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Factors influenced quality of life for women with breast cancer in Palestine. Mariam Samara-Awad, RN, MSN Lecturer – Bethlehem University Bethlehem, Palestine Hanan Saca-Hazboun, RN, MSN PhD student – Villanova University. Introduction.
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Factors influenced quality of life for women with breast cancer in Palestine. Mariam Samara-Awad, RN, MSN Lecturer – Bethlehem University Bethlehem, Palestine Hanan Saca-Hazboun, RN, MSN PhD student – Villanova University
Introduction In Palestine, breast cancer is the second most common cause of death, even thought the prevalence rate among Arab women is much lower than it is among western women (Bendel, 2006). The Palestinian Cancer Registry revealed that the incidence rate of breast cancer is 60 per 100,000 people, thus rendering it the most prevalent type of cancer (16.4%) in the total population (Abdeen, 2006).
Cont.. • The Cancer registry in Palestine also reports 280 breast cancer cases annually: 57% from the West Bank and 43% from the Gaza Strip (Palestinian Health Sector, 2007).
Cont… • Cancer treatment is provided in three governmental hospitals in West Bank and three in Gaza, and one non-governmental hospital in East Jerusalem. Due to the small number of centers, there is an increase in patient load. Palestinian health sector suffers from frequent shortages of medicines, medical supplies, equipment, and understaffed health facilities…
to Israel, Jordan or Egypt Cont.. • which make patient care inadequate (W.H.O, 2007). • As a result of these problems, the P.M.O.H refers many cancer patients to services out of the governmental hospitals to either Augusta Victoria Hospital, which is managed by the Lutheran World Federation to serve Palestinians in Jerusalem, or abroad to Israel, Jordan or Egypt .
Cont… • Furthermore, Palestinian women are typically diagnosed with breast cancer when it has reached a late stage which decreases the chance of recovery; they keep their condition secret and their cancer may remain undiagnosed. It is caused by several factors such as (1) ignorance about the nature of the disease;
Cont... • (2) a sense of modesty, which makes women feel uncomfortable about discussing problems associated with their breasts or undergoing a physical examination; (3) fear of the negative stigma associated with breast cancer, which can affect a woman's standing in the community (Rockoff, et al, 2004).
Background • Recent researches have excessively addressed the quality of life for women with breast cancer. However despite the fact that breast cancer is the most detected cancer and the most common cause of death among women in ethnic minorities (Ghafoor et al. 2003), no structured studies were conducted to investigate the phenomenon in developing countries including Palestine.
Background • Moreover, daily survival as compared to quality of life is the main concern of Palestinian women with breast cancer, and providing physical rather than holistic care is the main focus of health care providers in Palestine.
Purpose • The purpose of the study is to investigate the main factors that influence the quality of life for women with breast cancer in Palestine. Four dimensions of the quality of life include: the physical domain (i.e., meeting daily needs without physical symptoms), the psychosocial domain (appropriate support), the emotional domain (degree of worry and sadness), as well as the spiritual domain (mental activity or having trust and confidence in God).
The Sample and setting • A convenience sample of women with breast cancer who were attending oncology clinics during June through August 2008 was recruited from the oncology departments at the Ministry of Health hospitals (Al-Watani Hospital in Nablus, and Al-Hussein Hospital in Bethlehem) and in non-governmental organization (Augusta Victoria hospital).
The Sample and setting • The sample was chosen from among patients diagnosed with stage I- III breast cancer within one year or greater of diagnosis and whose ages ranged between 30 and 70. However, women suffering from major medical problems such as stroke, heart disease or terminal illness were excluded. The final sample included 108 women with an equal proportion from each hospital. Participation in the study was obtained through the patient’s verbal consent.
The Instrument • The questionnaire has two main parts: A. Demographic and health related variables developed by the researchers, and involved closed ended questions. B. Quality of Life that was developed by Ferrell and Grants (1995) and contains 46 items which cover a broad range of life aspects in each of the four domains. Permission from the authors was obtained, the original copy was translated from English into Arabic, and the scale was modified from a 11 lickert scale to 6 Lickert Scale to suit the study.
Table 1 - Demographic Indicators for women with breast cancer (n = 108).
Table 3 - Numbers, mean score and , standard deviation for the quality of life measures.
Table 4 – Mean scores and standard deviations of the main problems of physical well being.
Table 5 – Mean scores and standard deviations of the main problems of psychological well being.
Table 6 – Mean scores and standard deviations of the main problems of social concerns arranged.
Table 7 – Mean scores and standard deviations of the main problems of spiritual well being.
Statistical analysis Table 8 - Stage of cancer according to the age group and education level
Conclusion • The study investigated the main factors that influence the quality of life for women with breast cancer in Palestine. The results show that marital status, economic status, and level of education were not significantly correlated to the four domains of quality of life. • Due to lack of public awareness relating to early detection, women with breast cancer in Palestine are diagnosed at a later stage. • Women had a higher mean scores according to their spiritual well being with a mean of 4.23 are more spiritual. • There is a need to develop a strategy to provide effective screening and intervention measures for breast cancer patients.
Implications for nursing • Hughes (1987) mentioned that the word “cancer”, the fear it creates, the anxiety it induces, its effects, the painful process of treatments and the stress it prompts negatively affect quality of life. No research was carried out in Palestine on the effects of cancer on quality of life. Therefore, this represents the base for future research. The quality of life questionnaire developed by Ferrell and Grants (1995) was used in this study because it is specifically designed for such purpose and when it is translated into Arabic, it becomes a useful instrument that suit the conditions in our Palestinian community. Moreover, there is a need to empower nurses. This means that training must be provided for nurses to be specialized to provide holistic cancer care in Palestine.
Mariam S .Awad Thank you for listening
