Stress
and Quality of Life among Breast Cancer Patients
Sampoornam. W
Lecturer, PhD Scholar, Saveetha
University, Chennai
*Corresponding Author Email: sampoornamwebster@yahoo.in
ABSTRACT:
Context: Breast cancer cases have doubled
in India in the last two decades. In India the growing epidemic of breast
cancer presents a major challenge to the global public health especially given
the failure to cope with the current situation. Objectives: This study was done to assess the level of
stress and quality of life among breast cancer patients in Erode Cancer Centre
at Erode. Methods: The study design undertaken was non experimental descriptive
design. Stratified random sampling
technique was used based on the stages of breast cancer to select 40 samples
for the study. The tools used to collect the data were demographic variables, P.Herschbach Questionnaire on Stress in Cancer Patients
(QSC-R23) and the Quality Of Life instrument -Breast Cancer Patient Version.
Results: The result depicts that in
stage I breast cancer patients 60% had mild level of stress, 40% had moderate
level of stress and none of them with severe level of stress. In stage II 40% were with mild stress, 40%
with moderate stress and only 20% with severe stress. In stage III 30% had mild
stress, 30% with moderate stress and 40% with severe level of stress. In stage
IV none of them were with mild level of stress, 30% were with moderate stress
and 70% with severe stress. Breast cancer patient’s Quality of Life exhibits
that in stage I 40% had poor quality of life and 60% had very poor quality of
life. In stage II 50% had poor quality of life and 50% with very poor quality
of life. In stage III 20% were with poor quality of life and 80% were with very
poor quality of life. In stage IV 10% had poor quality of life and 90% had very
poor quality of life and none of them were with good quality of life between
stage I and IV.
KEY
WORDS: Stress, quality of
life, breast cancer.
INTRODUCTION:
Studies indicate that as India becomes
westernized, the incidence rate for breast cancer increases Sanjit Bagchi (2008). Breast cancer appears to bring
forth the greatest level of stress relative to other cancer diagnoses. Shapiro et,al., (2001) found that numerous
factors related to breast cancer lead to stress including the possibility of
recurrence and threat to life. Given that breast cancer is a significant
stressor and psychosocial variables such as stress are associated with Quality
of life Kreitle et al., (2007), Shapiro et al.,(2001). It is not surprising that individuals with cancer
are at risk for developing poorer Quality of life Dunn et al., (2006). Many patients find that recurrence of the
disease is more distressing than the initial cancer diagnosis. The nurse can
help the patient identify coping strategies and set priorities to optimize
quality of life. Brunner, (2009)
OBJECTIVES OF THE STUDY:
1. To assess the level of stress among breast
cancer patients
2. To assess the level of quality of life
among breast cancer patients
3. To determine association between the
quality of life scores and their selected demographic variables among breast
cancer patients
CONCEPTUAL FRAMEWORK:
The conceptual framework for this study was
based on Health Promotion Model
METHODS:
Design:
The design used for this study was non
experimental descriptive design.
Sample:
Stratified random sampling technique was
used based on the stages of breast cancer ranging from stage I – IV to select
40 samples for the present study.
Inclusion
criteria:
Breast cancer patients
·
with
clinical stage of cancer I – IV
·
who are
available during the period of data collection.
·
who are
willing to participate.
·
who can
speak in Tamil.
Exclusion
criteria:
Breast cancer patients
·
who
are critically ill
Tools:
Sec
A: It consists of
demographic variables such as age, education, occupation, work pattern, family
monthly income, family history of breast cancer and stages
of breast cancer.
Sec
B: It includes P.Herschbach
Questionnaire on Stress in Cancer Patients which consists of 23 items
Sec
C: It comprises Quality Of Life instrument -Breast
Cancer Patient with 46 items.
Data
collection procedure:
After obtaining written informed consent,
in-patient breast cancer patients who fulfilled the inclusion criteria were
recruited and enrolled for the study in Erode Cancer Centre at Erode. Based on
the stages of cancer ranging from Stage I – IV, 10 participants were randomly
selected in each stage of breast cancer. The participants were interviewed with
the tools which consists of demographic variables, P.Herschbach
Questionnaire on Stress in Cancer Patients and Quality Of Life instrument -Breast
Cancer Patient Version. The data were collected for 30-45 minutes on one to one
basis for the period of 15 days.
RESULTS:
Participant Characteristic distribution according to
their age in stage I depicts that the highest (50%) of them were in the age
group of 46–55 years and (30%) between 36-45 years and (20 %) of them were
above 55 years. Breast cancer patients according to their education showed that
the highest (60%) of them were educated and (40%) had no formal education.
Occupation depicts that the highest (60%) of breast cancer patients were coolie
workers and (20%) of them were house wife and only (20%) were unemployed.
According to their work pattern depicts that the highest (40%) of them were
heavy workers and (50 %) of them were moderate workers and only (10 %) of them were
sedentary workers. Family monthly income
depicts that the highest (60 %) of them belonged to the income group of below
Rs.3000 and (40 %) of them were in the income group of above Rs.3000. There was
no family history of breast cancer.
As per their age in stage II
showed that the highest (60%) of them were in the age group of 46–55 years and
(20 %) between 36-45 years and (20 %) of them were above 55 years. Their
education showed that the highest (70%) of them were educated and (30%) had no
formal education. Occupation depicts that the highest (60%) of them were coolie
workers and (20%) of them were house wife and only (20%) were unemployed. Work
pattern depicts that the highest (50%) of them were heavy workers and (30 %) of
them were moderate workers and only (20 %) of them were sedentary workers. Family monthly income depicts that the highest (70
%) of them belonged to the income group of below Rs.3000 and (30 %) of them
were in the income group of above Rs.3000. None had family history of breast
cancer.
In stage III highest (70%)
of them were in the age group of 46–55 years and (20 %) between 36-45 years and
(10 %) of them were above 55 years. Education showed that the highest (60%) of
them were educated and (40%) had no formal education. Occupation depicts that
the highest (40%) of them were coolie workers and (30%) of them were house wife
and only (30%) were unemployed. Work pattern depicts that the highest (50%) of
them were heavy workers and (20 %) of them were moderate workers and only (30
%) of them were sedentary workers. Family
monthly income depicts that the highest (60 %) of them belonged to the income
group of below Rs.3000 and (40 %) of them were in the income group of above
Rs.3000. In stage III none had family history of breast cancer.
In stage IV highest (50%) of
them were in the age group of 46–55 years and (30 %) between 36-45 years and
(20 %) of them were above 55 years. Education showed that (50%) of them were
educated and (50%) had no formal education respectively. Occupation depicts
that the highest (50%) of them were coolie workers and (30%) of them were house
wife and only (20%) were unemployed. Work pattern depicts that the highest
(50%) of them were heavy workers and (20 %) of them were moderate workers and
only (30 %) of them were sedentary workers. Family
monthly income depicts that the highest (70 %) of them belonged to the income
group of below Rs.3000 and (30 %) of them were in the income group of above
Rs.3000 and none of them had family history of breast cancer.
Table
1: Percentage distribution of stress scores between breast cancer stage I and
IV
|
Stages
of breast cancer
|
Level
of stress
|
|
Mild
stress
|
Moderate
stress
|
Severe
stress
|
|
Stage I
|
60%
|
40%
|
-
|
|
Stage II
|
40%
|
40%
|
20%
|
|
Stage III
|
30%
|
30%
|
40%
|
|
Stage IV
|
-
|
30%
|
70%
|
Table
2: Percentage distribution of quality of life scores between breast cancer
stage I and IV
|
Stages
of breast
cancer
|
Level
of quality of life
|
|
Good
quality of life
|
Poor
quality of life
|
Very
Poor quality of life
|
|
Stage I
|
-
|
40%
|
60%
|
|
Stage II
|
-
|
50%
|
50%
|
|
Stage III
|
-
|
20%
|
80%
|
|
Stage IV
|
-
|
10%
|
90%
|
Table 3:
Association between the quality of life scores and their selected demographic
variables with stage I breast cancer
|
Demographic
variables
|
df
|
 2
|
Table
value
|
Level
of significance
|
|
Age
|
1
|
0.04
|
3.84
|
P> 0.05 Not significant
|
|
Education
|
1
|
2.30
|
3.84
|
P> 0.05 Not significant
|
|
Occupation
|
1
|
0.47
|
3.84
|
P> 0.05 Not significant
|
|
Work pattern
|
1
|
0.90
|
3.84
|
P> 0.05 Not significant
|
|
Family monthly income
|
1
|
1.25
|
3.84
|
P> 0.05 Not significant
|
|
Family history of breast cancer
|
1
|
1.79
|
3.84
|
P> 0.05 Not significant
|
|
Stages of breast cancer
|
1
|
2.89
|
3.84
|
P> 0.05 Not significant
|
Table 4: Association between the quality of
life scores and their selected demographic variables with stage II breast cancer
|
Demographic
variables
|
df
|
2
|
Table
value
|
Level
of significance
|
|
Age
|
1
|
2.31
|
3.84
|
P> 0.05 Not significant
|
|
Education
|
1
|
1.30
|
3.84
|
P> 0.05 Not significant
|
|
Occupation
|
1
|
0.67
|
3.84
|
P> 0.05 Not significant
|
|
Work pattern
|
1
|
1.90
|
3.84
|
P> 0.05 Not significant
|
|
Family monthly income
|
1
|
1.55
|
3.84
|
P> 0.05 Not significant
|
|
Family history of breast cancer
|
1
|
0.49
|
3.84
|
P> 0.05 Not significant
|
|
Stages of breast cancer
|
1
|
4.10
|
3.84
|
P< 0.05 Significant
|
Table 5: Association between the quality of
life scores and their selected demographic variables with stage III breast
cancer
|
Demographic
variables
|
df
|
2
|
Table
value
|
Level
of significance
|
|
Age
|
1
|
3.31
|
3.84
|
P> 0.05 Not significant
|
|
Education
|
1
|
0.30
|
3.84
|
P> 0.05 Not significant
|
|
Occupation
|
1
|
2.67
|
3.84
|
P> 0.05 Not significant
|
|
Work pattern
|
1
|
2.50
|
3.84
|
P> 0.05 Not significant
|
|
Family monthly income
|
1
|
1.35
|
3.84
|
P> 0.05 Not significant
|
|
Family history of breast cancer
|
1
|
3.49
|
3.84
|
P> 0.05 Not significant
|
|
Stages of breast cancer
|
1
|
3.90
|
3.84
|
P< 0.05 Significant
|
Table 6: Association between the quality of
life scores and their selected demographic variables with stage IV breast
cancer
|
Demographic
variables
|
df
|
2
|
Table
value
|
Level
of significance
|
|
Age
|
1
|
2.51
|
3.84
|
P> 0.05 Not significant
|
|
Education
|
1
|
1.50
|
3.84
|
P> 0.05 Not significant
|
|
Occupation
|
1
|
1.77
|
3.84
|
P> 0.05 Not significant
|
|
Work pattern
|
1
|
0.90
|
3.84
|
P> 0.05 Not significant
|
|
Family monthly income
|
1
|
2.45
|
3.84
|
P> 0.05 Not significant
|
|
Family history of breast cancer
|
1
|
1.33
|
3.84
|
P> 0.05 Not significant
|
|
Stages of breast cancer
|
1
|
4.30
|
3.84
|
P< 0.05 Significant
|
DISCUSSION:
The results of this study elicit the
evidence of stress among all stages of breast cancer followed by poor quality
of life. Hitherto only few studies were conducted on stress among breast cancer
patients. This study can be effectively
utilized by the emerging researchers and can be a baseline for further research
studies to build upon. Future researchers can conduct an experimental study
based on quantitative approach. Psychiatric nurses play an important role in
conducting clinical research in the area of women and mental health especially
for breast cancer patients by examining and replicating similar studies.
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