The Palestinian perspective of quality of life (QOL) of cancer patients is important because it explores the situation in the country where the disease highly affects people, as it is the third leading cause of death in Palestine.1 The concept “Quality of life” itself is interpreted differently by people and health professionals,2 so the QOL concept varies depending on the different quality of life aspects; physical, social, emotional, functional, and spiritual which are all affected by cancer and its treatment.3 We conducted this research to highlight the concept of QOL for Palestinian cancer patients through providing an understanding about influences of cancer and chemotherapy on QOL of cancer patients; this was compared with international data about QOL.
The objectives of the study were as follows: (1) To highlight Health related QOL (HRQOL) and QOL domains scores for Palestinian cancer patients in comparison with international data. (2) To examine the association of HRQOL and QOL domains with socio-demographic characteristics, and cancer and chemotherapy related factors. (3) To examine the impact of cancer and chemotherapy on HRQOL of Palestinian cancer patients.
We used the EORTC QLQ-C30 (version 3.0) to assess QOL of 70 Palestinian cancer patients and we measured the sociodemographic and clinical variables, which affect the functional scales (Physical, Social, Psychological, Role, and Emotional function) and global QOL (GQOL) scale of the QLQ-C30. Participants were patients who were admitted to oncology wards to undergo chemotherapy in the 2 main oncology centers in Palestine.
Statistics has done on data using Statistical Package for the Social Sciences (SPSS) 15.0 for windows. It is done as recommended in Scoring manual of EORTC QLQ C30 3.0 which suggested by Quality of Life Group.
For the functional scales and the GQOL, we defined subjects with problematic functioning as those who scored ≤33%, while subjects in good condition scored >66%. For symptom scales, subjects scoring ≤33% were judged as having less severe symptoms, while those scoring >66% had more intense symptoms.4
The 70 patients were aged between 18 and 70 years, with a mean age of 50.13 years (SD=14.34) (Table 1). Of the patients, 48.6% were men and 51.4% were women; 62.8% were in stages III and IV of cancer. The score of GQOL was 48.4 and the 5 functional scales ranged from 45.9 to 57.6, which indicate poor function and QOL (Table 2). In addition, when using a 33.3% cutoff point, those with problematic function and QOL ranged from 27% to 57% of the sample. On relating the symptoms and items of EORTC QLQ-C30 which are; three symptom scales measuring fatigue, pain, and nausea and vomiting; six single-item symptom measures dyspnea, insomnia, loss of appetite, constipation, diarrhea, and financial difficulties, most of them were intense in the sample (16.9 to 62.3). All these results were problematic when comparing with international data about QOL. This indicates poorer QOL in Palestinian cancer patients. Factors that were found to be associated with GQOL and QOL domains were sex (RF: t=−2.254, df=68, P (2-tailed)=0.028), (DY: t= −2.039, df=68, P (2-tailed)=0.046), income (PF: F=6.196, df=1, P=0.015), pain (GQOL: r=−0.428, P<0.05), fatigue (GQOL: r=−0.299, P<0.05), and cancer stage (PF: F=3.14, df=3, P=0.031). Furthermore, the relationship was found to be negative between cancer and treatment-related scales with QOL scores, which indicates a negative impact of cancer and chemotherapy on QOL of Palestinian cancer patients.
By examining 70 Palestinian cancer patients, through five functional aspects; Physical, Emotional, Social, Cognitive, and role function; and one holistic aspect, results are shocking about QOL of Palestinian cancer patients. Results about QOL were low in all aspects; most of them were less than the half of full function, moreover, more intense symptoms and negative effects were found to be in Palestinian cancer patients. Also, through comparison, results were lower than international data about QOL of cancer patients, this mainly related to the situation of oncology care in Palestine. Thus, the negative impact of cancer and chemotherapy is clear. The poor QOL that is investigated in this study can be made better by increasing the awareness toward cancer and improving palliative care in Palestine. In addition, Palestinian cancer patients should receive more psychological, spiritual, and social care along with better financial support, as results regarding financial difficulties were problematic.
1. Husseini A, Abu-Rmeileh N, Mikki N, et al. Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory Lancet.. 2009;373:1041–1049
2. Berger A, Lockhart K, Agrawal S. Variability of patterns of fatigue and quality of life over time based on different breast cancer adjuvant chemotherapy regimens Oncology Nursing Forum.. 2009;36:563–570
3. Sun V, Ferrell B, Juarez G, et al. Symptom concerns and quality of life in hepatobiliary cancers Oncology Nursing Forum.. 2008;35:E45–E52
4. Alawadi S, Ohaeri J. Health—related quality of life of Kuwaiti women with breast cancer: a comparative study using the EORTC Quality of Life Questionnaire BioMed Central (BMC) Cancer.. 2009;9:222
Keywords:Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.
cancer; cancer patients; quality of life; pain