CHAPTER ONE

Introduction

Background to the Study

Cancer is a term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymphatic system. (National Cancer Institute, 2008). Cancer can involve any tissue of the body and have many different forms in each body area. Most cancers are named for the type of cell or organ in which they start.

Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Breast cancer is the commonest cancer in women and the most common cancer in Nigeria (Jayisemi, Sofela, Rufai, 2007). Although breast cancer is the most common type of cancer in women, the frequency does not equate mortality. Breast cancer accounts for 40% of cancers in women and is responsible for about 16% of all cancer related deaths in Nigeria (Obinna, 2012). The burden of breast cancer is increasing in both developed and developing countries. Despite the rising incidence of breast cancer, mortality from the disease has declined recently in some countries, including the United States, United Kingdom and Nigeria (WHO, 2006) due to recent advances in diagnosis and treatment of cancer which have led to an increase in cancer survival. There is a greater emphasis now on the quality beside quantity of survival. However little is known about the quality of life (QOL) of survivors.

Breast cancer is a serious, stressful and life-threatening disease. It is assumed that the diagnosis of cancer evokes far greater distress than many other diseases, regardless of prognosis. Thousands of women are treated each year for breast cancer. After the diagnosis of breast cancer, the women are faced with the diagnosis, personal interpretation of cancer, physical effects of the disease, long and short term side effects of the treatment

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regimes and the reaction of family and friends and all these affect the overall quality of life of the woman with breast cancer. Cancer treatment changes a woman’s total quality of life and those who survive are left with little or nothing to enjoy about life as they are often and always faced with psychological, physical and social difficulties such as pains, nausea, vomiting, insomnia and lethargy, including stress, anxiety and depression. All these affect the overall quality of life of women with breast cancer. (Lerman, Jarski, Rea, Gellish and Vicini,2011).

Quality of life (QOL) is a multidimensional concept which is defined as a person’s view of life, and with her satisfaction and pleasure with life (Arriba, 2010). Quality of life is the perceived quality of an individual’s daily life, that is, an assessment of their well being or lack of it. Quality of life includes the emotional, social, and physical aspects of the individual’s life. (Centre for Disease Control (CDC) 2014). Health-Related Quality of Life (HRQOL) is an individual’s satisfaction or happiness with the domains of life in so far as they affect or are affected by health. (American Thoracic Society, 2007). In health care, health-related quality of life (HRQOL) is an assessment of how an individuals’ well being may be affected over time by a disease, disability or disorder. Health-Related Quality of life typically involves the assessment of several dimensions/domains: physical well being, psychological well-being, social well-being, and spiritual well-being. For cancer patients, all these aspects of life are influenced. Breast cancer survivors increasingly experience long-term side effects that influence their quality of life (Wonghongkul, Dechaprom, Phumivichuvate and Losawatkul, 2006).

Although health-related quality of life can be affected positively or negatively by the outcome of treatment, there is always something the nursing team can do to improve it. Nurses can only provide effective and comprehensive nursing care to patients with breast

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cancer and their families if they understand these patients’ experiences in every area of their lives, hence the need for this study.

Statement of the Problem

Breast cancer has a lot of burden on the health-related quality of life of the individual as well as the society at large. The population of women with breast cancer is growing with breast cancer accounting for 40% of cancers among Nigerian women (Obinna, 2012). Women with breast cancer are at risk of poor health-related quality of life outcomes due to a number of reasons such as ignorance of the larger proportion of the populace on the causes and preventive measures and treatment options, late presentation and diagnosis at the hospitals, lack of facilities or ill equipped hospitals, (most cancer treatment centers in Nigeria lack modern diagnostic equipment).Also there is lack or insufficient manpower resulting to poor attention to patients’ experiences during diagnosis and treatment, high cost of treatment and fewer screening and treatment centers and all these have impact on the woman and will likely affect her quality of life.

The researcher during her hospital stay in the female surgical ward of the University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, witnessed how women with breast cancer experienced physiological pains, psychological distress for fear of approaching death, abandonment by friends and relations due to financial burden and feelings of hopelessness especially following the diagnosis and treatment. These situations are sometimes worsened by the side effects of treatment regimen and these women are usually faced with the challenges that affect their quality of life.

The foregoing prompted the interest of the researcher to compare the quality of life of these women at the University of Nigeria Teaching Hospital Ituku/Ozalla with those of other women without cancers since the hospital is a referral centre and handles referral cases from

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the South East zone of Nigeria and beyond and so handles most breast cancer cases in the south east region.

Purpose of the Study

This study was carried out to assess the health-related quality of life of women with breast cancer at UNTH Ituku/Ozalla and compare it with that of those without cancer in the different domains of life namely: physical, psychological and social.

Objectives

This research study was conducted to:

1.                 Assess the health-related quality of life of women with breast cancer and that of women with no breast cancer in the three domains- physical, psychological and social domains of life.

2.                 Compare the health-related quality of life scores of women with breast cancer and women with no breast cancer in the physical domain of life.

3.                 Compare the health-related quality of life scores of women with breast cancer and women with no breast cancer in the psychological domain of life.

4.                  Compare the health-related quality of life scores of women with breast cancer and

women with  no breast cancer in the social domain of life.

5.                 Determine the relationship between demographic characteristics e g. age, marital status, occupation and quality of life scores of women with breast cancer and those of women with no breast cancer.

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Research hypothesis

1.                  There is no significant difference in the health-related quality of life scores of women with breast cancer and those with no cancers in the physical domain of life.

2.                 There is no significant difference in the health-related quality of life scores of women with breast cancer and those with no cancers in the psychological domain of life.