A descriptive study to assess the level of stress among women with selected type of cancer in Erode Cancer Centre at Erode

Ms. S. Lavanya¹, Dr. Nalini Jeyavantha Santha², Dr. Gowri Sethu³

¹Vice Principal, Nandha College of Nursing, New Teachers Colony, Erode – 638011, Tamil Nadu

²Principal, Sacred Heart Nursing College, Madurai

³Dept. of Physiology, Saveetha University, Chennai

*Corresponding Author Email: sureshmahas@yahoo.co.in

ABSTRACT:

Background: Cancer diagnosis is a significant source of psychological stress, followed by an extended period of Stressful cancer treatment modalities. Not surprisingly, patients with a diagnosis of cancer report high psychological and emotional stress Objectives: To assess the level of stress among women with selected type of cancer. Design: A cross – sectional descriptive design was adopted for the study. Setting: Erode Cancer Centre, Erode Participants: 50 women fulfilling the inclusion criteria were selected by purposive sampling technique. Methods: All participants were interviewed a questionnaire to complete; questions were related to Baseline Proforma of women and Rating scale on The Impact of Event Scale (IES) and participants were given 20 minutes to complete the questionnaire. Results: The findings revealed that the stress among women with breast cancer shows that, majority (70%) of the samples had severe stress, and 30% of them had moderate stress, whereas women with cervical cancer 10 % were had mild stress, 30 % were had moderate stress and 60 % were had severe stress. It shows that breast cancer patients had more stress compared to cervical cancer patients. There was a significant association between the stress scores and variables like age and stages of cancer.

Conclusion: Stress is more among cancer patients. Maximum patient do not seek medical advice and adopt self-treat for themselves.

KEY WORDS: Stress, Women, Breast cancer and cervical cancer.

INTRODUCTION:

Cancer diagnosis is a significant source of psychological stress, followed by an extended period of stressful cancer treatment. Not surprisingly, patients with a diagnosis of cancer report high psychological and emotional stress. Although initial stress tends to decline over time for most patients, many others continue to suffer from high stress for years even after the successful completion of cancer treatment. Studies indicate that up to 30% of patients report high stress levels years from breast cancer diagnosis and surgery. Some patients even experience posttraumatic stress disorder precipitated by cancer diagnosis. (Spiegel, D.,2012).

Mood disturbance, particularly of depression and anxiety, is common with cancer diagnosis and has been highly correlated with psychological stress. About 20–40% of cancer patients have reported significant levels of depressive mood and anxiety, and these patients typically have reported higher frequency and severity of clinical symptoms including pain, fatigue, poor appetite, sleep disturbance, and poor quality of life. In some studies, depression has been associated with higher cancer recurrence and cancer mortality, although this association has not been consistent in all studies. (Van Oers HM, 2013).

Psychological stress may have multiple negative impacts on health outcomes. Chronic psychological stress has been linked to higher incidence of infections, accelerated aging and greater cardiovascular diseases in diverse populations. In patients with breast cancer, high psychological stress was associated with low physical and psychological quality of life and even a significantly shorter disease-free interval than women without major stress experience. In addition, stress was found to decrease the efficacy of or resistance to chemotherapeutic agents in animal models. (Stanton, A.L., 2010)

The psychoneuroimmunology literature clearly demonstrates that psychological and emotional stress induces significant alterations in various biological responses. The typical activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system may trigger a shift in immune cell traffics and facilitate inflammation via multiple neuroendocrine and immune pathways. Higher stress was correlated with poorer immune responses, and stress reduction seemed to improve immune responses (Natural killer cell activity) in women with breast cancer.

The psychological effects of breast cancer have been documented by using patients’ self-reported mood and psychological symptoms to assess their psycho-logical distress, sexual functioning, and overall quality of life; more rarely, investigators have used structured diagnostic interviews to assess psychiatric diagnoses. Findings indicate that the diagnosis of breast cancer is associated with heightened levels of negative emotions and psycho-logical distress, especially symptoms of anxiety and depression. Elevated symptoms of anxiety and depression near the time of diagnosis are typically reported in 30% to40% of patients, a rate that is approximately three to four times that found in the general population.(Georita M. Frierson

, and Debora L. Thiel, 2006)

Breast cancer is the most common malignancy of women worldwide accounting for 23% of all newly diagnosed cancer cases. It is also the leading cause of cancer mortality, representing 14.1%. In Zambia, it is second to cervical cancer and its incidence is steadily increasing. A diagnosis of cancer regardless of stage is a stressful event impacting on all facets of the patient and her family caregivers. For the family, a cancer diagnosis for a family member creates multiple challenges, including physical demand for practical care giving, emotional strain, change in role and responsibilities, and adjustment to work and career schedules. In order to adapt/cope, both the patient and family caregivers ought to employ certain coping mechanisms. Individuals with terminal illness who utilize coping strategies have better quality of life compared to those who do not.( Zambia Cancer Society. 2010)

STATEMENT OF THE PROBLEM:

A descriptive study to assess the level of stress among women with selected type of cancer in Erode Cancer Centre at Erode.

OBJECTIVES:

1. To assess the level of stress among women with selected type of cancer

2. To find out the association between stress scores among women with selected type of cancer and their demographic variables

HYPOTHESIS

H₁There is a significant level of stress among women with selected type of cancer

H₂There is a significant association between stress scores among women with selected type of cancer and their demographic variables

DELIMITATIONS

The study is limited to,

1. Level of stress

2. Women with breast cancer and cervical cancer

3. Erode Cancer Centre at Erode

MATERIALS AND METHODS:

Research approach

A quantitative research approach was selected to collect the data from the women with selected type of cancer to study the level of stress.

Research design

A cross sectional descriptive research design was used

Research setting

The study was conducted in Erode Cancer Centre at Erode

Population

The population for the present study was all the women breast cancer and cervical cancer between the age group of 30 -60 years.

Sample

The sample consisted of 50 women (25 breast cancer and 25 cervical cancer) admitted in Erode Cancer Centre at Erode

Sampling technique:

Purposive sampling technique was used to select the sample for the study.

Development of tool

A baseline Proforma and rating scale on The Impact of Event Scale (IES) is a short set of 15 questions that can measure the amount of stress that one associate with a specific event was selected with the help of review of literature, personal experience and discussion with experts.

Description of the tool

Section A: Baseline Proforma of the samples

Section B: Rating scale on The Impact of Event Scale (IES)

Section A: Baseline Proforma

It contained items for obtaining information regarding Age, Educational status, Religion, Occupation, Monthly family Income, Marital status, Stages of Illness and Duration of Hospitalization.

Section B: Rating scale on The Impact of Event Scale (IES)

It consisted of 15 items. Below is a list of comments made by people after stressful life events, indicating how frequently these comments were true during the past seven days. The scores can range from 0 to 75. 0 – not at all, 1 –rarely, 3- sometimes, 5 - often

Scoring procedure

Level of stress	Actual scores	Percentage
No stress (No Meaningful Impact)	0 – 8	< 11
Mild stress (Impact Event—you may be affected)	9 – 25	12 - 33
Moderate stress (Powerful Impact Event—you are certainly affected)	26 – 43	34 - 57
Severe stress (Severe Impact Event—this is capable of altering your ability to function)	44 – 75	> 58

Plan for data analysis

The data were analysed by using both descriptive and inferential statistics

Ø Baseline proforma of the samples were described by frequency and percentage distribution

Ø Frequency and percentage was used to assess the level of stress among women with breast and cervical cancer

Ø Chi square test was used to find out the association between stress scores and selected variables of women with breast and cervical cancer.

RESULTS:

Section A:

1. Breast cancer:

Most (91%) of the women were in the age group of 41 -50 years. However 72% of them were higher secondary education, 92% were Hindus, all of them were sedentary worker and above Rs 4500 income group, 92% of them were married, and 80% were stage II and 84% of them were less than 1week hospitalized.

2. Cervical cancer:

Most (92%) of the women were in the age group of 41 -50 years. However 80% of them were higher secondary education, 84% were Hindus, 90% were sedentary worker and 67% were above Rs.4500 income group, 90% were married, and 86% were stage II and 82% were hospitalized between 1 -2 weeks.

Section B:

The findings revealed that the level of stress among women with breast cancer shows that, majority (70%) of the samples had severe stress, and 30% of them moderate stress whereas women with cervical cancer 10 % were mild stress, 30 % moderate stress and 60 % severe stress. It shows that breast cancer patients had more stress compared to cervical cancer patients.

Section C:

There was a significant association between the stress scores and variables like age ( χ²= 4.43 , p > 0.05) and stages of illness ( χ²= 6.62 , p > 0.05). But there was no significant association with stress of women with breast cancer and cervical cancer with other variables like education, religion, occupation, monthly family income, marital status, stage of illness and duration of hospitalization.

CONCLUSION:

· The findings revealed that the level of stress among women with breast cancer shows that, majority (70%) of the samples had severe stress, and 30% of them moderate stress whereas women with cervical cancer 10 % were mild stress, 30 % moderate stress and 60 % severe stress.

· There was a significant association between the stress scores and variables like age and stages of cancer

· There was no significant association between the stress scores and variables like education variables like education, religion, occupation, monthly family income, marital status, stage of illness and duration of hospitalization.

RECOMMENDATIONS:

1. A study can be conducted with large samples to generalize the findings.

2. A comparative study can be done between urban and rural women.

3. A comparative study can be done between married and unmarried women.

4. SIM can be developed based on the learning needs of the women with cancer regarding stress and its self care management.

5. Intervention study can be conducted to know the effect of various treatment methods in reducing stress.

REFERENCES:

1. Georita M. Frierson, and Debora L. Thiel, Body Change Stress for Women With Breast Cancer: The Breast-Impact of Treatment Scale. Ann Behav Med. Aug 2006; 32(1): 77–81.

2. Spiegel, D., Bloom, J.R., Kraemer, H.C., andGottheil, E. (2012). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2 888–891.

3. Stanton, A.L., Danoff-Burg, S., Cameron, C.L., Bishop, M., Collins, C.A., Kirk, S.B., Sworowski, L.A., andTwillman, R. (2010). Emotionally expressive coping predicts psycholog-

4. ical and physical adjustment to breast cancer. Journal of Consulting and Clinical Psychology , 68, 875–882

5. Zambia Cancer Society. 2010. Cervical Cancer in Zambia. http://www.zambiacncersociety [accessed 19/04/10].

6. Van Oers HM, (2013), Anxiety and the patient with breast cancer: a review of current research and practice, S AfrFamPract 2013, Vol 55 No 4

Received on 18.05.2014 Modified on 02.07.2014

Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 321-324