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Indian Journal of Community Medicine

A study of expectations of cancer patients regarding treatment related side effects in Bhopal

Author(s): SC Tiwari, S Nandeshwar, V Agrawal, A Dusad, M Gupta

Vol. 32, No. 1 (2007-01 - 2007-03)

Patient’s expectancy is important because of its predictive and perhaps causal association with the development of actual side effects generated by chemotherapy and radiotherapy1 Expectations of cancer patients can contribute to the development of a treatment related side effects according to schema theory2 which depicts that information (e.g. sensory data) will be interpreted through relevant schema, meaning that an individual who expects a symptom (e.g. nausea) will be more likely to interpret and defi ne sensations associated with cancer treatment as nausea than an individual who does not expect the side effects. The present study was carried out to characterize what side effects patient expects regarding cancer treatment and to describe how patient’s characteristics affect these expectations.

Material and Methods

The present descriptive study was carried out from October 2004 to April 2005. The sample comprised of 160 newly diagnosed cancer patients who were planning to undergo either chemotherapy (CT) or radiotherapy (RT). Ninety patients were from Kamala Nehru Hospital, Bhopal and 70 were from Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal. Sample was taken randomly (every third patients) from the list of OPD patients who had not initiated the therapy. After obtaining informed consent, patients were counselled about the treatment option and the disease.

All the information regarding demographic data, type of cancer, and type of treatment option e.g. radiotherapy (RT), chemotherapy (CT) or radio-chemotherapy (RT+CT) were obtained in a questionnaire prepared by radiologists and oncologists from Kamala Nehru Hospital Bhopal. Side effects queried were the most common side effects usually experienced by cancer patients during the treatment, i.e. hair loss, vomiting, weight loss, pain, fatigue, sleep problems, depression, burning micturition and mouth ulcer. Each patient was interviewed prior to initiation of the therapy to assess the current symptoms due to cancer itself and expected symptoms regarding treatment related side effects. Patient’s response was recorded as “YES” if they certainly expected the side effect to be developed and “NO” if they certainly did not expect the side effects.

Results

Table 1 depicts that out of 160 patients, 47.5% were females and 52.5% were males. 31.25% were illiterate and 52.5% were educated below graduation whereas only 16.25% were graduates. Study sample was mainly dominated by breast cancer patients (22.5%).

Females expected signifi cantly higher number of side effects than males. Mean number of side effects is higher among educated than illiterates in all categories. In <60 years age group, female graduates expected greater number of side effects (mean 8.67) than female illiterates (7.67) whereas, male graduates expected lesser number of side effects (7.16) than female graduates (8.67). In addition, carcinoma cervix patients expected highest number of side effects (7.66) and bone cancer patients expected lowest number of side effects (4.25).

Table 1: Distribution of Patients According To Demographic Variables

Variables No.of Patients Percent Mean No. of
Expected Side
Effects
Sex
Males 84 52.5 6.28a
Females 76 47.5 7.76a
Age
<60yrs 116 72.5 6.95
Female 56 35.0 7.36
Illitrate 24 15.0 7.67
<college 26 16.2 3.33
>college 06 03.7 8.67c
Male 60 37 5 6.12
Illitrate 12 07.5 6.23
<college 36 22.5 7.14b
>college 12 07.5 7.16
>60 44 27 5 5.85
Female 20 12. 5 6.00
Illitrate 06 03. 7 4.66
<college 08 05.0 7.75b
>college 06 03.7 6.40c
Male 24 15 0 5.90
Illitrate 10 06.2 6.20
<college 10 06.2 5.60
>college 04 02.5 6.00
Treatment Option
Radiotherapy 58 36.2 7.06
Chemotherapy 50 31.2 6.54
Radio+chemo 52 32.5 6.41
Type of Cancer
Breast 36 22.5 7.44
Lung 32 20.0 7.43
Cervix 24 17.5 7.66
Oral 22 16.5 5.80
G.I. 18 16.0 5.00
Brain 12 06.5 5.40
Head&neck 08 05.0 6.60
Bone 08 05.0 4.25

A,b,c P<.005

Table 2 depicts that hair loss was the most common side effect expected by patients of < 60 years age group (77.5%) whereas pain (59%) and sleep problems (59%) were the most common in the age group of >60 yrs. With reference to gender, fatigue was expected by highest number of patients in both sexes, 92% illiterate patients expected fatigue. However, expectation of graduates was more towards weight loss (100%) and pain (92.2%). Fatigue was expected by all the patients with cancer of head and neck (100%). However, none of the bone cancer patients expected weight loss.

Table 2: Five Most Common Expected Side Effcts With Demographic Variabls

Variables Hair
Loss
(%)
Weight
Loss
(%)
Pain
(%)
Fatigue
(%)
Sleep
(%)
Age
<60yrs 77.5 72.4 65.5 75.8 68.9
>60yrs 31.8 54.5 59.9 50.0 59.0
Sex
Male 61.9 69.0 59.5 73.8 71.0
Female 50.0 63.0 65.7 71.0 63.0
Eduction
Illitrate 68.0 72.0 68.0 92.0 88.0
<graduates 59.5 61.9 66.6 66.6 59.5
>graduates 76.9 100.0 92.2 53.8 46.1
Treatment Option
Radiotherapy 48.2 75.8 68.9 75.8 68.9
Chemotherapy 12.0 56.0 60.0 68.0 52.0
Radio+chemo 65.3 65.3 61.5 69.2 84.6
Type of Cancer
Breast 83.3 53.5 77.7 72.2 55.5
Lung 75.0 75.0 68.7 75.0 75.0
Cervix 58.3 66.6 75.0 66.6 66.6
Oral 45.5 72.7 09.0 54.5 45.4
G.I. 71.2 66.6 77.7 88.8 88.8
Brain 50.0 50.0 50.0 50.0 75.0
Head&neck 25.0 75.0 75.0 100.0 75.0
Bone 25.0 00.0 75.0 25.0 50.0

Discussion

The predominant observation of this study was the high number of side effects expected by patients before the initiation of therapy, though there was a slight difference in the number of side effects expected by patients based on the different characteristics of the patients. In the present study female and younger patients expected signifi cantly higher number of side effects than male and older patients and this is supported by the study of Morrow (2003) who found similar results3.

Mean number of expected side effects was increased with the level of education in both < 60 and > 60 yrs. age group. Similarly Hofman et al (2004) found that non high school patients expected fewer numbers of side effects than their more educated counter part4.

A number of studies have shown that fatigue is the most common side effect experienced by cancer patients and it is worth noting that in the present study also most of the patients expected that they will develop fatigue as a side effect if they receive the cancer treatment5.

From the present study it can be concluded that most of the cancer patients expect high number of side effects related to cancer treatment. In addition, patient’s age, gender, education and type of cancer has clear influence on patient’s expectations regarding treatment related side effects. Proper counseling, education and information regarding treatment options and its side effects are essential to reduce these expectations. Further exploration of any fear should also be identifi ed and alleviated to prevent these expectations for the earlier and effective management of cancer treatment.

References

  1. Pendergrass KB. Options in the treatment of chemotherapy induced emesis. Cancer Pract. 1998; 6: 276-281.
  2. Thorndyke PW, Hayes Roth B. The use of schemata in the acquisition and transfer of knowledge. Cognitive Psychol. 1979; 11:82-106
  3. Morrow GR. Cancer patients’ expectation of experiencing treatment related side effects: A URCC CCOP study of 917 patients from community practices. Proc Am Soc Clin Oncol 2003; 22: 744.
  4. Hofman M, Morrow GR, Joseph A, Roscoe et al. Cancer patient’s expectation of experiencing treatment related side effects: A URCC CCOP study of 938 patients from community. Am. Can. Soc. Clin. Oncology. 2004; 101:851-857.
  5. Jereczek- Fossa BAM. Radiotherapy-related fatigue .Crit Rev Oncol- Hematol.2002; 41:317-325.

Dept. of Community Medicine
Gandhi Medical College, Bhopal (MP)
E-mail: [email protected]
Received: 3-9-05

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