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\def\RunningAuthor{Thenmozhi P and  Simeon I}
\firstPage{3813}
\articleType{Original Article}
\receivedDate{10 Jan 2020}
\acceptedDate{15 Feb 2020}
\revisedDate{13 Feb 2020}
\journalVolume{2020, 11}
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\journalDoi{ijrps.v11i3.2555}
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\title{\textbf{Quality of Life of Cancer Patients Receiving Chemotherapy}}
\author{Thenmozhi~P\textsuperscript{*}, 
            Simeon~I~\\[5pt]{Department of Medical Surgical Nursing, Saveetha College of Nursing, SIMATS, Chennai, Tamilnadu, India}}

\begin{abstract}
Quality of life is a significant part of patient care among cancer patients. Toxicities and adverse impacts of chemotherapy influence personal satisfaction in disease patients, and it likewise makes challenges in satisfying family and social jobs.  Hence the study aimed to assess the quality of life of cancer patients receiving chemotherapy.  Cross-sectional research design was employed with 50 samples which matched the inclusion criteria were selected by convenience sampling technique. Demographic variables data were collected by using a structured questionnaire followed by assessing the quality of life by using the EORTC QLQ-C30 questionnaire.  The findings of the study revealed the highest median value in the cognitive functioning, social functioning, role functioning and also in physical functioning compared symptom scale and in which the lowest score in the symptoms of nausea \& vomiting, loss of craving, fatigue, diarrhea and constipation and face many challenges related to finance. \textbf{\space }Based on findings, further studies can be conducted to correlate the quality of life with clinical assessment and focus on the mind-body exercise such as yoga, meditation and physical therapy like exercise, massage to enhance the quality of life and to complete the entire cycle of chemotherapy.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Cancer,\newline Chemotherapy,\newline Quality of Life,\newline Symptoms scale
\end{keywords}
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\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Thenmozhi~P~\\ Phone:\ ~\\  Email:\ thenmozhi.sethu@gmail.com
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\section{Introduction}
Cancer is a typical disease globally, and numerous new cases are showed up yearly around the world\unskip~\citep{793203:18895789}. The prevalence of cancer is ever-increasing globally, with a predictable 15 million new cases anticipated by 2020 \unskip~\citep{793203:18895789}. Cancer is a non-communicable disease that starts when an abnormal cell is proliferated by the genetic mutation of the cellular DNA. Death from cancer worldwide is estimated to be 13.1 million in 2030. Presently in India, it was Evaluated the number of individuals living with the malignant growth was around 2.25 million, new disease patients enrolled each year is 11,57,294 lakh, and Cancer-related deaths were 7,84,821 \unskip~\citep{793203:18895783}. The treatment modalities of cancer include chemotherapy, radiation therapy, surgery or combination of these therapies. Numerous variables influence quality of life decidedly or adversely. Tiredness, nervousness, worry for the future and the family, troubles to satisfy essential needs and changes in self-perception decline the quality of life of cancer patient \unskip~\citep{793203:18895785,793203:18895775}. Social help, monetary security and confidence in recuperation improve the quality of life \unskip~\citep{793203:18895780,793203:18895797,793203:18895781}. However, the cancer treatment is highly linked with significant side-effects which adversely affect quality of life (QoL) of the patients. Cancer patients are fighting with cancer and its treatment in their everyday life. They face physiological reactions like baldness, torment, tiredness, nausea, vomiting; some mental issues, for example, stress, uneasiness, gloom; and some social symptoms of social confinement, role and function loss; and these may exacerbate quality of life inevitably \unskip~\citep{793203:18895785,793203:18895775,793203:18895799}.

Chemotherapy is the cytotoxic or antineoplastic or anticancer drugs designed to control the abnormal proliferation of malignant growth cells in the body. It might be utilized as an essential treatment to demolish malignant growth cells, shrink a tumour size before surgery or destroy the remaining cancer cell after surgery or to relieve symptoms in an advanced stage. It may be administered either orally or straightly into the circulation system, to assault cancer cells all through the body, or they can be focused on explicit malignancy sites. It will be administered in repeated courses over a 3 to 6 month period with an interval period. It treats disease successfully; however, it regularly causes side effects depends upon the kind of malignancy, area, medication and its dose, and general wellbeing. Chemotherapy is related with various intense symptoms like nausea and vomiting, loss of hunger, mucositis, looseness of the bowels, infections, weakness and emotional distress\unskip~\citep{793203:18895803,793203:18895796}. Toxicities and adverse effects of chemotherapy mock the quality of life in cancer patients, and it additionally makes troubles in satisfying family and social roles, for example, the capacity to work or taking an interest in social exercises \unskip~\citep{793203:18895783}.

Quality of life is defined as individual consciousness about the positive and negative parts of malignant growth patients' side effects includes physical, emotional, social, and psychological capacities and, critically, infection manifestations and reactions of treatment \unskip~\citep{793203:18895788}. It is likewise being utilized as an essential result measure to assess the viability of treatment \unskip~\citep{793203:18895784,793203:18895798,793203:18895801}. 

\unskip~\citet{793203:18895802} Nowadays, it is one of the significant issues in oncology to assess quality of life of the malignant growth patients getting chemotherapy \unskip~\citep{793203:18895790}. The cancer-specific quality of life is closely associated with the stages of the cancer disease and cycle of chemotherapy \unskip~\citep{793203:18895794,793203:18895800}. Though the chemotherapy provides a complete cure, prolongs the survival which may improve the quality of life, patients are affected by very badly due to the side effects of chemotherapeutic drugs such as nausea, vomiting, pain, fatigue, hair loss, cognitive dysfunction, stomatitis, gastritis, body image disturbance, psychological issues which harm quality of life. Long haul survivors, psychosocial issues and physical side effects such as agony and lymphedema, especially the unfavourable impacts of systemic chemotherapy on quality of life despite everything endure \unskip~\citep{793203:18895774,793203:18895777,793203:18895778}.

\unskip~\citet{793203:18895792} The primary issues looking by long haul malignant growth survivors are identified with social/passionate help, wellbeing propensities, profound/philosophical perspective on life, and self-perception concerns. Malignancy and chemotherapy exacerbate personal satisfaction and increment the requirement for integral treatment \unskip~\citep{793203:18895787}. Few studies have proven that patients with lower quality of life prefer more complementary therapy \unskip~\citep{793203:18895786,793203:18895793}. With this background and considering the importance of the quality the life study was conducted to assess the quality of life, which enables the health care personnel to take measured appropriately to improve the quality of life.


    
\section{Materials and Methods}
The research approach adopted in the study was a quantitative approach by using non-experimental cross-sectional research design. The study was conducted after obtaining formal permission from hospital authority with 50 samples at oncology ward. Samples who matched the inclusion criteria were selected by convenience sampling technique. Samples who could not understand Tamil or English, who were mentally ill and critically ill, were excluded from the study. The participants who consented for willing to participate were informed about the purpose of the study and obtained informed consent. The interview method was used to collect the demographic variables followed by the quality of life was assess by using EORTC QLQ-C30 (European Organization of research in Treatment of Cancer - Quality of Life Questionnaire) on one to one basis. It is an integrated system for assessing the health-related quality of life (QOL) of cancer patients. This questionnaire consists of five functional scales such as physical functioning, role functioning, cognitive functioning, emotional functioning and social functioning along with three symptom scales for fatigue, pain, and nausea and vomiting. A global health status / QOL scale, additional symptoms commonly reported by cancer patients (dyspnoea, loss of appetite, insomnia, constipation and diarrhea) and perceived financial impact of the disease. It uses 5-point response categories ranging from 0 ("Not at all") to 4 ("Very much"). The total score is the summation of the 4 subscale scores. All of the scales and single-item measures ranged in score from 0 to 100. Thus a high score for a functional scale represented a high/healthy level of functioning, a high score for the global health status/QOL represented a high QOL. Still, a high score for a symptom scale/item represented a high level of symptomatology/problems. The Cronbach's Alpha coefficient revealed the reliability of the tool ranged from 0.78 to 0.91. Confidentiality and anonymity were maintained throughout the procedure. Collected data were analysed by using descriptive and inferential statistics. 


\begin{table*}[!htbp]
\caption{\boldmath {Frequency and percentage distribution of demographic variables of quality of life among Cancer Patients receiving Chemotherapy} }
\label{tw-b68cfb89a062}
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\begin{table*}[!htbp]
\caption{\boldmath {Assessment of quality of life among cancer patients receiving chemotherapy} }
\label{tw-f82f1398a6d7}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.30749999999999996\linewidth-2\tabcolsep}p{\dimexpr.375\linewidth-2\tabcolsep}p{\dimexpr.3175\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack  & \cAlignHack Inter quartile {\textendash} Upper quartile \mbox{}\protect\newline (25 - 75) Percentile & \cAlignHack Median\ensuremath{\pm} SD\\
\tblmidrule 
Physical Functioning &
  \cAlignHack 30 {\textendash} 80 &
  \cAlignHack 60 \ensuremath{\pm}  22.94\\
Role Functioning &
  \cAlignHack 20 {\textendash} 70 &
  \cAlignHack 70 \ensuremath{\pm}  20.46\\
Emotional Functioning &
  \cAlignHack 30 {\textendash} 80 &
  \cAlignHack 70 \ensuremath{\pm}  18.97\\
Cognitive Functioning &
  \cAlignHack 30 {\textendash} 80 &
  \cAlignHack 70 \ensuremath{\pm}  26.76\\
Social Functioning &
  \cAlignHack 20 {\textendash} 50 &
  \cAlignHack 30\ensuremath{\pm}  20.36\\
Global Health status &
  \cAlignHack 20 {\textendash} 40 &
  \cAlignHack 30 \ensuremath{\pm}  18.65\\
Symptoms Scales &
  \cAlignHack 20 {\textendash} 60 &
  \cAlignHack 50 \ensuremath{\pm}  14.20\\
Fatigue &
  \cAlignHack 20 {\textendash} 40 &
  \cAlignHack 30 \ensuremath{\pm}  13.87\\
Nausea \& Vomiting &
  \cAlignHack 20 {\textendash} 40 &
  \cAlignHack 30 \ensuremath{\pm}  16.54\\
Pain &
  \cAlignHack 22 {\textendash} 55 &
  \cAlignHack 33 \ensuremath{\pm}  15.45\\
Dyspnea &
  \cAlignHack 50 {\textendash} 90 &
  \cAlignHack 75 \ensuremath{\pm}  26.89\\
Insomnia &
  \cAlignHack 30 {\textendash} 80 &
  \cAlignHack 60 \ensuremath{\pm}  16.65\\
Appetite loss &
  \cAlignHack 22 {\textendash} 55 &
  \cAlignHack 33 \ensuremath{\pm}  12.56\\
Constipation &
  \cAlignHack 20 {\textendash} 40 &
  \cAlignHack 30 \ensuremath{\pm}  11.45\\
Diarrhea &
  \cAlignHack 33 {\textendash} 79 &
  \cAlignHack 50 \ensuremath{\pm}  19.76\\
Financial Difficulties &
  \cAlignHack 16 {\textendash} 59 &
  \cAlignHack 25 \ensuremath{\pm}  14.76\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\bgroup
\fixFloatSize{images/8c5063ab-034f-4ec2-8d8b-a841ce0de29b-upicture1.png}
\begin{figure*}[!htbp]
\centering \makeatletter\IfFileExists{images/8c5063ab-034f-4ec2-8d8b-a841ce0de29b-upicture1.png}{\includegraphics{images/8c5063ab-034f-4ec2-8d8b-a841ce0de29b-upicture1.png}}{}
\makeatother 
\caption{\boldmath {MedianScore of symptoms scale }}
\label{f-9a18f8858a59}
\end{figure*}
\egroup

    
\section{Results and Discussion}
Table~\ref{tw-b68cfb89a062} reveals the demographic variables of the participants. Out of 50 samples,30 (60\%) were male with the age group of more than 50 years and their monthly income Rs. 10001 {\textendash} 15000/-. With regards to the site of cancer, 17 (34\%) had cancer in the respiratory system, 27 (54\%) with gastrointestinal cancer and 06 (12\%) had reproductive cancer. Regarding the duration of illness, 22 (44\%) was in less than 2 years, and only one participant is living with cancer for more than 8 years. Regarding stages of cancer, the majority of them 28 (56\%) were in stage III, and around 30\% of the participants were receiving 5-6 cycle of chemotherapy (Table~\ref{tw-b68cfb89a062}).

A detailed analysis was done in the present study in assessing the quality of life. Table~\ref{tw-f82f1398a6d7} shows the 25 percentile, 75 percentile, median, and standard deviation of quality of life. All the components such as Physical function, Social function, Role function, cognitive function, Emotional function, symptom scale and Global Health status were assessed among the participants receiving cancer chemotherapy. The highest median score was 75\textbf{\ensuremath{\pm}}26.89. Followed by physical functioning, emotional functioning, and cognitive functioning has the same score of 70\textbf{\ensuremath{\pm}}18.97 to 26.76. Whereas Social functional scale and global health status QoL scale score was 30\textbf{\ensuremath{\pm}}18.65. The lowest score was 25\textbf{\ensuremath{\pm}}14.76 for financial difficulties. Regarding physical symptom, fatigue, nausea \& vomiting, anorexia, and constipation score yielded 30 \textbf{\ensuremath{\pm}}13.87 and insomnia, and dyspnea symptom score was 60 \textbf{\ensuremath{\pm}} 16.65 and 75 \textbf{\ensuremath{\pm} }26.89. 

The quality of life highly influenced by the symptom of fatigue, nausea \& vomiting, appetite loss, and constipation with the median score of 30 and the highest medial score was 75 for dyspnea as shown in Figure~\ref{f-9a18f8858a59}.\textbf{\space }

Quality of life is a broad multidimensional concept that usually includes subjective evaluation of both positive and negative aspects of life (WHO), and it is important to everyone. It is an overall assessment of a person's well being, which may include physical, emotional, and social dimensions, as well as stress level, sexual function, and self-perceived health status. Chemotherapy is the choices of treatment for cancer which kills or control the abnormally proliferated cells, thereby improving the quality of life. Despite remarkable adverse effects in the treatment of chemotherapy, the patients encounter certain physical, psychological, economic and social problems which affect their quality of life. Measuring the quality of life is one of the major goals of treatment and determining the efficiency and effectiveness of chemotherapy drugs. The most widely applicable instrument to measure the QOL in cancer patients is the EORTC QLQ-C30 \unskip~\citep{793203:18895784,793203:18895798,793203:18895787}. The present study intensively analyzed the quality of life of patients undergoing the treatment of chemotherapy using this EORTC QLQ-C30. The findings of the current study found that majority of them had scored better in the cognitive functioning, social functioning, role functioning and also in physical functioning. However, poor score found in symptom scale and of these, the lowest score was in the symptoms of nausea \& vomiting, loss of appetite, fatigue, constipation and diarrhea. The present study finding is supported by the study conducted by Malathy G Nayak et al., who revealed that QoL of the majority of patients was influenced by their symptoms. 82.3\% of them had low QoL scores \unskip~\citep{793203:18895782}. Similar findings of the low quality of life found in Global Health Status (GHS) and four items of symptom scale, that is, insomnia, pain, appetite loss, and constipation, and financial difficulties by the study conducted by \unskip~\citet{793203:18895776}.  Findings of the current study are contrasted with the MS Heydarnejad et al. who concluded that cancer is an important health issue influencing QoL. Still, a chemotherapy cycle may improve QoL in patients with solid tumours \unskip~\citep{793203:18895795}. Another study conducted by ParveenChagani et al. who observed that a general low QoL among grown-up disease patients experiencing chemotherapy treatment and it is perceived as a distressing treatment, which antagonistically influences the QoL of malignant growth patients \unskip~\citep{793203:18895791}. A study was done by Ali Dehkordi et al., who found QoL was highly associated with the cycle of chemotherapy \unskip~\citep{793203:18895779}. The present study lacks an association of demographic variables with the quality of life. Financial constrain is also one of the important issue found in the current study. Cancer patients on chemotherapy may undergo the toxic effects due to chemotherapy, but as health care personnel should encourage them to cope up with the treatment to lead a quality life. The smaller the gap between the patient's expectations and achievements is the higher the quality of life. There are number of alternative and complementary interventions are available to alleviate the distress symptoms due to the side effects of chemotherapy and fill the gap with a positive perception. 
    
\section{Conclusion}
The study findings concluded the subjective perceptions of the functional effect of physical, emotional, social, cognitive, symptoms associated with side effects of chemotherapy and, importantly, financial difficulties are very low which adversely affect the overall quality of life among chemotherapy among cancer patients. Based on the current study findings further studies can be conducted to correlate the quality of life with clinical assessment and focus on the mind-body exercise such as yoga, meditation and physical therapy like exercise, massage to improve the quality of life and to complete the entire cycle of chemotherapy. 
\section*{Acknowledgement}Authors would like to appreciate the participants who actively participate in the study and extend their cooperation to complete the study successfully. 

\textbf{Conflict of Interest }

Authors declare no conflict of interest

\textbf{Funding Support}

None.
    

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