Changes of Supportive Care Needs and Quality of Life in Patients with Breast Cancer

Jin-Hee Park; Mison Chun; Yong-Sik Jung; Young-Mi Jung

doi:10.5388/aon.2016.16.4.217

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Park, Chun, Jung, and Jung: Changes of Supportive Care Needs and Quality of Life in Patients with Breast Cancer

Original Article

Asian Oncology Nursing 2016; 16(4): 217-225.

Published online: 31 December 2016

DOI: https://doi.org/10.5388/aon.2016.16.4.217

Changes of Supportive Care Needs and Quality of Life in Patients with Breast Cancer

Jin-Hee Park¹, Mison Chun², Yong-Sik Jung³, Young-Mi Jung⁴

¹College of Nursing · The Institute of Nursing Science, Ajou University, Suwon, Korea.

²School of Medicine, Department of Radiation Oncology, Ajou University, Suwon, Korea.

³School of Medicine, Department of Surgery, Ajou University, Suwon, Korea.

⁴College of Nursing, Ajou University, Suwon, Korea.

Address reprint requests to: Jung, Young-Mi. College of Nursing, Ajou University, 164 World cup-ro, Yongtong-gu 16499, Suwon, Korea. Tel: +82-31-219-7019, Fax: +82-31-219-7020, j-dudal@hanmail.net

Received 11 November 2016 Revised 2 December 2016 Accepted 19 December 2016

(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 changes of supportive care needs and relationship to quality of life (QOL) in patients with breast cancer.

Methods

117 patients with breast cancer were administered the Supportive Care Needs Survey-Short form 34 and the Functional Assessment of Cancer Therapy-Breast before adjuvant therapy after mastectomy (T1), at the end of completing adjuvant therapy (T2), as well as 6 months after the completion of adjuvant therapy (T3). Data were analyzed using SPSS/Win 21.0.

Results

The highest unmet supportive care needs were observed in the health system and information domain and the psychological domain at each time point. The health system and information (F=22.49, p<.001) and physical and daily living needs (F=5.72, p=.004) were higher at T1 and T2 than T3. The psychological (F=7.43, p=.001) and patient care and support needs were higher at T1 than T2 and T3. Multiple regression analysis showed that breast cancer patients with greater physical and daily living and psychological needs were significantly associated with poorer QOL at all times.

Conclusion

Supportive care should be timely provided to breast cancer patients to improve their ability to cope with physical and psychological problem and QOL. Breast cancer patients who had more unmet needs in psychological and physical domains were more likely to have a poor QOL.

Keywords: Breast Neoplasms, Quality of Life, Needs

Figures and Tables

Table 1

Demographic and Clinical Characteristics of the Participants (N=117)

Variables	Categories	n (%) or M±SD
Age (year)	≤39	25 (21.4)
	40~49	58 (49.6)
	≥50	34 (29.0)
		45.1±7.25
Educational level	≤Middle school	12 (10.3)
	High School	57 (48.7)
	≥College	48 (41.0)
Current spouse status	No	19 (16.2)
Current spouse status	Yes	98 (83.8)
Religion	No	45 (38.5)
Religion	Yes	72 (61.5)
Employment status	Homemaker	63 (53.8)
Employment status	Full or part time	54 (46.2)
Income	≤200	16 (13.7)
	200~400	58 (49.6)
	>400	43 (36.7)
Supportive caregiver	No	7 (6.0)
Supportive caregiver	Yes	110 (94.0)
Menopause	No	84 (71.8)
Menopause	Yes	33 (28.2)
Operation	Partial mastectomy	108 (92.3)
Operation	Total mastectomy	9 (7.7)
Stage	I	58 (50.0)
Stage	II or III	58 (50.0)
Axillary lymphnode dissection	No	84 (71.8)
Axillary lymphnode dissection	Yes	33 (28.2)
Adjuvant treatment	Chemotherapy	6 (5.1)
	Radiation therapy	39 (33.3)
	Chemotherapy + Radiation therapy	72 (61.6)
Hormone therapy	No	25 (21.4)
Hormone therapy	Yes	92 (78.6)

Table 2

Prevalence of Top 10 Unmet Supportive Care Needs (N=117)

Domain and supportive care need		T1		T2		T3
Domain and supportive care need		n (%)	Rank	n (%)	Rank	n (%)	Rank
Physical and daily living needs	Pain	58 (49.6)	-	72 (61.5)	8	50 (42.7)	-
	Lack of energy/tiredness	63 (53.8)	-	79 (67.5)	2	64 (54.7)	4
	Feeling unwell a lot of the time	58 (49.6)	-	62 (53.0)	10	56 (47.9)	-
	Work around the home	70 (59.8)	10	57 (48.7)	-	46 (39.3)	-
	Not being able to do the things you used to do	53 (45.3)	-	49 (41.9)	-	34 (29.1)	-
Psychological needs	Anxiety	65 (55.6)	-	64 (54.7)	9	57 (48.7)	8
	Feeling down or depressed	63 (53.8)	-	61 (52.1)	-	56 (47.9)	-
	Feelings of sadness	58 (49.6)	-	51 (43.6)	-	52 (44.4)	-
	Fears about the cancer spreading	93 (79.5)	1	94 (80.3)	1	94 (80.3)	1
	Worry that the results of treatment are beyond your control	84 (71.8)	3	74 (63.2)	7	69 (59.0)	2
	Uncertainty about the future	80 (68.4)	5	76 (65.0)	4	66 (56.4)	3
	Learning to feel in control of your situation	70 (59.8)	-	75 (64.1)	5	56 (47.9)	9
	Keeping a positive outlook	63 (53.8)	-	59 (50.4)	-	56 (47.9)	9
	Feelings about death and dying	46 (39.3)	-	53 (45.3)	-	52 (44.4)	-
	Concerns about the worries of those close to you	77 (65.8)	7	59 (50.4)	-	52 (44.4)	-
Patient care and supportive needs	More choice about which cancer specialists you see	37 (31.6)	-	29 (24.8)	-	27 (23.1)	-
	More choice about which hospital you attend	37 (31.6)	-	31 (26.5)	-	25 (21.4)	-
	Reassurance by medical staff that the way you feel is normal	47 (40.2)	-	46 (39.3)	-	36 (30.8)	-
	Hospital staff attending promptly to your physical needs	47 (40.2)		44 (37.6)		35 (29.9)
	Hospital staff acknowledging, and showing sensitivity to your feelings and emotional needs	51 (43.6)	-	46 (39.3)	-	40 (34.2)	-
			-		-		-
Health system and information needs	Being given written information about the important aspects of your care	68 (58.1)	-	52 (44.4)	-	48 (41.0)	-
	Being given information (written, diagrams, drawings) about aspects of managing your illness and side-effects at home	86 (73.5)	2	59 (50.4)	-	55 (47.0)	-
	Being given explanations of those tests for which you would like explanations	76 (65.0)	8	62 (53.0)	-	58 (49.6)	6
	Being adequately informed about the benefits and side-effects of treatments before you choose to have them	78 (66.7)	6	60 (51.3)	-	52 (44.4)	-
	Being informed about your test results as soon as feasible	70 (59.8)	-	57 (48.7)	-	52 (44.4)	-
	Being informed about cancer which is under control or diminishing (that is, remission)	76 (65.0)	8	75 (64.1)	5	57 (48.7)	7
	Being informed about things you can do to help yourself to get well	81 (69.2)	4	78 (66.7)	3	63 (53.8)	5
	Having access to professional counselling if you, family or friend sneed it (eg, psychologist, social worker, counsellor, nurse specialist)	61 (52.1)	-	51 (43.6)	-	44 (37.6)	-
	Being treated like a person not just another case	45 (38.5)	-	36 (30.8)	-	30 (25.6)	-
	Being treated in a hospital or clinic that is as physically pleasant as possible	49 (41.9)	-	41 (35.0)	-	31 (26.5)	-
	Having one member of hospital staff with whom you can talk to about all aspects of your condition, treatment and follow-up	60 (51.3)	-	49 (41.9)	-	42 (35.9)	-
Sexuality needs	Changes in sexual feelings	35 (29.9)	-	45 (38.5)	-	33 (28.2)	-
	Changes in your sexual relationships	39 (33.3)	-	40 (34.2)	-	33 (28.2)	-
	Being given information about sexual relationships	39 (33.3)	-	38 (32.5)	-	27 (23.1)	-

T1= Before primary treatment after operation; T2= End of primary treatment; T3= 6 months after end of primary treatment.

Table 3

Change in Supportive Care Needs Over Time (N=117)

Variables	T1	T2	T3	F (p)	Bonferroni
Variables	M±SD	M±SD	M±SD	F (p)	Bonferroni
Supportive care needs	90.80±30.41	80.41±29.35	76.29±30.12	18.38 (<.001)	T1>T2,T1>T3
Physical and daily living needs	37.09±25.40	36.41±26.05	30.04±26.44	5.72 (.004)	T1>T3,T2>T3
Psychological needs	43.53±26.77	38.42±38.41	35.09±24.34	7.43 (<.001)	T1>T2,T1>T3
Patient care and supportive needs	35.47±28.13	28.59±25.36	25.21±26.71	8.21 (.001)	T1>T2,T1>T3
Health system and information needs	50.25±25.25	40.87±26.27	33.97±25.41	22.49 (<.001)	T1>T3,T2>T3
Sexuality needs	23.00±29.68	23.58±27.31	18.94±24.56	1.84 (.161)

T1= Before primary treatment after operation; T2= End of primary treatment; T3= 6 months after end of primary treatment.

Table 4

Regression Model with Quality of life as the Dependent Variable (N=117)

Model	Variables	Quality of life
		T1			T2			T3
		ß	t	p	ß	t	p	ß	t	p
1	(Constant)		3.22	.002		3.90	<.001		4.37	<.001
	Age	.07	0.57	.551	−.09	−0.76	.451	−.08	−0.63	.532
	Menopause (yes=1)	−.19	−1.49	.139	−.11	−0.84	.401	−.25	−2.08	.040
	Chemotherapy (yes=1)	.08	0.69	.575	.01	0.11	.916	.07	0.56	.578
	Radiotherapy (yes=1)	.02	0.11	.911	.08	0.52	.606	.02	0.13	.895
	Stage (II/III=1)	−.26	−2.09	.039	−.22	−1.77	.080	−.16	−1.28	.205
	F (p)	1.30 (.263)			1.40 (.220)			2.26 (.043)
	Adjusted R²	.02			.02			.06
2	(Constant)		4.26	<.001		6.64	<.001		6.79	<.001
	Age	.03	0.32	.770	.02	0.19	.853	−.05	−0.05	.616
	Menopause (yes=1)	−.09	−0.85	.396	−.12	−1.28	.203	−.16	−1.72	.088
	Chemotherapy (yes=1)	.02	0.02	.987	.04	0.44	.658	.00	0.02	.982
	Radiotherapy (yes=1)	.04	0.32	.751	−.07	−0.59	.560	−.03	−0.24	.813
	Stage (II/III=1)	−.12	−1.05	.298	−.07	−0.75	.457	−.06	−0.63	.533
	Psychological need	−.31	−2.46	.016	−.72	−5.25	<.001	−.33	−2.41	.018
	Health system and information need	.14	1.20	.232	−.27	2.32	.022	.10	0.96	.341
	Physical and daily living need	−.33	−3.00	.003	−.25	−2.61	.010	−.32	−3.05	.003
	Patient care and supportive need	−.05	−0.38	.705	−.08	−0.68	.495	−.13	−1.51	.135
	Sexuality need	−.02	−0.15	.885	.07	−0.75	.453	−.08	−0.93	.353
	F (p)	5.15 (<.001)			10.82 (<.001)			10.75 (<.001)
	Adjusted R²	.28			.48			.48
	Change of R²	.28			.46			.42

Notes

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (N0:1320290)

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