INTRODUCTION:

Cancer is a leading cause of death worldwide, accounting for 7.6 million deaths (around 13% of all deaths) in 2008. About 70% of all cancer deaths in 2008 occurred in low- and middle-income countries. Deaths from cancer worldwide are projected to continue rising, with an estimated 13.1 million deaths in 2030 (WHO)¹

In India, though infectious diseases continue to be a public health problem but an increase in the occurrence of non-communicable diseases has been noted particularly in urban areas and in economically advanced states. Punjab is one of India’s most prosperous states, seventy percent of the population is directly or indirectly associated with agriculture. As per 2001 census, 70% people live in villages and 30% in the urban areas. Villagers attributed higher occurrence of cancer to unhygienic living conditions and poor quality of drinking water. Cancer cases reported from villages of Talwandi Sabo block of district Bathinda of Punjab revealed prevalence of histologically confirmed cancer cases as 125.4 per 1,00,000 population. (Thakur J.S, 2008)²

There is no doubt that the diagnosis of a life threatening disease such as cancer is devastating and has an enormous effect on one's quality of life. In almost all studies, patients' quality of life was first assessed after the diagnosis and after or during each course of treatment. Therefore, the question remains as to what extent does the knowledge of diagnosis affect the results. If a patient has recently received 'bad news' indicating that he or she has developed cancer, any assessment especially on psychological aspects such as emotional functioning may be biased. .(Montazeri Ali,2004)³.

The Quality of life is general term integrating several aspects of life such as physical, psychological, social, economical, spiritual, cognitional, and sexual dimensions. A disturbance in any one aspect will in turn affect the other domains and this influences the overall quality of life. Quality of life is vital health outcome measure that is relevant to the care of cancer patients. (E. Vidhubala, 2005)⁴

Quality of life is multidimensional construct encompassing perception of both positive and negative aspects of dimensions such as physical, emotional , social and cognitive functions as well as negative aspects of somatic discomfort and other symptoms produced by a disease or its treatment. (Singh pal Divya, 2010)⁵

In physical symptoms, people with cancer nearly always experience considerable levels of psychological distress. Psychological health in cancer patients is defined by the presence or absence of distress as well as the presence or absence of positive wellbeing and psychological growth. It is determined by the balance between two classes of factors: the stress and burden posed by the cancer experience and the resources available for coping with this stress and burden. (Lin Yin- Kuan , 2011)⁶

Quality-of-life concerns affecting social well-being include family issues, such as sexual and marital problems and adjustment of children, and work-related issues, such as concern over cancer disclosure, stigma, re-entry into the workplace, changes in work priorities, discrimination, and health insurance. (Betty R., 1997)⁷

A cross-sectional study to assess the communicative acts of love, gratitude, and forgiveness, and to explore the extent to which the communicative acts, social well-being, and spiritual well-being predict the overall quality of life at the end stage of life when controlling for physical symptoms. Patients of age 35-80 years with a cancer diagnosis residing in their private home in a community setting, in the mid-western United States were choosen with convenience sampling. Results shows that there were strong, positive correlations among social and spiritual well-being, communicative acts, and quality of life at the end stage of life were found. (Prince-Paul M, 2008)⁸

OBJECTIVE OF THE STUDY:

· To assess the quality of life among cancer patients in terms of physical, social, emotional and functional well-being.

· To find out the relationship between the quality of life with the selected demographic characteristics.

· To develop and provide informational material in the form of pamphlets to improve the quality of life.

MATERIAL AND METHODS:

An exploratory research design was used in the present study. The present study was carried out in district Bathinda. A total 100 cancer patients were studied. Convenience sampling technique was used to select the sample.

Exclusion criteria- 1.Subjects who were not willing to participate.

2. People suffering with any other disease along with cancer like mental disorder.

3. People who were physically handicapped.

Description of research tool

A standardized tool was used to assess the quality of life among cancer patients.

It consist of two parts.

PART-A : (Section-a)- Socio-demographic Profile

(Section-b)- Physical profile

PART-B : FACT-G questionnaire

RESULTS:

Data were coded and entered in the master sheet. Analysis was done using SPSS. It consists of both descriptive and inferential statistics. The demographic characteristics of the study subjects are given in Table 1.

Socio demographic profile	%
Age (in years) ≤40 41-50 51-60 ≥61 Gender Male Female Religion Hindu Sikh Marital status Married Widow/ Widower Education Illiterate Elementary Secondary Graduate and above Occupation Farmer Labourer Professional/ Businessmen Housewife Family income per month (in Rs.) ≤5000 5001-10,000 10,001- 15,000 >15,000 Dietary Habits Vegetarian Non-Vegetarian Type of family Joint family Nuclear family Area of Residence Rural Urban Any type of addiction Alcohol Tobacco Alcohol, Tobacco Opioid None	15 20 35 30 31 69 21 79 88 12 68 15 12 05 16 11 09 64 51 34 9 6 73 27 30 70 74 26 10 06 05 01 78
Socio-demographic profile	%
Socio-economic status (S.E.S ) Upper Class (I) Upper Middle Class (II) Lower Middle Class (III) Upper Lower Class (IV) Lower Class (V)	01 12 22 49 16

SES according to Kuppuswamy’s scale of socio-economic status of family

Table 1. shows that less than half (35 %) cancer patients were in age group 51-60 years. 69 % cancer patients were females. Majority of cancer patients (79%) belonged to Sikh religion. In case of current marital status most of subjects 88 % were currently married. 68% cancer patients were illiterate. Slightly more than half (51%) cancer patients had family income less than Rs.5000 per month. Maximum of cancer patients (73%) were vegetarian. There were 70% of cancer patients who belong to nuclear family. 74% of subjects were residing in rural area. Slightly less than half (49%) of cancer patients belonged to upper lower class of socio-economic status.

The results of physical profile shows that more of the subjects were suffered with breast cancer (27%), 9 % cancer patients were in each group i.e suffered with Cervix cancer, Esophagus Cancer and Endometrial cancer, 5 % were suffered from ovarian cancer. Cancer patients suffered with Brain tumor, Oral cancer, Intestine cancer were 4 % in each, 3% subjects were in each suffered with Vocal cord cancer, Kidney Cancer, Prostate cancer, Blood cancer, Lymph node cancer. There were 2% subjects in each suffered with Colon cancer, Liver cancer, Bone cancer and Nasal bone cancer and only 1 % subjects were suffered with Ear lobe cancer, Penile caner, cancer of urinary bladder, Soft tissue sarcoma, Lung cancer and Adeno-carcinoma of throat in each. Maximum (75%) subjects were diagnosed from less than five years, 17% between 5-10 years, 6% were diagnosed between last 10-15 years, and only 2% subjects were diagnosed from more than 15 years. More than half (53%) subjects were at stage I of cancer, 20% subjects were not known to their stage of cancer, 13% subjects who were at stage II, 10% subjects of stage III, and only 4% subjects were at stage IV. Majority (85%) subjects had no family history of cancer, only 15% subjects had family history of cancer. Most of the subjects 92% were taking Allopathic treatment. There were 3% subjects in each who were taking Homeopathy and Ayurvedic treatment and only 2% subjects who had not taken any treatment. 76% subjects were taking treatment for less than 5 years. There were 15% subjects who were taking the treatment for 5-10 years, 6% had taken for 10-15 years and only 1% were taking the treatment for more than 15 years. There were only 2% subjects who had not taking any treatment. Maximum of the subjects 77% were chose private sector for treatment of cancer. There were 21% subjects who were chose government sector for treatment of cancer. There were only 2% subjects who had not chosen any health sector. More than half of the subjects 58% perceived polluted water was the cause of cancer, there were 19% subjects who perceived curse was the cause of cancer, 12% perceived pesticide was the cause and 11% perceived injury was the cause of cancer. None of the patient perceived that hereditary was the cause of cancer. Maximum of subjects 77% had not any affected family members with cancer. There were 16% subjects who had only 1 affected family member with cancer, 5% had 2 affected family members and 1% subjects in both the groups who had 3 and 4 affected family members with cancer. The outcome of suffered family members shows (22%) expired with cancer. There were only 1% subject who was alive, and none of suffered family member cured from cancer. 31% cancer patients had onset of disease in the age of 50-60 years. 26%, 24%, 13% had onset of disease in the age of 40-50 years, >60 years and 30-40 years, respectively. There were only 6% cancer patients who had onset of disease in the age of 20-30 years. More than half 53% of cancer patients had average quality of life, followed by 44% of cancer patients had good quality of life. There were only 3% of subjects who had poor quality of life. The Mean score of the domains of quality of life in terms of physical well-being, social well-being, emotional well-being, and functional well-being shows that the subjects had maximum mean score 26.35 in term of Social well-being, followed by 16.97, 14.30 and 12.19 Functional well-being, Emotional well-being, and Physical well-being, respectively.

Table 1: Mean quality of life score among cancer patients according to variables N=100

Variables

Mean±SD

F value

p value

Age (in years )

≤40

41-50

51-60

≥61

76.07 ± 14.36

72.70 ± 20.01

75.43 ± 18.67

57.93 ± 17.57

F=6.224

p=0.001^*

Occupation

Farmer

Laborer

Professional/Businessmen

Housewife

70.25 ± 19.73

53.91 ± 16.06

68.89 ± 25.54

72.44 ± 18.05

F=3.028

p=0.033^*

Stage of Cancer

III

Not known

76.15 ± 16.05

64.46 ± 18.22

68.80 ± 21.22

50.00 ± 35.74

60.65 ± 18.29

F=4.328

p=0.003^*

Maximum quality of life score = 108 *S=Significant

Minimum quality of life score = 00

It can be concluded that age, occupation and stage of cancer had highly significant impact on quality of life among cancer patients.

Table 2: Relationship of age onset of cancer with gender among cancer patients. N=100

Gender

Mean

p value

Male

Female

58.61

48.97

13.08

0.000^*

*Significant

It can be concluded that gender had highly significant impact on age onset of disease among cancer patients

DISCUSSION:

Cancer is the second biggest cause of death in India. There are 2.5 million cancer cases and four lakh deaths a year in India. The prevalence of cancer cases in Punjab as per survey is 30.54 per lakh population. Cancer is commonly seen is the worst of all illness. Death and cancer are equated by majority of population and it is therefore natural to assume that cancer has several negative impact on the quality of life of those stricken with the disease. The cancer disease has sustained substantial decrease in the quality of life and life expectancy. So a descriptive study was undertaken to assess the quality of life among cancer patients of district Bathinda, Punjab.

In this present study, a total of 100 cancer patients were selected by the purposive sampling technique for the study. Standardized tool was given to subjects to explore the quality of life among cancer patients. The analysis of data was done using descriptive and inferential statistics.

It has been found that maximum 35% cancer patients were in age group 51-60 years and 69% subjects were females. In case of current marital status 88 % were married and majority 79 % were belonged to Hindu religion. More than half 68% cancer patients were illiterate. Less than half 49% were belonged to upper lower class. Singh Pal Divya (2010)⁵who conducted the study among 100 cancer patients in Delhi and reported that 45% were aged between 40-59 years, 63% cancer patients were females and most of subjects 67% were married. 77% subjects belonged to Hindu religion and 21% cancer patients were illiterate. Most of patients 59% belonged to low socioeconomic status.

In the present study, more than half (64%) subjects were housewives and 18% were labourer. A study conducted by Yu.M et al.(2000, Hong-kong)⁹the results revealed that 53% were housewives.

One fourth of the cases 27% had breast cancer. A study conducted by Thakur J.S. (2008)²in Talwandi sabo revealed that 37% subjects had breast cancer.

More than half 53 % subjects who were at stage I of cancer whereas Cella. F. David (1993)¹⁰in Chicago shown that 46% subjects were at stage IV of cancer.

The first objective of the study was to assess the quality of life among cancer patients in terms of physical well-being, social well-being, emotional well-being and functional well-being. The findings of the present study revealed that the cancer patients had worse emotional well-being and better social well-being with mean score 12.19 and 26.35, whereas physical well-being and functional well-being shown 14.30 and 16.97 mean score. Thomas B.C.(2003)¹¹in Trivandrum, India and the revealed that the cancer patients had worse emotional well-being with mean score 18.1 and better social well-being with 22.3 mean score.

The second objective of the study was to find out the relationship between the quality of life with the selected demographic characteristics. The findings of the present study shown that the relationship between the quality of life among cancer patients with age was scientifically significant (p<0.001). Dapueto et al. (2003)¹²from Montevideo, USA found that there was scientific significant association between the quality of life among cancer patients with age (p<0.05).

In present study the association between the quality of life among cancer patients with occupational status was shown scientifically significant results (p<0.033). Thomas B.C.(2003)¹¹inTrivandrum, Indiawere shown parallel results that there was significant association between the quality of life among cancer patients with occupational status (p<0.05).

The association between the quality of life among cancer patients with gender, religion, marital status, education, dietary habits, type of family, family income, area of residence, socio-economic status, duration of disease diagnosed were not significant (p<0.05).

David cella (2001)¹³in Illinois, USA showed that there were not significant association between gender, religion, marital status, educational status. Dapueto et al. (2003)¹²in Montevideo, USArevealed that there was significant association between the quality of life and educational status (p<0.005)

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Received on 07.08.2014 Modified on 08.09.2014

Asian J. Nur. Edu. and Research 5(1): Jan.-March 2015; Page 18-22

DOI: 10.5958/2349-2996.2015.00005.1

An Exploratory Study to Assess the Quality of Life among Cancer Patients of District Bathinda, Punjab