Study Area and Setting
The study was conducted at Oncology center, TASH, Addis Ababa. Addis Ababa is the capital city of Ethiopia. It is the largest city in Ethiopia, with a population of 3,475,952 according to the 2007 population census with annual growth rate of 2.7%. Its area is estimated to be 540km2 altitudes ranging from 2200- 3000m above sea level, average temperature of 22.8oc and average rainfall of 1,180.4mm. Addis Ababa has 41 hospitals (13 public and 28 NGO and private), 29 health centers 122 health stations, 37 health posts and 382 modern private clinics (15).
Tikur Anbassa Specialized Hospital is government owned large referral teaching hospital, located in Kirkos sub-city under the administration of Addis Ababa University, College of Health sciences. The oncology center at the Hospital is the only referral center in the country. The hospital has 600 beds of which 18 are allocated to cancer treatment. Of the 201 physicians at the hospital, only two are hematologists, four are medical oncologists, four are radiotherapists, two are surgical oncologists, and one is a pediatric oncologist. Three palliative pain specialists moreover work on the hospital. Only 26 of the Tikur Anbessa’s 627 nurses are dedicated oncology nurses. In 2010, more than 260 000 patients in total were treated in the hospital, including more than 2000 adults and more than 200 children with cancer. Treatments offered at Tikur Anbessa hospital cancer center contain anti-cancer drugs, surgery and radiotherapy(17).
Study Design and Period
An institutional based cross –sectional study was conducted from March to April 2019.
Source Population
All breast cancer patients being evaluated and treated in oncology units were considered as a source population.
Study population
Those breast cancer patients visiting the hospital and being evaluated or treated at oncology unit during data collection time and who met the eligibility criteria were invited.
Inclusion criteria
All female breast cancer patients who visited the hospital during the data collection were eligible for participation in the study.
Exclusion criterion
Serious ill patients, unwilling to fill the questionnaire and patients didn’t take chemotherapy treatment was excluded from the study.
Sample size determination
The sample size was calculated using single proportion formula. Using the prevalence of breast cancer patients 14.8% (18). So that the sample size was calculated as follows:
n = (Zɑ /2)2p(1-p)
d2
Assumptions
(1.96)2 (0.148) (0.852) = 193.76=194
(0.05)2
by adding 10% non- response rate, the total sample size was: 194+19.4=213.4=214
Sampling procedure
Tikur Anbessa Specialized Hospital was selected because it is currently the only referral hospital which provides different types of therapy including radiation therapy for cancer patients in Ethiopia.
According to the one-year record of female breast cancer, 8000 cases were seen in the oncology unit at Tikur Anbessa Specialized Hospital (TASH). Since the duration of the study was four weeks, the calculated flow within the four weeks was 667 and the required sample size was 214 study cases that was come for initiation of treatment and on follow-up during data collection period was asked. Therefore, “K” was 3. Based on systematic random sampling technique every 3 study participants were enrolled in the study during data collection period.
Dependent variables
Independent Variables
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Socio-demographic (Age, educational status and religion)
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Socioeconomic (occupation and monthly income)
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Clinical factors: Body mass index (BMI), stage of the diseases, time since diagnosis and type of treatment.
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Lifestyle (smoking, alcohol intake and physical activity)
Operational Definition
Social networks:defined as the overall connectedness or relationship of the twelve domains includes (spouse, children, parents, partner’s parents, other relatives, close friends, religious, education, employment, neighbors, volunteer works, and other social groups(19).
Limited social networks: based on Social Network Index (SNI) score participants who were scored 0-3.
Medium social networks: based on Social Network Index (SNI) score participants who were scored 4-5.
Diverse social networks: based on Social Network Index (SNI) score participants who were scored ≥6(20).
Quality of life: Assessed by using functional scales, symptom scales and global health status scales(21). Functional scale includes: - Physical, Role, Cognitive, Emotional, Social Functioning, body image, sexual functioning, sexual enjoyment and future perspective. Global health status assessed by two items. And symptom scales include: - fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, financial difficulty, systemic therapy side effects, breast symptoms, arm symptoms and upset by hair loss.
Not affected quality of life: Participants who were scored 75 and above for functional and global health status scale and 25 and below for symptom scale.
Affected quality of life: Participants who were scored below 75 for functional and global health status scale and above 25 for symptom scale(21).
Data collection tools
Data was collected by using structured questionnaire which was adapted from literatures(9, 20, 21). The questionnaire was prepared in English language and then translated to the Amharic by experts who are expert in both languages, then back to English by another expert to ensure the uniformity of the instrument. Five percent of the sample size was pre-tested in Haleluia hospital to check whether the study population understand the questions and modified accordingly (if needed). The questionnaire contains three parts. The 1st part was used to assess socio-demographic characteristics the respondents, the 2nd was asses social networks of the respondents using Cohen’s social network index (SNI) which contains 12 items(19). And the last was used to asses quality of life of the respondents were using the European Organization for Research and Treatment of Cancer (EORTC) version 3.0 of QLQ-C30 (21, 22).
Data collection procedure
Six BSc nurses and two MSc supervisors were used for data collection. One day training was given for clarification of some terms and assessment tools, aim of the study concerning need for strict confidentiality of respondent’s information and time of data collection. Supervisors were closely monitor daily the data during data collection.
Data quality control
Data quality control was made by pre-tested in 5% of the total sample size. One full day training was given for data collectors and supervisor regarding the study, the questionnaire and data collection procedure by the main investigator. The Collected data were checked every day by supervisors and principal investigator for its completeness. Data was kept in the form of file in secure place where no one can access it except the investigator and confidentiality was insured by not recording names or any personal identity. Data was checked again for its completeness before data entry.
Data processing and analysis
First, data was checked for completeness then cleaned and coded before entered to epi-data manager version 4.2. Next data from completed questionnaire was entered (double entry) in to epi-data and transferred in to SPSS version 25 for analysis. Descriptive statistics were used to analyze demographic characteristics. Logistic regression models were used to evaluate associations between social network, social support, and quality of life. Bivariate and multivariate analysis with 95 % CI was employed. Variables found to have a P-value<0.2 in the binary logistic regression were entered into multivariate analysis and strength of association was declared at P value<0.05.
Ethical consideration
Ethical clearance was obtained from institutional review board of Addis Ababa University, College of Health Sciences, School of Nursing and Midwifery. Support letter from School of Nursing and Midwifery was written to Tikur Anbesa Specialized hospital. Informed written consent was gained from all study participants. Participants were informed about the important of the study. After information was provided about purpose of the study, non- invasiveness of the data collection procedure, confidentiality of the information and respondents were reassured that they would be anonymous (unnamed). Then respondents were given a chance to ask anything about the study and was free to refuse or stop at any moment they want if their choice.