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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 13  |  Issue : 3  |  Page : 293-297

Assessment of quality of life in patients receiving radiotherapy: A multicentric study


Department of Oral Medicine and Radiology, SRM Dental College, Chennai, Tamil Nadu, India

Date of Submission19-Nov-2020
Date of Decision28-Feb-2021
Date of Acceptance02-Mar-2021
Date of Web Publication18-Jun-2021

Correspondence Address:
Dr/ A Srividya
Department of Oral Medicine and Radiology, SRM Dental College, Bharathi Salai, Ramapuram, Chennai 600089, Tamil Nadu.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_332_20

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  Abstract 

Aim: Biomedical and psychosocial factors are crucial in ensuring overall positive patient outcomes after any treatment. Patients diagnosed with cancer often suffer from decreased morbidity due to fear, social stigma, and the side effects of various treatment modalities, including radiotherapy (RT). This study aims at assessing the Quality of Life (QOL) among patients suffering from cancer who are undergoing RT. It seeks to elucidate the factors affecting QOL during RT. Materials and Methods: A cross-sectional observational study was conducted at four cancer tertiary centers in Chennai city. Hundred and six patients undergoing RT were randomly selected. They were further grouped into three groups based on their treatment phase. The study used the Functional Assessment of Cancer Therapy - General questionnaire (FACT-G) to determine family, emotional, physical, and functional well-being of the patients. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS 20.0) software. Chi-square test was done to assess the relationship between QOL with gender and different treatment phases. The study used Kendell’s tau b test to evaluate the relationship between age and QOL. Results: Overall QOL scores showed that the majority (46%) of the patients experienced a good QOL. Statistical analysis showed no significant relationship between different phases of treatment and sexes with QOL. There exists a statistically significant negative relationship between age and QOL. The assessment of the QOL subscales revealed that all the patients received an excellent safety net from family, but physical well-being was the most affected. Conclusion: This confirms the aim that QoL wanes during the course of RT. Physical well-being was the most affected among the patients. Sex and treatment phase did not affect the QOL in patients, whereas there was a negative correlation between age and QOL. A routine QOL assessment as part of the treatment and prognosis is indispensable in the future.

Keywords: Cancer, Fact G, Palliative Care, Qol, Radiation Oncology, Radiation Therapy


How to cite this article:
Anbu Meena S, Srividya A, Kannan A, Krithika C L, Aniyan Y. Assessment of quality of life in patients receiving radiotherapy: A multicentric study. J Int Oral Health 2021;13:293-7

How to cite this URL:
Anbu Meena S, Srividya A, Kannan A, Krithika C L, Aniyan Y. Assessment of quality of life in patients receiving radiotherapy: A multicentric study. J Int Oral Health [serial online] 2021 [cited 2021 Oct 26];13:293-7. Available from: https://www.jioh.org/text.asp?2021/13/3/293/318453


  Introduction Top


“Quality of life (QoL) is an individual’s perception of their position of life in the context of culture, value systems in which they live and about their goals, standards, expectations and concerns.”[1] Health-related QOL includes determining the health and general aspects of patients presenting with various diseases.[2] According to the World Health Organization (WHO), cancer is the second deadliest disease, with 9.6 million deaths in 2018. In India, 97 per 1,00,000 people have cancer, especially in urban areas. The out-of-pocket expenditure incurred for cancer therapy in India is Rs. 29,066 and Rs. 84,320 in the public and private health care sectors, respectively.[3]

RT, as a primary or neoadjuvant treatment modality for oral cancer, is well established.[1] RT impairs physical, psychological, and social QoL. In patients undergoing treatment.[4] There are a few studies to elucidate the mental and physical impact of RT among patients with cancer. The present study hypothesizes that RT has a profound effect on QoL. The present study aims at determining QoL in patients with RT using FACT-G.


  Materials and Method Top


Study design

A multicentric, cross-sectional observational study was conducted in the four tertiary cancer centers by the same researcher in Chennai. The sample size was calculated with nMaster software (version 2.0) using the Regression-Correlation coefficient method. Alpha error (%) and Power (1-β) were kept at 5% and 95%, respectively. The minimum number of samples required by keeping Alpha and Beta at 5% and 80%, respectively, is 64.

Sample recruitment

Hundred and six patients undergoing RT were randomly selected. Patients were grouped into three groups based on the total duration of their radiotherapy. The RT duration was divided into three phases: first (beginning of RT), second (middle of RT), and third phase (end of RT). Patients were grouped into three phases based on their RT treatment stage at the point of survey.

Inclusion criteria were: cancer patients aged 32–80 years; all patients receiving radiotherapy intensity modulated radiotherapy (IMRT) irrespective of duration and dosage of radiotherapy; and patients receiving radiotherapy as primary or as adjuvant therapy.

Exclusion criteria were patients not receiving radiotherapy and patients treated with any other modality alone.

Questionnaire

The study used FACT-G Questionnaire to determine the family, emotional, social and functional well being of the patients, as shown in [Figure 1](A,B). FACT-G was developed by Dr. David Cella in 1987 for assessing the QoL in cancer patients. It is available in more than sixty languages. It has high validity and reliability.[5],[6]
Figure 1: (A,B) FACT-G questionnaire (English and Tamil version)

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Informed consent

Patients were informed in detail about the study. Only willing participants were recruited into the study after consent. Patients were explained that nonparticipation in the survey would not interfere with their routine treatment.

Data collection

The data were collected using both the English and Tamil forms (non-English speakers). Interview method was employed by a single observer in the presence of an expert (both languages) having 20 years of experience. Both were blinded to the study purpose and outcome. No attrition of the participants was seen in the present study due to the cross-sectional design of the study.

Statistical analysis

Statistical analysis was performed using SPSS, IBM, version 20.0 software. Chi-square test, which is a statistical test for categorical data, was used to assess the association between QoL with gender and treatment phases. Kendall’s tau b test is a nonparametric test that measures correlation between two variables. It was used to assess the relationship between age and QoL.


  Results Top


In the present study, out of 106 patients, 47 were males and 59 were females. The maximum patients were suffering from head and neck cancer (49), followed by breast cancer (23) and rectal cancer (4), respectively. The entire treatment days were subdivided into three phases, namely first (initial), second (intermediate), and third (final) phases. Overall QOL scores showed that 46% of patients had good, 40% had moderate, and 20% had poor QOL [Table 1] and [Table 2]. There was no statistically significant correlation found between QoL and gender (chi-square value = .337), as shown in [Table 3].
Table 1: Descriptive statistics of QoL in both the sexes

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Table 2: Descriptive statistics (%) of QoL in different stages of radiotherapy treatment

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Table 3: Chi-square tests showing correlation between sex and QoL of the patients

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There was no statistically significant correlation between QOL and the different treatment phases (χ2 = 2.014). Most of the patients were in their third phase of the treatment, that is 45, followed by 39 patients in the first and 23 in the second phases, respectively, as shown in [Table 4].
Table 4: Chi-square test showing correlation between treatment phase and QoL among the patients

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While evaluating each subscale in the QoL, family well-being was the best; this illustrates that almost every patient was getting support from the family. Emotional and functional well-being did not show significant variation. Physical well-being was the least, as shown in [Figure 2]. This can be attributed to the debilitating nature of the disease and the RT’s side effects. There was a negative correlation between QoL and advancing age (“r”= −0.190), as seen in [Table 5], [Figure 3].
Figure 2: Descriptive analysis of different subscales of well-being and patients

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Table 5: Kendall’s tau b test showing correlation between age of the patients and the QoL

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Figure 3: Co-relation between age and QoL

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  Discussion Top


The present study showed deterioration in the QoL of patients undergoing RT. Patient-specific and disease-specific factors together influence QoL. Deteriorating QoL has a profound effect on the continuation of treatment and the patient’s psychology. QoL may be perceived differently across various cultures and countries.[2] QoL is a multivalent and multidimensional concept that has both subjective and objective components.[7]

The present study found no association between gender and QoL; the results were similar to those of Elumelu et al., who found no association between QoL and gender using EORTC QLQ C-30.[8] Functional and psychosocial problems were more prevalent in males and were more in the initial treatment phase, as found in the study conducted by Gridhar et al.[1] Initially, patients in the present study had good family support. During the later phase, their functional and social well-being was adversely impacted. Physical status was the most affected during the RT treatment.

The present study results are similar to those of Bansal et al., who used EORTC QLQ C30 to evaluate 45 cancer patients undergoing RT.[9] In their prospective study, de Graeff et al. showed that mean global health and functional well-being was worse during RT than post-RT.[10] In the present study, patients, irrespective of the stage, had poor QoL; the results are dissimilar to previous studies, which found the stages of tumors and their sites to play an essential role in QoL.[11],[12],[13] The present study found a negative correlation between age and QoL; similar results were found by Kinoshita et al., in their prospective study on patients with colorectal cancer.[14] The results are not as per the results of M. Nayak et al., who found the QoL of patients with cancer to be independent of age.[15] Studies have shown a plummeting QoL among the aged population owing to their physical, financial, and social status.[16],[17]

The present study is multicentric. The study elucidates the effect of sex, treatment phase, and age on QoL’s four major subscales. Due to the cross-sectional study design and limited sample, the present study’s results cannot be generalized. Future studies focusing on oral health-related QOL in patients with head and neck cancer with a larger sample size are necessary. Also, the effect of other treatment modalities should be evaluated. Routine QoL assessment screening of patients with cancer will help build a rapport between the doctor and the patient; it will also improve treatment outcomes.[14] The management of cancer requires a multidisciplinary approach for long-term cure and organ preservation.[15]


  Conclusion Top


In the current study, patients enjoyed better family well-being, though physical well-being was most affected. The study reinstates the need to make the QoL assessment a regular feature from the early stages of cancer detection till the follow-up phase. QoL helps understand the impact of the disease and its treatment on life from the patient’s perspective. It will help in easing patients’ life post-therapy.

Acknowledgments

I would like to express my sincere and heartfelt gratitude to Dr. L. Padmanabhan, Dr. R. R. Rai, and Dr. Kartik Selvaraj, for being my source of inspiration and their help in completing this work.

Financial support and sponsorship

No funding was received for the present study.

Conflicts of interest

Nil.

Authors’ contributions

Not applicable.

Ethical policy and Institutional Review board statement

The present research gained clearance from the Institutional Review Board (SRM Dental College, Ramapuram-SRM/MandHS/SRMDC/2019/PG/011). The study was conducted based on the “Declaration of Helsinki” and reported using the “STROBE” criteria.

Patient declaration of consent

Patients were explained to in detail about the study, and only willing participants were recruited after written consent was obtained.

Data availability statement

The dataset used in the current study can be made available on reasonable request, by contacting the corresponding author.

 
  References Top

1.
Naidu GS, Shukla S, Nagi R, Jain S, Makkad RS. Evaluation of oral health related quality of life in subjects diagnosed with head and neck malignancies undergoing chemotherapy, radiotherapy, and surgery. J Indian Acad Oral Med Radiol 2019;31:228.  Back to cited text no. 1
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2.
Theofilou P. Quality of life: Definition and measurement. Europe’s J Psychol 2013;9:150-61.  Back to cited text no. 2
    
3.
Rajpal S, Kumar A, Joe W. Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014. PLoS One 2018;13:e0193320.  Back to cited text no. 3
    
4.
Takahashi T, Hondo M, Nishimura K, Kitani A, Yamano T, Yanagita H, et al. Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy. Radiat Med 2008;26:396-401.  Back to cited text no. 4
    
5.
Cella D. Quality of life: Concepts and definition. J Pain Symp Manage 1993;9:186-92.  Back to cited text no. 5
    
6.
Webster K, Odom L, Peterman A, Lent L, Cella D. The functional assessment of chronic illness therapy (FACIT) measurement system: Validation of version 4 the core questionnaire. Qual Life Res 1999;8:604.  Back to cited text no. 6
    
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Mooney A. Quality of life: Questionnaires and questions. J Health Commun 2006;11:327-41.  Back to cited text no. 7
    
8.
Elumelu TN, Adenipekun AA, Abdus-salam AA, Bojude AD, Campbell OB. Quality Of life in patients with head and neck cancer on radiotherapy treatment at Ibadan. Researcher 2011;3:1-10.  Back to cited text no. 8
    
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Bansal M, Mohanti BK, Shah N, Chaudhry R, Bahadur S, Shukla NK. Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy. Qual Life Res 2004;13:481-8.  Back to cited text no. 9
    
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de Graeff A, de Leeuw JR, Ros WJ, Hordijk GJ, Blijham GH, Winnubst JA. Long-term quality of life of patients with head and neck cancer. Laryngoscope 2000;110:98-106.  Back to cited text no. 10
    
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McKernan M, McMillan DC, Anderson JR, Angerson WJ, Stuart RC. The relationship between quality of life (EORTC QLO-C30) and survival in patients with gastro-oesophageal cancer. Br J Cancer 2008;98:888-93.  Back to cited text no. 11
    
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Alicikus ZA, Akman F, Ataman OU, Dag N, Orcin E, Bakis B, et al. Importance of patient, tumour and treatment related factors on quality of life in head and neck cancer patients after definitive treatment. Eur Arch Otorhinolaryngol 2009;266:1461-8.  Back to cited text no. 12
    
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Fang FM, Tsai WL, Chien CY, Chiu HC, Wang CJ. Health-related quality of life outcome for oral cancer survivors after surgery and postoperative radiotherapy. Jpn J Clin Oncol 2004;34:641-6.  Back to cited text no. 13
    
14.
Yucel B, Akkaş EA, Okur Y, Eren AA, Eren MF, Karapinar H, et al. The impact of radiotherapy on quality of life for cancer patients: A longitudinal study. Support Care Cancer 2014;22:2479-87.  Back to cited text no. 14
    
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Weng NG, Jacob SA, Delaney GP, Barton MB. Chemotherapy in head and neck cancers: Summary of recommendations and a critical review of clinical practice guidelines. Eur J Clin Med Oncol 2010;2:65-71.  Back to cited text no. 15
    
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Webb E, Blane D, McMunn A, Netuveli G. Proximal predictors of change in quality of life at older ages. J Epidemiol Community Health 2011;65:542-7.  Back to cited text no. 16
    
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Brett CE, Dykiert D, Starr JM, Deary IJ. Predicting change in quality of life from age 79 to 90 in the lothian birth cohort 1921. Qual Life Res 2019;28:737-49.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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