Assessment of Quality of Life of Prostate Cancer Patients Receiving Care in University of Nigeria Teaching Hospital Ituku-ozalla, Enugu State

doi:10.21203/rs.3.rs-3981975/v1

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Assessment of Quality of Life of Prostate Cancer Patients Receiving Care in University of Nigeria Teaching Hospital Ituku-ozalla, Enugu State

https://doi.org/10.21203/rs.3.rs-3981975/v1

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Introduction: Ensuring assessment of Health Status in research and clinical care enables improvement in treatment outcomes. This study aimed to evaluate the health status of prostate cancer patients at the University of Nigeria Teaching Hospital.

Methods: This study is a cross-sectional, descriptive survey involving 181 prostate cancer patients. Conducted in the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu state, over a period of five months (May to October 2023). Descriptive and inferential analyses was done using Statistical Package for Social Sciences, SPSS version 27. Correlation and post hoc tests, were employed to examine the relationships between socio-demographic variables and Health status Data was collected using a 15D Health status instrument. P≤0.05.

Results: Out of the 181 prostate cancer patients interviewed, 45.3% were 60 years and above. More than half were married. Most were employed with university education as their highest level of education. The 15D instrument showed that above half of prostate cancer patients had problem staying asleep (50.8%) and also had marked problems with their bladder (32%). About 34.3% of patients with prostate cancer have severe physical discomfort from pain and ache etc. There general state of health has a considerable effect on sexual activity. The quality of life of prostate cancer patients also increase as the level of education increases. (Graduate; 0.6840 ± 0.16934). Age and level of education are important determinant of quality of life in prostate cancer besides other socio-demographic variables.

Conclusion: Vitality and functional activities were the domains most affected by prostate cancer.

Health Status

Prostate cancer

patients

care

Prostate cancer stands as a significant global health concern, and its impact on individuals' quality of life is a crucial aspect of comprehensive cancer care.[1] In Nigeria, where the burden of cancer is rising, understanding the dimensions of quality of life among prostate cancer patients is imperative for optimizing healthcare delivery.[2] Prostate cancer is the most prevalent cancer among men in Nigeria, and its diagnosis and treatment often bring about physical, emotional, and social challenges. [3] Quality of life assessment in cancer patients has become an essential component of healthcare research, enabling a holistic understanding of the patient experience beyond the traditional clinical endpoints. [4] Due to this increase in patients’ longevity, there has been a growing focus on improving the health and well-being in the long-term post prostate cancer patients, especially through physical activity.[4] The quality of life of men with prostate cancer has been under studied, then that of patients with other ‘Neoplasms. As yet no comprehensive understanding exists of the physical, vocational, psychological, social, and sexual functioning in men with prostate cancer over the natural course of the disease [5]

This study seeks to employ validated instruments to comprehensively evaluate various domains of quality of life, including physical, emotional, social, and functional aspects. By focusing on the specific context of Ituku-Ozalla, Enugu State, the study aims to provide insights that may inform tailored interventions and support systems for prostate cancer patients in this region. As the intersection of cancer care, cultural influences, and healthcare infrastructure is intricate [6], this research intends to contribute valuable data that can enhance the overall well-being of individuals grappling with prostate cancer in this local setting.

The findings from this study could potentially guide healthcare practitioners, policymakers, and researchers in developing targeted strategies for improving the quality of life of prostate cancer patients in Enugu State and beyond. Moreover, the insights gained may pave the way for future research endeavors, fostering a more nuanced understanding of the challenges faced by prostate cancer patients and the efficacy of interventions implemented in this specific healthcare setting.

Study Design.

This study is a cross-sectional, descriptive survey that was conducted in the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu state, Nigeria over a period of five months (May to October 2023).

Study Site.

The study site was the University of Nigeria Teaching Hospital (UNTH) in Ituku-Ozalla, Enugu state. It is a 500-bed hospital with a significant number of personnel (professional and non-professional). The UNTH, Ituku-Ozalla, has broad goals in service, education, and research. It provides inpatient and outpatient services to its clients and is well-equipped to assist all types of health-related research. The hospital contains a well-known Oncology center.

Sample Selection

The sampling frame include a list of all the prostate cancer patients in UNTH, Enugu within the period of May to October 2023 who were willing to partake in the study. Patients unable to provide informed consent and newly diagnosed patients who had just reported to the clinic for management were excluded from the study.

Eligibility Criteria

Patients diagnosed with prostate cancer at UNTH, Enugu, who can read, communicate in English, and give consent, as well as those who are mentally able to participate in a study interview and complete questionnaires (i.e., without active severe mental or neurological disease), were all included in the study.

Data Collection

Data was collected using a 15D instrument of Health-related quality of life. The 15D is a generic, comprehensive, 15-dimensional, standardized, self-administered measure of health-related quality of life (HRQoL) that can be used both as a profile and single index score measure. Informed consent was sought from each respondent. Privacy and confidentiality were ensured throughout the course of the study.

The 15D questionnaire includes the following 15 dimensions: breathing, mental function, speech (communication), vision, mobility, usual activities, vitality, hearing, eating, elimination, sleeping, distress, discomfort and symptoms, sexual activity, and depression. Each dimension is divided into 5 levels, by which more or less of the attribute is distinguished.

Data Analysis

Descriptive and inferential statistics were calculated using the Statistical Package for Social Science (SPSS) version 27. Data was summarized using descriptive statistics (mean ± SD, frequency, and percentage). Inferential statistics used one-way ANOVA, post hoc test, and Pearson chi-square test, with statistical significance set at p-value ≤ 0.05.

Ethical Consideration

Ethical approval for this study was granted by the Health Research Ethics Committee of the University of Nigeria Teaching Hospital, Enugu State before the study commenced- NHREC/05/01/2008B-FWA00002458-1RB00002323. Informed consent was obtained from each respondent.

Table I outlines the demographic profile of respondents. Notably, individuals aged 51–60 constitute the largest group 69 (38.1%), followed closely by those aged 60 and above 82 (45.3%). Regarding marital status, a substantial majority are married 142 (78.5%). In terms of employment, 108 (59.7%) reported being employed. Educational diversity is observed, with 74 respondents (40.9%) being graduates. The majority of respondents identified as Christians 179 (98.9%).

Table II provides detailed insights into respondents' quality of life using the 15D instrument across various dimensions. For mobility, 20 respondents (11%) reported normal walking, while 32 (17.7%) indicated being completely bed-ridden. In terms of vision, 80 respondents (44.2%) reported normal vision, while 4 (2.2%) stated almost complete blindness. Similar detailed breakdowns are provided for hearing, breathing, sleeping, eating, speech, excretion, usual activity, mental function, discomfort and symptoms, depression, distress, vitality, and sexual activity.

Table III explores the correlation between socio-demographic factors and quality of life. Statistically significant differences were observed based on age (p = 0.0001), with mean scores of 0.7862 (SD = 0.11452) for 41–50 age group, 0.6490 (SD = 0.12462) for 51–60 age group, and 0.5650 (SD = 0.16484) for those aged 60 and above. Educational variations also influenced quality of life (p = 0.001), with mean scores of 0.5681 (SD = 0.14660) for primary, 0.6200 (SD = 0.14861) for secondary, and 0.6840 (SD = 0.16934) for tertiary education. Marital status showed significance (p = 0.002), with mean scores of 0.8615 (SD = 0.06087) for single, 0.6349 (SD = 0.15659) for married, 0.06578 (SD = 0.21507) for divorced, and 0.5673 (SD = 0.14994) for widowed respondents.

Table IV delves into specific differences identified through the Dunnett Post Hoc Test. Marital status revealed significant mean differences, such as 0.27228 (SE = 0.07127, Sig = 0.001) for single-widowed, 0.06759 (SE = 0.03402, Sig = 0.129) for married-widowed, and 0.09049 (SE = 0.06368, Sig = 0.372) for divorced-widowed. Employment status demonstrated notable differences, with mean differences of 0.13040 (SE = 0.06889, Sig = 0.078) for employed to unemployed and 0.00542 (SE = 0.6977, Sig = 0.1405) for retired-unemployed. Level of education also indicated distinctions, including − 0.11296 (SE = 0.03049, Sig = 0.001) for primary-graduate and − 0.06106 (SE = 0.02662, Sig = 0.044) for secondary to tertiary graduates

This study assessed the quality of life of prostate cancer patients receiving care in University of Nigeria Teaching Hospital Ituku-ozalla. The demographic characteristics reveal a predominantly middle-aged and elderly population, with a substantial majority being married, employed, and identifying as Christians. These findings align with previous studies highlighting the influence of age, marital status, and religious affiliation on health-related outcomes and quality of life [4, 7, 8]. The patient characteristics revealed a mean age of sixty and half (60.5801) years. This is in conformity with the work in Nigeria [2] by Akinremi et al. which has the incidence age of prostate cancer to be forty (40) years. Individual expectations of life in general and of how the disease will affect one’s life influence the experience of health-related quality of life.[7]

After prostate cancer diagnosis, treatments such as surgery, radiation therapy and chemotherapy followed by targeting and/or hormonal therapy, can cause different types of side effects and this impair health-related quality of life, [4] hence the need to determine the quality of life of prostate cancer patients. The quality-of-life measurement consisted of mobility, vision, hearing, breathing, sleeping, eating, speech, excretion, usual activity, mental function, discomfort and symptoms, depression, distress, vitality and sexual activity. Sexual activity is an impairing factor of health-related quality of life of prostate cancer patients as it has been implied that prostate cancer therapy has negative impact on sexual relationship and appears to worsen over time [8]. In this study; fatigue, vitality, pain and discomfort, sexual activity, usual activity, mobility and excretion were the major quality of life variables negatively affected by the disease, prostate cancer. The prevalence of individuals reporting normal walking and normal vision is consistent with previous studies emphasizing the importance of physical and sensory well-being in overall quality of life [9,10]

The correlation analysis establishes significant relationships between socio-demographic factors and quality of life. The decline in mean scores with increasing age is in line with existing literature on the impact of aging on health-related quality of life.[11] Educational differences also play a role, echoing studies emphasizing the positive association between higher education levels and better quality of life. [12,13] The marital status findings are consistent with research indicating variations in well-being among different marital groups.

The Dunnett Post Hoc Test, further elucidates specific differences. The identified mean differences in marital status and employment status align with studies illustrating the intricate interplay between social factors and quality of life [14,15]. Educational differences revealing distinctions among primary, secondary, and tertiary education levels mirror findings in the literature emphasizing the role of education in shaping health outcomes. [16,17]

In conclusion, this study offers valuable insights into the quality of life among prostate cancer patients receiving care at the University of Nigeria Teaching Hospital, Ituku-Ozalla. The socio-demographic data revealed a predominantly middle-aged and elderly population, emphasizing the influence of age, marital status, education, and employment on the patients' well-being.

The comprehensive assessment using the 15D instrument highlighted specific challenges faced by prostate cancer patients, with notable impacts on vitality, pain, discomfort, sexual activity, usual activity, mobility, and excretion. Prostate cancer adversely affects the QoL of patients, particularly in domains related to vitality and functional activities.

Recommendations:

Tailored Interventions: Considering the multifaceted impact of prostate cancer on various aspects of patients' lives, healthcare providers at the University of Nigeria Teaching Hospital should design and implement tailored interventions. These interventions could include specialized support programs addressing the identified areas of concern, such as vitality, pain, discomfort, sexual activity, and mobility.
Educational Programs: Initiating educational programs for patients and their families can enhance awareness about the potential challenges associated with prostate cancer diagnosis and treatment. By providing information and resources, healthcare professionals can empower patients to cope better with the physical and emotional aspects of the disease.

Single-Center Setting: The study was conducted exclusively at the University of Nigeria Teaching Hospital, Ituku-Ozalla. Therefore, the findings may not be fully representative of the diverse experiences of prostate cancer patients in other healthcare settings.
Cross-Sectional Design: The cross-sectional nature of the study limits the ability to establish causation between socio-demographic factors and quality of life. Longitudinal studies would provide a more comprehensive understanding of the dynamic nature of these relationships over time.
Sample Characteristics: The study predominantly included Christian participants, limiting generalizability across different religious groups. Future research should aim for more diverse samples to explore potential variations in quality-of-life experiences.
Instrument Limitation: While the 15D instrument is a validated tool, it might not capture all nuances of the prostate cancer patient experience. Exploring complementary assessment tools or qualitative methods could provide a more comprehensive understanding of their quality of life.

Conflict of interests

All authors have no conflicts of interest to declare

Funding Statement

There was no external funding for this study.

Author Contribution

The initial manuscript draft was conceived and written by O.F.D. Data collection and analysis were performed by S.O.O, O.C.D, O.F.D and M.O.A. The study's conceptualization was aided by O.F.D, E.A.A, and S.O.O. MOA conducted a comprehensive review of all manuscript drafts. All authors contributed significantly to all manuscript drafts, accepted responsibility for all aspects of the work, and authorized the final manuscript draft for publication.

Acknowledgement

I want to acknowledge the interns at University of Nigeria Teaching Hospital Enugu for painstakingly helping in distribution of the questionnaire

Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at University of Nigeria, Nsukka.

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Table I PATIENT SOCIO-DEMOGRAPHIC DATA

Variable	N	%
Age group
31–40	1	0.6
41–50	29	16
51–60	69	38.1
60 and above	82	45.3
Marital Status
Single	6	3.3
Married	142	78.5
Divorced	8	4.4
Widowed	25	13.8
Employment status
Employed	108	59.7
Retired	68	37.6
Unemployed	5	2.8
Education level of Respondent
Primary	41	22.7
Secondary	66	36.5
Graduate	74	40.9
Religion of Respondent
Christianity	179	98.9
Islam	2	1.1

Table II Patent’s Quality of Life Assessment Using 15d Instrument

Variables	Frequency (n)	Percentage (%)
Mobility
I am able to walk normally (without difficulty) indoors, outdoors and on stairs.	20	11
I am able to walk without difficulty indoors, but outdoors and/or on stairs I have slight difficulties.	43	23.8
I am able to walk without help indoors (with or without an appliance), but outdoors and/or on stairs only with considerably difficulty or with help from others.	45	24.9
I am able to walk indoors only with help from others.	41	22.7
I am completely bed-ridden and unable to move about.	32	17.7
Vision
I see normally i.e. I can read newspaper and TV text without difficulty (with or without glasses).	80	44.2
I can read papers and/or TV text with slight difficulty (with or without glasses).	59	32.6
I can read papers and/or TV text with considerable difficulty (with or without glasses).	25	13.8
I cannot read papers or TV text either with glasses or without, but I can see enough to walk about without guidance.	13	7.2
I cannot see enough to walk about without a guild i.e. I am almost or completely blind.	4	2.2
Hearing
I can hear normally i.e. normal speech (with or without a hearing aid).	128	70.7
I hear normal speech with a little difficulty.	40	22.1
I hear normal speech with considerable difficulty; in conversation I need voices to be louder than normal.	7	3.9
I hear even loud voices poorly; I am almost deaf.	6	3.3
I am completely deaf.	0	0
Breathing
I am able to breathe normally i.e. with no shortness of breath or other breathing difficulty.	95	52.5
I have shortness of breath during heavy work or sports, or when walking briskly on flat ground or slightly uphill.	51	28.2
I have shortness of breath when walking on flat ground at the same speed as others my age.	21	11.6
I get shortness of breath even after light activity e.g. washing or dressing myself.	7	3.9
I have breathing difficulties almost all the time, even when resting.	7	3.9
Sleeping
I am able to sleep normally, i.e. I have no problems with sleeping.	41	22.7
I have slight problems with sleeping e.g. difficulty in falling asleep, or sometimes waking at night.	92	50.8
I have moderate problems with sleeping e.g. disturbed sleep, or feeling I have not slept enough.	37	20.4
I have great problems with sleeping e.g. having to use sleeping pills often or routinely, or usual waking at night and/or too early in the morning.	9	5.0
I suffer severe sleeplessness, e.g. sleep is almost impossible even with full use of sleeping pills, or staying awake most of the night.	2	1.1
Eating
I am able to eat normally i.e. with no help from others.	109	60.2
I am able to eat by myself with minor difficulty (e.g. slowly, clumsily, shakily, or with special appliances).	36	19.9
I need some help from another person in eating.	28	15.5
I am unable to eat by myself at all, so I must be fed by another person.	6	3.3
I am unable to eat at all, so I am fed either by tube or intravenously.	2	1.1
Speech
I am able to speak normally i e clearly, audibly and fluently.	90	49.7
I have slight speech difficulties e.g. occasional fumbling for words, mumbling or changes of pitch.	63	34.8
I can make myself understood, but my speech is e.g. disjointed, faltering, stuttering or stammering.	23	12.7
Most people have great difficulty understanding my speech.	3	1.7
I can only make myself understood by gestures.	2	1.1
Excretion
My bladder and bowel work normally, and without problems.	3	1.7
I have slight problems with my bladder and/or bowel function, e.g. difficulties with urination, or loose or hard bowels.	48	26.5
I have marked problems with my bladder function e.g. occasional 'accidents' or severe constipation or diarrhea.	58	32.0
I have serious problems with my bladder and/or bowel function e.g. routine 'accidents', or need of catheterization or enemas.	55	30.4
I have no control over my bladder and/or bowel function.	16	8.9
Usual Activity
I am able to perform my usual activities (e.g. employment, studying, housework, free time activities) without difficulty.	13	7.2
I am able to perform my usual activities slightly less effectively or with minor difficulty.	29	16.0
I am able to perform my usual activities much less effectively, with considerable difficulty, or not completely.	51	28.2
I can only manage a small proportion of my previously usual activities.	39	21.5
I am unable to manage any of my previously usual activities.	49	27.1
Mental Function
I am able to think clearly and logically, and my memory functions well.	71	39.2
I have slight difficulties in thinking clearly and logically or my memory sometimes fails me. I have marked difficulties in thinking clearly and logically or my memory is somewhat impaired.	70 24	38.7 13.3
I have great difficulties in thinking clearly and logically or my memory is seriously impaired.	16	8.8
I am permanently confused and disoriented in place and time.	0	0
Discomfort and symptoms
I have no physical discomfort or symptoms e.g. pain, ache, nausea, itching etc.	4	2.2
I have mild physical discomfort or symptoms e.g. pain, ache, nausea, itching etc.	47	26.0
I have marked physical discomfort or symptoms e.g. pain, ache, nausea, itching etc.	58	32.0
I have severe physical discomfort or symptoms e.g. pain, ache, nausea, itching etc.	62	34.3
I have unbearable physical discomfort or symptoms e.g. pain, ache, nausea, itching etc.	10	5.5
Depression
I do not feel at all sad, melancholic or depressed.	38	21.0
I feel slightly sad, melancholic or depressed.	80	44.2
I feel moderately sad, melancholic or depressed.	38	21.0
I feel very sad, melancholic or depressed.	18	9.9
I feel extremely sad, melancholic or depressed.	7	3.9
Distress
I do not feel at all anxious, stressed or nervous.	42	23.2
I feel slightly anxious, stressed or nervous.	83	45.9
I feel moderately anxious, stressed or nervous.	32	17.7
I feel very anxious, stressed or nervous.	24	13.3
I feel extremely weary, tired or feeble, totally exhausted.
Vitality
I feel healthy and energetic.	4	2.2
I feel slightly weary, tired and feeble.	57	31.5
I feel moderately weary, tired and feeble.	58	32.0
I feel very weary, tired or feeble, almost exhausted.	49	27.1
I feel extremely weary, tired or feeble, totally exhausted.	13	7.2
Sexual Activity
My state of health has no adverse effect on my sexual activity.	2	1.1
My state of health has a slight effect on my sexual activity.	42	23.2
My state of health has a considerable effect on my sexual activity.	64	35.4
My state of health makes sexual activity almost impossible.	44	24.3
My state of health makes sexual activity impossible.	29	16.0

Table III Relationship between patients’ socio-demographic data and their quality of life.

	Frequency (N)	Mean	SD	SE	P- value
Age					0.0001*
41–50	29	0.7862	0.11452	0.02127
51–60	68	0.6490	0.12462	0.01511
60 and above	82	0.5650	0.16484	0.01820
Total	179	0.6328	0.16224	0.01213
Education Level					0.001*
Primary	41	0.5681	0.14660	0.02290
Secondary	65	0.6200	0.14861	0.01843
Tertiary	73	0.6840	0.16934	0.01982
Total	179	0.6328	0.16224	0.01213
Marital status					0.002*
Single	5	0.8615	0.06087	0.02722
Married	141	0.6349	0.15659	0.01319
Divorced	8	0.06578	0.21507	0.07604
Widowed	25	0.5673	0.14994	0.02999
Total	179	0.6328	0.16224	0.01213
P < 0.05

*statistically significant

Table IV Dunnett Post Hoc Test for Social Demographics and Quality of Life

Social demographic variables

Mean Difference

Standard error

P- Value

Marital status

Single widowed

Married widowed

Divorced widowed

0.27228

0.06759

0.09049

0.07127

0.03402

0.06368

0.001*

0.129

0.372

Employment status

Employed Unemployed

Retired Unemployed

0.13040

0.00542

0.06889

0.6977

0.078

0.1405

Level of education

Primary Graduate

Secondary Graduate

-0.11296

-0.06106

0.03049

0.02662

0.001*

0.044*

P≤0.05

*Statistically significant data

No competing interests reported.

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You are reading this latest preprint version

Assessment of Quality of Life of Prostate Cancer Patients Receiving Care in University of Nigeria Teaching Hospital Ituku-ozalla, Enugu State

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Version 1

Abstract

INTRODUCTION

METHODS

Sample Selection

Eligibility Criteria

Data Collection

Data Analysis

Ethical Consideration

RESULTS

DISCUSSION

Conclusion

Limitations of the Study

Declarations

Conflict of interests

Funding Statement

Author Contribution

Acknowledgement

Data Availability

References

Tables

Additional Declarations

Status:

Version 1