of frequency count and percentage with the aid of statistical package. Ninety questionnaires were distributed and all returned though not all were completely filled out.
The socio demographic characteristics of study respondents are shown in the table above.
A total of 90 respondents participated in the study. The majority of the participants were female (65.6%). Higher percentage (34.4%) of the respondent were between the ages of 35- 44years. This was followed by 45years &above (33.3%) and 25-34(21.1%) while 15- 24(11.1%).
The table show the marital status and majority (70.0%) were married. Higher percentages (66.7%) of the respondents are Christians while 32.2% were Muslims, and 1.1% of the respondents were missing.
Also, the ethnicity of the respondents revealed that most of the respondents are Yoruba (n=75; 83.3%), followed by Hausa (n=5; 5.6%), while n=8; 8.9% were Igbo and n=2; 2.2% responded others.
CHAPTER FIVE
DISCUSSION OF FINGINGS
INTRODUCTION
This chapter focuses on discussion of findings, implications for nursing, summary, conclusion, recommendations and suggestions for further studies.
DISCUSSION OF FINDINGS
The results of the data collected from 90 cancer patients who volunteered to be subjects of the study are discussed for further understanding in this section. The primary objective of this study was to determine the various coping strategies used by cancer patients and how it affects their quality of life.
The coping strategies used by cancer patients
In the literature on quality of life, coping has been found to be associated with career outcome (Rand and Fox, 2012). „Coping‟ refers to psychological strategies adopted to limit the impact of a traumatic or difficult situation on an individual’s internal mental state.
Although coping is intended to play a „protective‟ function, some coping strategies appear to be less effective than others among informal careers (Gottlieb and Wolfe, 2002; del-Pino Casado et al, 2011). In the study analysis of coping strategies used by cancer patients, it was observed that people have various ways of coping with stress like sleeping, praying, reading going for holidays etc. However, different coping styles were associated with better quality of life outcomes among the respondents. Coping styles used by respondents include; attending religious and social programs, attending counseling sections in the hospital, spending time with family members, attending to jobs, communicating experience with others, etc. Active coping and „acceptance‟ were related to higher quality of life scores on vitality in care recipients, but support seeking and avoidance were associated with higher quality of life(Myaskovsky et al, 2005).
This study observed that 88.9% of the participants attend to religious programs which show that the participants have a positive relationship, and full reliance on God gave participants hope that God was in control and that the disease was from him. The results suggest that belief in God helped the participants to accept the diagnosis and cope with the disease.
The effect of coping attitudes adopted by patients on the quality of life
In this study, it was show that the coping strategies adopted by the respondents have a great effect on their quality of life. However such effects indicates that few of the respondents adopts hindering factors such as difficulty concentrating at work, feeling embarrassed whenever they discuss their condition with others, feels lonely at times etc. which has a poor improvement on their quality of life while some of them adopted the facilitating factors like attending social and religious activities, spending time with family members, seeking God etc. has made the patients accept their condition and also improved their quality of life.
It is commonly believed that a person’s mental attitude in response to the cancer diagnosis affects his or her chances of survival. Although different coping strategies in cancer patients are predominantly designed in order to diminish the distress and to improve their quality of life, all studies did not prove convincing evidence that some psychological coping styles like acceptance, fatalism, denial, helplessness, hopelessness can play a clinically important part in the survival or recurrence of cancer. At the same time, many studies lay great stress on psychological and social factors that could be involved in the etiology and response to cancer and its treatment.
The relationship between coping styles and quality of life in cancer patients
In this study coping styles and quality of life works interchangeably and the coping styles adopted has made the patients accept their diagnosis which has made them grow independently thereby promoting their health status and increasing their quality of life.
There is considerable evidence suggesting that cancer patients suffer from substantial and long-term psychological distress associated with different forms of cancer and its medical treatment. Awareness of having a malignant life-threatening disease can obviously change patients‟ lives. Cancers and any type of treatment may lead to alteration in patient‟s appearance. This research has shown that the coping styles adopted has affected the quality of life (QOL) of the patients both positively (making them independent, accepting the reality of life, etc.) and negatively especially reducing self-confidence, decrease self-esteem, having problem with social interest, which may result finally to social withdrawal. This research also shows that pain interfered with their activities of daily living and some had trouble sleeping due to the side effects of the treatments given to them thereby resulting to poor overall health and quality of life. Studies have shown that psychological stress has a strong impact on accelerating the growth of various types of malignant tumors (Sturgeon M, Wetta-Hall R, Hart T, Good M, Dakhil S., 2009). Hence, psychosocial management of adjustment problems experienced by people with cancer seems to be an obvious requirement for a more effective treatment of the disease.
IMPLICATIONS FOR NURSING
Practice
This study has shown that majority of the respondents are aware of cancer support groups but few of them are members of such cancer support group. There is need to create awareness for the patients by the nurses so as to promote active participation in attending counseling sections in the hospital among the patients, in this way it helps to reduces negative or hindering factors contributing to quality of life.
Education
Nurses as a caregiver should educate and encourage the patients on active practices of activities and to help in identifying various coping styles best suitable for each patient. This finding may suggest that patients are able to handle avoidant coping on the part of the caregivers if patients‟ symptom distress is low or moderate, but in those situations in which their own symptom distress is high, avoidant coping by the caregiver has a detrimental relationship to their quality of life. In this situation, patients may perceive that their families or caregivers (nurses) are not supporting them or even abandoning them when, at that time, they are in greatest need of help. Therefore it is important that the nurses provide or maintains a supportive environment conducive for health for better improvement of their quality of life.
Research
Few research work has been carried out in Nigeria therefore further research should be done and investigation on how to improve the quality of life of cancer patients should be done.
Nurses should acquire more knowledge on the coping strategies that individual cancer patient can adopt so as to improve their quality of life.
SUMMARY
The study was designed to assess the coping strategies and its effect on the quality of life of cancer patients attending Federal teaching hospital Ido-Ekiti, a descriptive study design was adopted. A purposive sampling technique was used to select cancer patients in order to get participants for the study. A sample size of 100 participants was calculated for the research study but only 90 persons participated in the study. Endler and Parker Coping Inventory for Stressful Situations, and World Health Organization’s Quality of Life Questionnaire were used to evaluate their coping style and quality of life (QOL), respectively.
All the instruments used in this study were standardized with confirmed validity from previous studies. Test-retest method was used to test the reliability of the questionnaire. Chi- square Test was used in analysing data and to test the three hypotheses generated. The findings from the study revealed that there was no statistically significant relationship between coping strategies and gender, and also there was no significant relationship between coping strategies and religion. Furthermore, a significant relationship was found between coping styles used by cancer patients and quality of life of cancer patients.
CONCLUSION
This study has shown that cancer patients have various coping strategies like attending religious and social programs, attending counselling sections in the hospital, spending time with family members, attending to jobs, communicating experience with others, loneliness, etc. have moderate effect on their quality of life. This study observed that 88.9% of the participants attend to religious programs which show that the participants have a positive relationship, and full reliance on God gave participants hope that God was in control and that the disease was from him. The results suggest that belief in God helped the participants to accept the diagnosis and cope with the disease.
One of the most important findings of this study was that the coping strategies used by cancer patients accounted for a significant amount of variance in their quality of life. While a number of previous studies have reported a univariate relationship between coping strategies and quality of life or adjustment, it is noteworthy that within multivariate analyses, coping strategies retained their significant association with patients‟ quality of life. The finding in these research therefore emphasizes the importance of assessing the coping strategies used by patients because of its‟ significant association with quality of life.
RECOMMENDATIONS
Coping strategies are very influential in patient adjustment to the effects of cancer. Therefore the researcher recommends the following:
- Programs are needed to help patients and also their families learn active coping strategies and reduce avoidant coping strategies e.g. loneliness etc. to improve overall quality of
- Researchers and clinicians need to take a broader approach that includes both the patient and their family support network when designing studies and interventions to improve the quality of life of people with chronic
- Family based programs of care, rather than patient- based programs, may be the most effective way to improve the quality of life of cancer patients with advanced disease and their family
REFERENCES
- Anand, P., Kunnumakkara A., Kunnumakara, A., Sundaram, C., Harikumar K., Tharakan, S., Lai, O., Sung, B. &Aggarwal, B. (2008). “Cancer is a preventable disease that requires major lifestyle changes”. 25 (9): 2097–116. Doi:10.1007/s11095-008-9661-9. [Assessed 2/01/2017].
- American Society of Clinical Oncology. “Five Things Physicians and Patients Should Question”. Choosing Wisely: an initiative of the ABIM Foundation. American Society of Clinical Oncology. Archived from the original on 31 July 2012. Retrieved August 14, 2012. [Assessed 21/01/2017].
- American Cancer Society. “How is cancer diagnosed?” 2013-01-29. Retrieved 10 June 2014. [Assessed 21/01/2017].
- Baldassarre, G., Battista, S., Belletti, B., Thakur, S., Pentimalli, F., Trapasso, F., Fedele, M., Pierantoni, G., Croce, CM., & Fusco, A. (2003). “Negative regulation of BRCA1 gene expression by HMGA1 proteins accounts for the reduced BRCA1 protein levels in sporadic breast carcinoma”. Molecular and Cellular Biology. 23 (7): 2225–38. doi:10.1128/MCB.23.7.2225-2238.2003. [Assessed 21/01/2017].
- Bernstein, Carol., Anil R., Nfonsam, Valentine; Bernstein, Harris., (2013). “DNA Damage, DNA Repair and Cancer”. In Clark Chen. New Research Directions in DNA Repair. InTech. doi:10.5772/53919. [Assessed 21/01/2017].
