INTRODUCTION:

Cancer is an evil condition or thing that spreads destructively. It affects everyone and represents a tremendous burden on patients, families and societies. Its impact is likely to increase substantially, causing a lot of pain and suffering, if not treated properly in time, results in death.

Cancer is leading cause of death worldwide, majority of all cancer deaths occurred in developing/under developed countries; and head and neck cancer global incidence is 533,100 cases per year and fifth most common cancer⁽¹⁾. Males are affected significantly more than females with ratio from 2-4:1. It is estimated that at any given time there will be 3 million cancer patients in India. These cancers are life style dependent, with offending factors such as tobacco use, low socio economic status, multiple pregnancies and poor personal hygiene ^(2).

Head and neck cancer is especially traumatic emotionally because of disfigurement and functional impairment results from cancer and its treatment. There are numerous concern exist for the head and neck cancer patients mainly reaction to cancer, threat to ones mortality, body image issue, fears of treatment, family, social and vocational issues ⁽³⁾.

Though the modern medical treatments provide hope for number of cancer patients, cancer treatment may result in physical, psychological and other side effects which have a detrimental impact on quality of life including the reduced self confidence and low self esteem⁽⁴⁾. Patient with head and neck cancer experience significant changes in their quality of life. The socio demographic variables like educational status, perceived economic status and social security status demonstrated significant effect on the quality of life of head and neck cancer patients⁽⁵⁾. With the advent of more aggressive treatment modalities, quality of life assessment has become an essential part of clinical care and research studies.

In view of these the present communication was carried out to evaluate the quality of life of head and neck cancer patients and to find association of Quality of Life with their socio demographic characteristics to signify the need for special attention to quality of life assessment and impart the individual or group based cancer rehabilitation services.

MATERIAL AND METHODS:

The present descriptive cross sectional study was conducted with an aim to evaluate the quality of life of head and neck cancer patients. Approval by ethical committee of Pravara Institute of Medical Sciences was obtained. A sample comprising 50 patients of both male and female cancer patients in the age group of 18 and above was taken. Those patients satisfying the inclusion criteria and admitted in the oncology ward of Pravara Rural Hospital, (Loni (Bk), Maharashtra, India) were selected by using a simple random sampling technique. The patients who had metastasis status and other type of cancers were not included. The expert validated and pre tested WHO QOL questionnaire was the main tool used to collect the data. It consists of part: A – socio demographic characteristics, part: B – clinical characteristics of head and neck cancer and part: C – WHO QOL questionnaire; and the quality of life was categorized based on the obtained scores as poor, average and good. After seeking informed consent these were all interviewed by the researchers. The responses were voluntary and no probing questions were asked. The clinical characteristics of cancer related information were obtained from the patient perusal of medical record.

The data were expressed using descriptive statistics such as mean, standard deviation and mean percent for continuous variables; and frequency, percentage for categorical variables. These were to understand the distribution of subjects on the socio demographic and other variables to assess the quality of life of head and neck cancer patients. The inferential statistics like chi square test was used to find the association between the variables. P <0.05 was considered statistically significant.

RESULTS:

Socio demographic characteristics: A considerable number of patients (44%) were in the age group of above 56 years, majority (78%) were males while only 22% were females, highest percent (38%) was educated up to primary school level, more than half (56%) were belongs to nuclear family, majority (56%) had monthly per capita income of Rs. 1500 and above, and most (94%) under study were Hindus. (Table. 1)

Table 1: Socio demographic characteristics of subjects (n=50)

Variables

(%)

Age

Below 35 years

36 – 45 years

46 – 55 years

Above 56 years

Sex

Male

Female

Education

Illiterate

Primary

Secondary

Higher secondary

Graduate

Occupation

House wife

Daily wages

Private employee

Govt. employee

Farmer

Type of family

Nuclear

Joint

Extended

Monthly per capita income

Below Rs. 500

Rs. 501 – 1000

Rs. 1001 – 1500

Above Rs. 1500

Religion

Hindu

Christian

Clinical characteristics of head and neck cancer:

Most (98%) of patients had no family history of cancer whereas only 2% had the same, highest present (34%) had habit of tobacco chewing, a considerable number of patients (34%) had pharyngeal cancer as head and neck cancer followed by tongue cancer (30%), majority (70%) had duration of cancer more than 6 months, while 34% had stage IV cancer, half (50%) received radiation therapy followed by combined therapy (22%) and most (94%) had compliance with cancer treatment. (Table. 2)

Quality of life of head and neck cancer patients:

The range of QOL score was 60 – 300. The overall QOL of mean score was (213.2±10.7) which is 71% of total score indicate that patients had poor quality of life; as higher the score the poor is the quality of life. The QOL domain scores indicates that the ‘physical’ and ‘activity of daily living’ domain had average QOL with mean percent of <67% while other domains had poor quality of life. (Table. 3)

Table 2: Clinical characteristics of head and neck cancer (n=50)

Variables

(%)

Family history of cancer

Present

Absent

Personal habits (ill)

Smoking

Tobacco chewing

Use of Pan/Supari/Snuff

Use of smoking, tobacco and pan

No ill habits

Type of head and neck cancer

Buccal mucosa

Tongue

Lips

Pharynx

Esophagus

Others

Duration of illness

Less than 6 months

More than 6 months

Stages of cancer

III

Treatment modality

Chemotherapy

Radiation therapy

Surgery

Combined therapy

Treatment compliance

Regular

Irregular

Table 3: Quality of life of head and neck cancer patients (n=50)

QOL Domains

Mean

Mean %

Physical wellbeing

Psychological wellbeing

Family and social wellbeing

Activity of daily living

Safety and security

Financial resources

Leisure activity/recreation

Environment

Spirituality/religion

Health care and treatment

33.46

34.36

20.28

15.51

20.31

17.42

17.13

17.12

18.72

18.51

5.2

5.7

2.2

2.8

1.5

1.9

2.6

2.2

2.8

66.9

68.7

81.1

62.1

81.2

70.9

68.5

68.6

75.1

74.1

Overall

213.2

10.7

The score of the quality of life was found to be varying between age and education in its mean quality of life. Patients age above 35 years mean score (212.1±11.4) was higher than below 35 years age patients mean score (204.5±12.7) and the illiterate patients mean score (219.4±6.1) was higher than educated patients mean score (206.6±10.4) which interprets the advance aged and illiterate patients were had poor quality of life than others.

Association of quality of life scores with socio demographic characteristics:

There was a significant association found between quality of life with education, monthly income and religion at p< 0.05 level; however there was no association was found between quality of life and clinical characteristics of head and neck cancer. (Table. 4)

Table 4: Association of quality of life scores with socio demographic characteristics

Variables

χ2value

Level of significance

Age

Sex

Education

Occupation

Type of family

Per capita income

Religion

1.3

0.3

5.1*

0.6

0.5

14*

8.9*

χ2-value significant at 0.05 level; df (1) = 3.84 P>0.05; *significant.

DISCUSSION:

Quality of life is multi dimensional construct and the subjective satisfaction expressed or experienced by an individual in his physical, mental and social situation ⁽⁶⁾. The current study reveals that a head and neck cancer patient has poor quality of life which is supported by Pandey M et. al, ⁽⁷⁾ in a study among head and neck cancer patients to study the higher distress relates to poor quality of life. The result showed that majority of patients has poor quality of life because of influence of high amount of distress. In addition to the above study, other western studies ^{(8, 9)} also supported these findings.

Results shows that higher the age poor the quality of life, our results was consistent with Hammerlid E and Taft C ⁽¹⁰⁾ who reported that the head and neck cancer patients who had advanced age more often scored worse in health related quality of life than the younger patients. Further, findings shows that cancer patients who were illiterate had higher mean score (poor QOL) which is congruent with a study carried out by Aarstad HJ et.al, ⁽¹¹⁾ that educational level has significant relation with the lowered general quality of life. Given this overall poor quality of life, a significant association was found between quality of life and demographic characteristics like education (χ²=5.1), monthly income (χ2=14) and religion (χ2=8.9) at p< 0.05 level, this finding was similar that of Vartanian GJ et.al ⁽¹²⁾ who reported that a significant association was shown with quality of life and adjustment in educational status and in the income. This emphasizes the importance of socio demographic characteristics in influence of level of quality of life.

The results of this study provide the important implications for understanding the impact of head and neck cancer on patient’s quality of life. The findings of this study support the multidimensional notion of the cancer/treatment experience and demonstrate the effect of cancer and its treatment on the various domains of head and neck cancer patient’s quality of life.

CONCLUSION:

The findings demonstrated that head and neck cancer patients, similar to cancer patients in other countries, are affected by cancer and its treatment in many dimensions of their quality of life. The quality of life is not only the outcome of the disease and its treatment, but is also dependent on each patient’s socio demographic characteristics. Living with cancer creates great deal of physical, psychological and other dimensions of health problems and can worsen with the cancer treatment.

The results of the study indicating the need for assessment of QOL and individual or group based cancer rehabilitation services. The decrease in quality of life calls for interventions at family and societal level thereby the cancer survivors are not considered lower and neglected one. An intensive multi-focus rehabilitation programme is a need of an hour for head and neck cancer patients; thereby the health care professionals and policy makers must focus on measures/strategies to improve the QOL and survival.

ACKNOWLEDGEMENT:

The authors express our sincere thanks to the Pravara Institute of Medical Sciences (DU), the Medical Superintendent and HOD of Radiation Oncology of Pravara Rural Hospital, Loni (Bk) and the Head and Neck cancer patients for their kind cooperation and support.

REFERENCES:

1. World Health Organization. Cancer control: knowledge into action: WHO guide for effective programmes. Module 2. Geneva: World Health Organization, 2007.

2. ICMR 2010 (cited on 2012 Jan 2012); available from URL: http:// plusinsights.com / article/2010.

3. Anderson RC and Anderson FC. Psychological and psychosocial implication of head and neck cancer. The internet journal of mental health. 1 (2); 2002: 32-37

4. Arunachalam D, Thirumoorthy A, Saraswathi Devi and Thennarasu. Quality of life in cancer patients with disfigurement due to cancer and its treatment. Indian journal of palliative care. 17 (3); 2011:184-190.

5. Ayse ND, Mehmet S, Yucel D and Munir K. The effect of socio demographic factor on quality of life after treatment in patient with head and neck cancer. International journal of radiation oncology. 70 (1); 2008: 23-27.

6. Santosh Chaturvedi. What is important for quality of life to Indians – in relation to cancer? Indian journal of palliative care. 9 (2); 2003:62-70

7. Pandey M, Devi N, Ramdas K, Krishnan R and Kumar V. Higher distress relates to poor quality of life patients with head and neck cancer. International journal of oral and maxillofacial surgery. 38 (9); 2009:55-59.

8. Johnson S, Akdur R, Tunblick A and Cengiz. Socio economic status and head and neck cancer incidence in Canada: a case control study. Oral oncology. 99(1); 2009:12-24.

9. Peter L. Quality of life of cancer patients receiving inpatient and home based palliative care. Journal of advanced nursing. 53 (5); 2005: 524-33.

10. Hammerlid E and Taft CA. Prospective study of quality of life in head and neck cancer patients. The laryngoscope.111 (4); 2001:669-80.

11. Aarstad HJ, Aarstad AKH, Birkhaug EJ and Olofsson EB. The personality and quality of life in head and neck cancer patients following treatment. European journal of cancer. 39 (13); 2003: 1852-60.

12. Vartanian GJ, Carvalho LA, Yueh B, Priante MV, Melo LR and Kohlor FH. Long term quality of life evaluation after head and neck cancer treatment in a developing country. Arch Otolaryngeal Head Neck Surg. 130; 2003: 1209-13.

Source of support: Nil

Conflict of interest: Nil

Ethical clearance: PMT/PIMS/RC/2011.

Registration number: CON/16/11.

Received on 19.11.2012 Modified on 30.12.2012

Asian J. Nur. Edu. & Research 3(1): Jan.-March 2013; Page 21-24