Effectiveness of Multi Interventional Package on Quality of Life among Breast Cancer Patients Receiving Chemotherapy Drugs – Pilot Study

 

Ms. M. Geetha1, Prof. P. Padmavathi2, Dr. K. Menaka3

1Principal/ Ph. D Scholar, Vivekanadha Nursing College for Women, Veerachipalayam, Salem District – 637303

2Principal, Dhanvantri College of Nursing, Pallakkapalyam (PO), Namakkal Dist – 637303.

3Principal, Padmashree College of Nursing, Kancheepuram

*Corresponding Author E-mail: saravanangeetha07@gmail.com, padmasekar2009@gmail.com

 

ABSTRACT:

Background: Breast cancer is one of the most prevalent cancers among women in world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. Aim: The purpose of this study was to describe the impact of five interventions on the  quality of life (QOL) and the role of FACT-B Questionnaire in this way to health care professionals achieve a deeper understanding of QOL. Methods: The data for the research were collected by FACT-B scale one week and four months after breast cancer treatment with chemotherapy. In this Pilot study of 20 breast cancer patients took part in the intervention of Aerobic, Acupressue, Guided Imagery, Amla supplementation and Spiritual counselling.QOL was assessed using FACT-B Scale. Results: The results show that the patients with breast cancer receiving chemotherapy benefitted from the practised interventions during and after the treatment. In prior to enforce the QOL model, the breast cancer patients had poor quality of life. The effectiveness of the intervention was evaluated by post test scores. The mean score had improved from 48.05-99.07 with paired t-valve of 19.59 (P<0.05) after implementation of multi intervention package. The finding shows that there was a highly significant association found between pre and post scores. The Chi-Square test result shows that there is no significant association between patients with breast cancer receiving chemotherapy with demographic variables. Further research is required to determine the effectiveness of multi intervention package with large samples and to identify their underlying mechanism.

 

KEY WORDS: Multi Interventional Package, Quality Of Life, Breast Cancer Patients, Chemotherapy Drugs.

 

 


INTRODUCTION:

Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries.  The burden of cancer is increasing in economically developed countries as a result of population aging and growth as well as increasingly an adoption of cancer associated life style changes including smoking, physical activity and western diet.

 

 

Breast cancer in females and lung cancer in males are the most frequently diagnosed cancer and the leading cause of cancer for each sex in both economically developed and developing countries, except lung cancer is preceded by prostate cancer as the most frequent cancer among males in economically developed countries.

 

The goals of cancer treatment are achieves through multiple modalities such as surgery, radiation therapy and chemotherapy. Chemotherapy is effective in the treatment of metastatic nonsmoker cell lung cancer. Chemotherapy has an important role in the palliative treatment of breast cancer. Patient’s undergone chemotherapy have achieves months (or) years of symptoms-free survival. Cancer treatment like chemotherapy associated with negative side effect that diminishes quality of life.

 

GLOBAL SCENARIO:

About 12.7 million cancer causes and 7.6 million cancer deaths are estimated to have occurred in 2008 worldwide. 70% cancer death approximately in low and middle income countries and 30% of cancer could be prevented.

 

INDIAN SCENARIO:

As per Indian population census data, the rate of mortality due to cancer in India was high and alarming with about 8, 06,000 existing cases by the end of the last century. Cancer is the second most common disease in India responsible for maximum mortality with about 0.3 million deaths per year.

 

The prevalence of cancer in India is estimated to be around 2.5 million; with about 8, 00,000 new cases and 5, 50,000 deaths per annum. Most frequently observed cancers in Indian population are of lungs, breast, colon, rectum, stomach and liver.

 

NEED FOR THE STUDY:

The world’s population is expected to be 7.5 million by 2020 and approximately 15.0 million new cancer cases will be diagnosed and with deaths of about 12.0 million cancer patients. Multi intervention package have been introduced to improve physical activity and quality of life.

 

Wilken MK, Satiroff BA, (2012) reported that four of the participants were given a two week supply of the supplement and other four were given a two week supply of placebo. After two weeks, the supplement group receives a two week supply of the placebo and the placebo group received two week supply of the supplement. Participants recorded food and drink intake in daily food dairies and rated taste changes with each food as better, worse, (or) no change. All study participants reported positive changes with the supplement.

 

Nurse should obtain baseline detail in relation to the cancer patient health and health habits, since the treatment of cancer often involve complex changes in the patient ability to meet psychologic, physiologic and sociologic health care.

 

Nurses need to provide support and education for clients and care givers as they make the transition from hospital to home.

 

Investigator during the training in medical surgical nursing came across several cancer patients who receiving oncology drugs. In the personal experience of the researcher, one of researcher student was suffering from breast cancer. This both incidence made the researcher to think more about the cancer patient who receiving the oncology drug. The physical, psycologic and physiologic sufferings are more in patient who receiving the cancer treatment. Thus the researcher felt a strong need to test the effectiveness of multi interventional package including activities of daily living, aerobic exercise, spiritual well being, guided imagery, nutritional substitutes on cancer patient who receiving oncology drugs.

 

REVIEW OF LITERATURE:

Cramer H et al (2013) conducted a study on systematic review and meta-analysis of exercise interventions for colorectal cancer patients in University of Duisburg-Essen, Essen, Germany. Randomized controlled trials (RCTs) comparing exercise interventions to control conditions were analyzed. Total sample size used for the study was 238 patients. There was strong evidence for short-term improvements of physical fitness, after aerobic exercise compared with controls (SMD = 0.59; 95% CI 0.25, 0.93; P < 0.01). The researchers concluded that the exercise interventions as a routine intervention for colorectal cancer patients.

 

Malihi Z et al (2013) conducted a prospective study on Nutritional status and quality of life in patients with acute leukemia prior to and after induction chemotherapy in three hospitals in Tehran, Iran. Sixty-three acute leukemia patients [65% men and 35% women] were used for the study. The researcher concluded that the deteriorated nutritional status and quality of life was the result of the side effects posed by induction chemotherapy in the patients investigated in the present study. The findings highlight the need for an appropriate nutritional support programme to improve the nutritional status and quality of life in patients with leukemia undergoing chemotherapy. 

 

Su-Chen Lan, Yuch E Lin et al (2015) carried out a study on to examine the effect of acupressure on fatigue and depression in hepato cellular carcinoma patients undergoing Trans catheter arterial chemo embolization  This study was quasi experimental with non randomized two groups, using a pre and post text design. Sixty two participants were recruited from gastroenterology inpatients ward in a medical centre in a northern Taiwan. Patients were evaluated at five time point, before treatment T1 and 2,3,4 and five days after treating TACE (T2,T3 ,T4 and T5). Fatigue and depression were assessed by a VAS fatigue and VAS depression scale and each time point. Tang fatigue Rating scale and Beck Depression inventory were administered at T1and T3.Patients in the experimental group received a total of 5 days acupressure, administered 2 times per day over a weeks time frame. The duration of each acupoint massage was limited to 4 minutes. The study results shows that the experimental group had significantly less fatigue than control group, with lower sub scale scores on physical, psychological, daily and over all fatigue. So, it was identified that, Acupressure can improve fatigue in HCC patients during treatment with TACE, but did not alleviate depression.

 

METHODOLOGY:

Research Design:

One group pre test and post test design

Setting of the Study:

The study will be conducted in HCG Cancer Centre, in Erode.

Population:

Patients with breast cancer receiving chemotherapy

Sampling Technique:

Purposive Sampling

Sample Size: Based on the Incidence and the Prevalence of the breast cancer findings in the location. Total sample size was 20

 

Criteria for the selection of sample:

INCLUSIVE CRITERIA:

·         Patients with breast cancer receiving chemotherapy treatment.

·         Patients, who are willing to participate in this study.

·         Age group between 20 years and above.

·         Patients, who are all in the stage II and III of breast cancer are included.

·         Female patients are only included.

·         Patients with drug regimen of FAC and TAC regimen.

·         Both in patients and out patients who are receiving anti cancer drugs

 

EXCLUSIVE CRITERIA:

·         Patient who are seriously ill.

·         Patients with metastatis.

·         Patient who are suffering from any cardiac problem.

·         Patients whose age is below 20 years.

·          Patient with rheumatoid arthritis .

·         Patient with history of bleeding disorder.

 

Development of the Tool:

Data collection tool consist of

Section A: Demographic variables

Section B: Quality of life scale FACT-B

Section A

It consists of demographic characteristics of breast cancer patients , i.e. age, Marital status, type of family, occupation, monthly income, duration of illness, duration of taking treatment, relaxation techniques, personal habits, diet, history of hormonal therapy, history of using oral contraceptives, history of PCOD, family history of breast cancer, associated conditions.

 

Section B It consists of FACT-B scale to assess the quality of life for the breast cancer patients receiving chemotherapy.

i.         Physical well being

ii.        Social/Family well being

iii.      Emotional well being

iv.      Functional  well being

v.       Breast cancer subscale score

 

Grading of FACT-B Scale: – FACT-B Scale was graded as follows :–

Grade 1   - Not at all

Grade 2   - A little bit

Grade 3   - Somewhat

Grade 4   - Quiet a bit

Grade 5   - Very much

 

Data Collection Procedure

·         Permission was obtained from concern Hospital authorities.

·         Identify the patients receiving chemotherapy with breast cancer.

·         Getting the informed consent from the patient with breast cancer.

·         FACT-B Quality of life Scale in Tamil was used to assess the quality of life of breast cancer patients receiving chemotherapy.

·         Total cycle of chemotherapy -6

·         Each cycle of chemotherapy interval is 21 days.

·         Pretest conducted 7th day of first cycle of chemotherapy.

·         Administration of multi intervention package starts from 8th day of first cycle of chemotherapy. (3 days intervention of each cycle of chemotherapy and remaining three days were followed as reinforcement).

·         Administration of Multi intervention package includes Activities of daily living including aerobic exercise, acupressure (Pericardian meridian on inside of the forarm two inches above the wrist crease), guided imagery(watching video clips on natural wonder and killing of cancer cells), supplementation of amla 20gms (juice) and counselling including Spiritual activity. In experimental group, administration of multi intervention package includes each chemotherapy cycle  for the duration of 20-25 minutes per day for the period of four months duration to till the completion of chemotherapy cycle . Reinforcement of the package will be carried out.

·         Post test was conducted during fourth cycle and after sixth cycle of chemotherapy.

 

PLAN FOR DATA ANALYSIS:

The collected data was organized, tabulated and analyzed by using descriptive statistics that is percentage, mean and standard deviation.  The inferential statistics like Chi-square was used to find the association between demographic variables with post test scores of Quality of life scale.  The paired‘t’ test was used to find out the difference in pre and post test score of Quality of life scale scores.

 

STUDY FINDINGS:

Percentage distrubation of patients with breast cancer receiving chemotherapy and their demographic variables shows that the  35% percentage of patientrs were in the age group of 31-40 years, 40% of them were completed higher secondary education, 30% were private employee, 40% of them were being earned less than Rs.5000 per month. It is found that 30% of the patients were dignosed with breast cancer with the duration of 1 to 5 years, 40% of them were taking treatment less than 6 months, 70% of them were using relaxation technique as watching television and gardening, 30% of them had the habit of chewing tabacco, 75%  of them were belongs to non-vegetaria. 

 

Table 1: Frequency and percentage distribution of pre and post test scores of patients with breast cancer receiving chemotherapy in a Experimental group  (N-20)

Categories of Quality of life scale

Pre test score

Post test score

Frequency (N)

Percentage (%)

Frequency (N)

Percentage (%)

Worst

11

34%

-

-

Poor

09

66%

11

34%

Best

-

-

09

66%

 

In pre test most (34%) of them were  worst quality of life scale and only 66% of them were poor quality of life scale, whereas in post test score  (34%) of them were poor quality of life scale  and 66% of them were category of best quality of life. It seems that multi intervention package on quality of life was effective among patients with breast cancer receiving chemotherapy (Table-1).

 

The overall mean percentage to effect the effectiveness of multi intervention package on quality of life shows that the highest percentage of difference was on the physical well being (48.95%). The lowest percentage of difference was found on the emotional well being (25.45%) and  functional well being (29.2%). It seems that a multi intervention on quality of life found moderately effective and improving the quality of life (Table-2).

 


 

 

 

Table 2: Aspects wise comparison of mean, SD, and mean percentage of experimental group pre and post test scores of patient with breast cancer receiving chemotherapy.

S.

No

Aspects

Max. scores

Pre test score

Post test score

Difference in Mean (%)

Mean

SD

Mean(%)

Mean

SD

Mean (%)

1.

Physical well being

28

5.3

3.35

18.9

19

3.32

67.85

48.95

2.

Social/family well being

28

12.95

3.06

46.25

21.6

3.18

77.14

30.89

3.

Emotional well being

24

6.3

2.34

26.25

12.4

4.87

51.7

25.45

4

Functional well being

28

10.25

2.36

36.60

18.45

1.78

65.8

29.2

5

Additional concerns

40

13.25

1.59

33.12

28.25

3.12

70.6

37.48

 

Total

148

48.05

2.34

32.22

99.7

1.78

66.6

34.38

 

Table 3: Significance of Pre and Post test scores of experimental group

Sl. No.

Aspects

‘t’ Value

Level of Significant

1

Physical well being

5.85

P< 0.05 Significant

2

Social / family well being

4.439

P< 0.05 Significant

3

Emotional well being

3.57

P< 0.05 Significant

4

Functional well being

10.23

P< 0.05 Significant

5

Additional concerns

2.27

P< 0.05 Significant

 

Total

19.59

P< 0.05 Significant

df – 19 (n-1) Table Value = 1.729 (P < 0.05 Significant)


 

 

Hence it can be concluded that there is significant difference between pre and post test score of patients with breast cancer receiving chemotherapy (Table-3).

 

There is no significant association between patients with breast cancer receiving chemotherapy scores when compared to the age, marital status, type of family, education, occupation Income, duration of illness, duration taking treatment, relaxation techniques, personal habits, diets, hormonal therapy, oral contraceptives, history of PCOD, family history of breast cancer and associated conditions.

 

CONCLUSION:

From the finding it can be concluded that, in experimental group according to their age group shows that 35% of the patients were in the age group of 31-40 years and 30% were in the age group of 41-50 years. It seems that 40% of them were completed higher education and 40% were earning 10,001-15,000. In pre test, 34% of them were worst quality of life scale and 66% of them were poor quality of life. On the other hand, post test score reveals that 34% of them were poor quality of life and 66% of them were in the category of best quality of life. It shows that multi intervention package on quality of life was effective among patients with breast cancer receiving chemotherapy. In post test score, highest mean score percentage in the area of additional concern well being of patients with breast cancer. The lowest mean score percentage was found in emotional well being. The paired t test used to analyse the difference in pre and post test score.  It can be concluded that, there is significance difference between pre and post test score of patient with breast cancer. It concludes that the null hypothesis can be rejected based on the finding of this study. The Chi-Square test result shows that there is no significant association between patient with breast cancer receiving chemotherapy with demographic variables.

 

REFERENCE:

1.        Aintzane Sancho, Sergio carrera.Supervised physical exercise to improve the quality of life of cancer patients, The Efficancer randomized control trial, Biomed central, June 2015 Page 2-8.

2.        B.Y hydroang and p Liu.composition and Biological activities of hydrolysable tannis of fruits phyllanthus emblica Journal of Agricultural and food chemistry, Vol  62 no3 2014 pp529-541.

3.        Dr.A.Reena Evency.Effectiveness of  structured Teaching Programme on Knowledge regarding  Breast cancer and Cervical cancer among  School  student, The Journal of Nursing Trendz, Volume 2,Issue 2,2015,pp19-22.   

4.        Genc,F., and Tan,M. The effect of acupressure application on chemotherapy induced nausea, vomiting, and anxiety in patients with breast cancer, Palliative and supportive care, Advance online publication.Doi:10.1017/S1478951814000248.

5.        J.Ferlay I.Soerjonataram R.Dikshit. Cancer incidents and mortality worldwide sources, Methods and Major patents in GLOBOCIN 2012, International Journal of cancer,Vol.136,2015 pp E-359 E-386.

6.        Karagozoglu.,S., Tekyasar,F, and Yilnaz,FA. Effects of music therapy and guided visual imagery on chemotherapy induced anxiety and nausea –vomiting,Journal of clinical nursing 22,39-50

7.        M.Majeed B.Bhat,A.N.Jadhav.J, S.Srivastava. Ascorbic and tannins from Embica Officinalis gaertn Fruits a revisit, Journal Agricultural and food chemistry,Vol.57 No.1,2009 pp 220-225.

8.        Marina E.schmidt, Joachim wiskemann. Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy.A randomized controlled trial, International journal of caner, Vol.137  7/2015,page 2-4.

9.        P.Hanly I.E.Soerjomataram and L sharp. Measuring the social burden of cancer, the cost of lost productivity due to premature cancer related mortality in Europe, International Journal of Cancer Vol.136, No.4 2015 ppE136-E145.

10.     S.Mahap A.Pandey, S.Shukla. Anti-cancer activity Phyllanthus emblica Lin(Indian Gooseberry) Inhibition of transcription factor ap-1 and II pv gene expression cancer cells, Nutrition and Cancer,Vol65,2013 pp88-97.

11.     Su-Chen Lan, Yuch  En lin. Effects of acupressure on fatigue and depression fatigue in Hepato cellular  carcinoma patients treated with Trans catheter Arterial chemo Embolization, Evidence based complimentary and Alternative medicine, Hindawi Publications, 2015 page 1-10.

12.     Suzanna Mariazick, Gwenkarilyn Wyatt. Acupressure for persistant cancer related fatigue in breast cancer survivors. A study protocol for a randomized control trial, Bio med central, Complimentrary alternative medicine,2012 12:132.

13.     T .Zhao, Q.sun S.V Del Rincon A Lovato,M.Marques and M.Witcher. Gallotanin Imposes S phase arrest in breast cancer cells and   suppresses  the growth of triple  negative tumours  in Vivo,  PLosONE, vol9, no3, Article ID e92853.

 

 

 

 

Received on 02.02.2017          Modified on 15.02.2017

Accepted on 30.03.2017          © A&V Publications all right reserved

Int. J. Adv. Nur. Management. 2017; 5(2):164-168.

DOI: 10.5958/2454-2652.2017.00035.X