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ORIGINAL ARTICLE
Year : 2022  |  Volume : 31  |  Issue : 2  |  Page : 313-317  Table of Contents     

Quality of life and its sociodemographic determinants in breast cancer patients


1 Department of Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
2 Department of Psychiatry, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India

Date of Submission05-Jan-2021
Date of Acceptance06-Sep-2021
Date of Web Publication05-Jul-2022

Correspondence Address:
Dr. Himanshu Gupta
H. No. 20443, Street No. 12, Bibi Wala Road, G.T.B Nagar, Bathinda - 151 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_6_21

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   Abstract 


Background: Breast cancer is the most common cancer in women worldwide. As the outcome of any cancer treatment is not only dependent on disease-free interval but also on the quality of life (QOL) of the survivor. Hence, this study was conducted to evaluate QOL of breast cancer patients and sociodemographic factors affecting QOL of patients. Subjects and Methods: A cross-sectional study was conducted among 50 breast cancer patients and 50 controls, which fulfilled the selection criteria. The sociodemographic profile and QOL using the World Health Organization QOL-BREF were analyzed using the descriptive statistical methods. Results: All the QOL indicators were statistically significantly (P = 0.0001) lower among breast cancer patients. QOL indicators were statistically significantly (P < 0.01) lower in young age. Not much difference was observed according to religion and these were significantly (P < 0.05) higher among the homemakers. There was no significant difference in all the QOL indicators according to the marital status of the cases. However, these were significantly (P < 0.05) higher among rural cases compared with urban one. The QOL indicators were statistically significantly (P < 0.05) higher among the cases living in joint families than nuclear. No difference was observed among different socioeconomic status. Conclusion: QOL was significantly lower among the breast cancer patients. Age, occupational status, type of family, and locality were the significant factors that affect the QOL of breast cancer patients. Hence, psychological and social support can play an important role in improving QOL of cancer patient.

Keywords: Breast cancer, quality of life, sociodemographic factor


How to cite this article:
Surbhi, Gupta H, Brar GK, Jalota V. Quality of life and its sociodemographic determinants in breast cancer patients. Ind Psychiatry J 2022;31:313-7

How to cite this URL:
Surbhi, Gupta H, Brar GK, Jalota V. Quality of life and its sociodemographic determinants in breast cancer patients. Ind Psychiatry J [serial online] 2022 [cited 2022 Dec 2];31:313-7. Available from: https://www.industrialpsychiatry.org/text.asp?2022/31/2/313/349953



Cancer is most feared of all diseases, and much of the fear associated is due to anticipation of prolonged period of suffering and disabilities to the belief that little can be done to control malignancy or relieve symptoms. Breast cancer is the most common female cancer in the world.[1]

A diagnosis of cancer can challenge every dimension of individual – physical, spiritual, and emotional. Even if the prognosis is hopeful, the patient faces dilemmas concerning quality and meaning of life. Breast cancer poses the unique concerns for women in that they will face not only issue of pain and suffering but the issue of sexual identity and female attractiveness as well.[2]

Trend in cancer treatment is changing, i.e., there is an increasing emphasis on the overall outcome, not just on survival or the disease-free interval but also on the functional status and the quality of life (QOL) of the survivor.[3] The field of health-related QOL has burgeoned in the past two decade. The inclusion of this concept measure in medical research is common in the West, but there are few studies from developing countries.[4] Hence, this study is being conducted to evaluate QOL in breast cancer patients and to compare the same with healthy population. This study also aimed to assess sociodemographic factors affecting QOL in breast cancer patients.


   Subjects and methods Top


Patients diagnosed with breast cancer at tertiary care hospital, which fulfilled the selection criteria and gave written informed consent were included in this study. Participants in the control group were selected from the general population. Purposive sampling was done while selecting subjects in both the groups. Identification data including sociodemographic profile of breast cancer patients and participants in the control group were recorded in pro forma I, consisting of questions related to age, religion, occupation, marital status, locality, type of family, and socioeconomic status (modified Prasad's classification). World Health Organization QOL-BREF scale was used to assess QOL. Mann–Whitney U test was applied to compare QOL scores between the cases and controls. To compare QOL indicators according to demographic profile, Kruskal–Wallis test was applied. P < 0.05 was considered statistically significant. All the analyses were carried out by using the Statistical package for Social sciences version 20.0(SPSS, IBM, Chicago, IL, USA).

Design

It was a cross-sectional study. Patients and controls in the control group were assessed only once at the time of intake into the study.

Sample size

  1. Fifty cases of breast cancer patients
  2. Fifty persons from the general population who were served as the control group.


Inclusion criteria

  1. Patients diagnosed with breast cancer
  2. Female patients of age 18 years and above
  3. Patients who gave written informed consent for the study.


Exclusion criteria

  1. Patients with prior history of any psychiatric illness
  2. Patients with mental retardation
  3. Males suffering from breast cancer
  4. Patients who did not give consent.



   Results Top


[Table 1] presents the comparison of QOL scores between cases and controls. All the QOL indicators were statistically significantly (P = 0.0001) lower among the cases compared to controls.
Table 1: Comparison of quality of life scores between cases and controls

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[Table 2] depicts the comparison of QOL indicators according to the demographic profile of the cases, and it was found that there was significant difference (P = 0.0001) in all the QOL indicators among different age groups. Not much difference was observed in the QOL indicators according to religion, and these were significantly (P < 0.05) higher among the homemakers. There was no significant difference in all the QOL indicators according to marital status of the cases.
Table 2: Comparison of quality of life indicators according to demographic profile (age, religion, occupation, and marital status of the cases

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[Table 3] shows that QOL score was significantly (P < 0.05) higher among rural cases as compared to urban. The QOL indicators were significantly (P < 0.05) higher among the cases living in joint families than nuclear one. No difference was observed among different socioeconomic status.
Table 3: Comparison of quality of life indicators according to demographic profile (locality, type of family, and socioeconomic status) of the cases

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   Discussion Top


In India, the scenario of breast cancer is little different from developed countries.[5] In the absence of screening programs, majority of the breast cancers are still diagnosed in locally advanced stage.[6] Indian women population also differ in ethnic, social, cultural as well as economical aspects as compared to western women. On the other side, breast cancer is mainly a premenopausal disease in Asia while it is more likely to occur as a postmenopausal disease in western countries.[7]

Most of studies exist regarding deterioration in QOL in breast cancer patients and its relationship with various sociodemographic variables are from the West, and very few are from India.[6],[8] Therefore, this cross-sectional study was conducted on Indian women with breast cancer to assess the above-mentioned parameters.

[Table 1] illustrates that scores of all the QOL indicators were significantly lower among the cases as compared to controls. Thus, breast cancer resulted in significantly poor QOL and affected all the domains of QOL in breast cancer patients. Various other studies had also shown same results.

In a study done on 2236 Chinese women with newly diagnosed breast cancer were recruited and it was found that breast cancer patients showed significantly worse overall QOL and perceived health status than healthy women, reflected mainly by lower QOL scores in physical and psychological well-being domains.[9]

An Indian study found that QOL is lower in breast cancer patients and overall mean score for QOL was 59.3, which was comparable to this study. The average score of QOL indicator value is 59.38.[10]

Another Indian study reported that out of 84 breast cancer patients, majority of breast cancer patients had poor QOL.[11]

In our study, it was found that QOL was significantly different between different age groups, i.e., younger age was associated with poorer QOL. The finding of various studies also showed that younger women with breast cancer had poorer QOL than older women.[12],[13] However, this finding is contrary to the results found in other studies.[9],[14],[15] This can be explained by the fact that younger women have greater life stage challenges in adapting to the unexpectedness of breast cancer diagnosis, including possible losses in their careers, family life, and fertility.[13]

Minimal effect of marital status on QOL of breast cancer women was found in few studies,[15],[16] which is consistent to the finding of our study.

In a cross-sectional study, it was found that occupation status was significantly associated with QOL. The global health status was significantly higher in working women than in housewives.[17] This finding was contrary to the results of this study. However, in a study conducted on employment status and QOL in recently diagnosed breast cancer survivors, it was found that breast cancer women who stopped working during the 6-month follow-up period had lower QOL.[18] In our study, most of employed patient had done her duty on the daily basis. Hence, inability to attend duty regularly and fear of loss of duty could be reason of lower QOL in employed patients.

Breast cancer patients residing in the rural area had significantly higher QOL than those residing in the urban area. Women living in the rural areas could count on more support from family and friends and exhibited a greater will to live than the respondents from cities.[19] This finding was similar to the result of our study.

In our study, significantly higher QOL was found in patient living in joint family. This could be explained by more social support in joint families. Several studies also showed that perception of social support was a significant predictor of favorable prognosis.[20],[21],[22],[23]

In this study, no difference was observed among different socioeconomic status. This is inconsistent to the finding of other study.[24] This can be explained by free of cost treatment being provided to all our patients.

Some limitations are also worth mentioning. Sample size is limited; there is a need for a larger sample size to accurately assess the impact of breast cancer on QOL of the patients. All the variables were assessed cross-sectionally; hence, answers to cause-effect relationship between the variables cannot be given. Longitudinal studies should be carried out to look for the changes in QOL over a period of time in breast cancer patients.


   Conclusion Top


We noted that QOL was significantly lower among breast cancer patients. Age, occupational status, type of family, and locality were the significant factors that affect the QOL of breast cancer patients. Therefore, the study recommends that QOL assessment should be incorporated in the patient's treatment protocol. Emphasis should be given to psychological support to breast cancer patients to improve their QOL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.  Back to cited text no. 1
    
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Gangane N, Khairkar P, Hurtig AK, San Sebastián M. Quality of life determinants in breast cancer patients in Central Rural India Asian Pac J Cancer Prev 2017;18:3325-32.  Back to cited text no. 10
    
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Kanayamkandi J, Sunderam S. Quality of life among breast cancer patients: A cross sectional study. Int J Community Med Public Health 2017;4:686-9.  Back to cited text no. 11
    
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Sharma N, Purkayastha A. Factors affecting quality of life in breast cancer patients: A descriptive and cross-sectional study with review of literature. J Midlife Health 2017;8:75-83.  Back to cited text no. 12
    
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Mor V, Malin M, Allen S. Age differences in the psychosocial problems encountered by breast cancer patients. J Natl Cancer Inst Monogr 1994;16:191-7.  Back to cited text no. 13
    
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Saleha SB, Shakeel A, Shumaila E, Shazia R, Rashid R. An assessment of quality of life in breast cancer patients using EORTC QLQ C30/+Br 23 Questionnaire. IJCP 2010;2:98-104.  Back to cited text no. 14
    
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Safaee A, Moghimi-Dehkordi B, Zeighami B, Tabatabaee H, Pourhoseingholi M. Predictors of quality of life in breast cancer patients under chemotherapy. Indian J Cancer 2008;45:107-11.  Back to cited text no. 15
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Dubashi B, Vidhubala E, Cyriac S, Sagar TG. Quality of life among young women with breast cancer: Study from a tertiary cancer institute in south India. Indian J Cancer 2010;47:142-7.  Back to cited text no. 16
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Kannan K, Prashant K, Rao JG. Quality of life of women with breast cancer at a tertiary care hospital. Int J Biol Med Res 2011;2:1003-5.  Back to cited text no. 17
    
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Timperi AW, Ergas IJ, Rehkopf DH, Roh JM, Kwan ML, Kushi LH. Employment status and quality of life in recently diagnosed breast cancer survivors. Psychooncology 2013;22:1411-20.  Back to cited text no. 18
    
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Pacian A, Kulik TB, Pacian J, Chruściel P, Żołnierczuk-Kieliszek D, Jarosz MJ. Psychosocial aspect of quality of life of Polish women with breast cancer. Ann Agric Environ Med 2012;19:509-12.  Back to cited text no. 19
    
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De Boer MF, Ryckman RM, Pruyn JF, Van den Borne HW. Psychosocial correlates of cancer relapse and survival: A literature review. Patient Educ Couns 1999;37:215-30.  Back to cited text no. 20
    
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Gerits LJ. Psychoneuroimmunology and breast cancer: Predictors of acute stress symptoms as a consequence of the diagnosis. In: Dissertation. Leiden, Germany: University of Leiden; 1997.  Back to cited text no. 22
    
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Carlsson M, Hamrin E. Psychological and psychosocial aspects of breast cancer and breast cancer treatment. A literature review. Cancer Nurs 1994;17:418-28.  Back to cited text no. 23
    
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Munasinghe WH, Rathnayaka NN. Quality of life and satisfaction with care among breast cancer survivors receiving different treatments strategies in Sri Lanka. Cancer Ther Oncol Int J 2016;2:1-5.  Back to cited text no. 24
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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