Assessing the Quality of Life of Patients With Radiation and Chemotherapy

INTRODUCTION

Cancer is the second leading cause of death globally, accounting for one in six deaths, with nearly 70% occurring in low- and middle-income countries. In India, cancer mortality has doubled between 1990 and 2016. In 2018, the country recorded about 1.15 million new cancer cases, and this number is projected to almost double by 2040 due to demographic changes. Globally, lung cancer remains the leading cause of cancer-related deaths, accounting for 18% of all cancer fatalities, while in India, it has an incidence rate of 5.5% and contributes to nearly 8% of cancer deaths.^[1]

Radiation therapy is a widely used cancer treatment, but it may produce long-term morbidities that emerge months or years after exposure, often becoming permanent. These adverse effects significantly influence patients’ quality of life (QoL), making its assessment vital yet complex. Evaluating toxicities requires careful differentiation between acute and chronic effects and consideration of varied follow-up durations. Clear reporting is needed as most acute effects gradually resolve over time. With improved survival and advances in treatment, there is an increasing focus on patient-reported outcomes and QoL.^[2] Ionizing radiation damages both cancerous and normal cells within the treatment field; unlike surgery, which is invasive, and chemotherapy, which produces systemic effects, radiotherapy is localized and non-invasive.^[3]

While radiotherapy can help patients maintain relatively good QoL, it may also induce stress and psychological symptoms. Side effects differ by radiation technique and treatment site. Many arise from cytotoxicity and inflammatory responses, leading to nausea, vomiting, fatigue, edema, or erythema. Although these are generally mild and self-limiting, they can evoke psychological distress, including anxiety and depression. Frequent treatment sessions may further remind patients of their illness, contributing to emotional burden and social withdrawal.^[3]

In India, evidence on QoL among cancer patients remains limited, with most research emerging from Western populations. Scanty reports indicate poor QoL among patients receiving chemotherapy.^[4] Some studies indicate that lower income was linked to reduced physical, social, and psychological well-being.^[5] Studies on breast cancer patients noted overall good QoL but highlighted concerns regarding sexual functioning. Research is concentrated mainly in southern and eastern India, with fewer studies from northern regions. Significant associations between socio-demographic and clinical variables and breast cancer QoL have been reported.^[6] Lung cancer patients in North India experienced declines in overall QoL and social functioning post-treatment.^[7] Chemotherapy administered orally, intravenously, or subcutaneously affects QoL depending on cancer type and treatment stage.^[8]

Cancer impacts all aspects of an individual’s life. The diagnosis of malignancy profoundly diminishes a patient’s QoL, which can persist due to the aggressive nature of treatment. Patients often undergo chemotherapy and radiation therapy as part of their treatment regimen.^[9] The objective was to find the QoL of patients with radiation and chemotherapy.

MATERIAL AND METHODS

A quantitative approach using a descriptive cross-sectional study design was conducted among 132 cancer patients aged 20 years and above who underwent either radiation or chemotherapy treatment. Ethical consent was obtained from the NUINS/CON/NU/IEC/2019–20/1471 ethical committee of the institute on April 10, 2019. The study took place at a selected tertiary care hospital in Mangalore, a 1000-bed facility with an oncology department offering radiation and chemotherapy. The study procedures were explained, and informed consent was obtained from all participating patients. The sample size was calculated based on the estimation of the proportion, and purposive sampling was used for data collection. The study inclusion criteria were all the radiation therapy or chemotherapy patients with stage I and II cancer, and those willing to participate were included in the study. Those patients undergoing combined interventions of radiation and chemotherapy or surgery were excluded from the study.

The data were collected by using the two tools. The investigator reviewed the article and prepared the demographic and QoL assessment tool. The first tool focused on demographic characteristics, including 12 items including types of cancer. The second tool was used to assess the QoL of patients with radiation and chemotherapy by using a four-point rating scale. This tool focused on seven domains: general well-being, physical well-being, economic well-being, cognitive well-being, spiritual well-being, rest and sleep, and psychological well-being. Participants rated each domain on a scale from 0-3, with higher scores indicating better QoL and those with lower scores indicating poor QoL, which was estimated based on the review of literature.^[9,10] The tool was validated by seven nursing experts. A pilot study was conducted, and the data were analysed. The reliability of the tool was assessed by using Cronbach’s alpha = 0.82, and it was found to be reliable. The data was collected after explaining the purpose of the study and obtaining consent. Collected data were entered into a Microsoft Excel spreadsheet, and analyses were done using SPSS version 20 for Windows.

RESULTS

This study focuses on the QoL of cancer patients in the radiation and chemotherapy group. The collected data were analysed for normality using the Shapiro-Wilk test, and it was found that the data followed normality as the p >0.05 value for the Shapiro-Wilk test.

Description of the type of cancer among the radiation and chemotherapy groups

The present study depicts that among those who underwent radiation therapy, the types of cancer were as follows: Cervical cancer (20, 30.3%), Breast cancer (16, 24.2%), Mouth cancer (12, 18.1%), Lung cancer (8, 12.3%), Rectal cancer (3, 4.5%), and other cancers (7, 10.6%). In the chemotherapy group, the types of cancer were: Cervical cancer (18, 27.2%), Breast cancer (20, 30.3%), Mouth cancer (9, 13.6%), Lung cancer (7, 10.6%), Rectal cancer (1, 1.7%), and other cancers (11, 16.6%) [Figure 1].

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Figure 1:

Type of cancer among radiation and chemotherapy groups.

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DISCUSSION

This study focused on subjects who were majority aged 41-60 years. A similar study was conducted to assess the QoL of cancer patients, which depicts that the mean age at diagnosis was 57 years (range, 16-86 years).^[11]

The present study result depicts the reported cases of smoking and alcohol consumption in both groups. These results were congruent with the study concluding that alcohol and tobacco, alone or in combination, are associated with an increased risk of various cancers.^[12]

In this study had a family history of cancer this was similar to the study report it shows that 08 (51.08%) reporting first degree relatives with cancer.^[12] The majority of participants in both groups had been diagnosed with cancer for less than 1-6 months, these findings were supported by the cohort study results it depicts the cancers with the shortest median diagnostic intervals were breast (26 days), testicular (44 days), and lung (112 days), cervical (232 days) The 90th centile diagnostic intervals were 4–7 months for both cohorts for breast and testicular cancers.^[13]

Present study depicts that radiation or chemotherapy treatment given for different types of cancer like breast cancer, cervical cancer, rectal cancer, and ovarian cancer, obtained similar findings to the study conducted by Seol KH et al., it also depicts breast cancer in 7 (26.9%), cervical cancer in 4 (15.4%), rectal cancer in 2 (7.7%), ovarian cancer in 1 (3.8%), and lung cancer in 1 (3.8%). ³ Another study also supported that most were diagnosed with cervical (32.7%) and breast cancer (14.5%).^[14]

The results show that the QoL of patients receiving radiation therapy showed that out of seven domains, physical and economic well-being were more worsened compared to other domains. Similar findings were observed in a study conducted by Seol KH et al., which also indicated that economic imbalance and financial difficulty were significantly associated with a lower QoL score (p = 0.010).^[3]

In chemotherapy (Group 2), the affected domain was physical and spiritual well-being. In another study, findings indicated that the emotional domain was minimally impacted in both study groups (p = 0.800). Specifically, 92% of patients undergoing radiotherapy reported mild effects on their physical domain, compared to 47% of patients receiving chemotherapy who reported moderate effects.^[15]

The findings of the other study involving chemotherapy patients showed a statistically significant enhancement was observed in the overall QoL score (p = 0.005). Conversely, cognitive functioning notably declined (p = 0.01). Despite improvements in physical (PF) and emotional functioning (EF) scores, role (RF) and social functioning (SF) scores exhibited a decrease.^[16]

In this study, significant differences between the two groups were found in general, economic, cognitive, spiritual, and psychological domains. A similar pattern has been reported in the literature: Raoof et al. compared QoL in cancer patients treated with chemotherapy versus radiotherapy and found that patients receiving chemotherapy experienced more impairment in several QoL domains compared to the radiotherapy group.^[16]

CONCLUSIONS

A cancer diagnosis presents one of the most profound health challenges, deeply affecting patients’ overall well-being throughout their treatment journey. Radiation therapy and chemotherapy remain the most commonly used cancer treatments. This chapter explores the QoL in patients undergoing these therapies and highlights areas for future research. The QoL domains differ between patients undergoing radiation therapy and those receiving chemotherapy.