Study Area and Setting
The study was conducted at the Oncology center, TASH, Addis Ababa. It is the largest city in Ethiopia, with a population of 3,475,952 according to the 2007 population census. 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 (10).
Tikur Anbassa Specialized Hospital is a 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 (14).
Study Design and Period
A Hospital-based cross-sectional study was conducted from March1 to April 1/ 2019.
Source Population
All breast cancer patients being evaluated and treated in oncology units
Study population
Those breast cancer patients visiting the hospital and being evaluated or treated at the oncology unit during data collection time
Inclusion criteria
All-female breast cancer patients who visited the hospital during the data collection period
Exclusion criterion
Serious ill patients, unwilling to fill the questionnaire and patients didn’t take chemotherapy treatment were excluded.
Sample size determination
The sample size was calculated using a single proportion formula. By taking prevalence of breast cancer patients 14.8% (15), Marginal of error=5% and CI= 95%
n = (Zɑ /2)2p(1-p) =(1.96)2 (0.148) (0.852) =194
d2 (0.05)2
by adding 10% non- response rate, the total sample size was 214
Sampling procedure
Tikur Anbessa Specialized Hospital was selected purposely because it is currently the only referral hospital for cancer patients in Ethiopia. Subjects were selected by using systematic random sampling by taking the one-year record of female breast cancer( 8000 cases), and taking average cases of one month(667 cases) from yearly report and the required sample size was taken every Kthvalue=3.
Dependent variables
Social support and Quality of life among female breast cancer patients.
Independent Variables
Socio-demographic and economic variables (Age, educational status and religion, occupation and monthly income) , Clinical factors(Body mass index (BMI), stage of the diseases, time since diagnosis and type of treatment), and Lifestyle (smoking, alcohol intake and physical activity)
Operational Definition
Social support: defined as the degree to which interpersonal relationships serve particular support or functions (including emotional/informational support, tangible support, positive social interaction, and affectionate support (16).
Good social support: Participants who were scored mean and above the mean for social support questions.
Poor social support: Participants who were scored below the mean for social support questions.
Quality of life: Assessed by using functional scales, symptom scales, and global health status scales(17). The 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(17).
Data collection tools
Data was collected by using a structured questionnaire that was adapted from literature (16-18). The questionnaire was 1st prepared in English and then translated to the Amharic language by experts and, then re-translated 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 the calarity of the questionarie.
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, the aim of the study concerning the need for strict confidentiality of respondent’s information and time of data collection. Supervisors were closely monitored daily data during data collection.
Data quality control
A pre-teste was done on 5% of the total sample size. One full-day training was given for data collectors and supervisors regarding the study, the questionnaire and the data collection procedure. The Collected data were checked every day by supervisors and principal investigators for its completeness. Data was kept in the secured place where no one can access it and confidentiality were ensured by not recording names or any personal identity.
Data processing and analysis
Data were checked , cleaned and coded before entered to epi-data manager version 4.2. Next data was entered (double entry) into epi-data and transferred into SPSS version 25 for analysis. Descriptive statistics were used to analyze demographic characteristics. Logistic(bivariate and multivariate) regression models were used to evaluate associations between social support, and quality of life at 95 % CI . 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 the institutional review board of Addis Ababa University, College of Health Sciences, School of Nursing and Midwifery. A support letter from the 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 importance of the study and respondents were reassured that they would be anonymous (unnamed). Then respondents were given a chance to ask anything about the study and were free to refuse or stop at any moment they want if their choice.