EJIHPE | Free Full-Text | Comparative Study of the Quality of Life and Coping Strategies in Oncology Patients

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EJIHPE | Free Full-Text | Comparative Study of the Quality of Life and Coping Strategies in Oncology Patients


3. Results

Based on the eligibility criteria, 303 patients were selected. Three of them declined to participate (one in Group A and two in Group B) due to pain and the unavailability of time for the interview. Thus, the final sample was composed of 300 participants.

Women (n = 154; 51.3%), individuals living with a partner (n = 204; 68%), being catholic (n = 186; 62%), illiterate individuals and those with only primary school education (n = 183; 61%), and individuals with a household income equal to or less than three times the minimum monthly wage (n = 193; 64.7%) predominated in the sample. The participants in Group A were older (p p Table 1).
Table 2 displays the descriptive statistics for the coping scores. Coping strategies were used little by the participants. There was a significant difference among groups for the problem-solving factor (p = 0.006), which was used more by the participants in Group C. In Group B, the escape/avoidance score was significantly lower (p

In Group A, the participants had a lower total quality-of-life score (median: 6.5) related to the other groups (p < 0.01), as well as lower scores in the psychological well-being (p < 0.01) and physical symptom (p < 0.01) domains.

Table 3 shows the results of the multivariate analyses using the generalized linear model for coping strategies and quality of life. Age (p p = 0.052), all levels of schooling (p = 0.029, p = 0.009, p = 0.049), and quality of life (p p = 0.034), group (p = 0.015), sex (p = 0.042), income (p = 0.014; p = 0.005; p = 0.049), and coping (p
The Cronbach’s alpha of the McGill Quality of Life Questionnaire (MQoLQ) instrument was 0.85, and that of the Ways of Coping Questionnaire was 0.89; both are generally suitable for assessing accuracy [46].
Table 4 presents the factors that interfered with the participants’ perception of quality of life in the last two days. It is noted that family problems and pain stand out among the most influential in the perception of the construct.

4. Discussion

This study aimed to compare the quality of life and coping strategies among three cancer patient groups, identifying associated clinical and sociodemographic factors. Based on the current results, mean scores of the quality of life (QoL) were relatively good for the participants overall. However, those who were under palliative care had a poorer perception of the construct. This group showed substantial impacts in the physical well-being, psychological well-being, and symptom domains compared to the other groups.

In this context, the progression of the disease worsened the quality of life, highlighting the similarity between the construct and physical well-being perception. In fact, in a randomized study involving 733 patients with advanced or metastatic lung cancer undergoing different medicinal treatments, it was observed that the progression of the disease and symptoms contribute to a decreased quality of life (QoL) [47]. Data corroborated by another prospective study carried out with 105 cancer patients treated in an outpatient clinic of a tertiary hospital identified impairment of global well-being and low general quality of life of the participants [48].
When it comes to patients with advanced cancer, a particular approach to predicting their disease progression and commencing palliative care can enhance their quality of life. This is because the treatments suggested for such patients may not always alleviate their symptoms or stop the cancer from spreading, as supported by the cancer-related literature [49]. Hence, palliative care can be much more beneficial to them by avoiding and reducing their suffering and acknowledging their culture, spirituality, beliefs, and values.
In this study, the positive association between QoL and not receiving pharmacological pain control can be attributed to the fact that patients do not feel pain or that it is insignificant to the point of not interfering with their QoL. On the other hand, it is known that cancer pain management is still a challenge for health professionals, who encounter several obstacles related to the patient, such as a lack of knowledge about pain and its treatment, as well as incorrect conceptions about the use of opioids, often leading to underestimations of the pain and the proposed treatment [49].
The inverse association between income and QoL is in disagreement with findings described in a recent study involving cancer patients, which reported that individuals with low socioeconomic status, low level of schooling and advanced age had poorer health-related QoL [50]. Cancer can lead to financial difficulties for families as patients and caregivers often stop working after being diagnosed with the disease [51]. In this context, socioeconomic status, income, and level of education are factors associated with survival in patients with breast cancer, as documented in the literature [52].
The negative association found between QoL and age confirms the results of a previous study involving 608 older patients with cancer: age negatively impacted physical function and positively impacted emotional function [53]. The impact of age on QoL was also systematically studied in a review carried out with 6024 cancer patients which showed that QoL domains can be influenced by age [54]. Furthermore, it must be considered that comorbidities and physiological changes associated with ageing can influence the metabolism of anticancer drugs and their toxicity, thus impacting the quality of life [55].
Another important finding of the present investigation was a significant association positive between QoL and coping strategies; however, such strategies were little used by the study participants. This finding can be explained by theoretical frameworks that emphasize the role of these coping mechanisms in promoting positive affect, resilience, and overall well-being [53]. When examining the results for each subscale of coping, our study provides a nuanced understanding of the specific coping strategies that were used and can enhance patients’ well-being. These data are in line with a study carried out with 224 women with early-stage breast cancer in Iran wherein emotion-focused coping strategies were significant predictors of quality of life [34].
In the present study, social support was the most used coping strategy by the participants. Previous studies showed that women with breast cancer tend to use social support and withdrawal strategies more often than other coping mechanisms [54]. However, it is known that levels of social support, which decrease after cancer diagnosis and treatment, are crucial for cancer patients to return to their normal routine and recover their health-related quality of life. However, little is known about how this social support is provided, even though it has been linked to improvements in overall well-being and quality of life [55]. Furthermore, these authors emphasize that this support from the beginning of the disease and throughout follow-up might allow for specific interventions to improve recovery, especially in the most vulnerable patient groups.
Age is considered the most important predictive variable for coping strategies, as shown in the literature [56]. Our results showed a negative association between age and coping. This result can be attributed to the fact that older adults with cancer less frequently report psychological uncertainties, social stress, and situational stress compared to other age groups, as evidenced in recent research [57]. On the other hand, recent studies are showing that elderly cancer patients present hopelessness, resignation, safety-seeking behavior, and a reduced capacity to adapt to stress effectively [58]. Therefore, it is important to be more attentive to elderly patients upon arrival at oncology services to prevent the use of maladaptive strategies [59].
Participants in Group C, who were currently undergoing treatment, used coping strategies more frequently than other groups. This result is consistent with a previous study of 187 gastric cancer patients which found that emotion-focused and problem-focused coping strategies mediated the relationship between global and situational meaning and psychological well-being. For the authors, the relationship between changes in beliefs and goals, as well as psychological well-being, was also mediated by coping [60].
The positive association between coping and level of schooling can be attributed to the fact that a high level of education can improve the feeling of mastery and, thus, contribute to these patients having better access to information and understanding of medical information and the disease itself [59]. Furthermore, this difference in educational level reflects the disparity in economic status among individuals, thus subsequently affecting their health in various ways.

The theoretical foundations and empirical evidence discussed for each of our findings help to explain the mechanisms underlying the associations observed in this research. The discussion highlights the role of coping strategies for cancer patients and their influence on quality of life. Furthermore, it showed how these constructs are subjective and influenced by consistent sociodemographic predictors, as shown in the literature.

Although it was not the objective of this research to analyze the psychometric properties of the instruments, the reliability analysis carried out using Cronbach’s alpha showed that both instruments reached values above those estimated in the literature [44], which is 0.7. Concerning the Coping Strategies Inventory, in other Brazilian studies, Cronbach’s alpha values range from 0.81 to 0.89 [43,61]. In our study, the value found was 0.89, which can be attributed to the sample size, context in which it was applied, and patients’ profile.

Finally, the process of adjustment to cancer diagnosis and treatment appears to be dynamic and affected not only by the individual characteristics of each patient but also by sociodemographic and social factors. The expected family support during the disease does not always occur, and this trajectory is marked by negative feelings that impact quality of life.

Limitations

This study has certain limitations that need to be taken into consideration. Firstly, the interviews were conducted at a single moment, which might not be enough to capture the full extent of changes experienced by individuals in different age groups. Secondly, the study was carried out in a single center, which had its unique characteristics. Moreover, the participants in the study had different types of cancer and clinical conditions, making them a heterogeneous group.

5. Conclusions

The study found that cancer patients receiving palliative care experience a lower quality of life compared to the other groups. Patients who do not use pain medication, patients with higher coping scores, and male patients reported a better perception of quality of life. However, this perception decreases in older patients and patients with higher income levels.

The average coping score was low, demonstrating that it was a strategy little used by the participants. Among the strategies used, social support prevailed. In our sample, patients who undergo treatment for cancer currently and have higher education levels and quality-of-life scores had better coping. However, the use of this strategy decreases in older patients.

Although this research provides valuable insights into the practical relevance of the results in oncology, it is considered important to highlight that this is an observational study. Therefore, we cannot establish a causal relationship concerning specific responses and the disease. On the other hand, the participants’ reports gave visibility to family problems, suffering, and limitations imposed by the disease, thus influencing the perception of QoL. The key findings from this study serve as a foundation for further exploration of the relationships between coping strategies, spiritual coping, symptoms of depression, anxiety, and stress among patients with cancer. It also offers support to health professionals to direct care strategies aimed at the real needs of these cancer patients that often go unnoticed or are little known.


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