One thousand one hundred and twenty-five (1125) cancer patients were enrolled in this study. Of these patients, 23 were ineligible. The reasons for patient ineligibility were as follows: five (5) subjects were in palliative care, 4 subjects did not have sufficient knowledge of the Arabic language, 8 subjects found the questionnaire long enough to answer all the items, and 6 patients did not have time because of the distances they travelled (exhaustion, fatigue).
As a result, one thousand one hundred and two (1102) patients were included in this study
Table 1
Socio-economic characteristics of cancer patients in Morocco.
|
2010
|
|
2020
|
|
|
|
Number of caces
|
Percentage
|
Number of caces
|
Percentage
|
P
|
Sample
|
1600 new cases
|
1102 new cases
|
|
Sex
|
|
|
|
|
|
Man (male)
|
685
|
42,8
|
242
|
22
|
0.001
|
Woman (female)
|
915
|
57,2
|
860
|
78
|
|
Marital Status
|
|
Single
|
400
|
25
|
122
|
11,1
|
|
Married
|
832
|
52
|
813
|
73,8
|
0.001
|
Divorced
|
272
|
17
|
93
|
8,3
|
|
Widowed
|
96
|
6
|
75
|
6,8
|
|
Ethnic Group
|
|
Arab
|
1200
|
75
|
902
|
81,9
|
|
Amazigh
|
400
|
25
|
200
|
18,1
|
0.001
|
Spoken Langauge
|
|
|
Arabic
|
480
|
75
|
1018
|
92,4
|
|
Amazigh
|
1120
|
25
|
82
|
7,4
|
0.001
|
Frensh or English
|
0
|
0
|
2
|
0,2
|
|
Level of education
|
|
Illiterate
|
608
|
38
|
472
|
42,8
|
0.001
|
Qurranic
|
560
|
35
|
195
|
17,7
|
|
Primary
|
320
|
20
|
232
|
21,1
|
|
Secondary
|
48
|
3
|
155
|
14,1
|
|
University
|
64
|
4
|
48
|
4,4
|
|
Social Security
|
|
No insurance
|
1328
|
83
|
724
|
66,2
|
0,001
|
With Inssurance
|
192
|
12
|
354
|
32,1
|
|
Paid
|
80
|
5
|
19
|
1,7
|
|
Patient’s income
|
|
No income
|
|
|
643
|
58,30%
|
0,001
|
Les than 270 $
|
1216
|
76
|
317
|
28,70%
|
|
270 $ and more
|
|
|
142
|
13
|
|
According to the results obtained, women represent 78% of the sample (860 participants), while men represent only 22% (242 participants). It emerges that married status predominates with 73.8% of patients. Single status followed with a frequency of 11.1%. Divorced or widowed persons are represented at 8.3% and 6.8% respectively.
The age of the participants ranged from 20 to 92 years old. The median age is 51 years. The most affected age group is 40-60 years (59.62%), of which women represent 85%.
Concerning the confession of the participants, Islam is the main religion with more than 99% and only one participant is of Jewish origin. The study population consists of a mixture of ethnic groups: 81.9% Moroccan Arabs, 18.1% Amazigh.
Arabic is the official language for cancer patients 92.4%. The spoken language is the Moroccan dialect that is called darija, i.e. "The common language". It is generally used as a tool for communication between Arabic and Berber speakers. Darija is the most widely used language throughout Morocco.
The illiteracy rate is very high 42.4% of the study population. Only 18.6% have reached secondary or university level. The educational situation at the rural level is much more deleterious.
Socio-economic characteristics
According to Table 1, 68.8% of the patients investigated are unemployed patients or patients who lost their jobs due to their illnesses. To this end, 58.2% have no income, 28.7% receive less than the SMIG (legal minimum wage in Morocco), which is $270/month, and only 13% of patients receive a monthly payment to help them cover the costs of care.
For social security, 66.2% of participants have no insurance. In this case, the state covers the costs related to treatment up to the limit of treatments available in public health institutions. 32.1% of the participants are members of the health insurance which is based on the principles of social insurance for the benefit of persons in gainful employment (state employees and private sector employees). As a result, 86% of the participants claim the high cost of medicines and examinations related to health care.
Concerning the geographical remoteness of patients, according to the results obtained 68.5% of patients come from outside the city of Rabat, almost half of them from rural areas. To access care, NIO patients travel a distance of up to 1,300 km with a median of 80.00 km. Nearly two-thirds of patients report significant transportation costs exceeding an average of $30. Add to this the cost of hotels and food.
As a result, 66% of patients turn to their families or associations to ensure their care and/or stay. In this worrying context, almost all patients claim that cancer is an expensive disease as well as a disease that leads to a drop in income and the inevitable impoverishment of Moroccan patients.
Marital and family relationship
59.5% of participants have gynaecomammary cancer. 72.3% believe that their body image has changed after their cancer, 74% of whom are female. As a result, 71.1% feel isolated from the outside world following their cancer. And almost half of the patients are ashamed to talk about their cancer pathology to others as well as suffer from stigma and discrimination either in the family, friends or professional environment. 9% of the participants have experienced rejection by at least one member of their family or close friends.
Consequently, some patients cannot share their disease with others, even sometimes the closest includes the spouse (10% of participants keep their disease secret).
On the conjugal level, 93 participants were victims of divorce, 87 of whom were women. Similarly, 233 patients claim the distance and indifference of their partners after their cancer.
Beliefs related to cancer
According to the results obtained, 22.3% of the participants consider cancer a dangerous disease, 8.8% consider it malignant, 22.1% consider it fatal and 7.1% consider it frightening. 16.3% see cancer as a monster that is difficult to manage. Nevertheless, despite these pejorative connotations related to cancer, the belief of cure is very strong since more than 83% of patients keep the hope of cure and believe in drug treatments.
Table 2
Religious characteristics related to cancer
|
2010
|
2020
|
|
|
|
Number of caces
|
Percentage
|
Number of caces
|
Percentage
|
p
|
Sample
|
1600 new cases
|
1102 new cases
|
|
Religiuos costoms
|
|
|
|
|
|
Believer non practicing
|
852
|
51
|
160
|
14,5
|
0,001
|
Practicing believer
|
784
|
49
|
743
|
85,5
|
|
Wearing the Veil
|
|
|
|
|
|
Yes
|
622
|
68
|
590
|
68,5
|
0,001
|
No
|
293
|
32
|
270
|
31,5
|
|
Visit of the marabouts
|
|
|
|
|
|
No
|
1296
|
81
|
1029
|
93,4
|
0,001
|
Yes
|
304
|
19
|
73
|
6,6
|
|
Medical Plants
|
|
|
|
|
|
No
|
1184
|
74
|
534
|
48,5
|
0,001
|
Yes
|
416
|
26
|
568
|
51,5
|
|
Alcohol and Tobacco cessation
|
|
|
|
|
|
No
|
40
|
23,5
|
64
|
5,8
|
|
Yesi
|
128
|
76,50%
|
227
|
20,6
|
|
Healthy person
|
1432
|
|
811
|
73,6
|
|
Rokia
|
|
|
|
|
|
No
|
Not known
|
Not known
|
643
|
58,3
|
|
Yes
|
Not known
|
Not known
|
459
|
41,7
|
|
Religious beliefs related to cancer
Based on the results, the impact of the occurrence of cancer is variable according to the degree of practice (Aggoun, 2010). Among practicing believers (85.5%), cancer is a divine test, therefore it resulted in an acceptance of the disease or even pride in being chosen by the god (errihani et al, 2010). more than half of them become more practitioners following their cancer. This behaviour is seen in several ways: first, prayer, reading the Qur’an and praising the god become systematic and regular in almost all patients and more than half of them do more prayer and praise.
Nevertheless, another part of the participants (10%) believe that their illness is due to a divine punishment. Hence, the need to avoid certain behaviours such as alcohol and tobacco in almost all patients is necessary. More than two thirds of the participants wear a veil systematically, either to cover alopecia related to the different anti-cancer therapies or in order to be closer to God. Some patients adopt rather harsh religious behaviours even against medical advice, such as fasting (3.4%) or the great and/or small pilgrimage (0.4%).
Another important aspect is the use of medicinal plants more than half of the patients surveyed use them. Dozens of plants are used in different forms (plant extract, fumigation, mixed with other plants,). The most used plants according to our investigation are (Saffron, Propolis, Thyme, Oregano, Nigella, Myrtle, Cypress, Arar, Eucalyptus, Dill, Mugwort, Potentilla anserina, Lavender, Pomegranate, Garlic,) even the most harmful plants (Arestiloch, Euphorbia). More than half of the respondents use plants mentioned in the Qur’an and the sunnah: honey, dates, pomegranate and its leaves, nigella, wing, ginger, olives and figs. Moreover, Almost 42% of patients use ROKIA as an anti-cancer remedy which is either before, in parallel or after anti-cancer treatments.
According to our Moroccan culture, the visit of marabouts has a divine power 'albaraka' where marabouts can be found for the treatment of incurable diseases, or for the treatment of mental illnesses or for the treatment of the evil eye (marouf, 2007). In our context, 6.6% of the participants make use of the visits of the marabouts. Another attitude, which has just been added to the last one and which can be adopted alone or in parallel with the visit of the marabouts, is that of treatment by traditional healers (dawaya, kawaya or alhijama) at the rate of 7.5% of the total number of participants.