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Health-Related Predictors of Quality of Life in Cancer Patients in Saudi Arabia

Health-Related Predictors of Quality of Life in Cancer Patients in Saudi Arabia J Canc Educ (2018) 33:1011–1019 DOI 10.1007/s13187-017-1198-3 Health-Related Predictors of Quality of Life in Cancer Patients in Saudi Arabia 1,2 2 3 Anwar E. Ahmed & Alaa S. Almuzaini & Mohannad A. Alsadhan & 4 2 5 Abdulrahman G. Alharbi & Hanin S. Almuzaini & Yosra Z. Ali & Abdul-Rahman Jazieh Published online: 7 March 2017 The Author(s) 2017. This article is published with open access at Springerlink.com Abstract Research on Saudi Arabian cancer patients is a pri- (145 breast, 109 colorectal, 38 leukemia, 45 lymphoma, and ority at King Abdulaziz Medical City (KAMC), Riyadh, 99 other types) who attended the Oncology Outpatient Clinics Saudi Arabia. Because there is limited research on the quality at KAMC. Sociodemographics, clinical symptoms, and can- of life (QoL) of Saudi Arabian cancer patients, the aim of this cer treatments were collected for each patient. We used the SF- study was to identify the predictors of the QoL in a sample of 36 instrument to assess QoL. Of the cancer patients studied, Saudis with cancer. In August 2016, a cross-sectional study 28.4% had a family history of cancer, and, according to sub- was conducted on 438 patients with a variety of cancer types group analyses, the elderly, those lacking formal education, the unemployed, those diagnosed with Stage III/IV, and those with metastasis had significantly worse physical functions than the other cancer patients. According to multiple linear regres- * Anwar E. Ahmed sion analyses, cancer patients who exercised regularly tended ahmedan@ngha.med.sa; ahmeda5@vcu.edu to have better physical function, emotional role function, vital- ity, social function, and general health (increase in SF-36 scores Alaa S. Almuzaini of 8.82, 9.75, 5.54, 6.66, and 4.97, respectively). Patients with Almuzaini.a.s@gmail.com first-year-after-cancer diagnosis tended to have poor emotional Mohannad A. Alsadhan wellbeing, social function, and general health (decrease in mohannadalsadhan@gmail.com SF-36 scores of 5.20, 7.34, and 6.12, respectively). Newly Abdulrahman G. Alharbi diagnosed cancer patients and patients who did not exercise Dr.harbi93@gmail.com tended to experience significantly poor QoL in several do- Hanin S. Almuzaini mains; thus, the effectiveness of exercise must be assessed in Almuzaini.h.s@gmail.com Saudi cancer patients as an intervention to improve QoL. Yosra Z. Ali aliyz@vcu.edu . . . Keywords SF-36 QoL Regularexercise First-year-cancer diagnosis Saudi Arabia Abdul-Rahman Jazieh jazieha@ngha.med.sa King Abdullah International Medical Research Center (KAIMRC), Introduction Riyadh, Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, According to the Saudi Ministry of Health Cancer Registry in Riyadh, Saudi Arabia Riyadh, more than 15,653 people in Saudi Arabia (77.6% College of Medicine, King Saud University, Riyadh, Saudi Arabia were Saudis) were diagnosed with cancer in 2013. The crude incidence rate was 57.5 per 100,000 population per year. The College of Medicine, Imam Abdulrahman Al Faisal University, Dammam, Saudi Arabia Saudi Government’s vision for 2030 is to significantly miti- gate the challenges faced by the health sector in preventing Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia cancers through analyzing independent risk factors and 1012 J Canc Educ (2018) 33:1011–1019 improving health and control cancer outcomes through impact on QoL in Saudi cancer patients. We also hypothesized treating the symptoms of cancers. that exercise may impact QoL positively in cancer patients. Cancer not only affects patients physically, but it may also impact the quality of life (QoL) of cancer survivors negatively [1, 2]. Recently, much attention has been paid to the negative Materials and Methods impact of cancer and its treatment on the QoL in cancer pa- tients. Several reports have indicated that greater QoL impair- A survey study was conducted in the outpatient oncology ment in patients with cancer may be attributable to treatment clinics, KAMC, Ministry of National Guard Health Affairs. side effects, cancer symptoms, and psychological distress The study obtained scientific and ethical approval from the [2–4]. IRB office at King Abdullah International Medical Research There is evidence that older age has negative effects on the Center (KAIMRC), Riyadh (# RSS16/004). The study includ- QoL in cancer patients [5, 6], while gender has an influence on ed a consecutive sample of cancer patients with different types the degree of QoL impairment [7]. Lack of education has a of cancer who were attending outpatient oncology clinics for negative effect on cancer patients [7], and low income has also follow-up with oncology specialists during the study period been negatively associated with QoL in cancer patients (August 14–31/2016). The subjects of the study administered [8–11]. Other factors contributing to QoL impairment may a one-time survey with a consent form explaining the aims of include clinical presentations of cancer patients such as the the study and asking whether they wanted to complete the stage, type, and site of the cancer [7, 12]. It has been docu- survey. Assent was obtained from parents of all cancer pa- mented internationally that measuring the quality of life in tients with ages between 14 and 17 years. We obtained written cancer patients is an important aspect of cancer management consent from those patients age 18 years and above. and treatment, and could serve as an effective tool for clinical A total of 540 subjects who consented were administered trials [1, 13–15]. the survey, and 436 surveys were completed and returned (145 To date, research on QoL in cancer patients in Saudi Arabia breast, 45 lymphoma, 109 colorectal, 38 leukemia, and 99 has been insufficient. Only three studies in Saudi Arabia have other types of cancer) with a response rate of 80.7%. addressed the quality of life in cancer patients. Colorectal Sociodemographics data were collected for each patient such cancer [16] and breast cancer [17, 18]patients werereported as age, gender, height, weight, university degree, marital sta- to have a low QoL. According to the authors, there are numer- tus, regular exercise, family support, and employment status. ous factors associated with a major reduction in all domains of We collected clinical data on patients and their cancer charac- QoL, including educational level, employment status, patho- teristics such as type of cancer, family history of cancer, can- logical staging, and tumor location [16–18]. There are numer- cer stage (I, II, III, or IV), multiple tumors, newly diagnosed ous self-report questionnaires used to measure QoL, including cancer patients or first-year-after-cancer diagnosis, whether the European Organization for Research and Treatment of patient received chemotherapy, whether patient had surgery Cancer (EORTC) quality of life [19] which is used by to remove tumors, whether patient received immunotherapy, Almutairi et al. The Short-Form Health Survey SF-36 (the whether patient received radiation therapy antibiotics, side RAND 36-item) questionnaire [20] is a self-report question- effects of treatment, metastasis, sleep deprivation, fever, and naire commonly used to assess QoL, and it has been used chronic disease other than cancer. The following section de- consistently in Saudi patients with sickle cell disease [21, scribes the quality of life questionnaire used to assess patients’ 22]. However, there is a paucity of data using SF-36 measure health status. in Saudi cancer patients. The impact of sociodemographics, cancer characteristics, and treatment are important to consider when assessing QoL Quality of Life Instrument in the cancer population. It allows clinicians to describe and assess the health status of cancer patients, provide interven- Quality of life was assessed by the Medical Outcomes Study tions, and measure their effectiveness. This study is of interest 36-item short-form (SF-36) questionnaire [20], an instrument to oncologists who provide routine care to cancer patients in with an Arabic version [23] and established reliability that Saudi Arabia. Research on Saudi Arabian cancer patients is a provides subjective evaluation of quality of life. It has been priority at King Abdulaziz Medical City (KAMC), Riyadh, used in general and disease-specific populations. The SF-36 is Saudi Arabia. In this study, we used data from a study con- a self-rated tool comprising 36 items grouped into eight do- ducted at King Abdulaziz Medical City in Riyadh (KAMC-R) mains: physical function, physical role health, emotional role to determine the impact of sociodemographics, clinical symp- functions, vitality, emotional wellbeing, social function, bodi- toms, and cancer treatments on QoL measures in Saudi cancer ly pain, and general health. Each of these domains ranges from patients. We hypothesized that being elderly, newly diagnosed 0 (poor health) to 100 (best health). The SF-36 questionnaire patients, and the cancer prognosis would have a negative was found to be reliable in this population with Cronbach’s J Canc Educ (2018) 33:1011–1019 1013 alpha values ranging between 0.60 Bsocial function^ and 0.91 account for 24 multiple comparisons, the Bonferroni correction Bphysical function.^ of α/n = 0.05/24 = 0.0021 was used to compare QoL differ- ences between sociodemographics and clinical characteristics (Tables 1 and 2,Fig. 1). Multivariate analyses: Multiple linear Data Analysis regression models were used to examine the relationship be- tween the sociodemographics, clinical symptoms, and cancer The data analysis was conducted using IBM SPSS Statistics 23 (SPSS, Chicago, IL). Patients’ characteristics: sample statistics treatments and each QoL domain, and to identify predictors of such as means and standard deviation were used to summarize the SF-36 subscales. Regression coefficients were used to in- numerical data. Counts and percentages were used to summa- terpret the linear regression findings. In all multivariate analy- rize categorical data (Table 1). Bivariate analyses:Inorder to ses, the significance level (α)was setat0.05. Table 1 Differences in quality of life by sociodemographics and clinical characteristics (N =436) Overall Physical functioning Role limitations due Role limitations due to Vitality to physical health emotional problems Characteristics n % Mean SD P Mean SD P Mean SD P Mean SD P Gender Male 157 36.0 46.8 30.8 0.429 24.7 36.6 0.620 33.3 41.9 0.507 44.0 21.6 0.924 Female 279 64.0 49.1 28.7 26.5 37.6 30.6 41.2 43.8 22.3 Elderly No 270 61.9 55.1 27.6 0.001* 25.8 37.3 0.985 32.1 41.0 0.737 46.1 22.0 0.009 Yes 166 38.1 37.2 29.0 25.9 37.1 30.7 42.2 40.4 21.7 University No 312 71.6 44.1 28.8 0.001* 25.9 37.0 0.985 29.9 40.6 0.185 42.2 22.1 0.010 Yes 124 28.4 58.9 28.4 25.8 37.8 35.8 43.4 48.2 21.2 Employed No 321 73.6 45.6 28.3 0.001* 26.5 37.0 0.562 31.5 41.5 0.926 43.2 21.8 0.246 Yes 115 26.4 56.0 31.2 24.1 37.7 31.9 41.5 46.0 22.4 Married No 99 22.7 47.2 30.1 0.678 30.3 38.8 0.177 32.0 40.1 0.911 45.2 23.6 0.524 Yes 337 77.3 48.6 29.3 24.6 36.6 31.5 41.9 43.5 21.5 Obese No 273 71.7 50.1 29.2 0.217 28.0 38.9 0.216 32.8 42.3 0.460 44.4 21.6 0.876 Yes 108 28.3 45.9 31.3 22.9 35.0 29.3 40.9 44.0 23.7 Family history of cancer No 312 71.6 47.5 29.7 0.339 27.6 37.9 0.112 33.3 42.3 0.147 44.9 22.4 0.129 Yes 124 28.4 50.4 28.6 21.4 35.0 27.2 39.0 41.4 20.7 1st year after cancer diagnosis No 196 45.1 46.9 28.1 0.405 21.8 33.7 0.045 32.0 41.5 0.800 42.5 23.3 0.243 Yes 239 54.9 49.2 30.4 28.9 39.4 31.0 41.3 45.0 20.8 Cancer Types Breast 145 33.3 54.4 28.8 0.002* 29.3 38.3 0.292 33.6 42.2 0.137 43.9 20.8 0.242 Colorectal 109 25.0 42.7 26.6 23.4 35.1 32.1 41.6 41.2 22.4 Leukemia 38 8.7 52.9 29.5 23.7 37.2 23.7 38.7 42.1 23.4 Lymphoma 45 10.3 52.8 29.7 32.8 39.8 43.0 42.4 50.0 24.8 Others 99 22.7 41.7 31.2 21.2 36.3 25.9 40.0 44.8 21.2 Stage III/IV I/II 216 58.7 53.1 29.4 0.001* 29.2 38.3 0.006 36.0 43.2 0.001* 47.4 20.3 0.001* III/IV 152 41.3 42.0 29.1 18.9 32.9 22.1 36.2 38.6 22.5 Multiple tumors No 291 68.5 49.9 29.6 0.034 28.7 38.5 0.003 35.9 42.8 0.001* 46.5 21.7 0.001* Yes 134 31.5 43.4 28.9 18.1 31.8 22.6 36.9 37.5 21.4 Cancer surgery No 199 45.6 48.1 30.5 0.890 25.0 37.3 0.659 30.5 41.0 0.615 43.6 21.3 0.800 Yes 237 54.4 48.5 28.6 26.6 37.2 32.5 41.8 44.2 22.6 Chemotherapy No 101 23.2 48.2 29.8 0.958 33.7 41.3 0.027 38.3 45.1 0.082 46.6 22.5 0.164 Yes 335 76.8 48.3 29.4 23.5 35.6 29.6 40.1 43.1 21.8 Radiation therapy No 238 54.7 50.3 29.8 0.142 29.0 39.3 0.055 33.3 41.8 0.352 46.4 22.6 0.009 Yes 197 45.3 46.1 28.7 22.2 34.2 29.6 41.1 40.9 20.9 Immunotherapy No 206 47.5 51.3 30.7 0.054 28.5 40.3 0.149 37.1 44.3 0.010 47.0 21.2 0.007 Yes 228 52.5 45.9 27.9 23.4 34.0 26.8 38.2 41.3 22.3 Antibodies No 319 75.2 49.9 29.1 0.115 26.8 38.3 0.477 34.6 43.0 0.013 45.2 22.4 0.123 Yes 105 24.8 44.6 31.1 23.8 34.4 23.8 36.3 41.3 20.8 Metastasis No 303 69.5 51.2 29.0 0.002* 28.5 38.5 0.016 35.1 42.9 0.005 46.9 21.7 0.001* Yes 133 30.5 41.8 29.5 19.7 33.4 23.6 36.9 37.2 21.3 Fever No 263 60.3 50.4 30.7 0.058 30.1 39.5 0.002* 38.1 43.9 0.001* 46.8 22.1 0.001* Yes 173 39.7 45.1 27.1 19.4 32.4 21.6 35.2 39.6 21.1 Family support No 37 8.5 49.9 33.0 0.736 26.4 35.3 0.933 42.3 45.6 0.137 43.4 25.7 0.878 Yes 399 91.5 48.2 29.1 25.8 37.4 30.6 40.9 44.0 21.7 Chronic disease other than No 271 62.2 52.0 29.1 0.001* 25.9 38.4 0.964 29.4 40.7 0.160 44.7 21.7 0.358 cancer Yes 165 37.8 42.2 29.0 25.8 35.3 35.2 42.5 42.7 22.5 Regular exercise No 293 67.2 44.4 29.6 0.001* 23.2 36.1 0.038 28.0 41.0 0.009 41.1 21.6 0.001* Yes 143 32.8 56.2 27.4 31.3 39.0 38.9 41.5 49.7 21.7 *The variable is significant using Bonferroni correction cut-off at α/n = 0.05/24 = 0.0021, where n is the number of tests, P=P-value. 1014 J Canc Educ (2018) 33:1011–1019 Table 2 Differences in quality of life by sociodemographics and clinical characteristics (N =436) Emotional wellbeing Social functioning Pain General health Characteristics Mean SD P Mean SD P Mean SD P Mean SD P Gender Male 63.7 19.7 0.479 55.7 26.8 0.470 56.0 27.0 0.020 51.7 16.7 0.528 Female 62.3 20.4 57.7 27.7 49.7 26.8 50.5 18.3 Elderly No 62.1 20.9 0.374 58.9 27.2 0.065 51.4 27.7 0.557 52.2 18.0 0.054 Yes 63.9 18.9 53.9 27.4 52.9 25.9 48.9 17.1 University No 62.2 19.9 0.344 56.8 27.8 0.786 50.2 27.3 0.030 49.6 17.9 0.009 Yes 64.3 20.7 57.6 26.2 56.4 26.0 54.4 17.0 Employed No 62.8 19.6 0.978 57.7 26.6 0.389 51.5 26.1 0.584 49.9 17.5 0.054 Yes 62.9 21.7 55.1 29.3 53.2 29.6 53.7 18.2 Married No 62.5 19.9 0.848 60.0 26.7 0.218 53.9 25.8 0.421 52.3 17.4 0.379 Yes 62.9 20.3 56.1 27.5 51.4 27.4 50.5 17.9 Obese No 63.0 19.7 0.729 56.2 27.7 0.493 53.4 27.5 0.150 51.0 17.6 0.633 Yes 62.2 20.1 58.3 27.2 49.0 25.7 50.0 17.9 Family history of cancer No 64.4 19.9 0.011 58.7 28.0 0.028 54.3 28.0 0.002* 51.7 17.5 0.149 Yes 58.9 20.5 52.6 25.1 46.2 23.5 49.0 18.4 1st year after cancer diagnosis No 63.4 20.9 0.542 58.2 28.0 0.358 51.9 27.5 0.954 51.8 17.4 0.331 Yes 62.2 19.6 55.8 26.7 51.8 26.5 50.1 18.0 Cancer types Breast 61.4 20.0 0.161 58.4 28.2 0.278 49.0 26.6 0.073 50.7 19.2 0.564 Colorectal 65.7 20.3 54.6 24.0 52.7 26.2 50.0 14.8 Leukemia 60.9 21.8 56.6 27.4 56.8 25.0 49.1 20.6 Lymphoma 67.1 21.6 64.2 28.7 60.8 29.3 54.9 16.1 Others 60.5 18.5 54.5 28.8 49.6 27.5 51.2 18.2 Stage III/IV I/II 64.0 18.7 0.011 61.8 23.9 0.001* 55.4 25.5 0.001* 53.3 16.0 0.001* III/IV 58.4 21.7 50.7 29.4 43.8 26.7 46.5 18.2 Multiple tumors No 64.5 19.7 0.003 59.4 26.3 0.004 55.6 26.5 0.001* 52.7 17.1 0.001* Yes 58.3 20.7 51.2 28.8 42.6 25.9 46.5 18.4 Cancer surgery No 63.4 18.5 0.589 55.7 28.2 0.348 52.4 26.7 0.753 49.7 17.7 0.190 Yes 62.3 21.4 58.1 26.6 51.6 27.4 52.0 17.8 Chemotherapy No 63.9 21.1 0.527 59.2 26.9 0.365 58.2 28.8 0.008 51.6 18.6 0.678 Yes 62.5 19.9 56.3 27.5 50.1 26.2 50.7 17.5 Radiation therapy No 65.3 19.2 0.005 57.6 27.1 0.645 55.1 26.3 0.006 52.4 17.4 0.054 Yes 59.9 21.0 56.3 27.8 48.0 27.3 49.1 18.1 Immunotherapy No 64.5 19.3 0.073 57.4 26.4 0.771 56.9 25.8 0.001* 51.4 17.3 0.615 Yes 61.1 20.9 56.6 28.4 47.9 27.2 50.6 18.3 Antibodies No 63.4 20.4 0.333 57.5 27.5 0.332 53.0 26.1 0.431 51.1 17.5 0.993 Yes 61.3 19.0 54.5 27.5 50.4 29.6 51.0 19.2 Metastasis No 64.9 20.2 0.001* 59.9 26.5 0.001* 56.3 26.2 0.001* 53.6 17.0 0.001* Yes 58.1 19.4 50.3 28.2 42.1 26.3 44.8 17.9 Fever No 66.4 18.5 0.001* 59.7 26.4 0.010 57.1 26.2 0.001* 54.1 17.8 0.001* Yes 57.4 21.4 52.8 28.4 44.1 26.4 46.1 16.6 Family support No 59.5 24.8 0.292 57.4 28.2 0.919 54.5 30.3 0.547 48.8 17.0 0.440 Yes 63.1 19.7 57.0 27.3 51.7 26.7 51.1 17.8 Chronic disease other than No 63.3 19.8 0.508 57.5 27.0 0.609 54.3 27.0 0.018 52.9 17.6 0.003 cancer Yes 62.0 20.8 56.1 28.0 48.1 26.8 47.7 17.6 Regular exercise No 60.8 20.7 0.003 53.7 27.4 0.001* 48.2 26.7 0.001* 48.4 17.9 0.001* Yes 66.9 18.4 63.8 26.0 59.7 26.1 56.2 16.3 *The variable is significant using Bonferroni correction cut-off at α/n = 0.05/24 = 0.0021, where n is the number of tests, P=P-value. J Canc Educ (2018) 33:1011–1019 1015 Fig. 1 Error bar chart: impact of cancer complications on bodily pain ratings. Notes: The higher the score, the less pain Results cancer, followed by patients with leukemia, lymphoma, colo- rectal, and other cancer types. Patients’ Characteristics The mean scale score for role limitations due to physical health was 25.9 (±SD = 37.2). A greater impact on role limi- Of the 438 cancer patients studied, 64% were female and tations due to physical health was found in cancer patients 28.4% had a family history of cancer. The average age of with fever. The mean scale score for role limitations due to the sample was 52.9 (±SD = 17.3) with a range of 14–97 years. emotional problems was 31.6 (±SD = 41.4). Cancer patients The median number of months after-cancer diagnoses was 12 with stage III or IV, multiple tumors, and fever reported sig- (interquartile range 5–24 months). The majority of subjects nificantly poorer role limitations due to emotional problems (76.8%) received chemotherapy, 41.3% had cancer stage III when compared to their counterparts. The mean scale score or IV, 30.5% had metastasis, and 24.8% were treated with for vitality was 43.9 (±SD = 22.0), and significantly lower antibiotics. Other patient characteristics are reported in scores on vitality were observed in patients with old age, stage Table 1. III or IV, multiple tumors, metastasis, and fever when com- pared to their counterparts. However, patients who regularly Bivariate Analyses exercised reported higher scores on vitality than those who did not exercise. The mean scores by sociodemographics, clinical symptoms, The mean scale score for emotional wellbeing was 62.8 and cancer treatments of each of the eight QoL domains mea- (±SD = 20.2). Lower mean scores on emotional wellbeing sured by the SF-36 are presented in Tables 1 and 2 and Fig. 1. was found in cancer patients with metastasis and fever when The mean physical function was 48.30 (±SD = 29.4). compared to their counterparts. The mean scale score for so- According to subgroup analyses, the elderly, those lacking cial functioning was 57.0 (±SD = 27.4). Cancer patients with formal education, the unemployed, those diagnosed with stage stage III or IV and metastasis reported significantly lower III/IV, those with metastasis, and those with chronic disease scores on social functioning when compared to their counter- other than cancer have significantly worse physical functions parts, while patients who practiced regular exercise reported than the other cancer patients. However, regular exercise was higher scores on social functioning than those who did not. predictive of increasing physical function. Higher mean scores The mean scale score for pain was 52.0 (±SD = 27.0). Bodily pain was significantly increased in patients with a family of physical functions were found in patients with breast 1016 J Canc Educ (2018) 33:1011–1019 history of cancer, stage III or IV, multiple tumors, receiving with different cancers in Saudi Arabia. This study is of interest immunotherapy, metastasis, and fever, while patients who reg- to QoL researchers and providers caring for cancer patients. It ularly exercised reported less bodily pain than those who did has identified several predictors that appear to be correlated not exercise. The mean scale score for general health was 50.9 with QoL in cancer patients. One of our findings was that the (±SD = 17.8). Patients with stage III or IV, multiple tumors, elderly reported poorer vitality and physical function. These metastasis, and fever reported lower scores on general health findings are consistent with previous studies in demonstrating when compared to their counterparts. older cancer patients may have a negative impact on QoL [5, 6]. It is also evident that patients with first-year-after-cancer Regression Analyses diagnosis reported a poorer health-related quality of life. Specifically, patients with first-year-after-cancer diagnosis Multivariate analyses (Table 3) showed that elderly and stage tended to have poor emotional wellbeing, social function, III or IV were found to be significant negative predictors of and general health (decrease in SF-36 scores of 5.20, 7.34, physical health (decrease in physical health scores of 13.79 and 6.12, respectively). An Iranian study has also shown that and 7.82, respectively), while regular exercise was found to be first-year-after-cancer diagnosis is a predictor for poor physi- a significant positive predictor of physical health (increase in cal, emotional, and social functioning [24]. Cancer disclosure physical health score of 8.82). A family history of cancer had a and patient’s quality of life and its impact on cancer treatment negative impact on role limitations due to physical health (de- and management must be assessed as their relation has yet to crease in role limitations due to physical health score of 10.3). be fully studied in Saudi Arabia. Patients with chronic disease other than cancer had a positive Our study investigated the association between cancer treat- impact on role limitations due to emotional problems (increase ments and QoL. Vitality and emotional wellbeing are reported in role limitations due to emotional problem score of 19.66). significantly worse among those who received radiation thera- Poor vitality was predicted by the elderly and those receiving py. Several other studies have also shown that poor QoL is radiation therapy (decrease in vitality scores of 8.11 and 5.92, linked with cancer treatments [2–4]. An interventional study respectively), while the presence of other chronic diseases and is warranted to assess the impact of radiation therapy on QoL. regular exercise were positive predictors of vitality (increase The study also compares the QoL of survivors with differ- in vitality scores of 5.11 and 5.54, respectively). ent types of cancer. The QoL depends on the location of the Family history of cancer, newly diagnosed cancer patients cancer. Leukemia was found to be associated with poor qual- (first-year-after-cancer diagnosis), radiation therapy, and fever ity of life. This has been frequently addressed in various stud- were negatively correlated with poor emotional wellbeing (de- ies [25–27]. QoL assessmentinpatientswithleukemiacan crease in emotional wellbeing scores of 7.54, 5.20, 8.05, and provide insights into the effects of leukemia treatment and its management. 5.54, respectively), while family support was positively cor- related with better emotional wellbeing (increase in emotional This study also investigated the association between regu- wellbeing score of 9.70). Newly diagnosed cancer patients lar exercise and QoL of patients with cancers. Other studies and stage III or IV were negatively correlated with poor social have shown similar findings [28–30]. In our study, exercise functioning (decrease in social functioning scores of 7.34 and tended to improve physical function, role limitations due to 9.32, respectively), while regular exercise was positively cor- emotional problems, vitality, social function, and general related with better social functioning (increase in social func- health (increase in SF-36 scores of 8.82, 9.75, 5.54, 6.66, tioning score of 6.66). Cancer stage III or IV and fever had and 4.97, respectively). The effectiveness of physical exercise negative impacts on pain (decrease in pain score of 8.08 and must be assessed in Saudi cancer patients as an intervention to 8.01, respectively). Newly diagnosed cancer patients, leuke- improve QoL and control cancer outcomes. Several limita- mia patients, those with metastasis, and those with fever had tions were noted. The cross-sectional design may not allow negative impacts on general health (decrease in pain score of causality assessment. There is a potential for sampling selec- 6.12, 10.2, 8.34, and 4.93, respectively), while those with tion bias, in that cancer patients who are attending outpatient family support and regular exercise regimens had positive clinics may more often be likely to participate, given the per- impacts on general health (increase in general health scores ceived severity of their cancer. However, this research has of 7.43 and 4.97, respectively). clearly identified several factors that appear to affect QoL in cancer patients. Discussion Conclusions This survey addresses health outcomes in a sample of Saudi Arabians with different types of cancer. There is a lack of Regular exercise in cancer patients was a significant positive research addressing health-related quality of life in patients predictor of better vitality, social function, and general health. J Canc Educ (2018) 33:1011–1019 1017 Table 3 Multiple regression showing predictors of health-related quality of life in patients with cancers Physical functioning Role limitations due to Role limitations due to Vitality Emotional wellbeing Social functioning Pain General health physical health emotional problems B P B P B P BP B P B P BP B P (Constant) 54.04 21.81 41.78 55.70 62.70 77.07 66.46 62.86 Female gender −3.72 .412 3.61 .536 −3.84 .556 0.10 .976 1.09 .720 0.73 .860 −1.92 .623 −2.86 .277 Elderly −13.79 .001* 1.62 .751 −6.04 .289 −8.11 .005* 1.23 .642 −6.88 .059 0.25 .941 −3.67 .110 University 5.29 .184 0.29 .955 3.89 .496 2.97 .306 1.54 .563 −2.94 .419 4.77 .164 1.10 .632 Employed 3.94 .353 2.88 .598 −2.50 .681 1.50 .627 0.63 .824 −4.56 .240 −3.56 .330 0.13 .956 Married 1.61 .701 −8.98 .096 −4.42 .462 −3.31 .278 −2.42 .388 −5.07 .186 −4.82 .182 −3.41 .160 Obese −1.57 .667 −4.01 .392 −3.17 .544 2.78 .295 1.45 .550 4.14 .215 −1.27 .685 0.73 .729 Family history of cancer 2.64 .478 −10.3 .033* −6.55 .221 −4.43 .103 −7.54 .003* −4.90 .152 −4.14 .197 −1.08 .616 1st year after cancer diagnosis −1.32 .705 6.74 .133 −3.86 .441 −2.77 .276 −5.20 .027* −7.34 .022* −4.28 .155 −6.12 .003* Breast cancer 8.96 .058 10.38 .088 8.91 .189 −4.24 .218 1.31 .679 −0.19 .965 −1.19 .769 −2.33 .393 Colorectal cancer −1.77 .712 −0.78 .899 2.00 .771 −5.66 .106 2.16 .502 −2.45 .578 0.10 .981 −4.25 .127 Leukemia cancer 4.09 .556 1.19 .895 −5.06 .613 −7.85 .122 −2.52 .589 −8.16 .201 −0.74 .901 −10.2 .012* Lymphoma Cancer −0.78 .905 4.90 .562 10.64 .260 0.82 .863 6.54 .137 6.03 .317 9.13 .107 −0.64 .866 Stage III/IV −7.82 .042* −5.15 .297 −10.72 .052 −2.89 .302 −0.17 .947 −9.32 .008* −2.03 .540 −1.63 .463 Multiple tumors 0.43 .918 −5.98 .272 −5.92 .330 −5.07 .100 −4.14 .144 −5.80 .135 −8.08 .027* −2.35 .338 Cancer surgery −0.41 .908 4.37 .340 −0.21 .968 −0.51 .844 0.96 .687 −0.99 .762 0.76 .803 0.72 .727 Chemotherapy −0.56 .902 −2.23 .705 −2.63 .689 −0.91 .786 1.99 .516 −1.56 .710 −3.77 .340 −1.84 .488 Radiation therapy −6.08 .078 −5.62 .205 0.01 1.000 −5.92 .019* −8.05 .001* −0.82 .794 −4.48 .131 −3.78 .059 Immunotherapy −5.09 .188 −4.06 .414 −5.42 .329 −5.42 .055 −1.76 .496 −0.39 .912 −7.47 .026 0.71 .751 Antibodies 0.32 .935 6.08 .232 −3.58 .528 2.53 .380 −0.41 .875 0.78 .829 3.12 .360 3.02 .187 Metastasis −5.68 .219 3.55 .551 −1.99 .764 −4.65 .167 −3.05 .324 −4.21 .321 −6.18 .121 −8.34 .002* Fever −0.59 .867 −5.74 .205 −8.41 .097 −2.98 .245 −5.54 .019* −6.15 .057 −8.01 .009* −4.93 .016* Family support 5.38 .353 5.75 .441 4.16 .618 6.75 .111 9.70 .013* 2.12 .689 8.82 .078 7.43 .028* Chronic disease other than cancer −0.33 .926 7.47 .102 19.66 .001* 5.11 .048* 0.22 .926 2.58 .427 −2.52 .409 −2.64 .199 Regular exercise 8.82 .013* 7.78 .088 9.75 .056 5.54 .032* 2.45 .301 6.66 .041* 5.76 .060 4.97 .016* Model summary F value 3.108 1.496 1.957 2.834 2.448 2.450 3.280 3.269 P value 0.001 0.067 0.006 0.001 0.001 0.001 0.001 0.001 R 0.204 0.110 0.139 0.189 0.168 0.168 0.215 0.212 R 0.452 0.331 0.373 0.435 0.410 0.410 0.464 0.461 *Adjusting for other predictors in model, predictor is significant at α = 0.05. 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Health-Related Predictors of Quality of Life in Cancer Patients in Saudi Arabia

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Springer Journals
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Copyright © 2017 by The Author(s)
Subject
Biomedicine; Cancer Research; Pharmacology/Toxicology
ISSN
0885-8195
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1543-0154
DOI
10.1007/s13187-017-1198-3
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Abstract

J Canc Educ (2018) 33:1011–1019 DOI 10.1007/s13187-017-1198-3 Health-Related Predictors of Quality of Life in Cancer Patients in Saudi Arabia 1,2 2 3 Anwar E. Ahmed & Alaa S. Almuzaini & Mohannad A. Alsadhan & 4 2 5 Abdulrahman G. Alharbi & Hanin S. Almuzaini & Yosra Z. Ali & Abdul-Rahman Jazieh Published online: 7 March 2017 The Author(s) 2017. This article is published with open access at Springerlink.com Abstract Research on Saudi Arabian cancer patients is a pri- (145 breast, 109 colorectal, 38 leukemia, 45 lymphoma, and ority at King Abdulaziz Medical City (KAMC), Riyadh, 99 other types) who attended the Oncology Outpatient Clinics Saudi Arabia. Because there is limited research on the quality at KAMC. Sociodemographics, clinical symptoms, and can- of life (QoL) of Saudi Arabian cancer patients, the aim of this cer treatments were collected for each patient. We used the SF- study was to identify the predictors of the QoL in a sample of 36 instrument to assess QoL. Of the cancer patients studied, Saudis with cancer. In August 2016, a cross-sectional study 28.4% had a family history of cancer, and, according to sub- was conducted on 438 patients with a variety of cancer types group analyses, the elderly, those lacking formal education, the unemployed, those diagnosed with Stage III/IV, and those with metastasis had significantly worse physical functions than the other cancer patients. According to multiple linear regres- * Anwar E. Ahmed sion analyses, cancer patients who exercised regularly tended ahmedan@ngha.med.sa; ahmeda5@vcu.edu to have better physical function, emotional role function, vital- ity, social function, and general health (increase in SF-36 scores Alaa S. Almuzaini of 8.82, 9.75, 5.54, 6.66, and 4.97, respectively). Patients with Almuzaini.a.s@gmail.com first-year-after-cancer diagnosis tended to have poor emotional Mohannad A. Alsadhan wellbeing, social function, and general health (decrease in mohannadalsadhan@gmail.com SF-36 scores of 5.20, 7.34, and 6.12, respectively). Newly Abdulrahman G. Alharbi diagnosed cancer patients and patients who did not exercise Dr.harbi93@gmail.com tended to experience significantly poor QoL in several do- Hanin S. Almuzaini mains; thus, the effectiveness of exercise must be assessed in Almuzaini.h.s@gmail.com Saudi cancer patients as an intervention to improve QoL. Yosra Z. Ali aliyz@vcu.edu . . . Keywords SF-36 QoL Regularexercise First-year-cancer diagnosis Saudi Arabia Abdul-Rahman Jazieh jazieha@ngha.med.sa King Abdullah International Medical Research Center (KAIMRC), Introduction Riyadh, Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, According to the Saudi Ministry of Health Cancer Registry in Riyadh, Saudi Arabia Riyadh, more than 15,653 people in Saudi Arabia (77.6% College of Medicine, King Saud University, Riyadh, Saudi Arabia were Saudis) were diagnosed with cancer in 2013. The crude incidence rate was 57.5 per 100,000 population per year. The College of Medicine, Imam Abdulrahman Al Faisal University, Dammam, Saudi Arabia Saudi Government’s vision for 2030 is to significantly miti- gate the challenges faced by the health sector in preventing Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia cancers through analyzing independent risk factors and 1012 J Canc Educ (2018) 33:1011–1019 improving health and control cancer outcomes through impact on QoL in Saudi cancer patients. We also hypothesized treating the symptoms of cancers. that exercise may impact QoL positively in cancer patients. Cancer not only affects patients physically, but it may also impact the quality of life (QoL) of cancer survivors negatively [1, 2]. Recently, much attention has been paid to the negative Materials and Methods impact of cancer and its treatment on the QoL in cancer pa- tients. Several reports have indicated that greater QoL impair- A survey study was conducted in the outpatient oncology ment in patients with cancer may be attributable to treatment clinics, KAMC, Ministry of National Guard Health Affairs. side effects, cancer symptoms, and psychological distress The study obtained scientific and ethical approval from the [2–4]. IRB office at King Abdullah International Medical Research There is evidence that older age has negative effects on the Center (KAIMRC), Riyadh (# RSS16/004). The study includ- QoL in cancer patients [5, 6], while gender has an influence on ed a consecutive sample of cancer patients with different types the degree of QoL impairment [7]. Lack of education has a of cancer who were attending outpatient oncology clinics for negative effect on cancer patients [7], and low income has also follow-up with oncology specialists during the study period been negatively associated with QoL in cancer patients (August 14–31/2016). The subjects of the study administered [8–11]. Other factors contributing to QoL impairment may a one-time survey with a consent form explaining the aims of include clinical presentations of cancer patients such as the the study and asking whether they wanted to complete the stage, type, and site of the cancer [7, 12]. It has been docu- survey. Assent was obtained from parents of all cancer pa- mented internationally that measuring the quality of life in tients with ages between 14 and 17 years. We obtained written cancer patients is an important aspect of cancer management consent from those patients age 18 years and above. and treatment, and could serve as an effective tool for clinical A total of 540 subjects who consented were administered trials [1, 13–15]. the survey, and 436 surveys were completed and returned (145 To date, research on QoL in cancer patients in Saudi Arabia breast, 45 lymphoma, 109 colorectal, 38 leukemia, and 99 has been insufficient. Only three studies in Saudi Arabia have other types of cancer) with a response rate of 80.7%. addressed the quality of life in cancer patients. Colorectal Sociodemographics data were collected for each patient such cancer [16] and breast cancer [17, 18]patients werereported as age, gender, height, weight, university degree, marital sta- to have a low QoL. According to the authors, there are numer- tus, regular exercise, family support, and employment status. ous factors associated with a major reduction in all domains of We collected clinical data on patients and their cancer charac- QoL, including educational level, employment status, patho- teristics such as type of cancer, family history of cancer, can- logical staging, and tumor location [16–18]. There are numer- cer stage (I, II, III, or IV), multiple tumors, newly diagnosed ous self-report questionnaires used to measure QoL, including cancer patients or first-year-after-cancer diagnosis, whether the European Organization for Research and Treatment of patient received chemotherapy, whether patient had surgery Cancer (EORTC) quality of life [19] which is used by to remove tumors, whether patient received immunotherapy, Almutairi et al. The Short-Form Health Survey SF-36 (the whether patient received radiation therapy antibiotics, side RAND 36-item) questionnaire [20] is a self-report question- effects of treatment, metastasis, sleep deprivation, fever, and naire commonly used to assess QoL, and it has been used chronic disease other than cancer. The following section de- consistently in Saudi patients with sickle cell disease [21, scribes the quality of life questionnaire used to assess patients’ 22]. However, there is a paucity of data using SF-36 measure health status. in Saudi cancer patients. The impact of sociodemographics, cancer characteristics, and treatment are important to consider when assessing QoL Quality of Life Instrument in the cancer population. It allows clinicians to describe and assess the health status of cancer patients, provide interven- Quality of life was assessed by the Medical Outcomes Study tions, and measure their effectiveness. This study is of interest 36-item short-form (SF-36) questionnaire [20], an instrument to oncologists who provide routine care to cancer patients in with an Arabic version [23] and established reliability that Saudi Arabia. Research on Saudi Arabian cancer patients is a provides subjective evaluation of quality of life. It has been priority at King Abdulaziz Medical City (KAMC), Riyadh, used in general and disease-specific populations. The SF-36 is Saudi Arabia. In this study, we used data from a study con- a self-rated tool comprising 36 items grouped into eight do- ducted at King Abdulaziz Medical City in Riyadh (KAMC-R) mains: physical function, physical role health, emotional role to determine the impact of sociodemographics, clinical symp- functions, vitality, emotional wellbeing, social function, bodi- toms, and cancer treatments on QoL measures in Saudi cancer ly pain, and general health. Each of these domains ranges from patients. We hypothesized that being elderly, newly diagnosed 0 (poor health) to 100 (best health). The SF-36 questionnaire patients, and the cancer prognosis would have a negative was found to be reliable in this population with Cronbach’s J Canc Educ (2018) 33:1011–1019 1013 alpha values ranging between 0.60 Bsocial function^ and 0.91 account for 24 multiple comparisons, the Bonferroni correction Bphysical function.^ of α/n = 0.05/24 = 0.0021 was used to compare QoL differ- ences between sociodemographics and clinical characteristics (Tables 1 and 2,Fig. 1). Multivariate analyses: Multiple linear Data Analysis regression models were used to examine the relationship be- tween the sociodemographics, clinical symptoms, and cancer The data analysis was conducted using IBM SPSS Statistics 23 (SPSS, Chicago, IL). Patients’ characteristics: sample statistics treatments and each QoL domain, and to identify predictors of such as means and standard deviation were used to summarize the SF-36 subscales. Regression coefficients were used to in- numerical data. Counts and percentages were used to summa- terpret the linear regression findings. In all multivariate analy- rize categorical data (Table 1). Bivariate analyses:Inorder to ses, the significance level (α)was setat0.05. Table 1 Differences in quality of life by sociodemographics and clinical characteristics (N =436) Overall Physical functioning Role limitations due Role limitations due to Vitality to physical health emotional problems Characteristics n % Mean SD P Mean SD P Mean SD P Mean SD P Gender Male 157 36.0 46.8 30.8 0.429 24.7 36.6 0.620 33.3 41.9 0.507 44.0 21.6 0.924 Female 279 64.0 49.1 28.7 26.5 37.6 30.6 41.2 43.8 22.3 Elderly No 270 61.9 55.1 27.6 0.001* 25.8 37.3 0.985 32.1 41.0 0.737 46.1 22.0 0.009 Yes 166 38.1 37.2 29.0 25.9 37.1 30.7 42.2 40.4 21.7 University No 312 71.6 44.1 28.8 0.001* 25.9 37.0 0.985 29.9 40.6 0.185 42.2 22.1 0.010 Yes 124 28.4 58.9 28.4 25.8 37.8 35.8 43.4 48.2 21.2 Employed No 321 73.6 45.6 28.3 0.001* 26.5 37.0 0.562 31.5 41.5 0.926 43.2 21.8 0.246 Yes 115 26.4 56.0 31.2 24.1 37.7 31.9 41.5 46.0 22.4 Married No 99 22.7 47.2 30.1 0.678 30.3 38.8 0.177 32.0 40.1 0.911 45.2 23.6 0.524 Yes 337 77.3 48.6 29.3 24.6 36.6 31.5 41.9 43.5 21.5 Obese No 273 71.7 50.1 29.2 0.217 28.0 38.9 0.216 32.8 42.3 0.460 44.4 21.6 0.876 Yes 108 28.3 45.9 31.3 22.9 35.0 29.3 40.9 44.0 23.7 Family history of cancer No 312 71.6 47.5 29.7 0.339 27.6 37.9 0.112 33.3 42.3 0.147 44.9 22.4 0.129 Yes 124 28.4 50.4 28.6 21.4 35.0 27.2 39.0 41.4 20.7 1st year after cancer diagnosis No 196 45.1 46.9 28.1 0.405 21.8 33.7 0.045 32.0 41.5 0.800 42.5 23.3 0.243 Yes 239 54.9 49.2 30.4 28.9 39.4 31.0 41.3 45.0 20.8 Cancer Types Breast 145 33.3 54.4 28.8 0.002* 29.3 38.3 0.292 33.6 42.2 0.137 43.9 20.8 0.242 Colorectal 109 25.0 42.7 26.6 23.4 35.1 32.1 41.6 41.2 22.4 Leukemia 38 8.7 52.9 29.5 23.7 37.2 23.7 38.7 42.1 23.4 Lymphoma 45 10.3 52.8 29.7 32.8 39.8 43.0 42.4 50.0 24.8 Others 99 22.7 41.7 31.2 21.2 36.3 25.9 40.0 44.8 21.2 Stage III/IV I/II 216 58.7 53.1 29.4 0.001* 29.2 38.3 0.006 36.0 43.2 0.001* 47.4 20.3 0.001* III/IV 152 41.3 42.0 29.1 18.9 32.9 22.1 36.2 38.6 22.5 Multiple tumors No 291 68.5 49.9 29.6 0.034 28.7 38.5 0.003 35.9 42.8 0.001* 46.5 21.7 0.001* Yes 134 31.5 43.4 28.9 18.1 31.8 22.6 36.9 37.5 21.4 Cancer surgery No 199 45.6 48.1 30.5 0.890 25.0 37.3 0.659 30.5 41.0 0.615 43.6 21.3 0.800 Yes 237 54.4 48.5 28.6 26.6 37.2 32.5 41.8 44.2 22.6 Chemotherapy No 101 23.2 48.2 29.8 0.958 33.7 41.3 0.027 38.3 45.1 0.082 46.6 22.5 0.164 Yes 335 76.8 48.3 29.4 23.5 35.6 29.6 40.1 43.1 21.8 Radiation therapy No 238 54.7 50.3 29.8 0.142 29.0 39.3 0.055 33.3 41.8 0.352 46.4 22.6 0.009 Yes 197 45.3 46.1 28.7 22.2 34.2 29.6 41.1 40.9 20.9 Immunotherapy No 206 47.5 51.3 30.7 0.054 28.5 40.3 0.149 37.1 44.3 0.010 47.0 21.2 0.007 Yes 228 52.5 45.9 27.9 23.4 34.0 26.8 38.2 41.3 22.3 Antibodies No 319 75.2 49.9 29.1 0.115 26.8 38.3 0.477 34.6 43.0 0.013 45.2 22.4 0.123 Yes 105 24.8 44.6 31.1 23.8 34.4 23.8 36.3 41.3 20.8 Metastasis No 303 69.5 51.2 29.0 0.002* 28.5 38.5 0.016 35.1 42.9 0.005 46.9 21.7 0.001* Yes 133 30.5 41.8 29.5 19.7 33.4 23.6 36.9 37.2 21.3 Fever No 263 60.3 50.4 30.7 0.058 30.1 39.5 0.002* 38.1 43.9 0.001* 46.8 22.1 0.001* Yes 173 39.7 45.1 27.1 19.4 32.4 21.6 35.2 39.6 21.1 Family support No 37 8.5 49.9 33.0 0.736 26.4 35.3 0.933 42.3 45.6 0.137 43.4 25.7 0.878 Yes 399 91.5 48.2 29.1 25.8 37.4 30.6 40.9 44.0 21.7 Chronic disease other than No 271 62.2 52.0 29.1 0.001* 25.9 38.4 0.964 29.4 40.7 0.160 44.7 21.7 0.358 cancer Yes 165 37.8 42.2 29.0 25.8 35.3 35.2 42.5 42.7 22.5 Regular exercise No 293 67.2 44.4 29.6 0.001* 23.2 36.1 0.038 28.0 41.0 0.009 41.1 21.6 0.001* Yes 143 32.8 56.2 27.4 31.3 39.0 38.9 41.5 49.7 21.7 *The variable is significant using Bonferroni correction cut-off at α/n = 0.05/24 = 0.0021, where n is the number of tests, P=P-value. 1014 J Canc Educ (2018) 33:1011–1019 Table 2 Differences in quality of life by sociodemographics and clinical characteristics (N =436) Emotional wellbeing Social functioning Pain General health Characteristics Mean SD P Mean SD P Mean SD P Mean SD P Gender Male 63.7 19.7 0.479 55.7 26.8 0.470 56.0 27.0 0.020 51.7 16.7 0.528 Female 62.3 20.4 57.7 27.7 49.7 26.8 50.5 18.3 Elderly No 62.1 20.9 0.374 58.9 27.2 0.065 51.4 27.7 0.557 52.2 18.0 0.054 Yes 63.9 18.9 53.9 27.4 52.9 25.9 48.9 17.1 University No 62.2 19.9 0.344 56.8 27.8 0.786 50.2 27.3 0.030 49.6 17.9 0.009 Yes 64.3 20.7 57.6 26.2 56.4 26.0 54.4 17.0 Employed No 62.8 19.6 0.978 57.7 26.6 0.389 51.5 26.1 0.584 49.9 17.5 0.054 Yes 62.9 21.7 55.1 29.3 53.2 29.6 53.7 18.2 Married No 62.5 19.9 0.848 60.0 26.7 0.218 53.9 25.8 0.421 52.3 17.4 0.379 Yes 62.9 20.3 56.1 27.5 51.4 27.4 50.5 17.9 Obese No 63.0 19.7 0.729 56.2 27.7 0.493 53.4 27.5 0.150 51.0 17.6 0.633 Yes 62.2 20.1 58.3 27.2 49.0 25.7 50.0 17.9 Family history of cancer No 64.4 19.9 0.011 58.7 28.0 0.028 54.3 28.0 0.002* 51.7 17.5 0.149 Yes 58.9 20.5 52.6 25.1 46.2 23.5 49.0 18.4 1st year after cancer diagnosis No 63.4 20.9 0.542 58.2 28.0 0.358 51.9 27.5 0.954 51.8 17.4 0.331 Yes 62.2 19.6 55.8 26.7 51.8 26.5 50.1 18.0 Cancer types Breast 61.4 20.0 0.161 58.4 28.2 0.278 49.0 26.6 0.073 50.7 19.2 0.564 Colorectal 65.7 20.3 54.6 24.0 52.7 26.2 50.0 14.8 Leukemia 60.9 21.8 56.6 27.4 56.8 25.0 49.1 20.6 Lymphoma 67.1 21.6 64.2 28.7 60.8 29.3 54.9 16.1 Others 60.5 18.5 54.5 28.8 49.6 27.5 51.2 18.2 Stage III/IV I/II 64.0 18.7 0.011 61.8 23.9 0.001* 55.4 25.5 0.001* 53.3 16.0 0.001* III/IV 58.4 21.7 50.7 29.4 43.8 26.7 46.5 18.2 Multiple tumors No 64.5 19.7 0.003 59.4 26.3 0.004 55.6 26.5 0.001* 52.7 17.1 0.001* Yes 58.3 20.7 51.2 28.8 42.6 25.9 46.5 18.4 Cancer surgery No 63.4 18.5 0.589 55.7 28.2 0.348 52.4 26.7 0.753 49.7 17.7 0.190 Yes 62.3 21.4 58.1 26.6 51.6 27.4 52.0 17.8 Chemotherapy No 63.9 21.1 0.527 59.2 26.9 0.365 58.2 28.8 0.008 51.6 18.6 0.678 Yes 62.5 19.9 56.3 27.5 50.1 26.2 50.7 17.5 Radiation therapy No 65.3 19.2 0.005 57.6 27.1 0.645 55.1 26.3 0.006 52.4 17.4 0.054 Yes 59.9 21.0 56.3 27.8 48.0 27.3 49.1 18.1 Immunotherapy No 64.5 19.3 0.073 57.4 26.4 0.771 56.9 25.8 0.001* 51.4 17.3 0.615 Yes 61.1 20.9 56.6 28.4 47.9 27.2 50.6 18.3 Antibodies No 63.4 20.4 0.333 57.5 27.5 0.332 53.0 26.1 0.431 51.1 17.5 0.993 Yes 61.3 19.0 54.5 27.5 50.4 29.6 51.0 19.2 Metastasis No 64.9 20.2 0.001* 59.9 26.5 0.001* 56.3 26.2 0.001* 53.6 17.0 0.001* Yes 58.1 19.4 50.3 28.2 42.1 26.3 44.8 17.9 Fever No 66.4 18.5 0.001* 59.7 26.4 0.010 57.1 26.2 0.001* 54.1 17.8 0.001* Yes 57.4 21.4 52.8 28.4 44.1 26.4 46.1 16.6 Family support No 59.5 24.8 0.292 57.4 28.2 0.919 54.5 30.3 0.547 48.8 17.0 0.440 Yes 63.1 19.7 57.0 27.3 51.7 26.7 51.1 17.8 Chronic disease other than No 63.3 19.8 0.508 57.5 27.0 0.609 54.3 27.0 0.018 52.9 17.6 0.003 cancer Yes 62.0 20.8 56.1 28.0 48.1 26.8 47.7 17.6 Regular exercise No 60.8 20.7 0.003 53.7 27.4 0.001* 48.2 26.7 0.001* 48.4 17.9 0.001* Yes 66.9 18.4 63.8 26.0 59.7 26.1 56.2 16.3 *The variable is significant using Bonferroni correction cut-off at α/n = 0.05/24 = 0.0021, where n is the number of tests, P=P-value. J Canc Educ (2018) 33:1011–1019 1015 Fig. 1 Error bar chart: impact of cancer complications on bodily pain ratings. Notes: The higher the score, the less pain Results cancer, followed by patients with leukemia, lymphoma, colo- rectal, and other cancer types. Patients’ Characteristics The mean scale score for role limitations due to physical health was 25.9 (±SD = 37.2). A greater impact on role limi- Of the 438 cancer patients studied, 64% were female and tations due to physical health was found in cancer patients 28.4% had a family history of cancer. The average age of with fever. The mean scale score for role limitations due to the sample was 52.9 (±SD = 17.3) with a range of 14–97 years. emotional problems was 31.6 (±SD = 41.4). Cancer patients The median number of months after-cancer diagnoses was 12 with stage III or IV, multiple tumors, and fever reported sig- (interquartile range 5–24 months). The majority of subjects nificantly poorer role limitations due to emotional problems (76.8%) received chemotherapy, 41.3% had cancer stage III when compared to their counterparts. The mean scale score or IV, 30.5% had metastasis, and 24.8% were treated with for vitality was 43.9 (±SD = 22.0), and significantly lower antibiotics. Other patient characteristics are reported in scores on vitality were observed in patients with old age, stage Table 1. III or IV, multiple tumors, metastasis, and fever when com- pared to their counterparts. However, patients who regularly Bivariate Analyses exercised reported higher scores on vitality than those who did not exercise. The mean scores by sociodemographics, clinical symptoms, The mean scale score for emotional wellbeing was 62.8 and cancer treatments of each of the eight QoL domains mea- (±SD = 20.2). Lower mean scores on emotional wellbeing sured by the SF-36 are presented in Tables 1 and 2 and Fig. 1. was found in cancer patients with metastasis and fever when The mean physical function was 48.30 (±SD = 29.4). compared to their counterparts. The mean scale score for so- According to subgroup analyses, the elderly, those lacking cial functioning was 57.0 (±SD = 27.4). Cancer patients with formal education, the unemployed, those diagnosed with stage stage III or IV and metastasis reported significantly lower III/IV, those with metastasis, and those with chronic disease scores on social functioning when compared to their counter- other than cancer have significantly worse physical functions parts, while patients who practiced regular exercise reported than the other cancer patients. However, regular exercise was higher scores on social functioning than those who did not. predictive of increasing physical function. Higher mean scores The mean scale score for pain was 52.0 (±SD = 27.0). Bodily pain was significantly increased in patients with a family of physical functions were found in patients with breast 1016 J Canc Educ (2018) 33:1011–1019 history of cancer, stage III or IV, multiple tumors, receiving with different cancers in Saudi Arabia. This study is of interest immunotherapy, metastasis, and fever, while patients who reg- to QoL researchers and providers caring for cancer patients. It ularly exercised reported less bodily pain than those who did has identified several predictors that appear to be correlated not exercise. The mean scale score for general health was 50.9 with QoL in cancer patients. One of our findings was that the (±SD = 17.8). Patients with stage III or IV, multiple tumors, elderly reported poorer vitality and physical function. These metastasis, and fever reported lower scores on general health findings are consistent with previous studies in demonstrating when compared to their counterparts. older cancer patients may have a negative impact on QoL [5, 6]. It is also evident that patients with first-year-after-cancer Regression Analyses diagnosis reported a poorer health-related quality of life. Specifically, patients with first-year-after-cancer diagnosis Multivariate analyses (Table 3) showed that elderly and stage tended to have poor emotional wellbeing, social function, III or IV were found to be significant negative predictors of and general health (decrease in SF-36 scores of 5.20, 7.34, physical health (decrease in physical health scores of 13.79 and 6.12, respectively). An Iranian study has also shown that and 7.82, respectively), while regular exercise was found to be first-year-after-cancer diagnosis is a predictor for poor physi- a significant positive predictor of physical health (increase in cal, emotional, and social functioning [24]. Cancer disclosure physical health score of 8.82). A family history of cancer had a and patient’s quality of life and its impact on cancer treatment negative impact on role limitations due to physical health (de- and management must be assessed as their relation has yet to crease in role limitations due to physical health score of 10.3). be fully studied in Saudi Arabia. Patients with chronic disease other than cancer had a positive Our study investigated the association between cancer treat- impact on role limitations due to emotional problems (increase ments and QoL. Vitality and emotional wellbeing are reported in role limitations due to emotional problem score of 19.66). significantly worse among those who received radiation thera- Poor vitality was predicted by the elderly and those receiving py. Several other studies have also shown that poor QoL is radiation therapy (decrease in vitality scores of 8.11 and 5.92, linked with cancer treatments [2–4]. An interventional study respectively), while the presence of other chronic diseases and is warranted to assess the impact of radiation therapy on QoL. regular exercise were positive predictors of vitality (increase The study also compares the QoL of survivors with differ- in vitality scores of 5.11 and 5.54, respectively). ent types of cancer. The QoL depends on the location of the Family history of cancer, newly diagnosed cancer patients cancer. Leukemia was found to be associated with poor qual- (first-year-after-cancer diagnosis), radiation therapy, and fever ity of life. This has been frequently addressed in various stud- were negatively correlated with poor emotional wellbeing (de- ies [25–27]. QoL assessmentinpatientswithleukemiacan crease in emotional wellbeing scores of 7.54, 5.20, 8.05, and provide insights into the effects of leukemia treatment and its management. 5.54, respectively), while family support was positively cor- related with better emotional wellbeing (increase in emotional This study also investigated the association between regu- wellbeing score of 9.70). Newly diagnosed cancer patients lar exercise and QoL of patients with cancers. Other studies and stage III or IV were negatively correlated with poor social have shown similar findings [28–30]. In our study, exercise functioning (decrease in social functioning scores of 7.34 and tended to improve physical function, role limitations due to 9.32, respectively), while regular exercise was positively cor- emotional problems, vitality, social function, and general related with better social functioning (increase in social func- health (increase in SF-36 scores of 8.82, 9.75, 5.54, 6.66, tioning score of 6.66). Cancer stage III or IV and fever had and 4.97, respectively). The effectiveness of physical exercise negative impacts on pain (decrease in pain score of 8.08 and must be assessed in Saudi cancer patients as an intervention to 8.01, respectively). Newly diagnosed cancer patients, leuke- improve QoL and control cancer outcomes. Several limita- mia patients, those with metastasis, and those with fever had tions were noted. The cross-sectional design may not allow negative impacts on general health (decrease in pain score of causality assessment. There is a potential for sampling selec- 6.12, 10.2, 8.34, and 4.93, respectively), while those with tion bias, in that cancer patients who are attending outpatient family support and regular exercise regimens had positive clinics may more often be likely to participate, given the per- impacts on general health (increase in general health scores ceived severity of their cancer. However, this research has of 7.43 and 4.97, respectively). clearly identified several factors that appear to affect QoL in cancer patients. Discussion Conclusions This survey addresses health outcomes in a sample of Saudi Arabians with different types of cancer. There is a lack of Regular exercise in cancer patients was a significant positive research addressing health-related quality of life in patients predictor of better vitality, social function, and general health. J Canc Educ (2018) 33:1011–1019 1017 Table 3 Multiple regression showing predictors of health-related quality of life in patients with cancers Physical functioning Role limitations due to Role limitations due to Vitality Emotional wellbeing Social functioning Pain General health physical health emotional problems B P B P B P BP B P B P BP B P (Constant) 54.04 21.81 41.78 55.70 62.70 77.07 66.46 62.86 Female gender −3.72 .412 3.61 .536 −3.84 .556 0.10 .976 1.09 .720 0.73 .860 −1.92 .623 −2.86 .277 Elderly −13.79 .001* 1.62 .751 −6.04 .289 −8.11 .005* 1.23 .642 −6.88 .059 0.25 .941 −3.67 .110 University 5.29 .184 0.29 .955 3.89 .496 2.97 .306 1.54 .563 −2.94 .419 4.77 .164 1.10 .632 Employed 3.94 .353 2.88 .598 −2.50 .681 1.50 .627 0.63 .824 −4.56 .240 −3.56 .330 0.13 .956 Married 1.61 .701 −8.98 .096 −4.42 .462 −3.31 .278 −2.42 .388 −5.07 .186 −4.82 .182 −3.41 .160 Obese −1.57 .667 −4.01 .392 −3.17 .544 2.78 .295 1.45 .550 4.14 .215 −1.27 .685 0.73 .729 Family history of cancer 2.64 .478 −10.3 .033* −6.55 .221 −4.43 .103 −7.54 .003* −4.90 .152 −4.14 .197 −1.08 .616 1st year after cancer diagnosis −1.32 .705 6.74 .133 −3.86 .441 −2.77 .276 −5.20 .027* −7.34 .022* −4.28 .155 −6.12 .003* Breast cancer 8.96 .058 10.38 .088 8.91 .189 −4.24 .218 1.31 .679 −0.19 .965 −1.19 .769 −2.33 .393 Colorectal cancer −1.77 .712 −0.78 .899 2.00 .771 −5.66 .106 2.16 .502 −2.45 .578 0.10 .981 −4.25 .127 Leukemia cancer 4.09 .556 1.19 .895 −5.06 .613 −7.85 .122 −2.52 .589 −8.16 .201 −0.74 .901 −10.2 .012* Lymphoma Cancer −0.78 .905 4.90 .562 10.64 .260 0.82 .863 6.54 .137 6.03 .317 9.13 .107 −0.64 .866 Stage III/IV −7.82 .042* −5.15 .297 −10.72 .052 −2.89 .302 −0.17 .947 −9.32 .008* −2.03 .540 −1.63 .463 Multiple tumors 0.43 .918 −5.98 .272 −5.92 .330 −5.07 .100 −4.14 .144 −5.80 .135 −8.08 .027* −2.35 .338 Cancer surgery −0.41 .908 4.37 .340 −0.21 .968 −0.51 .844 0.96 .687 −0.99 .762 0.76 .803 0.72 .727 Chemotherapy −0.56 .902 −2.23 .705 −2.63 .689 −0.91 .786 1.99 .516 −1.56 .710 −3.77 .340 −1.84 .488 Radiation therapy −6.08 .078 −5.62 .205 0.01 1.000 −5.92 .019* −8.05 .001* −0.82 .794 −4.48 .131 −3.78 .059 Immunotherapy −5.09 .188 −4.06 .414 −5.42 .329 −5.42 .055 −1.76 .496 −0.39 .912 −7.47 .026 0.71 .751 Antibodies 0.32 .935 6.08 .232 −3.58 .528 2.53 .380 −0.41 .875 0.78 .829 3.12 .360 3.02 .187 Metastasis −5.68 .219 3.55 .551 −1.99 .764 −4.65 .167 −3.05 .324 −4.21 .321 −6.18 .121 −8.34 .002* Fever −0.59 .867 −5.74 .205 −8.41 .097 −2.98 .245 −5.54 .019* −6.15 .057 −8.01 .009* −4.93 .016* Family support 5.38 .353 5.75 .441 4.16 .618 6.75 .111 9.70 .013* 2.12 .689 8.82 .078 7.43 .028* Chronic disease other than cancer −0.33 .926 7.47 .102 19.66 .001* 5.11 .048* 0.22 .926 2.58 .427 −2.52 .409 −2.64 .199 Regular exercise 8.82 .013* 7.78 .088 9.75 .056 5.54 .032* 2.45 .301 6.66 .041* 5.76 .060 4.97 .016* Model summary F value 3.108 1.496 1.957 2.834 2.448 2.450 3.280 3.269 P value 0.001 0.067 0.006 0.001 0.001 0.001 0.001 0.001 R 0.204 0.110 0.139 0.189 0.168 0.168 0.215 0.212 R 0.452 0.331 0.373 0.435 0.410 0.410 0.464 0.461 *Adjusting for other predictors in model, predictor is significant at α = 0.05. 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Journal of Cancer EducationSpringer Journals

Published: Mar 7, 2017

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