The mean age of the patients was 47.8±10.5 years, and ranged from 22 to 74 years. Patients who were younger than 50 years were 61.2% of the patients. The majority of the patients were married, residents of urban area and housewives. One third of the patients were illiterate, and 74.7% were diagnosed within 1 year of the study interview. 7.9%, 55.7% and 36.4% of the patients had localized, locally advanced and metastatic disease respectively (Table 1).
Table 1
Socio-demographic and clinical characteristics of the study participants (n=178).
Characteristics
|
Number (n=178)
|
Percent (%)
|
Age groups (years)
|
|
|
≤ 40
|
49
|
27.5
|
41 - 50
|
60
|
33.7
|
51 - 60
|
48
|
27.0
|
> 60
|
21
|
11.8
|
Mean ± SD*
|
47.76 ± 10.5
|
|
Range
|
22 - 74
|
|
Marital Status
|
|
|
Single
|
1
|
0.6
|
Married
|
158
|
88.8
|
Widow
|
15
|
8.4
|
Divorced
|
4
|
2.2
|
Residence
|
|
|
Urban
|
109
|
61.2
|
Rural
|
69
|
38.8
|
Occupational Status
|
|
|
Housewife
|
143
|
80.3
|
Working
|
33
|
18.6
|
Retired
|
2
|
1.1
|
Education
|
|
|
Illiterate
|
58
|
32.6
|
Educated
|
120
|
67.4
|
Disease Duration
|
|
|
≤ 1 year
|
133
|
74.7
|
> 1 year
|
45
|
25.3
|
Median duration (months)
|
6
|
|
IQR**(months)
|
9
|
|
SEER Stage (n=176)***
|
|
|
Localized
|
14
|
7.9
|
Regional spread
|
98
|
55.7
|
Distant metastasis
|
64
|
36.4
|
Number of Chemotherapy Cycles (n=163)***
|
|
|
≤ 6
|
90
|
55.2
|
> 6
|
73
|
44.8
|
Mean ± SD*
|
6.6 ± 3.2
|
|
Range
|
2 - 24
|
|
*SD: Standard Deviation
**IQR: Interquartile Range
***The remaining number of cases (total cases=178) had missing data or not reported.
Prevalence of chemotherapy side effects, practice and effectiveness of self-care behaviors:
The most commonly experienced side effects were hair loss, fatigue and mouth dryness followed by oral and gastro-intestinal side effects (Table 2).
Table (2)
The prevalence of common chemotherapy side effects among breast cancer patients (n=178).
Chemotherapy side effects
|
Number
|
Percent (%)
|
Anorexia
|
123
|
69.1
|
Nausea and Vomiting
|
122
|
68.5
|
Hair Loss
|
175
|
98.3
|
Fatigue
|
160
|
89.9
|
Mouth Sores
|
91
|
51.1
|
Mouth Dryness
|
153
|
86.0
|
Taste Alteration
|
125
|
70.2
|
Mood Disturbance
|
132
|
74.2
|
Sleeping Disturbance
|
92
|
51.7
|
Paresthesia
|
101
|
56.7
|
Cognitive Disorders
|
83
|
46.6
|
The practice and effectiveness of self-care measures:
The practice of self-care behaviors ranged from moderate (64.4% for managing paraesthesia, 56.4% for managing mouth sores and 54.7% for managing taste alteration) to low level (23.3% for managing cognitive disorders and 26.9 for managing hair loss) (Table 3).
Some self-care measures were observed to be practiced by small proportion of patient although they were reported to be effective by high proportion of patients who practiced them. An example is eating small frequent meals for managing anorexia was practiced by 33% of patients who experienced it, although it was reported to be effective by 75.6% of the patients who practiced it. Also adding lemon, orange or mint to drinking water for managing taste alteration was practiced by 32.0% of patients who had taste alteration, and it was considered an effective self-care measure by 82.5% of patients who practiced it (Table 3).
The overall practice of self-care behaviors for all side effects was 48%. It represents the total number of practiced self-care behaviors for managing all chemotherapy side effects by the patients out of the maximum expected number of self-care behaviors to be practiced by the patients (Table 3).
Table (3)
The practice and effectiveness of self-care behaviors.
Self-Care Behaviors for managing side effects
|
Practice of Each Self-Care Behavior *
|
Effectiveness of the Practiced Self-Care Behaviors**
|
Anorexia
|
(N=123)
n (%)
|
n (%)
|
Eating small frequent meals
|
41 (33.3)
|
31 (75.6)
|
Avoiding drinking liquids within meals
|
48 (39.0)
|
19 (39.6)
|
Making eating settings enjoyable
|
100 (81.3)
|
50 (50.0)
|
Self-care practice (%)
|
51.2
|
|
Nausea and Vomiting
|
(N=122)
n (%)
|
n (%)
|
Eating dry foods, dry toast and crackers
|
53 (43.4)
|
31 (58.5)
|
Eating food cold or at room temperature
|
51 (41.8)
|
26 (51.0)
|
Resting upright after meal
|
84 (68.9)
|
56 (66.7)
|
Self-care practice (%)
|
51.3
|
|
Hair Loss
|
(N=175)
n (%)
|
n (%)
|
Cutting hair very short
|
33 (18.9)
|
17 (51.5)
|
Wearing a wig
|
16 (9.1)
|
11 (68.8)
|
Protecting scalp from heat, cold and sun
|
92 (52.6)
|
27 (29.3)
|
Self-care practice (%)
|
26.9
|
|
Fatigue
|
(N=160)
n (%)
|
n (%)
|
Taking short naps during day
|
51 (31.9)
|
30 (58.8)
|
Asking family or friends to help in daily tasks
|
103 (64.4)
|
98 (95.1)
|
Practicing relaxing hobbies
|
57 (35.6)
|
38 (66.7)
|
Self-care practice (%)
|
43.0
|
|
Mouth Sores
|
(N=91)
n (%)
|
n (%)
|
Eating soft foods (easy to swallow)
|
57 (62.6)
|
48 (84.2)
|
Avoiding salty, spicy and acidic foods
|
67 (73.6)
|
54 (80.6)
|
Using cacao butter
|
30 (33.0)
|
19 (63.3)
|
Self-care Practice (%)
|
56.4
|
|
Mouth Dryness
|
(N=153)
n (%)
|
n (%)
|
Rinsing mouth every 2 hours
|
46 (30.1)
|
32 (69.6)
|
Keeping water bottle nearby for frequent water sips.
|
99 (64.7)
|
86 (86.9)
|
Keeping lips moist with lip moisturizer
|
37 (24.2)
|
21 (56.8)
|
Self-care Practice (%)
|
39.7
|
|
Taste Alteration
|
(N=125)
n (%)
|
n (%)
|
Adding lemon ,orange or mint to drinking water
|
40 (32.0)
|
33 (82.5)
|
Adding new flavorings to food
|
86 (68.8)
|
52 (59.8)
|
Keeping mouth clean, brushing teeth regularly
|
79 (63.2)
|
41 (51.9)
|
Self-care Practice (%)
|
54.7
|
|
Mood Disturbance
|
(N=132)
n (%)
|
n (%)
|
Talking about fears with family and friends
|
62 (46.2)
|
58 (93.5)
|
Relaxation activities
|
61 (45.5)
|
60 (98.4)
|
Psychological counseling
|
7 (5.3)
|
7 (100)
|
Self-care Practice (%)
|
32.8
|
|
Sleeping Disturbance
|
(N=92)
n (%)
|
n (%)
|
Avoiding caffeine for at least 6 hours before bedtime
|
52 (56.5)
|
3 (5.8)
|
Drinking warm caffeine-free drinks before sleep
|
24 (26.1)
|
12 (50.0)
|
Fixing the sleeping and waking up times
|
21 (22.8)
|
8 (38.1)
|
Self-care Practice (%)
|
41.7
|
|
Paresthesia
|
(N=101)
n (%)
|
n (%)
|
Protecting extremities from hot or cold temperatures
|
65 (64.4)
|
36 (55.4)
|
Avoiding snug clothes or shoes
|
82 (81.2)
|
34 (41.5)
|
Sitting down while doing daily activities
|
48 (47.5)
|
22 (45.8)
|
Self-care Practice (%)
|
64.4
|
|
Cognitive Disorders
|
(N=83)
n (%)
|
n (%)
|
Using a detailed daily planner
|
10 (12.0)
|
8 (80.0)
|
Avoiding multi-tasking
|
27 (32.5)
|
9 (33.3)
|
Getting enough sleep
|
21 (25.3)
|
10 (47.6)
|
Self-care Practice (%)
|
23.3
|
|
Self-care practice for all side effects (%)
|
48
|
|
* Practice was calculated from those who experienced each side effect.
** Effectiveness is calculated from those who practiced each self-care behavior.
Associations and possible independent effects of different socio-demographic and clinical factors on the level of self-care behavior.
The practice of self-care behaviors for individual patients was categorized into good and poor levels. The overall self-care behaviors practice was 48%, patients who showed total self-care behaviors application below 48% were considered to have poor level, while patients who showed total self-care behaviors application equal or above 48% were considered to have good level.
On the univariate analysis level; being above 50 years was significantly associated with good level of self-care behavior (P value: 0.025). Patients who received any level of education showed significantly good level of self –care compared to illiterate patients (P value: 0.042). Having localized disease was significantly associated with good level of self-care behavior (P value: 0.010). Surprisingly, patients who experienced fewer side effects (≤ 6 side effects) showed significantly higher proportion of good level of self-care behavior compared to patients who experienced more than > 6 side effects (P value: 0.022). Getting information from media (Internet and Television) was found to be significantly associated with good level of self-care behavior (P value: 0.033).
Binary logistic regression model was built, where the level of practice of self-care behavior was the dependent variable. The model contained 5 independent variables (age, educational level, tumor stage, number of side effect experienced and getting information from media sources). These factors had significant associations with the level of self-care practice at the univariate analysis. However, only three independent factors (age, tumor stage and number of experienced side effects) made unique statistically significant contribution to the model. The model showed that patients aged over 50 years were 2.3 times more likely to have good level of self-care practice compared to patients who were 50 years old or younger (OR: 2.41, P value: 0.007). Patients who had locally advanced disease were 88% less likely to have good level of self-care compared to patients who had localized disease (OR: 0.12, P value: 0.008). Patients who had metastatic disease were 81% less likely to have good level of self-care behavior compared to patients who had localized disease (OR: 0.19, P value: 0.044). Patients experiencing higher number of side effects (> 6 side effects) were 55 % less likely to have good level of self-care practice compared to patients experiencing fewer side effects (≤ 6 side effects) (OR: 0.45, P value: 0.042).