Nico, Darlene Jasmine G. Panela, Fatima Ruby C. Pangilinan, Carmela Mariz D. Paras, Ana Concepcion B. Pasamba, Edmundo

1. Quality of Life (QoL) of Filipino Breast Cancer Patients in Various Treatment Modalities: A Descriptive Study Nico, Darlene Jasmine G. Panela, Fatima Ruby C. Pangilinan, Carmela Mariz D. Paras, Ana Concepcion B. Pasamba, Edmundo Salas, Julie Ann S. Salayog, Kathereene M. Samama, Sittie Rizza Sambile, Mary Grace Sancha, Carlo Henry A. Georgina T. Paredes, M.D., MPH, Adviser

2. INTRODUCTION • Worldwide, breast cancer is the most frequently diagnosed life-threatening cancer in women and the leading cause of cancer death among women. • Malignant neoplasm is the 3rd leading cause of morbidity and mortality in the Philippines and breast cancer ranks 2ndamong these malignancies. (DOH, 2007) • 26 females out of 100 females and 1 male for every 105 males may be diagnosed with breast cancer in the Philippines.(Philippine Foundation for BREAST Care, Inc. (PFBCI), 2009)

3. INTRODUCTION • The primary goal of breast cancer treatment is to assess the stage of the disease and to remove underlying masses within the affected breast/s (American Cancer Society; 2008) • Treatment decisions are based on the optimal modality for the stage and biological characteristics of the cancer, the patient’s age, preferences, and their effects on the quality of life of the patient (American Cancer Society; 2008)

4. INTRODUCTION • Quality of life is a descriptive term that refers to people’s emotional, social and physical well-being and their ability to function in the ordinary tasks of living. • It is measured using especially designed and tested instruments which quantifies people’s abilities to function in the ordinary tasks of living. (Psychooncology 2008) • QoL measures may therefore help to decide between different treatments, to inform patients about the likely effects of treatments, to monitor the success of treatments from the patient’s perspective, and to plan and coordinate care packages.

5. INTRODUCTION • More attention to the reduction and management of disease and treatment-related symptoms could improve QoL among women with breast cancer. • External stressors (Ex.: finances, work, etc.) also contribute to the overall diminished quality of life in all treatments. • In the Philippines, there is an ongoing demand for research into the accompanying psychological effects of breast cancer treatments and this study accounts for the effects of chemotherapy, hormonal therapy and combined therapy on the quality of life specifically among Filipino breast cancer patients.

6. OBJECTIVES • Describe the QoL of breast cancer patients undergoing chemotherapy, hormonal therapy and combination therapy along the following domains: • Physical state • Mental/emotional state • Stress • Life enjoyment and • Overall quality of life

7. SIGNIFICANCE OF THE STUDY • To benefit both breast cancer patients and doctors in clinical decision-making, as it will consider the effects of specific therapeutic regimens on the patient’s quality of life. • Enable the family of those afflicted to better understand the effects of the disease on the overall wellbeing of their loved one.

8. METHODOLOGY • STUDY DESIGN: • Descriptive Study • TARGET POPULATION: • Diagnosed female breast cancer patients undergoing either hormonal therapy, chemotherapy or combined therapy; treated or still undergoing treatment from different hospitals. • SIZE OF SAMPLE: • (n=k2 SD2/d2) • n = [(1.96) 2 x 352] / 122 = 33 respondents

9. METHODOLOGY Pre-existing validated 55-item QoL questionaire entitled the “Health, Wellness and Quality of Life Questionnaire” made by Dr. Terrie Lewine of the Back to Life Wellness Education Center in Philadelphia, Pennsylvania. Translated into Filipino by a licensed Filipino teacher who graduated from the Polythechnic University of the Philippines. 14 pre-tested translated questionnaires were administered last November 2008– January 2009 to female breast cancer patients from Laguna, Nueva Ecija, Rizal and Metro Manila. Ten 3rd year medical students researchers administered the questionnaires

10. METHODOLOGY INCLUSION: Diagnosed female breast cancer patients (within in any stage of the disease) who have undergone or are undergoing either hormonal therapy, chemotherapy or combined therapy. • EXCLUSION: • Not dx w/ disease • Male breast cancer patients • Diagnosed with breast cancer but have not undergone any form of therapy yet. Researchers coordinated with oncologists of the hospitals Information gathered via the questionnaire. 36 out of 50 valid and fully-answered questionnaires by the eligible breast cancer patients were used as data for the research.

11. METHODOLOGY Breast Cancer patients undergoing Hormonal Therapy Breast Cancer patients undergoing Chemotherapy Breast Cancer patients undergoing Combined/Mixed Therapy Physical state Physical state Physical state Mental/ emotional state Mental/ emotional state Mental/ emotional state Stress evaluation Stress evaluation Stress evaluation Life enjoyment Life enjoyment Life enjoyment Overall Quality of Life Overall Quality of Life Overall Quality of Life

12. DATA AND RESULTS Study population (36): Mean age of 49 years old 22% within hormonal therapy: mean age at 53 years old 50% within chemotherapy: mean age at 50 years old 28% within combined therapy: mean age at 45 years old

13. DATA AND RESULTS Respondent Mode Scores - Physical State[1-Physical Pain; 2-Spine Stiffness; 3-Fatigue; 4-Colds and Flu; 5-Headache; 6- Nausea; 7-Menstrual Pain; 8-Allergies; 9-Dizziness; 10-Accidents]

14. DATA AND RESULTS Respondent Mode Scores – Mental/Emotional State1-How Painful; 2-Negative Feelings; 3-Moodiness; 4-Depression; 5-Worriness; 6-Concentration; 7-Anxiety / Fear; 8-Fidgety; 9-Sleep Problems; 10-Recurring Thoughts / Dreams

15. DATA AND RESULTS Respondent Mode Scores – Stress Evaluation[1-Stress; 2-Significant Relationship; 3-Health; 4-Finances; 5-Sex Life; 6-Work; 7-School; 8-General; 9-Emotional; 10-Daily Coping]

16. DATA AND RESULTS Respondent Mode Scores – Life Enjoyment[1-Openness; 2-Wellbeing; 3-Positive Feeling; 4-Interest; 5-Feeling of Being Open; 6-Level of Confidence; 7-Level of Compassion; 8-Satisfaction; 9-Feeling of Happiness; 10-Level of Satisfaction With Sex Life; 11-Time Devoted]

17. DATA AND RESULTS Respondent Mode Scores – Overall QoL[1-Personal life; 2-Spouse/Significant Other; 3-Romantic Life; 4-Job/Work; 5-Co-workers; 6-The actual work you do; 7-TheA handling of problems in your life; 8-What you are accomplishing in life; 9- The way you look to others; 10-Self-evaluation of appearance; 11-Ability to adjust to change; 12-Life As A Whole; 13-Overall contentment; 14-Extent to which your life has been the way you want it]

18. DISCUSSION • PHYSICAL STATE: • Our results showed physical pain to be the only prevailing trait within all 3 treatments. • Nausea was predominantly experienced by the respondents under chemotherapy • Dizziness was experienced by all treatment groups, more so with combined therapy • Spine stiffness is mostly manifested by those on hormonal therapy • Fatigue and presence of colds and flu were more for respondents under chemotherapy. • Fatigue was more present in patients under hormonal therapy • Headache results were higher in respondents under hormonal and chemotherapy

19. DISCUSSION • MENTAL AND EMOTIONAL STATE: • Respondents under hormonal therapy experienced more discomfort. • Negative feelings were more experienced by respondents under hormonal and combined therapy. • Moodinesswascommonunder the three treatment modalities.

20. DISCUSSION • MENTAL AND EMOTIONAL STATE: • Depressionis mostly felt by those on hormonal and combined therapy. • Worriness was seen in patients under chemotherapy and combined therapy as compared to hormonal therapy.

21. DISCUSSION • MENTAL AND EMOTIONAL STATE: • Difficulty concentrating was mostly experienced by patients under hormonal therapy • Our study showed that anxietyis mostly experienced by those on combined therapy. • Feeling restless or fidgety is occasionally experienced mostly in patients underhormonal therapy as compared to the two treatment modalities. • In our study, respondents under hormonal therapymostly had sleep problems in contrast to chemotherapy and combined therapy.

22. DISCUSSION MENTAL AND EMOTIONAL STATE: Chemotherapy mostly had recurring thoughts and dreams as compared to combined therapy and hormonal therapy

23. DISCUSSION • STRESS EVALUATION: • Our study showed that most patients under chemotherapy and combined therapy NEVER had problems with most of the subtopics under stress while those under hormonal therapy RARELY experienced it. • Family had a positive impact on patients under all therapy which was seen in our results wherein most chemotherapy and combined therapy respondents never had problems with family and most in hormonal therapy rarely encountered it

24. DISCUSSION • STRESS EVALUATION: • Hormonal therapy rarely dealt with problems regarding their significant others while respondents under chemotherapy and combined therapynever had problems with regard to it. • The respondents under hormonal therapydid not find sexual history applicable to them and those under chemotherapy and combined therapydid not have problems with it.

25. DISCUSSION • LIFE ENJOYMENT: • Chemotherapy patients were more open to guidance of their inner voice/feelings. • Hormonal therapy the greatest positive feelings about themselves. • Maintaining a healthy lifestyle was more important for those within hormonal and chemotherapy. • Hormonal therapy patients were the most confident. • Hormonal and chemotherapy patients were equally compassionate and accepting of others. • Hormonal and combined therapy had higher feelings of satisfaction, happiness and they devoted more time to do things which they enjoyed.

26. DISCUSSION • OVERALL QUALITY OF LIFE: • Those within hormonal therapy had the highest scores toward having positive feelings about life as a whole and with regard to how life turned out as they wanted it. • Hormonal therapy group also showed a positive effect on both personal and interrelational factors • Chemotherapy respondents on the other hand had the highest scores only with regard to co-worker relationships.

27. DISCUSSION • OVERALL QUALITY OF LIFE: • Combined therapy results showed the highest scores of being mostly satisfied in the subsets involving romantic life, work, handling of personal problems, personal accomplishments, how one appears to others, self-evaluation, ability to adjust to change, contentment and life as a whole. • Chemotherapy, despite its adverse drug reactions and supposed effects of psychological distress, showed moderate to high results within this domain

28. CONCLUSION • Physical state: Pain was the prevalent factor causing decreased QoL scores in all treatment modalities. • Mental/emotional state:Increased moodiness was the only constant factor across all treatments. Recurrent thoughts, dreams and negative feelings were high in the chemotherapy group and can be supported by its profound effects on the cognitive functioning of the patient. • Stress was markedly decreased in all three treatments, contradicting prior studies done which show otherwise, especially so in chemotherapy. • Overall QoL showed the highest scores within those in the hormonal therapy group.

29. LIMITATIONS • Results can neither be generalized to breast cancer patients nor to specific ethnic groups across the country • Sample does not represent the whole Philippines based on sampling method employed in the study. • Breast cancer patients who were interested in participating were the only ones who completed the questionnaires • Some of the patients surveyed came from a foundation where treatment is paid for/ subsidized by the foundation itself making the burden of treatment considerably less, hence invariably having an effect on the quality of life. • Quality of life questionnaire was also based from a foreign study of chronic illnesses and neither solely intended for breast cancer patients nor to Filipino respondents. • Lack of budget to cover all the breast cancer patients in the country

30. RECOMMENDATIONS • Use of Filipino culture-based questionnaires • Ask about their spiritual beliefs and the effects of these beliefs in their lives in times of hardships • Be expanded to a larger group that may include culturally diverse groups • Separate investigation is recommended to further evaluate the quality of life of patients on specific stages of breast cancer, especially those with metastatic cancers and the use of QoL as a predictor for survival. • Studies on the QoL of male breast CA patients can also be done

31. THANK YOU

32. METHODOLOGY • SOURCES OF DATA • UERM hospital at the private clinics of different oncologists (Dr. Gracieux Fernando & Dr. Joan Tagorda) • UERM OPD-Surgery Department (Dr. Rafael Azares) • Manila Doctors Hospital (Dr. Theresa Chauhdry & Dr. Villalon) • Eduardo L. Joson Memorial Hospital – Nueva Ecija (Dr. Pamela Panela) • Breast Cancer Foundation of East Avenue Medical Center (Mrs. Maria Lourdes V. Cortez & Dr. Elizabeth C. Pineda)