Psychosocial Factors Determining Quality of Life Among Cancer Patients in Nepal

Abstract

The cancer disease is on the rise in Nepal but lacks exact data to estimate its burden insociety and the psychosocial suffering of the patients. The cancer patients are beingintervened with varieties of medical treatment in Nepal but growing literaturesindicate that single (medical) treatment approach is not adequate. It is important tolook into the other side of the treatment. The social and emotional impact of thedisease, in Nepal, are not seriously examined, and attended leaving the patients,families and friends alone to cope, often ill-equipped to deal with the illness andunfamiliar with assistance and resources. Cancer patients are forced unintentionally toexperiencepersonal crisis affecting their psychological and social integrity in thought,feeling, and interpersonal relationship and behavior, increasing psychosocial problemsand endangering one’s sense of self and to deal with health problem. Withoutpsychosocial support, people feebly struggle, feel isolated in coping with living andsense of dying issues, accentuating vulnerability and affecting quality and quantity oftheir lives. In general, seriousness of the diagnosis, strictness of the treatment procedure andspecific psychosocial reactions of the ill person are the main objectives,which refersto the patient's ability to enjoy normal life activities. A methodological triangulationapproach was used to assess the demographics, disease characteristics andpsychosocial factorsto answerthe researchquestionsand see the relation with qualityof life. The importance of assessing the psychosocial factors both positive andnegative and quality of life of cancer patients may generate awareness of inner worldand understanding of patient, the nature and level of social support, enhancement ofcoping strategies and facilitating re-adjustment. Parametric and non-parametricstatistical tests were used to analyze the data and draw conclusion for this study. Present study was conducted among 300 Nepalese cancer patients from hospitals aswell as from their door-steps. The study covered 18 to 80 years old cancer patients,majority (64.4%) of them were female, married, illiterate and from low socio-economic status. Majority of the samples were stage III and IV cancer, receivingmultiple modalities of treatment and had financial problem for treatment. Quantitative result revealed that duration of diagnosis ranges from 2 to 72 months. This study alsorevealed that majority of research participants had less than one fourth (22.5%)psychosocial adjustment factors such as perceiving high of level of social support,self-esteem and coping. Majority of the samples were suffering from anxiety (67.1%)and depression (70.9%). There was significant statistical association betweeneducational status and psychological domain of QOL, gender and social relationshipdomain of QOL, stages of cancer andquality of life and itsenvironment domain too.Role in the family and modalities of treatment were not associated with quality of life.Non-linear relationship revealed that coping was positively correlated with quality oflife all its domains. Social support and self-esteem were negatively correlated withquality of life and all its domains.Anxiety and depression was inversely correlatedwith environment domain of quality of life among cancer patients in Nepal. On the basis of both qualitative and quantitative result, this study concluded thatpsychosocial factors determine the quality of life of the cancer patients in Nepal.Social support and coping were proved as strong predictors for quality of life. On theother hand, qualitative data revealed that the young aged, educated, from low socio-economic status and with a longer duration of diagnosis required additional care toimprove quality of life. Emotional/informational social support, especially from closepersons (spouse/ relatives/ friends), positive attitude of providers, willpower,engagement coping, lessening the symptoms of anxiety and depression are essentialcomponents of quality of life. Psychological aspect of cancer can be strengthened bypsychosocial care and social aspects of cancer patients can be empowered by psycho-education. Special training to the health care providers is required to improve thequality of life of cancer patients in Nepal.