Research Article (Open access) |
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SSR Inst. Int. J. Life Sci., 9(3): 3215-3222, May 2023
Assess the Depression and Quality of Life
among Women Suffering from Selected Gynaecological Cancers Attending Oncology
Units of Selected Hospitals
Yashodha
Hadimani1*, Jayashri Awarsang2, Deelip S Natekar3
1Student, Department of Obstetrics and Gynaecological
Nursing, Shri B.V.V.S Sajjalashree Institute of Nursing Sciences, Bagalkot,
Karnataka, India
2Associate Professor, Department of Obstetrics and
Gynaecological Nursing, Shri B.V.V.S Sajjalashree Institute of Nursing Sciences,
Bagalkot, Karnataka, India
3Principal, Department of Community Health Nursing,
Shri B.V.V.S Sajjalashree Institute of Nursing Sciences, Bagalkot, Karnataka,
India
*Address for Correspondence: Yashodha Hadimani, Student, Department of Obstetrics
and Gynaecological Nursing, Shri B.V.V.S Sajjalashree Institute of nursing
sciences, Bagalkot, Karnataka, India
E-mail: yashodhahadmani010@gmail.com
ABSTRACT- Background: Gynecological
cancers are significant and probable life-threatening diseases that harm
patients' physical and psychological health. The leading cause of death in female’s
psychological problems like depression endure and can cause an extra burden
during their treatment. Therefore, this study helps evaluate depression and well-being
among gynaecological malignancies.
Methods: Women's depression was evaluated by a standardized CES-D Scale and
QOL by WHOQOL Bref scale, a sample of 100 women with cancers admitted at HSK
and Kerudi cancer hospital, Bagalkot was selected using a purposive sampling
technique, descriptive survey design was adopted. Statistical data were tested
and scrutinized using descriptive and inferential analysis.
Results: 100% of women had moderate depression. The mean percentage of depression
score was 61.45% with mean and SD (37±4.9). Of the women, 71 % had moderate, 21%had
poor, and 8% had good QOL. The mean percentage of QOL of women was 48.1% with
mean and SD (62.5±12.1). A Strong relation was found between depression scores with
your family members known to you (χ=4.52, p<0.05), Area of
residence (χ=3.88, p<0.05), and whether you have undergone
previously any surgery for the treatment of cancer (χ=8.93, p<0.05).
No association was found between QOL scores with study variables. A Negative
correlation (r=-0.27, p<.05) was found between depression and Total QOL
scores.
Conclusion: Most patients have moderate depression and moderate QOL. This study
is effective in identifying depression and QOL.
INTRODUCTION- Malignancy
is a group of illnesses characterized by unrestricted cellular growth with
local tissue invasion and systematic metastasis. Neoplasm is derived from the
Greek word, neo=new and plasma =formation. Neoplasm is defined as an abnormal
new growth of tissues that serves no useful purposes and may harm the host
organism [1]. Carcinoma is a destructive neoplasm in which the basic
structure and activity of the cells have become unbalanced, usually because of
changes in the DNA [2]. Gynaecological cancers such as cervical,
uterine, ovarian, tubal, and vulvar are sedate and probably critical illnesses [3].
Gynaecological cancer can harm women's self-concept, physique,
sense of femininity, and marital relations [4]. In cancer patients, mental
problems are more common, like depression and anxiety, present and can cause an
extra burden during their treatment course and making it more challenging in
terms of management and control compliance during the treatment course,
duration of hospital stay and ultimately, survival rate [5].
According to the World Health Organization, well-being is defined as
individuals’ perceptions of their position in life in the context of their
culture and systems of values in which they live and about their goals,
expectations, standards, and concerns [6]. This study selected
gynaecological cancers, including breast, cervical, and endometrial.
MATERIALS AND METHODS
Study
design and participants-
The study was conducted with a descriptive survey
design. 100 women with gynaecological cancer were admitted to oncology units at
HSK Hospital Navanagar, Bagalkot and Halamma Kerudi Cancer Hospital. Bagalkot was
selected for the study by purposive sampling, ready to join, and women present
during data collection were involved as participants.
Instruments
CES-D
and WHOQOL Bref scale- CES-D scale and WHOQOL
Bref scale were used to examine the level of depression and standard of life.
There were 20 questions on the CES-D scale and 26 on 4 aspects of QOL among
women attending Halamma Kerudi cancer hospital Navanagar, Bagalkot oncology
units. Participants were requested to use separate 3 points and 4 points
Likert-type scales for depression and QOL, respectively. The intended 'r-value
after spearman brown's prophecy formula is 0.84 for the CES-D scale and 0.79
for the WHOQOL Bref scale, suggesting the developed tool was highly reliable.
Study design and participants- It
was a descriptive survey design. A purposive sample of 100 gynaecological
cancer patients attending oncology units of selected hospitals of Bagalkot was
selected for the study, who are willing to participate in the study and
gynaecological cancer patients who are present at the time of data collection
are included in the study.
Instruments
CES-D and WHOQOL Bref scale- CES-D
scale and WHOQOL Bref scale has used to assess depression and quality of life.
There were 20 questions on the CES-D scale and 26 questions on 4 aspects of QOL
among women suffering from selected gynaecological cancers attending oncology
units of selected hospitals of Bagalkot. Respondents were asked to rate on
separate 5 points on the Likert type scale. After Spearman Brown's prophecy
formula, the calculated 'r-value is 0.84 for CES-D scale and 0.78 for WHOQOL
Bref scale, suggesting the developed tool was highly reliable.
Data
collection procedures- Prior approvals were
taken from pertinent foundations before the information acquisition procedure
started. The study subjects were accompanied in oncology units during the study
period at HSK and Halamma Kerudi Hospital, Bagalkot. Every cancer patient who
gratified the inclusion criteria was entered for gathering information.
Aspirants accomplished permission, and the aim of the study was interpreted to
participants who asked questions in Kannada or the language comprehensible to
them. The whole data collection was built on participants' autonomous reports.
Inclusive criteria
The study includes women who
are,
Ø
Aged
between 30 and 60 above.
Ø
Admitted
with gynaecological cancers.
Ø Available during the time of data collection
Ø
Able
to comprehend Kannada or English.
Ø
Available
at the time of data collection.
Ø
Ready
to participate in the study.
Exclusive criteria
The study
excluded women who were
Ø critically ill and impotent to provide data.
Ø Unable to propagate.
Ø Unable to join throughout the study period.
Ø Not willing to
give written consent.
Statistical
analysis- Data procured were explored regarding the
study's objectives through descriptive and inferential statistics. Participants'
responses are taken into consideration, and prepared a master sheet.
Demographic data was examined by obtaining frequencies and percentages. Answered
questions were deliberated by average and SD. A Chi-square experiment was
applied to find out the association between depression and quality of life with
their selected socio-demographic variables approachable in tables and graphs.
Ethical clearance- A
certificate of ethical authorization was secured from the institution's ethical
committee.
RESULTS- Age-wise
allocation of women with gynaecological cancers revealed that a greater part of
women (44%) belonged to 30-60 years of age (and 53%) belonged to the Hindu
religion. (68%) were belong to the Housewives. (29%) were completed their
primary and secondary education. 29% had a monthly income of 10,001 to 20,000, and
64% were married. (60%) were belonging to their ancestors who had cancer. (52%)
were live in an urban Area. (48%) were having breast cancer. (41%) were below 6
months and 6 months to 1 year, having a duration of time with cancer. (67%) women had no previous surgery for the
treatment of cancer. (57%) were exposed to radiation therapy. (59%) were
received the chemotherapy 1 to 2 times (Table 1).
Table
1: Percentage-wise majority of the
distribution of women according to sample characteristics
Sample
characteristics |
Category |
Percentage
(%) |
Age |
30-60
years |
44 |
Religion |
Hindu |
53 |
Occupation |
Housewives |
68 |
Educational
status |
Primary
and secondary education |
29 |
Family monthly
income |
10001-20000Rs |
29 |
Marital status |
Married |
64 |
Family history
of cancer |
Yes |
60 |
Area of residence |
Urban |
52 |
Type of cancer |
Breast
cancer |
48 |
Duration of time
with cancer |
≤
6 months & 6 months to 1 yr |
41 |
Undergone previous surgery for
the treatment of cancer |
No |
67 |
Have you been exposed to any
radiation therapy? |
Yes |
57 |
How many times have you received
the chemotherapy |
1-2
times |
59 |
A
higher percentage of women with gynaecological cancers had Moderate Depression
(100%), and no women with mild depression. Quality of life among women with
gynaecological cancers, where data reveals that most women (71%) had a moderate
quality of life. Some women had a poor quality of life (21%), and the remaining
parents had good quality of life (8%) and there were no women of very good and
very poor quality of life (Table 2).
Table 2: Evaluation of depression
and QOL of women with gynaecological cancers
Level
of Depression |
Frequency |
Ratio
(%) |
Mild |
00 |
0 |
Moderate |
100 |
100 |
Degree
of QOL |
Frequency |
Percentage |
Very
good QOL |
0 |
0 |
Good
QOL |
8 |
8 |
Moderate
QOL |
71 |
71 |
Poor
QOL |
21 |
21 |
Very
poor QOL |
0 |
0 |
Table 3: Assessment of mean,
standard deviation, and mean percentage of depression score and quality of life
among women of gynaecological cancers
Maximum score |
Mean |
SD |
Mean
(%) |
|
OQOL |
10 |
4.52 |
1.51 |
45.2 |
Psychological
domain |
30 |
14.2 |
3.36 |
47.2 |
Physical
domain |
35 |
17.1 |
3.54 |
48.85 |
Social
Domain |
15 |
7.46 |
1.76 |
49.7 |
Environmental
domain |
40 |
19.29 |
4.10 |
48.27 |
Total
QOL |
130 |
62.5 |
12.1 |
48.1 |
Depression |
60 |
37 |
4.9 |
61.5 |
Table 4: Correlation between
depression and quality of life scores of women suffering from selected
gynaecological cancers
Correlation
between Depression and Quality of life |
||
Correlation
between Depression and Quality of life |
OQOL
Domain |
-0.211
|
Physical
domain |
-0.274
|
|
Psychological
Domain |
-0.324
|
|
Social
Domain |
-0.1476
|
|
Environmental
Domain |
-0.157
|
|
Total
QOL |
-0.27
|
Table
5: Relationship between scores of depression with their
research variables
S.No |
Research
variables |
DF |
Chi-square
value |
1 |
Age
|
1 |
0.19 |
2 |
Religion |
1 |
0.58 |
3 |
Occupation
|
1 |
0.09 |
4 |
Educational
status |
1 |
0.84 |
5 |
Family
monthly income |
1 |
0.09 |
6 |
Marital
status |
1 |
0.17 |
7 |
Have
any of your family members know you? |
1 |
4.52 |
8 |
Area
of residence |
1 |
3.88 |
9 |
Type
of cancer that you have been diagnosed with |
1 |
0.031 |
10 |
Duration
of time with cancer |
1 |
3.71 |
11 |
Have
you undergone previously any surgery for the treatment of cancer |
1 |
8.93 |
12 |
Have
you been exposed to any radiation therapy? |
1 |
0.007 |
13 |
How
many times have you received chemotherapy? |
1 |
1.239 |
Table
value= 3.84
Table
6: Association
between scores of qualities of life with study variables
S.No |
Study
variables |
DF |
Chi-square
value |
1 |
Age
|
1 |
0.075 |
2 |
Religion |
1 |
0.333 |
3 |
Occupation
|
1 |
0.023 |
4 |
Educationals
status |
1 |
0.116 |
5 |
Family
monthly income |
1 |
0.767 |
6 |
Marital
status |
1 |
0.082 |
7 |
Have
any of your family members known you? |
1 |
1.709 |
8 |
Area
of residence |
1 |
1.903 |
9 |
Type
of cancer that you have been diagnosed with |
1 |
0.147 |
10 |
Duration
of time with cancer |
1 |
0.891 |
11 |
Have
you undergone previously any surgery for the treatment of cancer |
1 |
2.078 |
12 |
Have
you been exposed to any radiation therapy? |
1 |
0.439 |
13 |
How
many times have you received chemotherapy? |
1 |
0.235 |
DF-
Degree of freedom, Table value= 3.84
DISCUSSION- This
chapter deliberates the vital judgements of the study and reviews them about judgements
from the results of other studies. The present work examined depression and
quality of life among women suffering from selected gynaecological cancers
attending oncology units of selected hospitals in Bagalkot. To achieve the study's
objectives, the descriptive cross-sectional co-relational survey research
design was adopted. By using the purposive sampling technique, 100 women were
chosen as participants.
Percentage-wise distribution of women according to
their age depicted that the majority of women (44%) belonged to 30-60 years of
age, (31%) of women were 60 and above years, (25%) belonged to 25 to 39 years of age. The
study's findings are consistent and supported by a previous study conducted by Sundaram et al. [7] in
Jharkhand, India. The result showed that most of the patients (62.7%) were 40-60 years old.
The majority of women (53%) were Hindus, 34% of women
were Muslims, 9% of the women were Christian and followed by 4% of the women
were of other religions.
The percentage-wise allocation of women suffering from selected gynaecological cancers according to their Occupation, the majority, 68% of women were housewives, 15% were in daily wages, 12% were self-employees, and 5% of women were professionals. This study is supported by another study conducted by Zaitsu et al. [8]. Results revealed that most parents had completed secondary schooling, most were employed 60.3%, and from a socioeconomic perspective, middle- and high-income groups outnumbered the low-income group by 38.2%. The majority, 29% of women, had completed primary and secondary education, 26% had finished a degree, and 16% of women had not finished any formal education.
The majority (29%) of women's family monthly income
was between 10,001 to 20,000, (28%) of women had a family monthly income above
20,000 and (26%) of women had an income between 50001 to 10,000, and (17%) of
women’s family monthly income was below 5000. The majority, 64% of women, were
Married, (17%) were Unmarried, (11%) were widows, and (8%) were Divorced. The
study is inconsistent and not supported by a study conducted by Luo et
al. [9]
result showed that 57.8% of the patients were married,13.0% were unmarried, and
29.2% were separated. Percentage-wise
distribution of women (60%) their ancestors had no cancer, were as (40%) had
cancer. The highest percentage (52%) of women were from Urban, and (48%) of
women were from Rural. The study was similar to
the previous study conducted by Zahnd et al. [10]. Result findings
show that Combined cancer frequency rates were generally elevated in urban
populations, disregarding the South. However, the urban decrease in incidence
rate was more substantial than in rural populations (10.2% vs. 4.8%,
respectively. Rural cancer disparities included higher rates of
tobacco-related, HPV related, lung and bronchus, cervical, and colorectal
cancers over most population groups. Further, HPV-associated cancer occurrence
rates enlarge in rural areas (APC=0.724, p<0.05) while temporal trends
remain fixed in urban areas. The majority of participating women were (48%) Breast cancer and (41%)
of the participated women were Cervical cancer, and (11%) were in Endometrial
cancer. The study is inconsistent and not
supported by the study conducted by Shirali et al. [11]. Results showed that
the mean age of patients was 52.8±12.4, and 43% had uterine, 30% had ovarian,
25% had cervical, and 2% had vulvovaginal cancer. The highest percentage of women with cancer showed that (41%)
were below 6 months and 6 months to 1 year, and (15%) are 1 to 4 years, and the
remaining (3%) were more than 5 years with cancer. Percentage-wise distribution
of women who had previously undergone any surgery for cancer treatment shows the
highest percentage (67%) had no surgery, and (33%) had previous surgery. Percentagewise
distribution of women exposed to radiation therapy shows the highest percentage
is (57%) of women saying Yes and (43%) not exposed to radiation therapy. The
study's findings are inconsistent
and not supported by other studies conducted by Moroney et
al. [12]. Results showed that (35%) of women were exposed to radiation
therapy. Percentage-wise
distribution of women who have received chemotherapy shows the highest
percentage (59%) of women who received chemotherapy 1 to 2 times, and (32%)
never, and the remaining (9%) had not received the chemotherapy. Results
of the present study were inconsistent and not supported by a previous study
conducted by Uma
[13]. Results showed less than 30% defaulted during adjuvant therapy
and 20% after the preliminary investigation.
Assessment of levels of depression among women suffering from selected gynaecological cancers reveals that most women had moderate depression (100%). The study was reinforced by a similar study led by Purkayastha et al. [14]; results exhibited that depression and poor QOL is natural among breast cancer patients. Findings related to the assessment of mean, SD and mean percentage of depression scores of women suffering from selected gynaecological cancers reveals 61.45% with mean and SD (37±4.9). This study was supported by the study conducted by Alquraan et al. [15]. Results showed that the mean age±SD of patients (n=169) was 49.12± 6.48 years.
Findings related to the scores of qualities of life
illustrate the highest percentage of women had Moderate QOL (71%), some of them
had poor QOL (21%), and the remaining had Good QOL (8%). Alam et al.
supported and conducted this study [16]. The result revealed that 5.02% had
high QoL, 12.54% had average QoL,53.76% had low QoL, and the remaining 28.67%
had very low QoL. Outcomes related to the analysis of mean,
standard deviation, and mean percentage of total QO Lillustrate, the total mean
percentage of total QOL of women was 48.1% with mean and SD (62.5 ±12.). This
study was endorsed by the study conducted by Sadoughi et al. [17]. Results disclosed that the mean of anxiety, depression, and
Quality of Life were 10.21±4.79, 8.31±4.74, and 63.74±19.20, respectively.
Findings related to the assessment of domain-wise mean,
SD and mean% of total QOL among women
with gynaecological cancer revealed that the highest mean percentage of women (49.7%)
was found for a social domain with mean and SD (7.46±1.76), followed by the
physical domain (48.85%) with mean and SD(17.1±3.54), environmental domain (48.2%)
with mean and SD(19.29±4.102), psychological domain (47.2%) with mean and
SD(14.2±3.36), and overall (45.2%) with mean and SD(4.52±1.51). This study was
supported by the study conducted by Gangane
et al. [18].
Results revealed that the mean score
of total QOL was
the overall mean score for QOL was 59.3.
Findings regarding the Correlation between depression scores
of qualities of life among women suffering from selected gynaecological cancers
showed a significant negative correlation [r= -0.27, p<0.05) among
women with gynaecological cancer. This study was supported by a study conducted
by Rong et al. [7]. Results revealed a significant negative correlation
between depressive symptoms and QoL (r = −0.400, p<0.05).
Findings related to the association
between the depression scores of women with their study variables showed that a
significant association was found with whether your family members are known to
you. (χ2=4.52; p<0.05) area of residence (χ2=3.88, p<0.05)
and this study is supported and conducted by Chen et al. [20]. Results show that
depressive symptom scores were strongly associated with the housing
environment.
Findings regarding the association between the depression
score and have you been undergone previously any surgery for the treatment of
cancer (χ2= 8.93, p<0.05) were consistent and supported, and
conducted by Held
et al. [21]
results show that the depression score was associated
with 0.20, p<0.001.
Findings regarding the association between scores of degrees
of life of women with their study variables showed no association between the quality-of-life
scores with study variables. This
study was supported by a study conducted by Orindi et al. [22]. Results in
findings show the modal age groups (30%) were 45-54 years old and (22.5%) were
25-34 years. Females comprised 63%, and those with post-primary level education
66% (p=0.030). Total QOL scores were outstandingly higher among the older
age groups, higher education levels, formally employed, and better monthly
income within socio-demographic characteristics. These results indicate that most
of the patients experienced good enough QOL.
CONCLUSIONS- Depression affects treatment participation and can
cause poor resolution and results in solid mortality. It can affect a person's
daily life by aggravating physical ailments and augment the negative impact on
patients and their families throughout the disease.
The nurse's role is to help caretakers cope with their family and hospital
environment by providing satisfactory health education to the patient and
guiding necessary possessions for the caregivers. Our study concluded that most
patients have moderate depression and moderate QOL. This study is effective in
identifying depression and QOL.
Future researchers can look over the effect of numerous
psychological measures to lessen depression to enhance their overall standard
of life and
ensure the continuity of quality care; measuring the quality of life in
patients with gynaecological is essential.
CONTRIBUTION OF
AUTHORS
Research concept- Yashodha
Hadimani, Jayashri Awarsang
Research design-
Yashodha Hadimani, Jayashri Awarsang
Supervision-
Yashodha Hadimani, Dr. Deelip S Natekar
Materials-
Yashodha Hadimani
Data collection- Yashodha
Hadimani
The Data
collection and Interpretation- Yashodha Hadimani
Literature Search-
Yashodha Hadimani
Writing article- Yashodha
Hadimani
Critical review- Jayashri
Awarsang, Dr. Deelip S Natekar
Article editing- Yashodha
Hadimani, Jayashri Awarsang, Dr. Deelip S Natekar
Final approval- Yashodha
Hadimani, Jayashri Awarsang, Dr. Deelip S Natekar
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