Distress and Quality of Life in Cancer Patients Receiving Chemotherapy

Ji Young Seo; Myungsun Yi

doi:10.5388/aon.2015.15.1.18

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Seo and Yi: Distress and Quality of Life in Cancer Patients Receiving Chemotherapy

Original Article

Asian Oncology Nursing 2015; 15(1): 18-27.

Published online: 31 March 2015

DOI: https://doi.org/10.5388/aon.2015.15.1.18

Distress and Quality of Life in Cancer Patients Receiving Chemotherapy

Ji Young Seo¹, Myungsun Yi²

¹College of Nursing, Seoul National University, Soeul, Korea.

²College of Nursing, The Research Institute of Nursing Science, Seoul National University, Soeul, Korea.

Address reprint requests to: Seo, Ji Young. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea. Tel: +82-2-740-8839, Fax: +82-2-747-3948, sjy@snu.ac.kr

Received 23 January 2015 Revised 24 February 2015 Accepted 27 March 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the levels of distress and quality of life in cancer patients receiving chemotherapy and to identify the relationship between distress and quality of life.

Methods

Data were collected during 2013 from 128 cancer patients receiving chemotherapy at a hospital located in Seoul, South Korea. Distress thermometer and problem list were used to measure distress, and the Functional Assessment Cancer Therapy-general questionnaire was used to measure quality of life. Descriptive statistics, t-tests, one-way ANOVA, the post-hoc Scheffé test, and Pearson's correlation coefficients were used to analyze the data.

Results

Among the 128 participants, 68 (53.1%) were male and the mean age was 52.55 years. Forty two (32.8%) were diagnosed with stage 4 and 73 (57.0%) were having recurrence or metastasis. The mean score for distress was 4.01 out of 10. Seventy four (57.8%) participants had a score of 4 or higher, indicating clinically significant distress. Emotional problems had the highest item mean among five domains. The mean score for quality of life was 68.51 ± 14.22 out of 108. Distress and quality of life were negatively correlated (r= -.52, p<.001).

Conclusion

Distress level with specific problems should be regularly assessed to relieve distress and improve the quality of life of cancer patients receiving chemotherapy.

Keywords: Chemotherapy, Neoplasm, Stress, Quality of Life

Figures and Tables

Table 1

Difference in Distress and Quality of Life by Sociodemographic and Illness-related Characteristics (N=128)

Variables	Categories	n (%)	Distress		Quality of life
Variables	Categories	n (%)	M ± SD	t or F (p) Scheffé	M ± SD	t or F (p) Scheffé
Gender	Male	68 (53.1)	3.74 ± 2.26	- 1.48 (.142)	69.71 ± 14.44	1.21 (.312)
Gender	Female	60 (46.9)	4.33 ± 2.32	- 1.48 (.142)	67.15 ± 13.96	1.21 (.312)
Age (year)	20~29	6 (4.7)	3.17 ± 2.32	0.44 (.781)	79.67 ± 9.77	1.29 (.276)
	30~39	11 (8.6)	4.37 ± 1.57		67.55 ± 6.15
	40~49	31 (24.2)	4.26 ± 2.29		65.65 ± 14.36
	50~59	42 (32.8)	3.81 ± 2.32		68.52 ± 15.49
	≥ 60	38 (29.7)	4.08 ± 2.50		69.34 ± 14.50
Marital status	Single	12 (9.4)	4.00 ± 2.09	0.42 (.685)	71.42 ± 15.64	0.27 (.761)
	Married	114 (89.1)	3.99 ± 2.31		68.20 ± 14.06
	Other	2 (1.6)	5.00 ± 3.53		68.50 ± 23.33
Religion	None	43 (33.6)	4.35 ± 2.52	0.69 (.604)	68.53 ± 12.14	1.08 (.369)
	Christian	41 (32.0)	3.59 ± 2.36		71.41 ± 17.01
	Buddhist	28 (21.9)	4.21 ± 2.13		65.89 ± 11.98
	Catholic	15 (11.7)	3.93 ± 1.79		66.47 ± 15.08
	Other	1 (0.8)	3.00 ± 0.00
Education	≤ Middle school	16 (12.5)	4.06 ± 2.21	0.44 (.957)	70.00 ± 13.24	2.27 (.107)
	High school	64 (50.0)	4.06 ± 2.42		65.89 ± 14.40
	≥ College/University	48 (37.5)	3.94 ± 2.20		71.50 ± 13.91
Perceived economic status	High^a	6 (4.7)	5.00 ± 3.41	1.79 (.171)	68.00 ± 15.11	3.45 (.035) c<b
	Moderate^b	97 (75.8)	2.21 ± 0.22		70.22 ± 14.06
	Low^c	25 (19.5)	2.27 ± 0.45		62.00 ± 13.27
Occupation	Yes	42 (32.8)	3.79 ± 1.92	- .79 (.431)	70.31 ± 13.74	1.00 (.318)
Occupation	No	86 (67.2)	4.13 ± 2.46	- .79 (.431)	7.63 ± 14.45	1.00 (.318)
Type of cancer	Digestive tract cancer	48 (37.5)	3.75 ± 2.31	0.77 (.574)	72.52 ± 14.35	2.01 (.070)
	Hepatobiliaty & pancreatic cancer	17 (13.3)	4.59 ± 2.43		61.24 ± 14.39
	Breast cancer	17 (13.3)	4.35 ± 2.32		64.00 ± 12.84
	Lung cancer	11 (8.6)	2.73 ± 2.24		67.55 ± 11.24
	Lymphoma & sarcoma	23 (18.0)	3.83 ± 2.27		69.00 ± 15.15
	Others	12 (9.4)	3.50 ± 2.24		69.08 ± 12.49
Time period since diagnosis (month)	1~6	51 (39.8)	3.80 ± 2.38	0.76 (.554)	71.86 ± 13.44	1.46 (.218)
	7~12	20 (15.6)	3.65 ± 2.28		68.55 ± 12.69
	13~18	14 (10.9)	3.93 ± 2.40		67.36 ± 15.13
	19~24	7 (5.5)	5.00 ± 1.73		63.86 ± 9.08
	≥ 25	36 (28.1)	4.36 ± 2.27		65.08 ± 16.00
Stage of cancer	Stage 1	9 (7.0)	4.00 ± 2.29	0.51 (.729)	61.11 ± 17.95	1.14 (.342)
	Stage 2	31 (24.2)	3.71 ± 2.44		71.03 ± 16.39
	Stage 3	33 (25.8)	4.30 ± 2.40		66.82 ± 13.44
	Stage 4	42 (32.8)	4.19 ± 2.12		68.57 ± 12.88
	Unknown	13 (10.2)	3.46 ± 2.40		71.69 ± 11.38
Previous treatment	Chemotherapy	50 (39.1)	4.08 ± 2.11	0.25 (.801)	69.08 ± 13.95	0.36 (.717)
Previous treatment	Chemotherapy + others	78 (60.9)	3.97 ± 2.42	0.25 (.801)	68.14 ± 14.47	0.36 (.717)
Comorbodity	Yes	33 (25.8)	4.36 ± 2.58	1.01 (.314)	71.61 ± 14.00	1.46 (.147)
Comorbodity	No	95 (74.2)	3.89 ± 2.19	1.01 (.314)	67.43 ± 14.47	1.46 (.147)
Place injected chemotherapy	Hospitalization	61 (47.7)	3.66 ± 2.99	- 1.70 (.091)	69.92 ± 14.69	1.07 (.286)
Place injected chemotherapy	Daycare center or day injection room	67 (52.3)	4.34 ± 2.27	- 1.70 (.091)	67.43 ± 14.26	1.07 (.286)
Metastasis or recurrence	Yes	73 (57.0)	4.08 ± 2.20	0.50 (.610)	67.66 ± 13.73	0.97 (.333)
	No	39 (30.5)	3.74 ± 2.46		71.05 ± 15.38
	Unknown	16 (12.5)	4.38 ± 2.42		66.19 ± 13.51
Cumulative cycles of chemotherapy	1~5 cycles	48 (37.5)	3.98 ± 2.42	0.42 (.794)	71.58 ± 12.88	1.47 (.217)
	6~10 cycles	33 (25.8)	4.00 ± 2.26		66.15 ± 14.11
	11~15 cycles	14 (10.9)	3.43 ± 2.62		70.43 ± 16.56
	≥ 16 cycles	29 (22.7)	4.28 ± 1.89		66.48 ± 15.12
	Unknown	4 (3.1)	4.75 ± 3.30		59.00 ± 11.52

Table 2

Levels of Distress (N=128)

Distress score	n (%)	Cumulation %
	M ± SD = 4.01 ± 2.30
0	11 (8.6)	8.6
1	10 (7.8)	16.4
2	14 (10.9)	27.3
3	19 (14.8)	42.2
4	16 (12.5)	54.7
5	24 (18.8)	73.5
6	9 (7.0)	80.5
7	20 (15.6)	96.1
8	4 (3.1)	99.2
9	1 (0.8)	100.0
10	0 (0.0)	100.0
Total	128 (100.0)	100.0

Note. Distress score<4=54/128 (42.2%); Distress score≥4=74/128 (57.8%).

Table 3

Comparison of Problem List by Distress Group (N=128)

Problem list	Total score	Distress score <4 (n=54)		Distress score ≥4 (n=74)		t	p
Problem list	Total score	n (%)	Ranking	n (%)	Ranking	t	p
Practical	34.83 ± 9.04 (27.2%)	10.17 ± 2.64 (18.8%)		26.33 ± 7.22 (35.6%)		-5.15	<.001
Child care	26 (20.3)	6 (11.1)	17	20 (27.0)	18
Housing	44 (34.4)	10 (18.5)	13	34 (45.9)	10
Insurance/financial	44 (34.4)	13 (24,1)	10	31 (41.9)	12
Transportation	38 (29.7)	13 (24.1)	10	25 (33.8)	15
Work/school	26 (20.3)	10 (8.5)	13	16 (21.6)	20
Treatment decision	41 (32.0)	9 (16.7)	14	32 (43.2)	11
Family	24.50 ± 18.36 (19.1%)	5.50 ± 4.8 (10.18%)		19.00 ± 13.95 (25.7%)		- 1.83	.117
Dealing with children	24 (18.6)	3 (5.6)	20	21 (28.4)	17
Dealing with partner	25 (19.5)	6 (11.1)	17	19 (25.7)	19
Ability to have children	2 (1.6)	1 (1.9)	22	1 (1.4)	25
Family health issues	47 (36.7)	12 (22.2)	11	35 (47.3)	9
Emotional	84.75 ± 16.13 (66.2%)	12.83 ± 7.28 (23.8%)		43.66 ± 9.07 (59.0%)		- 6.50	<.001
Depression	49 (38.3)	11 (20.4)	12	38 (51.4)	8
Fear	52 (40.6)	11 (20.4)	12	41 (55.4)	6
Nervousness	54 (42.2)	13 (24.1)	10	41 (55.4)	6
Sadness	48 (37.5)	7 (13.0)	16	41 (55.4)	6
Worry	89 (69.5)	27 (50.0)	1	62 (83.8)	1
Loss of interest in usual activities	47 (36.7)	8 (14.8)	15	39 (52.7)	7
Spiritual/religious concerns	13 (10.2)	5 (9.3)		8 (10.8)	23	- 0.65	.197
Physical	41.68 ± 19.42 (32.6%)	12.82 ± 6.49 (23.7%)		28.85 ± 15.55 (39.0%)		- 4.97	<.001
Appearance	60 (46.9)	18 (33.3)	7	42 (56.8)	5
Bathing/dressing	30 (23.4)	10 (18.5)	13	20 (27.0)	18
Breathing	17 (13.3)	4 (7.4)	19	13 (17.6)	21
Changes in urination	33 (25.8)	14 (25.9)	9	19 (25.7)	19
Constipation	35 (27.3)	15 (27.8)	8	20 (27.0)	18
Diarrhea	24 (18.6)	8 (14.8)	15	16 (21.6)	20
Eating	58 (45.3)	14 (25.9)	9	44 (59.5)	4
Fatigue	81 (63.3)	24 (44.4)	3	57 (77.0)	2
Feeling Swollen	41 (32.0)	12 (22.2)	11	29 (39.2)	13
Fevers	16 (12.5)	6 (11.1)	17	10 (13.2)	22
Getting around	37 (28.9)	11 (20.4)	12	26 (35.1)	14
Indigestion	43 (33.6)	12 (22.2)	11	31 (41.9)	12
Memory/concentration	58 (45.3)	20 (37.0)	5	38 (51.4)	8
Mouth sores	32 (25.0)	8 (14.8)	15	24 (32.4)	16
Nausea	61 (47.7)	19 (35.2)	6	42 (56.8)	5
Nose dry/congested	40 (31.3)	14 (25.9)	9	26 (35.1)	14
Pain	34 (26.6)	8 (14.8)	15	26 (35.1)	14
Sexual	28 (21.9)	7 (13.0)	16	21 (28.4)	17
Skin dry/itchy	47 (36.7)	8 (14.8)	15	39 (52.7)	7
Sleep	61 (47.7)	23 (42.6)	4	38 (51.4)	8
Substance abuse	5 (3.9)	2 (3.7)	21	3 (4.1)	24
Tingling in hands/feet	76 (59.4)	25 (46.3)	2	51 (68.9)	3
Total	40.41 ± 19.32 (31.6)	11.46 ± 6.27 (21.2)		29.20 ± 14.22 (39.5)

Table 4

Comparison of Quality of Life By Distress Group (N=128)

Variables	Total (n = 128)	Conversion (4)	Distress score < 4 (n = 54)	Distress score ≥ 4 (n = 74)	t	p
Variables	M ± SD	Conversion (4)	M ± SD	M ± SD	t	p
FACT-G ( = PWB + SWB + EWB + FWB)	68.51 ± 14.22	2.54	77.46 ± 11.52	61.97 ± 12.37	7.20	< .001
Physical well-being (PWB)	19.33 ± 5.38	2.76	22.17 ± 4.35	17.26 ± 5.13	5.69	< .001
Social/family well-being (SWB)	16.66 ± 5.18	2.38	17.61 ± 5.08	15.96 ± 5.17	1.79	.075
Emotional well-being (EWB)	16.14 ± 5.04	2.69	19.37 ± 3.10	13.78 ± 4.88	7.38	< .001
Functional well-being (FWB)	16.38 ± 5.39	2.34	18.31 ± 5.65	14.97 ± 4.76	3.62	< .001

FACT-G=Functional Assessment Cancer Therapy-General.

Table 5

Correlation between Distress and Quality of Life (N=128)

Variables	Distress	FACT-G	PWB	SWB	EWB	FWB
Variables	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Distress	1.00
FACT-G	- .52 ( < .001)	1.00
PWB	- .45 ( < .001)	.66 ( < .001)	1.00
SWB	- .09 (.294)	.59 ( < .001)	.06 (.463)	1.00
EWB	- .52 ( < .001)	.74 ( < .001)	.51 ( < .001)	.18 (.039)	1.00
FWB	- .35 ( < .001)	.71 ( < .001)	.21 (.017)	.36 ( < .001)	.33 ( < .001)	1.00

FACT-G=Functional Assessment Cancer Therapy-General; PWB=Physical well-being; SWB=Social/family well-being; EWB=Emotional well-being; FWB=Functional well-being.

Notes

This article is a revision of the first author's master's thesis from Seoul National University

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