Ahmed Nuru

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Nursing Thesis and Dissertations
2021-07
Quality of Life and Associated Factors

Among Adult Cancer Patients
Undergoing Chemotherapy Treatment at
Amhara National Regional State,
Ethiopia, 2021
Ahmed, Nuru
http://ir.bdu.edu.et/handle/123456789/13431
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BAHIR DAR UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCES
DEPARTMENT OF ADULT HEALTH NURSING
QUALITY OF LIFE AND ASSOCIATED FACTORS AMONG ADULT

CANCER PATIENTS UNDERGOING CHEMOTHERAPY TREATMENT AT
AMHARA NATIONAL REGIONAL STATE, ETHIOPIA, 2021
BY: AHMED NURU (BSC)
JULY 2021
BAHIR DAR, ETHIOPIA
i
SCHOOL OF HEALTH SCIENCES
QUALITY OF LIFE AND ASSOCIATED FACTORS AMONG ADULT CANCER

PATIENTS UNDERGOING CHEMOTHERAPY TREATMENT AT AMHARA
NATIONAL REGIONAL STATE, ETHIOPIA, 2021
BY:
AHMED NURU (BSC)
Advisors: Mr. Sitotaw Kerie (Assistant professor)

Mr. Henok Biresaw (Assistant professor)
A THESIS SUBMITTED TO THE DEPARTMENT OF ADULT HEALTH

NURSING, SCHOOL OF HEALTH SCIENCES, COLLEGE OF MEDICINE,
AND HEALTH SCIENCES, BAHIR DAR UNIVERSITY FOR PARTIAL
FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF
MASTERS IN ADULT HEALTH NURSING.
JULY 2021
BAHIR DAR, ETHIOPIA
ii
Declaration
This is to certify that the thesis entitled “Quality of life and associated factors among adult cancer
patients undergoing chemotherapy treatment at Amhara National Regional State, Ethiopia, 2021
submitted in partial fulfillment of the requirements for the degree of Master of Adult Health Nursing,
in school of Health sciences of Department of Adult Health Nursing, Bahir Dar University, is a
record of original work carried out by me and has never been submitted to this or any other
institution to get any other degree or certificates. The assistance and help I received during the course
of this investigation have been duly acknowledged.
Ahmed Nuru Muhamed (Bsc) ______________ _____________
Name of the candidate Date Signature
iii
ADVISOR’S APPROVAL FORM
Approval of Thesis Report
I hereby certify that I have supervised, read, and evaluated this thesis titled “Quality of life, and
associated factors among adult cancer patients undergoing chemotherapy treatment at Amhara
National Regional State, Ethiopia: 2021by Ahmed Nuru prepared under my guidance. I recommend
the thesis reported be submitted for oral defense.
Advisor’s name Signature Date
1. Mr. Sitotaw Kerie (Bsc, Msc, Assistant Professor) ____________ __________

2. Mr. Henok Biresaw (Bsc, Msc, Assistant Professor) ____________ ___________
iv
EXAMINER’S APPROVAL FORM

Approval of Thesis Report
We hereby certify that we have examined this dissertation/thesis entitled “Quality of

life and associated factors among adult cancer patients undergoing chemotherapy
treatment at Amhara National Regional State, Ethiopia, 2021 by Ahmed Nuru. We
recommend and approve the thesis a degree of “Master of Sciences in Adult Health
Nursing”
Board of Examiners
_____________________ ________________ _____________
External examiner’s name Signature Date
_____________________ ________________ _____________
Internal examiner’s name Signature Date
_____________________ ________________ _____________
Chair person’s name Signature Date
v
ACKNOWLEDGEMENT
First and foremost, I would like to express my deepest gratitude to My Advisors Mr. Sitotaw Kerie
and Mr. Henok Biresaw for their unreserved guidance and constructive comments to accomplish
this research paper. Next, my genuine thanks go to Bahir Dar University and Wolkite University for
giving me an opportunity for my education and financial support. My thank also goes to the Felege
Hiwot Comprehensive Specialized Hospital and University of Gondar Specialized Hospital
oncology department & their staffs for their valuable cooperation and contribution during the data
collection process. Last but not least I would like to express my gratitude to the supervisors, all data
collectors for their involvement and study participants who were voluntary and spent their precious
time to give valuable evidence during the data collection time.
vi
ACRONYMS AND ABBREVIATIONS
ANRS --------------------------------Amhara National Regional State
CF--------------------------------------Cognitive Functioning
EF--------------------------------------Emotional Functioning
ETB------------------------------------Ethiopian Birr
ECOG----------------------------------Eastern cooperative oncology Group
EORTC-------------------------------European organization for research and treatment of cancer
EORTC QLQ C30 ------------------European organization for research and treatment of cancer
quality of life questionnaire core 30
FMOH----------------------------------Federal Ministry of Health
FHCSH---------------------------------Felege Hiwot Comprehensive specialized Hospital
GLOBOCAN ------------------------ Global cancer observatory
HRQOL-------------------------------Health-Related Quality of life
LMICs ------------------------------- Low- and Middle-Income countries
PF--------------------------------------Physical Functioning
NCD----------------------------------- Non-Communicable Diseases
RF--------------------------------------Role Functioning
SF--------------------------------------Social Functioning
SPSS-----------------------------------Statistical Package For Social Science
TASH----------------------------------Tikur Anbessa Specialized Hospital
UGSH---------------------------------University of Gondar Specialized Hospital
UK -------------------------------------United Kingdom
USA------------------------------------United States of America
WHO-----------------------------------World Health Organization
iv
TABLE OF CONTENT
Table of Contents
ACKNOWLEDGEMENT .........................................................................................................vi
ACRONYMS AND ABBREVIATIONS ..................................................................................iv
TABLE OF CONTENT ..............................................................................................................v
LIST OF TABLES ................................................................................................................... viii
LIST OF ANNEXES ..................................................................................................................x
1.1 Background of the Study ....................................................................................................... 1
1.2 Statement of the problem ...................................................................................................... 3
1.3 Significance of the study ....................................................................................................... 4
2. LITERATURE REVIEW....................................................................................................... 5
2.1. Quality of life of patients with cancer ................................................................................. 5
2.2. The symptoms experienced by cancer patients undergoing chemotherapy ........................ 6
2.3 Factors Associated with Quality of life ................................................................................ 8
2.3.1 Sociodemographic characteristics ...................................................................................... 8
2.3.2 Psychological Factors ......................................................................................................... 9
2.3.3 Clinical characteristics and QoL ..................................................................................... 10
2. 4 CONCEPTUAL FRAMEWORK ..................................................................................... 12
3. OBJECTIVES ...................................................................................................................... 13
3.1 General objective................................................................................................................. 13
3.2 Specific Objectives ......................................................................................................... 13
4. METHODS .......................................................................................................................... 14
4.1. Study area and period ........................................................................................................ 14
v
4.2 Study design ....................................................................................................................... 14
4.3. Population ......................................................................................................................... 15
4.3.1 Source Population ............................................................................................................ 15
4.3.2 Study population .............................................................................................................. 15
4.4. Inclusion and Exclusion criteria ........................................................................................ 15
4.4.1 Inclusion criteria:.............................................................................................................. 15
4.4.2 Exclusion Criteria:............................................................................................................ 15
4.5 Study Variables .................................................................................................................. 15
4.5.1 Dependent variables ......................................................................................................... 15
4.5.2 Independent variables ....................................................................................................... 15
4.6. Operational definition: ...................................................................................................... 16
4.7. Sample size determination ................................................................................................ 16
4.8. Sampling technique and Sampling Procedures ................................................................. 18
4.9. Data collection ................................................................................................................. 18
4.9.1 Data collection tool: ........................................................................................................ 18
4.10.2 Data collection procedure............................................................................................... 20
4.11. Data Quality assurance: .................................................................................................. 20
4.12. Data processing and analysis .......................................................................................... 20
4.13. Ethical clearance ............................................................................................................. 22
5. RESULT ............................................................................................................................... 23
5.1 Socio-Demographic characteristics ..................................................................................... 23
5.2 Clinical characteristics ........................................................................................................ 25
5.3 Psychological Factors.......................................................................................................... 27
vi
5.3.1 Anxiety and depression ................................................................................................ 27
5.4. Quality of life scores ........................................................................................................ 28
5.4.1. Global health status/QOL ................................................................................................ 28
5.4.2. Functional and symptom scale scores of EORTC QLQ C-30 ........................................ 28
5.5. Factors associated with Quality of Life ............................................................................ 29
6. DISCUSSION ................................................................................................................ 33
7. LIMITATION OF THE STUDY ......................................................................................... 38
8. CONCLUSION AND IMPLICATION ............................................................................... 39
8.1 Conclusion........................................................................................................................... 39
8.2 Implication to Nursing practice ........................................................................................... 39
9. RECOMMENDATION ................................................................................................. 40
REFERENCES......................................................................................................................... 41
ANNEXES ............................................................................................................................... 46
vii
LIST OF TABLES
Table 1: Sample size calculation by using different variables. ................................................ 17

Table 2: Socio-demographic characteristics of adult cancer patients under chemotherapy
treatment at ANRS, Ethiopia 2021. n=310 .............................................................................. 24
Table 3: Clinical characteristics of adult cancer patients under chemotherapy at ANRS,
Ethiopia, 2021 n = 310 ............................................................................................................. 26
Table 4: Anxiety and depression among adult cancer patients under chemotherapy at ANRS,
Ethiopia, 2021 n = 310 ............................................................................................................. 27
Table 5: Functional and symptom scale score among adult cancer patient undertaking
chemotherapy treatment at ANRS, Ethiopia, 2021 n = 310 ..................................................... 29
Table 6: Bivariable and multivariable logistic regression of determinant factors with QoL of
adult cancer patients under chemotherapy at ANRS, Ethiopia, 2021 n=310 ........................... 31
viii
LIST OF FIGURES
Figure 1. Conceptual framework of quality of life, experiences, and associated factors among
adult cancer patients undertaking chemotherapy treatment at ANRS, Ethiopia, 2021 ............ 12
Figure 2: Quality of Life among adult cancer patients undertaking chemotherapy at ANRS,
Ethiopia: 2021 .......................................................................................................................... 28
ix
LIST OF ANNEXES
Annex 1: Information sheet ...................................................................................................... 46
Annex 2: English Version Questionnaire ................................................................................. 47
Annex 3: Amharic Version Questionnaire ............................................................................... 54
Annex 4: Scoring items ............................................................................................................ 62
x
ABSTRACT
Background: A cancer diagnosis is a very stressful event and has tremendous consequences for
most persons who experience it, affecting all aspects of life. Quality of life has become an important
patient-reported measurement in chronic diseases especially in cancer assessing how patients feel,
physically and emotionally while fighting the diseases could help in improving better care.
Chemotherapy treatment despite having therapeutic effects it has many adverse effects, which can
affect the quality of life of cancer patients. In Ethiopia factors affecting the Quality of life of cancer
patient undertaking chemotherapy treatment is not well explored.
Objective: To assess Quality of Life, and associated factors among adult cancer patients undergoing
chemotherapy treatment at Amhara National Regional State Referral Hospital oncology treatment
centers, Ethiopia, 2021.
Methods: An institutional based cross-sectional study was conducted in Amhara National Regional
state oncology treatment center from February 15 to April 30 2021. A total of 314 patients were
included using simple random sampling. Data were entered into Epi Data 4.6 and analyzed with
SPSS version 23. Data were mainly analyzed using descriptive statistics, and factors associated with
quality of life were identified by the multivariable binary logistic regression model.
A P-value of < 0.05 was used as the criterion for statistical significance and OR with 95% confidence
interval was used to indicate the strength of association.
Result: The mean age of the study participants was 45.79 years. The mean Quality of Life of cancer
patients was 44.32. Multivariable logistic regression revealed that college and above education AOR
4.3 (1.49-12.32), underweight AOR 0.45 (0.24-0.84), >5th cycle of chemotherapy AOR 4 (1.78-
9.11), stage IV cancer AOR 0.21(0.06-0.71), comorbidity AOR 0.28 (0.14-0.57), anxiety AOR 0.32
(0.12-0.84), and depression AOR 0.29 (0.13-0.63) were significantly associated with quality of life.
Conclusion and recommendation: Quality of life of adult cancer patients under chemotherapy
treatment at Amhara National Regional State was poor. Education, anxiety, depression,
comorbidity, body mass index, stage of cancer, cycle of chemotherapy were significantly associated
with Quality of Life. Therefore, Quality of life assessments, appropriate symptom management,
nutritional support, and integration of psycho-oncology care shall be included to improve their
quality of life.
Keywords: cancer, Quality of life, chemotherapy
xi
1. INTRODUCTION
1.1 Background of the Study
According to the Global cancer observatory (GLOBOCAN 2020) estimate, the incidence of cancer
will increase from 19.3 million to 30.2 million, and its mortality from 9.9 million to 16.3 million
in 2040. In Africa, the incidence and mortality of cancer are estimated to increase from a
1.11million to 2.10 million, and 711thousand to 1.37 million respectively in 2040. Likewise, the
rate of cancer is escalating in Ethiopia. The incidence of cancer will increase from 7400 to 151,000
and cancer-related mortality will increase from 51,900 to 102,000 in the year 2040 (1). The
increasing prevalence of cancer in recent years, and its effects on various physical, psychological,
and social dimensions of human life, have made it the century's major health problem (2).
Cancer is a group of diseases characterized by uncontrolled and unregulated growth of cells that
can affect any part of the body. Despite advances in medicine, being diagnosed with cancer is a
very stressful event and has tremendous consequences for most persons who experience it, affecting
all aspects of life (3). Previous studies have shown that cancer patients experienced a wide range
of physical, psychosocial, financial issues, alongside other confrontations, and the endless struggle
during the disease decreases their quality of life (4–6).
The World health organization (WHO) define Quality of life (QoL) as an individual's perception
of life, values, objectives, standards, and interests in the context of the culture (7). It is a subjective
and wide concept that assesses individuals holistically including physical, psychological, social,
and spiritual aspects and it can be affected by many factors relating to physical health,
psychological state, level of independence, and social relations, as well as personal beliefs and their
relations with significant aspects of the external environment (8) and measured through varying
indicators, such as health status or personal functioning (7).
1
Assessment of patients' symptoms, functioning, and quality of life in everyday oncology practice
has numerous benefits including the ability to provide clinicians and patients with accurate
expectations about the likely impact of treatments on wellbeing and functioning, the ability to
identify common problems that will need to be addressed, and the ability to identify therapies and
interventions effective in addressing these problems and , as well as promoting joint decision
making when it comes to caring decisions (9). As a result, assessment of patients’ QoL is
recommended in evidence-based national guidelines for cancer care in the USA, Netherlands, and
Germany (10–12). In addition, findings suggest that QoL data may improve clinicians‟ ability to
predict treatment response and survival time in certain contexts. Besides, numerous studies have
found that a better quality of life measure is associated with longer survival of patients in different
types of cancer (8,9,13)
Quality of life has become an important patient-reported measurement in chronic diseases

especially in cancer (3). How patients feel, physically and emotionally, while they are fighting the
diseases can have an enormous effect on their ability to carry out normal daily functions as well as
on their interpersonal relationships and their ability to work (14). It has also been proposed that
determining QoL in cancer patients could help in better care and could be as prognostic as medical
factors and as the survival benefit that pharmacological treatment could provide, predicting the
individual's ability to manage the disease and maintain long-term health and well-being (3). QoL
tool is increasingly being used by clinical researchers as a primary outcome measure in studies to
evaluate the effectiveness of treatment so that proper symptomatic therapy can be provided to them
to enhance their Quality of Life (3). Furthermore, the World Health Organization has recommended
that QoL in cancer patients be considered as a major endpoint in cancer clinical trials (15).
2
1.2 Statement of the problem
Cancer can create difficulties in fulfilling family and social roles such as the ability to work or
participate in common social activities that leads them toward feeling of incompetence and lack of
confidence, and consequently affects their quality of life (3). It has been evident that poor QoL has
a negative effect not only on physiological symptoms but also on the psychological functioning of
the individual (16).
Chemotherapy is a systemic drug therapy used to destroy rapidly growing cells in the body and its
one of the most common and frequently used cancer treatment modalities (17). It can have an
impact on patients' QoL in a variety of ways, both positively (by alleviating symptoms and slowing,
halting, or reversing functional declines) and negatively (by the impact of side effects) (17).
Various studies show chemotherapy treatment often has an impact on quality of life and cause
anxiety, depression, had more unmet sexuality needs, left their jobs as the number of cycles
increased and experienced a higher level of symptoms (13,14,17,18).
Despite chemotherapy having a therapeutic effect, it has serious adverse effects that can have
detrimental effects on the QoL of an individual (17). Nausea and vomiting, loss of appetite, fatigue,
constipation, mouth ulcers, alopecia, and weight changes are the most frequently recorded side
effects encountered by patients during and after chemotherapy cycles (3,17). Furthermore,
chemotherapy treatment necessitates a long course of treatment and regular hospitalization to
achieve the desired result (17). The financial implications also bring an undue burden to their lives,
lowering their overall quality of life (17).
The patient feelings, and thoughts during cancer diagnosis and treatment are the determining factors
of the disease management and QoL. On the other hand culture influences individuals’ beliefs,
traditions, and values concerning perspectives of health and illness (19) but there is a paucity of
evidence whether patients’ experiences, influence Ethiopian cancer patients’ quality of life.
3
Considering the increasing prevalence of cancer and its destructive effects on QoL studies that
examine QoL and associated factors are very few in Ethiopia. Many of the previous studies focused
on all types of treatment modalities so they could not show the specific additional burden of
chemotherapy treatment can pose on their QoL. Besides, there were important factors that affect
the QoL of cancer patients that are yet not addressed especially in our country’s context which
includes body mass index (20,21), depression, anxiety (22) and performance status (23,24). So,
this study investigates these variables in relation to QoL. Therfoere, this current study was aimed
to assess the QoL, and associated factors among adult cancer patients undergoing chemotherapy
treatment.
1.3 Significance of the study
Cancer patients experience physical symptoms and psychological distress which can negatively
affect their quality of life. Therefore, it is critical for health care professionals to become familiar
with the effect of cancer diagnosis and its treatment on patients' QOL for enhancement of service
provision. Hence the findings of this study are expected to provide a foundation for health care
professionals to identify factors that affect the QoL of cancer patients, helps to integrate quality of
life assessment in the cancer treatment protocol, and it is also used as a source of information for
researchers, health educators, and managers
4
2. LITERATURE REVIEW
2.1. Quality of life of patients with cancer
The WHO, define health as “The state of complete physical, mental and social wellbeing
not merely the absence of disease and infirmity”(7). Quality of Life is an indication of a person’s
wellbeing in ways of the ability to perform daily task, physical, emotional, cognitive,
social, and role functioning. A study on an electronic web-based survey on QoL examines different
aspects of QoL. The most highly ranked patient-reported outcomes are quality of life (96%),
independence (95%), and ability to perform normal activities (94%) (25).
Many studies show that cancer patients in the developed countries have a better QoL in most of the
scales than in developing countries (3,13,23,26). A clinical trial and epidemiological studies on
different European countries (EORTCS Reference Manual) shows participants have a global health
status/QoL with a mean of 61.3, concerning functional domain high level of functioning was found
for the cognitive functioning (CF) with a mean of 82.6, Physical functioning (PF) 76.7, and Social
functioning (SF) 75.0 subscales, the most affected functional status was role functioning (RF) and
emotional functioning (EF) with a mean of 70.5, and 71.4 respectively (27).
A study on the quality of life of cancer patients in Nepal found that participants had a GHS/QoL
score of 85.54 and a functional scale of 77.03, indicating good quality of life in terms of individual
domains participants scored role functioning 78.84, emotional functioning 82.95, physical
functioning 83.15, cognitive functioning 85.44, and the most affected functional domain was social
functioning with a mean of 39.65 (23). A study on QoL among adult cancer patients under
chemotherapy in India reveals a mean QoL score of 61.93, but the functional well-being was the
most commonly affected in the study subjects with a mean score of 13.95 (13).
Another study conducted in Pakistan shows that the overall QoL of cancer patient found to be a
mean of 57.37, concerning functional domains, participants scored social well-being with a mean
5
of 22.33 whereas individuals had much lower scores on physical and emotional well-being, that is,
10.41and 10.32, respectively (17).
According to study in Tanzania, The overall QoL score was below average with a mean of 49.5. In
terms of individual domains, participants performed best in EF with a mean of 71.8, CF 64, and PF
53.5, while individuals performed poorly in RF 47.8 and SF 39. (28). A similar result was seen in
a cross-sectional study conducted in Rwanda on the quality of life of cancer patients undergoing
chemotherapy treatment, where participants had a QoL with a mean of 28.76, indicating poor
quality of life, and participants scored all domains below an average with a mean of EF 49.2, PF
43.47, RF 41.09, and CF 36.3 (3).
A study comparing the level of QoL of Ethiopian cancer patients with German cancer patients
found that the Ethiopian patients had lower QoL on all functioning scales (except emotional
functioning). The Ethiopian sample's functioning scale results were all associated with a global
health status/QoL Scale (26). Another cross-sectional study conducted at Tikur Anbessa
Specialized Hospital (TASH) on the evaluation of Quality of life in Ethiopia found that the
GHS/QoL Scale of a cancer patient has a mean of 57.28 (SD= 25.28) with regards to individual
domains participants scored PF with a mean of 62.71, lower EF 45.88, RF 43.36, and SF 39.69
(16).
2.2. The symptoms experienced by cancer patients undergoing chemotherapy
Cancer is one of the leading causes of morbidity and mortality (2). The most common symptoms
experienced by cancer patients undertaking chemotherapy treatment were nausea and vomiting,
pain, fatigue, loss of appetite, and weight changes (29). Also, chemotherapy can cause immuno-
suppression, alopecia, renal toxicity, cardiac toxicity, pulmonary toxicity, neurotoxicity, infertility,
chest pain, stomatitis, dyspnea, neurosensory or motor problems, and hemorrhage (29). The
presence of any or a combination of these side effects can negatively affect both clinical outcomes
6
and quality of life and disrupt treatment plans, often leading to lower adherence, and
discontinuation (29).
In the EORTCS QLQ C30 reference manual study in Europe, the most common symptoms of
cancer patients were fatigue, insomnia, and pain with a mean of 34.6, 28.9, and 27.0, respectively
(27). According to QoL study in Sweden showed, fatigue had the highest mean of 42.65, followed
by pain 32.14, and insomnia 33.33 (30). A study on the QoL of cancer patients under treatment in
Nepal found that participants scored symptom scale with a mean of 16.14 that is low indicating
participants have low symptoms concerning specific symptoms participants scored loss of appetite
with a mean of 20.27, insomnia 18.23, pain 17, fatigue 14.05, nausea and vomiting 8.63,
constipation 6.39, dyspnea 4.35 and diarrhea 1.07 (23).
Nausea/ vomiting was found to affect routine activities of patients including household activities,
feeding style, and daily function (26). A study conducted in Brazil, Malaysia, and Pakistan
discovered that nausea/vomiting and fatigue are highly associated with Quality of life which
affected their ability for self and family care (17,22,29). A cross-sectional study on the prevalence
of chemo-induced nausea and vomiting, and its impact on patients’ quality of life at the oncology
unit of TASH, in Ethiopia, shows 76.8% of patient experienced chemotherapy-induced nausea and
64.1 % of patient experienced chemotherapy-induced vomiting and it was associated with poor
quality of life (31). Another study on QoL in Ethiopia at UGSH found that the most bothersome
symptoms were Nausea and vomiting with a mean of 43.3, Insomnia 42.1, followed by fatigue
41.47 (32).
Patients with cancer frequently experience pain as a result of their disease or treatment strategies
and it’s one of the most distressing symptoms of cancer that affects all aspects of life (32). A study
in Nepal reveals among the symptoms, pain, and fatigue were highly negatively correlated with
Quality of life (23). Another study on the assessment of quality of life of cancer patients under
chemotherapy in Rwanda shows the most experienced symptoms was pain with a mean of 78.76
which shows a high level of pain experienced by cancer patients undergoing chemotherapy (3).
7
2.3 Factors Associated with Quality of life
Quality of Life among cancer patients undertaking chemotherapy treatment considered to be the
effect of an illness and its treatment as perceived by patients and is affected by factors such as,
physiological side effects (hair loss, pain, fatigue, nausea, vomiting), psychological problems
(stress, anxiety, depression), social side effects (social isolation, role, and function loss),
sociodemographic (age, gender, education, income), diseases and treatment-related complications
(stage of cancer, distance metastasis, and treatment modalities) (33).
2.3.1 Sociodemographic characteristics
The impact of sociodemographic characteristics on the quality of life of cancer patients undergoing
chemotherapy treatment is inconsistent and variable. A facility-based cross-sectional study on
health-related quality of life of cancer patients under chemotherapy treatment in Greece, Egypt,
and Ethiopia showed that there is no correlation between QoL and age, sex, marital status, and
occupational status (16,34,35).
A study on the QoL of cancer patients undergoing chemotherapy treatment in Pakistan discovered
that female gender, unemployment, and post-chemotherapy side effects lasting more than a week
account for 34.1 percent of the variability in the mean (17). Another study on determinants of QoL
among cancer patients in Malaysia and Jordan shows Socio-demographic variables i.e. age,
religion, educational level, and working status were significantly associated with all domains of
QoL (22, 14).
The educational status was another factor that can impair the QoL of cancer patients. A study in
the USA, Turkey, India, and Jordan shows that illiterate patients had significantly correlated with
poor QoL when compared to their educated counterparts. (13,14,36,37). A study in Kenya among
8
Gynecological cancer patients also reveals patients who had completed secondary and tertiary
levels of education had higher total QoL scores compared to those with lower levels of education
(33). Low levels of education have been associated with decreased awareness of the disease, late
screening, and presentation to health facilities with a resultant poor prognosis hence low QOL
scores (33).
A study on the impact of the financial burden on cancer patient quality of life in the United States
showed that 69.6 percent, "claimed no financial problems at all," while a much smaller proportion,
8.6 percent report "a lot of financial problems,”. Patients who reported “a lot” of financial
difficulties as a result of cancer care costs were more likely to rate their physical health, mental
health, and satisfaction with social activities and relationships as poor compared to those who did
not report any financial difficulties (38). A study in Pakistan also showed that the magnitude of
cancer-related financial difficulty was a more significant predictor of quality of life than age,
education, and marital status (15).
A study in Tanzania, Rwanda, Addis Ababa, and Gondar shows, the score of financial difficulties
was high and associated with QoL with a mean of 84.3, 98.63, 88.42, and 69.6 respectively (3,31,
32,38). The most pronounced differences between German and Ethiopian cancer patients were
found to be financial difficulties with a mean of 37.8, and 67.1 respectively (26). This illustrates
that the financial burden of cancer patients in developing countries is considerably high and this
factor is relevant for the QoL of cancer patients in developing countries (3).
2.3.2 Psychological Factors

A cancer diagnosis is a traumatic event that has a significant impact on the patients and their
families and may cause responses of shock, uncertainty, hopelessness, anxiety, and depression (40).
Anxiety and depression are common among cancer patients and they affect the QoL of patients (4).
Different studies have reported that anxiety and depression, which occur during diagnosis and
treatment, increase the frequency of physical and psychological symptoms, have a negative effect
9
on QoL, and reduce treatment adaptation (22,41,42). A Study on determinants of quality of life in
Malaysia, Jordan Lebanon, and Ghana shows both anxiety and depression were significantly
correlated with worse global QoL score, functioning scores, and high symptom complaints
(14,22,41,43).
2.3.3 Clinical characteristics and QoL
Cancer and its treatment affect the nutritional status of patients by altering their metabolic function
and reducing their food intake (44). The European Society for Clinical Nutrition and Metabolism
advocates systematic nutritional assessment before and during all exclusive chemotherapy
procedures to identify nutritional deficits early and to plan targeted actions (45). Symptoms such
as poor appetite, reduced food intake, weight loss, pain, nausea and vomiting, diarrhea and
constipation, compromise the nutritional status of patients, implying increased morbidity,
mortality, and treatment costs; and with significant impact on QoL (46).
A systematic review on the relationship between nutritional status and QoL in cancer patients
shows better nutritional status was associated with a better QoL (20). A study in Brazil showed that
Malnutrition is significantly associated with increased morbidity and mortality, reduced response
to treatment, diminished chances of survival, and worse QoL (47). A study on adult cancer patients
in Mexico showed that the mean global quality of life of patients having weight loss of 10% was
48.8, which is lower compared to 62.8 among patients without weight loss and significantly
associated with QoL (46). A Study on the quality of life and nutritional status among cancer patients
on chemotherapy in Oman Shows well-nourished participants had a mean score of 76.14 ± 15.49,
moderately malnourished had a mean of 61.46 ± 16.77, and severely malnourished had a mean
score of 40.47 ± 18.28 and this finding was statistically correlated with QoL (48).
Performance status is the assessment of the level of function and capability of self-care. A study on
quality of life among cancer patients under chemotherapy in Nepal, Japan, and Turkey shows
Patients with a better ECOG (Eastern Cooperative Oncology Group) performance status reported
10
significantly higher scores in all the scales of the instrument were found to be associated with
quality of life at a statistically significant level (23,52,24).
A facility-based cross-sectional study among adult cancer patients under treatment in Nepal,
Malaysia, and Jordan shows cancer patients with advanced cancer had greater deterioration and
lower scores on all domains of QoL and the presence of distant metastasis affects the quality of life
of cancer patients (20,19,13).
A cross-sectional Study among cervical cancer patients at Addis Ababa revealed that there was a
significant decline in QoL of women having Stage IV tumors compared with stage II and III
patients (50). Another study conducted in Gondar found a significant correlation between tumor
stage and QoL, indicating that advanced cancer stage is associated with poor quality of life. As the
disease progresses, it will bring more discomforting symptoms and distress, thus in return decreases
their quality of life (32).
Concerning cycles of chemotherapy treatment a study in Iran and Egypt shows there was significant
difference between the level of QoL in patients with 2 chemotherapy cycles and/or with 3-5 cycles
(60, 38). Another study on Quality of life and associated factors of adult cancer patients under
chemotherapy treatment in Ethiopia reveals patients who had completed 4 or more cycles of
chemotherapy reported good QoL than patients who take 2 chemotherapy or less (52).
Comorbidity in cancer patients has increased a greater health care needs, greater likelihood of
disability, increased cost of care, and a higher likelihood of financial burden, all these can be
associated with impaired quality of life (53). A longitudinal study on Health-related quality of life
and psychological distress among cancer survivors in Southeast Asia shows co-morbidities were
associated with Health-related quality of life and psychological distress (54). A facility-based cross-
sectional study in China and Iran also shows patients with one or more comorbid conditions scored
significantly worse physical functioning, global quality of life, compared to patients without
comorbidity (37,53).
11
2. 4 CONCEPTUAL FRAMEWORK
clinical information
Socio-demographic
• Type of cancer
factors
• Body mass index
• Age
• Cycle of
• Sex
Quality chemotherapy
• Religion
of Life • Time since Diagnosis
• Residences
• Stage of cancer
• Marital status
• Comorbidity
• Educational status
• Performance status
• Occupational status
• Wealth Index Psychological factor
• Anxiety
• Depression
Figure 1. Conceptual framework of quality of life, experiences, and associated factors among
adult cancer patients undertaking chemotherapy treatment at ANRS, Ethiopia, 2021
Source: Adapted from literatures (16,22,23,50,55,56)
12
3. OBJECTIVES
3.1 General objective
1. To assess the Quality of life, and associated factors among adult cancer patients undergoing
chemotherapy treatment at Amhara National Regional State, Ethiopia, 2021.
3.2 Specific Objectives

1. To determine the quality of life of adult cancer patients undergoing chemotherapy treatment at
Amhara National Regional State, Ethiopia, 2021
2. To identify factors associated with the quality of life of adult cancer patients undergoing
chemotherapy treatment at Amhara National Regional State, Ethiopia, 2021
13
4. METHODS
4.1. Study area and period
This study was conducted on adult cancer patients undertaking chemotherapy treatment at Amhara
National Regional State (ANRS) oncology treatment centers. Amhara National Regional state is
the second popules region in Ethiopia. There were two referral hospital that give chemotherapy
treatment for all types of cancer cases in ANRS that is Felege Hiwot Comprehensive Specialized
Hospital (FHCSH) and University of Gondar Specialized Hospital (UGSH).
Felege Hiwot Comprehensive Specialized Hospital is found in Bahir dar city 565 km far from Addis
Ababa (the capital city of Ethiopia). The oncology treatment center of FHCSH was established in
June 2017. The hospital currently provides diagnostic, surgical, and chemotherapy treatment
services for cancer patients. The oncology unit contains a total of 18 beds for inpatient treatment,
it is run by nine nurses, three pharmacists, three General Practitioner, and one Oncologist (57).
University of Gondar Specialized Hospital (UGSH) is a teaching and referral hospital located in
Gondar Town 748 km North West of Addis Ababa. The Gondar cancer center was established in
January 2015. It is run by eleven nurses, one pharmacy, four GP, and one oncologist, the oncology
inpatient ward has a total of 18beds (32).
The study was conducted from March 15 – April 30, 2021
4.2 Study design

Institutional based cross sectional study design was conducted.
14
4.3. Population
4.3.1 Source Population

The source populations were all adult cancer patients who are on chemotherapy treatment follow-
up at FHCSH and UGSH.
4.3.2 Study population

The study population were all randomly selected adult cancer patients undertaking chemotherapy
treatment during the data collection periods at FHCSH and UGSH.
4.4. Inclusion and Exclusion criteria
4.4.1 Inclusion criteria:

Patients who are 18 years and older, received at least one cycle of chemotherapy treatment
irrespective of the site of cancer was included in the study.
4.4.2 Exclusion Criteria:

Patients with hearing or communication impairment were excluded.
4.5 Study Variables
4.5.1 Dependent variables

Quality of Life
4.5.2 Independent variables

Socio-demographic factors
Age, sex, residences, religion, educational status, marital status, occupation, and wealth Index
15
Clinical information
BMI, type of cancer, time since diagnosis, number of chemotherapy cycles, stage of cancer,
performance status, and comorbidities
Psychological Factors
Anxiety, depression
4.6. Operational definition:
1. Good Quality of life= In this study, Good QoL means when the mean score of global health status
(QoL) score above 50
2. Poor Quality of life= In this study poor QoL means when the mean score of global health status
(QoL) is below 50 (58,59).
3. Comorbidity- In this study Comorbidity is the presence of any additional chronic clinical entity
that exist alongside cancer (60)
4. Performance status: is the assessment of the level of function and capability of self-care using the
Eastern cooperative oncology group Measuring scale ranging from 0 (full active ) to 4 (Bedridden)
(61).
5. BMI (body mass index): is calculated as weight in kilogram divided by height meter square. Weight
is taken to the nearest 0.5 kg and height is to the nearest 0.5cm. BMI is categorized as Below 18.5
Underweight 18.5 – 24.9 Normal 25.0 – 29.9 Overweight (62).
4.7. Sample size determination

Sample Size:
The Sample size was determined using a single population proportion formula by assuming 5%
marginal error (d), 95% confidence interval (alpha=0.05), and the proportion of affected quality
of life of cancer patients in Ethiopia at UGSH was 52.7% (P=0.527) (32).
𝑃(1−𝑃)
ni= 𝑍 2 𝑑2
Where: ni = initial sample size. Zα /2 = 1.96 (Z = score corresponds to 95% confidence level).
P = proportion of affected quality of life of cancer patients
16
q= proportion of not affected quality of life of cancer patients
d2 = margin of error (0.05)
0.527(0.473)
ni= 1.962 = 383
0.052
The source population is 1100 (currently active patients on chemotherapy treatment at FHCSH
(600) and UGSH (500) since the source Population is <10,000, by using correction formula, the
final (Nf) sample size was calculated as
Nf= n/ (1+n/N)
Nf=383/ (1+383/1100) = 285
Considering a 10% of contingency for non-responses, the final sample size was 314
For the second objective sample size was determined by using double population proportion
formula and four key factors were taken from the previous literature (16,52,63) and sample size
was computed by Epi info version 7.2 software
Table 1: Sample size calculation by using different variables.
S.No Associated factors Assumptions Sample
Size
1. Sex Power = 80%, Ratio = 1:1, Outcome 135
in unexposed group = 71%, COR =
0.326, Outcome in exposed group =
44.4% and adding 10% nonresponse
rate
2. Time since Power = 80%, Ratio = 1:1, Outcome 47
diagnosis in unexposed group = 33%, COR =
79.6% adding 10% nonresponse rate
3. Stage of cancer Power = 80%, Ratio = 1:1, Outcome 62
in unexposed group = 20%, COR = 6,
17
Outcome in exposed group = 60%
adding 10% nonresponse rate
4. Cycle of Power = 80%, Ratio = 1:1, Outcome 49
chemotherapy in unexposed group = 50%, COR =
8.3% adding 10% nonresponse rate
4.8. Sampling technique and Sampling Procedures

The sample frame was based on the number of cancer patients who had an appointment during the
data collection period at FHCSH and UGSH Oncology treatment centers referring from the
registration books. The medical registration number of patients having an appointment at the two
hospitals during the data collection period listed together and the appropriate sample was randomly
generated using SPSS.
4.9. Data collection
4.9.1 Data collection tool:
The European organization for research and treatment of cancer prepare a Quality of life
Questionnaire that can assess the QoL of cancer patients in which patient-reported outcomes are
collected (9). The reliability and validity of the Amharic version of EORTC QLQ-C30 for
assessment of the quality of life in cancer patients in Ethiopia demonstrated a Cronbach alpha value
of 0.871 (64).
The QLQ-C30 is the main questionnaire that is aimed to address the quality of life of cancer
patients. It incorporates 30 items among which are five functional scales (physical, role, cognitive,
emotional, and social functioning); three symptom scales (fatigue, pain, and nausea or vomiting),
a two-item global health/QoL scale, and six single items (dyspnea, appetite loss, insomnia,
constipation, diarrhea, and financial difficulties), sociodemographic and clinical characteristics are
18
added from the existing literature. The data was collected through face-to-face interview and
variables on clinical characteristics was extracted from medical charts.
Global health status (QoL) scale consists of two items evaluating overall health (“How would
you rate your overall health during the past week?) and (“How would you rate your overall quality
of life during the past week”) scored on 7-point numerical rating scales with 1 being “Very Poor”
and 7 being “excellent”. This measure has proven useful and reliable for the assessment of patients’
self-perceived overall QoL (65) and showed good internal consistency in our sample (Cronbach’s
α= 0.87). The EORTC Quality of Life Group recommends using the global health status / QoL
scale (based upon Q29 and Q30 ) as the overall summary measure of QoL (66).
Eastern cooperative oncology group performance status A validated Amharic version of
Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was used to assess the
patient’s
performance status; it is commonly used to identify how the disease affects the patient’s ability to
perform activities of daily living which are rated on a scale from 0 (fully active) to 4 (bedridden),
Higher scores reflect worse function (64) and were ranked 0-1 as good status and 2-4 as bad (50).
The Hospital Anxiety and Depression questionnaire were used to assess the patient’s levels of
anxiety and depression. The HADS is a valid and reliable instrument, which was originally
designed to assess psychiatric conditions (anxiety and depression) in general medical settings and
not psychiatric clinics. The HAD consists of 14 items divided into two subscales (anxiety and
depression) with 7 items each, which are evaluated on a 4-point Likert scale from 0 to 3, in which
0 is the most favorable response and 3 the least favorable. The score for each subscale is calculated,
and scores of 11 or higher are considered to indicate depressive disorder or anxiety. Scores of 7 or
lower indicate that the individual should not be identified as a case, and scores between 8 and 10
are considered borderline findings. The Psychometric properties of the Amharic Version of HADS
Questionary in cancer patients had good reliability with Cronbach’s α coefficients of 0.91 (total
scale), 0.86 (anxiety scale), 0.85, and (depression scale) (67).
Wealth index-contained 19 questions about housing conditions, and household characteristics.
They were computed and reduced the number of variables by principal component analysis
(PCA).Then classified into 5 quintiles using Ethiopian demographic health servey (68).
19
Clinical information: information related to the patients diseases and treatment condition was
extracted from medical chart.
4.10.2 Data collection procedure

The data were collected by four trained nurses (two at each hospital) and two supervisors. The
training was given to data collectors on how to collect the data correctly by the principal
investigator for one day and supervision were conducted every day to monitor the data collection
procedure
4.11. Data Quality assurance:

The validated Amharic version of the EORTC QLQ C-30, and HAD questioner was used. Pretest
was done on 16 (5%) patients at FHCSH before the actual date of data collection. Based on the
result of the pretest, corrections and modifications were made to the questionnaire before applied
to the study population. Before data collection, the objective of the study was verbally clarified for
each participant and the participant's questions were answered and adequate training and
supervision was provided for the data collectors. The field questionnaires were checked for
completeness by the data collector and supervisor every day. Computer frequencies and data sorting
are used to check for missed variables, outliers, or other errors during data entry.
4.12. Data processing and analysis

I. Data Scoring
The principle for scoring of EORTC QLQ-C30 was
Estimate the average of the items that contribute to the scale and then linearly transform to
standardize the raw score, so that scores range from 0 to 100.
In practical terms, if items I1, I2, ... In are included in a scale, the procedure is as follows:
Raw Score = RS = (I1 + I2 +...+ In) / n
20
apply linear transformation to 0-100 to obtain the score S,
Function scale: (1-(RS-1)/range) *100
Symptom scale: ((RS-1)/range) *100
Global health status / QoL: S = ((RS -1) /range) *100
The range is the difference between the maximum possible value of RS and the minimum possible
value (66). Thus a high score for a functional scale represents a high/ healthy level of functioning;
a high score for the global health status / QoL represents a high QoL, but a high score for a symptom
scale/item represents a high level of symptoms/ problems (66).
After transformation QoL was dichotomized into poor QoL and good QoL based on the review of
literatures using 50 as a cut-off point (55,58,59). The review stated the cutoff point 50 could show
clinical impairment or clinical enhancement while used the EORTC questioner (55,58,59).
II. Statistical Analysis
Data was entered cleaned and coded into Epi-data 4.2 Software and then exported to SPSS- Version
23 for analysis. Simple descriptive statistics such as frequencies, mean, and standard deviation (SD)
was calculated. The internal consistency of the QLQ C-30 and HAD questionnaire was assessed
with Cronbach’s alpha value of the multi-item scales based on the recommendation of (α > 0.7)
bivariable analysis was performed to assess the association between the dependent variables and
various explanatory variables. Those explanatory variables with a p-value < 0.25 during bivariable
analysis were entered in the multivariable logistic regression analysis model and variables with a
p-value ≤ of 0.05 in multivariable analysis were considered significant. Multicollinearity was
assessed by the collinearity diagnostics (Variance Inflation Factor and the tolerance test). The
goodness of the model was checked by Hosmer and Lemeshow test. Finally, the results of the
analysis were presented in tables, charts, and graphs as appropriate
21
4.13. Ethical clearance
Ethical clearance was obtained from the institutional review board of Bahir Dar University, College
of Medicine and Health Science to conduct the research. A formal letter was submitted to FHCSH
and UGSH, informed verbal consents were obtained from the study participants after clearly
introducing the purpose, benefits, and risks of the study. The respondents’ right to refuse or
withdraw from participating in the interview at any time was fully respected and the information
provided by each respondent was kept confidential by making each questionnaire coded and not
sharing personal information of any patient to the third party
22
5. RESULT
5.1 Socio-Demographic characteristics
Out of 314 respondents intended to be included in the study, a total of 310 patients participated
and giving a response rate of 98.7%. Of the respondents, 219 (69.7%) were female 175 (57.8%)
were below the age of 50 with a mean (SD) age of 45.81 years (10.98). More than half of the
participants 66 (54.2%) have no formal education. About 219 (70.6%) were married, 284 (91.6%)
were Orthodox Christianity followers, 209 (67.4%) of patients were lives in rural areas.
Concerning the occupation of the participants, 117 (37.7%) were housewives followed by farmers
85 (27.4) (see table 2)
23
Table 2: Socio-demographic characteristics of adult cancer patients under chemotherapy
treatment at ANRS, Ethiopia 2021. n=310
Variables Category Frequency Percent
Age 18-40 97 31.3
41-49 82 26.5
50-59 94 30.3
>=60 37 11.9
Sex Female 216 69.7
Male 94 30.3
Residences Rural 209 67.4
Urban 101 32.6
Religion Orthodox 284 91.6
Muslim 20 6.5
Protestant 6 1.9
Marital status Married 219 70.6
Single 22 7.1
Divorced 38 12.3
Widowed 31 10
Educational No Formal 168 54.2
status Education 86 27.7
Primary 31 10
Secondary 25 8.1
College and
above
Occupational Housewife 117 37.7
Status Farmer 85 27.4
Merchant 48 15.5
Government 29 9.4
employee 16 5.2
Unemployed 15 4.8
Other*
Wealth Index Lowest 58 18.7
Second 89 28.7
Middle 33 10.6
Fourth 68 21.9
Highest 62 20
* student, Pension, daily laborer
24
5.2 Clinical characteristics
Among participants, breast cancer was the leading type of cancer accounting for 25.5% followed
by GI cancer 23.5%. The mean length of time since their diagnosis of cancer was 14.95 months.
Most of the participants 175 (56.5%) have a normal body mass index. Seventy-one (22.9%)
participants had comorbid diseases, among these 54.9 % of participants had hypertension. One
hundred thirty-two (42.6 %) participants were at stage III of cancer. Regarding the current
chemotherapy treatment, 96 (31%) participants were in their fifth and above cycle of treatment
(See Table 3).
25
Table 3: Clinical characteristics of adult cancer patients under chemotherapy at ANRS, Ethiopia,
2021 n = 310
Variables Category Frequency Percent

Cancer Type Breast cancer 79 25.5
GI cancer*a 74 23.9
Gynecological 68 21.9
cancer*b 57 18.4
Hematological 17 5.5
cancer 15 4.8
Lung Cancer
Prostate Cancer
Time Since < 12 Months 218 70.3
Diagnosis 12 – 24 Months 29 9.4
25 – 36 Months 22 7.1
37 – 48 Months 16 5.2
49 – 60 Months 14 4.5
>60 Months 11 3.5
BMI <18.5 100 32.3
18.5-24.9 175 56.5
>25 35 11.3
Cycle of Two 63 20.3
Chemotherapy Three 62 20
Four 89 28.7
Five and above 96 31
Stage of Stage I 18 5.8

Cancer Stage II 68 21.9
Stage III 131 42.3
Stage IV 93 30
Comorbidity No Comorbidity 239 77.1

Hypertension 39 12.6
DM 16 5.2
Cardiac Diseases 9 2.9
Other*c 7 2.3
ECOG PS* Good 215 69.4
Bad 95 30.6
*a GI Cancer, Colorectal, Gastric, Esophageal cancer *c Asthma, HIV/AIDS

26
*b Gynecological cancer Cervical, Ovarian, GTD * ECOG-PS= Eastern Cooperative Oncology Group
Performance Status; n= Sample size
5.3 Psychological Factors
5.3.1 Anxiety and depression

The mean (SD) of anxiety and depression subscale scores was 8.83 (3.287), and 9.29 (4.177)
respectively. more than half of the participants 184 (59.2%) and 158 (51%) have a score of
normal status on the anxiety and depression scale (See Table 4).
Table 4: Anxiety and depression among adult cancer patients under chemotherapy at ANRS,
Ethiopia, 2021 n = 310
Variable frequency (%)

Anxiety
Normal 184 (59.4)
Borderline 80 (25.8)
Case 46 (14.8)
Depression
Normal 158 (51.0)
Borderline 83 (26.8)
Case 69 (22.3)
27
5.4. Quality of life scores
5.4.1. Global health status/QOL
The mean global health status/QoL of the study participants was 47.63 with a standard deviation
of 10.068
Figure 2: Quality of Life among adult cancer patients undertaking chemotherapy at ANRS,
Ethiopia: 2021
5.4.2. Functional and symptom scale scores of EORTC QLQ C-30
In the EORTC QLQ C-30, the functional scale of study participants ranged from a mean (SD) of
44.48 (21.29) for emotional functioning to cognitive functioning 61.07 (21.44). The most affected
functional scale was emotional functioning, followed by role functioning with 189 (61%) and 172
(55.5%) participants had scored < 50 respectively whereas the cognitive functioning state of the
participants was the least affected functional scale with only 72 (23.2) of participants had scored
below 50. From symptoms appetite loss and fatigue was the most affected with a mean of 69.14
and 66.88 respectively (See Table 5).
28
Table 5: Functional and symptom scale score among adult cancer patient undertaking
chemotherapy treatment at ANRS, Ethiopia, 2021 n = 310
Scale/Item Mean (SD) Good n (%) Poor n (%)

Functional 48.4 (16.28) 139 (44.8) 171 (55.2)
Scales
Physical 46.73 (23) 141 (45.5) 169 (54.5)
Functioning
Role 45.75 (25.73) 138(43.9) 172 (54.8)
Functioning
Emotional 44.48 (21.29) 123(39.2) 187 (59.6)
Functioning
Cognitive 61.07 (21.44) 238 (76.8) 72 (23.2)
Functioning
Social 47.53 (28.39) 150(48.4) 160 (51.6)
Functioning
Symptom 60.16 (14.66) 65 (21) 245 (71)
Scale
Fatigue 66.88 (17.71) 65 (21) 245 (71)
Nausea and 50.91 (16.25) 120 (38.7) 190 (61.3)
Vomiting
Pain 62.31 (29.12) 106 (34.2) 204 (65.8)
Dyspnea 29.68 (25.17) 251(81) 59 (19)
Insomnia 48.28 (21.67) 158 (51) 152 (49)
A ppetite loss 69.14 (26.77) 71 (22.9) 239 (77.1)
Constipation 39.89 (25.37) 202 (65.2) 108 (34.8)
Diarrhea 30.86 (23.32) 199 (64.2) 111 (35.8)
Financial 65.16 (25.25) 88 (25.25) 222 (71.6)
difficulties
5.5. Factors associated with Quality of Life

In the bivariable logistic regression analysis, educational status, marital status, occupational
status, BMI, type of cancer, cycles of chemotherapy, stage of cancer, ECOG performance status,
presences of comorbidity, anxiety, and depression were significantly associated with QoL at P <
0.25 and entered for multivariable analysis. The final model was correctly classifying good QoL
by 72.4% and poor QoL by 80.7%. The model was a good fit as showed by Hosmer-Lemeshow
goodness-of-fit (X2 9.176, p=0.328)
29
In the multivariable analysis educational status, BMI, stage of cancer, comorbidity, anxiety,
depression, and the cycle of chemotherapy treatment had significant association with QoL. The
multivariable analysis showed that adult cancer patients with educational status of college and
above had 4.3 times more likely to have good QoL AOR 4.3 (1.49-12.32) as compared to patients
who had no formal education.
Besides patients whose BMI < 18.5 kg/m2 are 55% less likely to have good QoL compared with
Normal weight participants with AOR 0.45 (0.24-0.84). Similarly, Patients who are at an advanced
stage of cancer (Stage IV), were 79% less likely to have good quality of life than Patients with an
early stage of cancer (Stage I) with AOR 0.21(0.06-0.71). Those who had comorbid diseases were
72% less likely to have good QoL as compared with those who had no comorbid diseases AOR
0.28(0.14-0.57).
Anxiety and depression affect the QoL of cancer patients. This study shows patients with anxiety
68% less likely to have good QoL than normal individuals AOR 0.32 (0.12-0.84) and patients with
depression 71% less likely to have good QoL than normal individuals AOR 0.29 (0.13-0.63).
Quality of life got better with chemotherapy treatment. Patients who took 5 and above cycles of
chemotherapy treatment had 4 times more likely to have good QoL AOR 4 (1.78-9.11) than those
who took 2 cycles of chemotherapy treatment.
30
Table 6: Bivariable and multivariable logistic regression of determinant factors with QoL of adult
cancer patients under chemotherapy at ANRS, Ethiopia, 2021 n=310
Good Poor
Variables QoL QoL COR AOR (95CI) P Value
Educational Status
No Formal education 66 102 1
Primary Education 36 50 1.1 (0.66- 1.88) 0.94(0.48-1.83) 0.853
Secondary Education 15 16 1.5 (0.67-3.13) 1.5(0.58-3.90) 0.391
College and above 17 8 3.3 (1.34-8.04) 4.3(1.49-12.32) 0.007*
Marital Status
Married 102 117 1
Single 10 12 0.96 (0.39-2.30) /
Divorced 12 26 0.53 (0.25- 1.1) /
Widowed 10 21 0.55 (0.25-1.21) /
Occupational status
Farmer 37 48 1 /
Merchant 21 27 1.01 (0.49-2.06) /
Govt employee 19 10 2.46 (1.02-5.93) /
Housewife 46 71 0.84 (0.47-1.48) /
Unemployed 5 11 0.59 (0.18-1.84) /
Other 6 9 0.86 (0.28-2.64 /
Body Mass Index
Normal weight 87 88 1 1
Underweight 30 70 0.43 (0.26-0.73) 0.45(0.24-0.84) 0.012*
Overweight 18 17 0.95 (0.46-1.97) 1.06(0.44- 2.59) 0.889
Comorbidity
No 118 121 1 1 1
Yes 16 55 0.29 (0.16-0.55) 0.28(0.14-0.57) <0.001*
31
ECOG-PS
Good 100 115 1
Bad 34 61 0.64 (0.39-1.05) /
Stage of Cancer /
Stage one 11 7 1 1
Stage two 40 28 0.9 (0.31-2.63) 0.95(0.28-3.21) 0.934
Stage three 59 72 0.52 (0.19-1.43) 0.3(0.09-0.99) 0.050
Stage four 24 69 0.22 (0.07-0.64) 0.21(0.06-0.71) 0.012*
Cancer Type
Breast cancer 38 41 1
GI Cancer 24 50 0.52 (0.27-0.99) /
Hematological
30 27 1.19 (0.60-2.37) /
cancer
Gynecological
26 42 0.66 (0.35-1.29) /
cancer
Lung cancer 8 9 0.96 (0.34-2.74) /
Prostate cancer /
8 7 1.23 (0.41-3.73)
Cycle of
chemotherapy
2nd Cycle 21 41 1 1
3rd Cycle 21 41 1.02 (0.48-2.15) 0.98(0.41-2.39) 0.976
4th Cycle 35 54 1.3 (0.66-2.54) 1.59(0.71-3.54) 0.255
>5th Cycle 57 39 2.9 (1.50-5.68) 4 (1.78-9.11) 0.001**
Anxiety Scale
No Anxiety 87 97 1 1
Borderline 38 42 1.01 (0.59-1.71) 1.05(0.55- 2.02) 0.883
Anxiety 9 37 0.27 (0.12-0.59) 0.32(0.12-0.84) 0.021*
Depression Scale
No Depression 75 83 1 1
Borderline 43 40 1.19 (0.69-2.02) 1.56(0.77-3.13) 0.210
Depression 16 53 0.33 (0.18-0.63) 0.29(0.13-0.63) 0.002**
**significant level at p<0.01 *significant level at p<0.05 / indicates: not included in the model
32
6. DISCUSSION
Cancer and its treatment strategies substantially affect the QoL of patients. Estimation of QoL of
patients living with Cancer helps to evaluate the effectiveness of treatment. In developing countries
including Ethiopia, QoL measurement is not performed routinely. This study aimed to determine
the rate of QoL, and associated factors among adult cancer patients attending referral hospitals in
ANRS, Ethiopia. Based on this the mean score of QoL was found to be (44.32). However, the result
of this study is lower than studies conducted in European countries with a mean of 61.3 (27), Nepal
85.54 (22), India 61.93 (13), and Pakistan (57.37) (17). A low level of QoL in this study could be
explained by cancer treatment centers that have been established only recently, and advanced
treatments including radiotherapy and palliative care are not yet started (32). Furthermore, due to
less availability of screening program for cancer patients in Ethiopia, patients usually admitted once
they are at an advanced stage, which may necessitate for frequent hospital visits, this, in turn, may
cause psychological and economic stress, resulting in poor QoL (55,59), The availability of well-
resourced health facilities in high-income countries and the relative lack of these facilities in this
study setting (13) and the hospitals lacks multidisciplinary teams like clinical psychologist,
oncologists, palliative physicians, pain management teams so that the patient's whole life
dimensions are not well investigated (32,50,69).
According to the results of this study, all dimensions of functional scales except cognitive function
were shown to be below the mean of 50 which is consistent with studies conducted in Brazil,
Turkish, and Pakistan (17,70,71). Chemotherapy can reduce the functional capacity of cancer
patients (13). Reduced emotional, physical, social, and role functioning might be due to the fact
that most of the cancer patients in this study have advanced-stage of cancer which can hinder their
functioning from different activities in addition when they become ill, they have a disruption in
their usual activities so that their daily activities were highly affected which leads to poor QoL
(59,72).
33
Higher scores of symptoms 60.16 in this research were also observed in comparison with studies
done in Nepal (16.14) and Sweden (10.9) (23,26) but consistent with studies conducted in Addis
Ababa (53.9), and Rwanda (61.13) (3,72). Studies indicated that symptoms experienced in cancer
patients influence the continuance of treatment and, affect the QoL of patients (13,50). A study in
turkey reported that cancer patients suffered from a variety of symptoms such as nausea and
vomiting, fatigue, pain, and hair loss during their treatment and have an impact on patients daily
living and quality of life (73). A high number of symptoms in this study could be explained by late
diagnosis of cancer, poor symptom management (3,69,74) better health care system in developed
countries incomparision with this study setting (55), and in Nepal majority of the study participants
are at an early stage of cancer (23)
The findings of this study showed that concurrent with previous studies, the most affected
symptoms in cancer patients were appetite loss of 69.14, fatigue with a mean of 66.88, and pain of
62.31, which’s higher than the population mean, indicating that it has an impact on the patient’s
quality of life and affected their ability for self and family care which was consistent with studies
conducted in Gondar, Addis Ababa, Rwanda and Tanzania (3,16,26,28) However, the EOCRTS
Reference value of adult cancer patients has a mean of fatigue 34.6, appetite loss 21.1 and pain 27.
The discrepancy of the result could be the reference value manual is based on pretreatment QoL
data only. Therefore, the reason for higher symptoms in this study due to the different treatment
side effects that impact their quality of life (50).
Dyspnea 29.68, constipation 39.89, and diarrhea 30.86 are less common symptoms, which was
consistent with studies conducted in Gondar, Addis Ababa, and Tanzania (28,32,50), However, a
study done in The UK found diarrhea as the most frequently reported symptom (75). The
discrepancy could be due to the different treatment protocols used for the management of cancer
among different countries (75)
Despite the use of health insurances program patients scored financial difficulties with a mean of
65.16 consistent with a study conducted at Addis Ababa (63.88), and Gondar (67.1), Rwanda
34
(98.63,) Tanzania (84.3) (3,26,28,55). This illustrates that the financial burden of cancer patients
in developing countries is considerably high because chemotherapy is a prolonged and expensive
treatment that creates a financial burden among cancer patients and since the study participants are
adult populations the impairment in the functional status has an effect on the economic status of
the family (3).
In this study, the educational status of college and above is associated with good QoL. This is
consistent with previous studies conducted in Addis Ababa, Kenya and Jordan (13,22,67).
Education is one of the important factors that help in promoting QoL. This could be patients with
higher educational status have better knowledge, understanding, and awareness than illiterate
patients in terms of diagnosis and follow-up care which ultimately improves their overall QoL
(33,59).
Underweight is associated with poor QoL. This was consistent with a study conducted in Oman,
Korea, and Brazil (46,47,76). This could be patients with a better nutritional status had better
functions, reduces the side effects of diseases, and improves both the prognosis of treatment and
the patient's quality of life, whereas malnourished patients had lower physical performance and
experienced greater symptoms as well as increased anxiety and depression that affect their quality
of life (20).
According to this study patients with stage IV cancer are associated with poor QoL. This finding
was consistent with studies conducted in Addis Ababa, Gondar, and Jordan (13,36,57). This could
be in this study more than 70% of participants are at stage III and above which are linked with more
symptoms, anxiety, depression, poor physical and emotional functioning that affect their overall
QoL (59). As the disease progresses, it will bring more discomforting symptoms, impairment in
physical functioning, and they have more stress, anxiety, and depression that are more likely to
affect their quality of life (14,50).
Chemotherapy treatment increases the survival rate and gives hope to the patients. This study shows
35
patients on their 5th and above cycles of chemotherapy treatment have good QoL than those who
took 2 cycles of chemotherapy treatment. This show that QoL is directly related to cancer treatment
procedure improvement of QoL in cancer patient can be carried out by utilizing chemotherapy
treatment. These results are consistent with studies conducted in Addis Ababa, Egypt, and Iran
(35,51). This could be chemotherapy very often induces acute side-effects that usually develop at
the end of the first cycle and beyond that worsen QoL later on an improvement in their health
condition and subsidization of symptoms improve their QoL (3,22,74). But this is contrary to
studies conducted in Turkey (36). The discrepancy of this result might be due to the study design
and the instrument used to measure the outcome variable. Unlike the present study, a study
conducted in Turkey has used nightingale symptom assessment scale N-SAS to measure the QoL
of Patients (36,59).
This study shows comorbidity associated with poor QoL. The findings of this study are consistent
with previous research linking chronic disease to aspects of QoL among cancer patients in China
and Iran study (37,53). This could be due to comorbid diseases compromises the quality of life
through increasing symptoms, impairment on functional wellbeing, and anxiety that can affect their
overall QoL (16).
Anxiety and depressions are associated with poor QoL. Similarly, various studies also show
psychological distress is a strong factor behind the battle with cancer and patients reported a higher
amount of anxiety and depression and affects their quality of life (14,78). This finding was
consistent with Gahanna, Jordan, Lebanon, Malaysia, and Brazil studies (14,22,41,43,79). This
could be because of uncertainty surrounding disease prognosis (40), treatment side-effect (74), and
the treatment modality are mostly disease-centered and patients' psychosocial well-being is largely
undermined (22,50)
Generally, the finding of this study revealed that adult cancer patients undertaking chemotherapy
treatment at ANRS oncology treatment centers have poor QoL, educational status, psychological
36
factors i.e., anxiety and depression, BMI, stage of cancer, cycle of chemotherapy, comorbidity was
significantly associated with QoL of cancer patients.
37
7. LIMITATION OF THE STUDY
The QoL data was collected by interview and it is preferable if done by self-administered questioner
the results are subjectd to social desirability bias.
Body mass index are used for assessing nutritional evaluation owing to its own limitations;
Therefore, a comprehensive nutritional assessment tool is necessary for patients with cancer.
For the sake of interpretation the outcome variable has been dichotomized in to two. This might
result in underestimating the extent of variation in the outcome between groups, such as the
association of some events, and considerable variability may be subsumed within each group.
Therefore the results of this study should be taken in caution.
38
8. CONCLUSION AND IMPLICATION
8.1 Conclusion
In this study, the overall quality of life of adult cancer patients undertaking chemotherapy treatment
is below average. Emotional, role and physical and social domains were affected while the
cognitive domain of QoL was the least affected. In the symptom and single items pain, loss of
appetite, fatigue, and financial difficulty are the most affected domains of QoL. Multiple factors
have been associated with QoL of cancer patients. These are educational status, body mass index,
stage of cancer, comorbid diseases, anxiety, depression and number of chemotherapy cycles.
8.2 Implication to Nursing practice
This study identifies key factors that can affect QoL of cancer patients. identification of those
predictor factors would permit health care professionals to focus on the management strategies that
can be important in improving their QoL. The study finding implies that cancer patients undertaking
chemotherapy treatment has a high number of symptoms. Hence this finding emphasizes the need
for better management of cancer-related symptoms, proper pain management, and psycho-social
care should be included to improve patients QoL.
39
9. RECOMMENDATION
Federal Ministry of health

➢ To consider integration of psychological support mechanism with the oncology treatment
➢ Incorporating quality of life assessment in the patient’s treatment protocol which can address the
patient’s psychological need.
To Health Professionals
➢ Health care professionals shall encourage patients to explain their feelings, problems, concerns,
and give value for quality of life of cancer patients.
➢ Health care providers should also focus on treating the side effects of chemotherapy.
➢ Giving education on daily basis on cancer and chemotherapy
To Researchers
➢ Research with prospective study shall be implemented to assess the QoL of cancer patients at
different time intervals, and it would be better if further studies focus exclusively on each of the
cancer types, and doing reference data for QoL for the general Ethiopian population so that the data
could be compared with those of cancer patients.
40
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45
ANNEXES
Annex 1: Information sheet
This questionnaire is designed to examine the quality of life of adult cancer patients under chemotherapy
treatment session. I kindly request you to give me your attention to explain you about the purpose and
general condition of the study
Study title; Quality of life experiences and associated factors among adult cancer patients undergoing
chemotherapy treatment at Felege Hospital Comprehensive specialized Hospital and University of
Gondar Specialized Hospital, North west Ethiopia, 2021
objective of this study: is to assess the quality of life, experiences and associated factors of adult
cancer patients under chemotherapy treatment session. You are selected to be one of the participants in
this study. The study will be conducted through interview. Apart from the time you are going to use
during the interview, there will be no any risk acquired by participating in the study.
Benefits of the study: Taking part in the study helps;
To improve the knowledge about quality of life of cancer patients during chemotherapy treatment session
To identify factor that affect quality of life of cancer patients To provide basic information for
researchers, health policy makers, administrators, and for patients on quality of life of cancer patients.
Personal information: information that you are going to give me during the data collection will be
confidential. Your name will not be written in the questionnaire and once the data is entered into a
computer, it will be coded and password protected.
You have the right to withdraw from participating in the study whenever you want
Are you willing to participate in the study? 1. Yes 2. No Thank you!
If there are any questions or enquires any time about the study or the procedure, please contact me
Contact address of the principal investigator Ahmed Nuru Phone: +251927624174
Informed consent form (English version)
I understand all the information provided to me by the data collector, and I am willing to participate
in the interview. Signature______________ Date_____________ Thank you!
46
Annex 2: English Version Questionnaire
Variables Responses
11 Sex Male Female

12 Age ………… Years
13 Weight (Kg)______ Hight (cm) _______
14 Educational status A. Illiterate
B. Read and write
C. Primary education
D. Secondary education
E. College and above
15 Occupation status A. Farmer
B. Merchant
C. Housewife
C. Government employee
D. Jobless
E. Other
16 Residences A. Urban
B. Rural
17 Religion A. Orthodox Christian
B. Muslim
C. Protestant
D. Catholic
E. Other -----
18 Marital status A. Married
B. Single
C. Divorced
D. Other
47
NO 2. Clinical data extracted from patients’ medical chart
Variables
Responses
100 What type of cancer do you A. Breast B. Cervical C.
have? Colorectal D. Hematological E.
Other____(specify)
101 What was the date you were ____, _____, _____
diagnosed with this cancer? Date Month Year
102 Time since Diagnosis <12 months
(Duration since diagnosis) 12-36 months
calculate 24-60 months
>60 months
103 What is your current stage of A. Stage I B. Stage II C. Stage III
diagnosis D. Stage IV
104 How many cycles of A. Two B. Three C. four D. five E.
chemotherapy treatment sessions six F. seven
received?
105 Co morbidity Yes

No
106 If yes what is the disease type? A. Hypertension

B. Diabetes mellitus
C. Heart disease
D. Asthma
E. Other
107 ECOG /WHO Performance status
0. Fully Active 0.
1. Ambulatory and able to carry out 1.
work of a light 2.
48
2. Ambulatory and unable to carry out 3.
any work activities 4.
3. more than 50% of working hour
confined to bed or chair
4. Totally confined to bed or chair
Part 3-Housing Condition (Wealth Index)

1 Television Yes No
2 Radio Yes No
3 Non- Mobile Telephone Yes No
4 Electric stove Yes No
5 Refrigerator Yes No
6 Washing machine Yes No
7 Couch Yes No
8 Bicycle/Motorcycle Yes No
9 Car Yes No
10 Chair Yes No
11 How many hectares of agricultural land 1.------------Hectar
do members of this household own? 2. I don’t have
12 What is the type of toilet facility you 1. Flush or Pour Flush Toilet
have 2. Pit Latrine
inyour house? 3. No Facility/Bush/Field
49
13 What is the main source of drinking water 1. Piped Water
used by your household? 2. Protected Spring
3. Unprotected spring
4. Dug Well
5. River /Lake/Pond
6. Water from Spring/Dam
7. No
14 How many of the following animals does 1. Milk cows, oxen or bulls?
this household own? 2. Chickens
3. Sheep
4. Goats
5. Horses, donkeys, or mules
15 Owner of the house? 1. Private
2. Government
3. Private rental
4. Other
16 Number of room in the household?
17 How many peoples are sleeping per room
in this household?
18 What is the main material of the roof of 1. Natural roofing (wood planks, cardboard)
the dwelling? 2. Metal/Corrugated Iron
3. Cement/ Calamine Fiber
4. Ceramic Tiles
5. Others . . .
19 What is the main material of the floor of 1. Earth/Sand/Dung
the dwelling? 2. Wood Planks
3. Cement
4. Ceramic Tiles
5. Carpet
6. Others (Specify)
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Part 4: EORTC QLQ-C30 (version 3)
No EORTCS Questions Response
Not A Quite a Very

at all little bit much
1 Do you have any trouble doing strenuous activities, like carrying a heavy
shopping bag or a suitcase?
2 Do you have any trouble taking a long walk?
3 Do you have any trouble taking a short walk outside of the house?
4 Do you have to stay in a bed or a chair for most of the day?
5 Do you need help with eating, dressing, washing yourself or using the
toilet?
During the Past Week
6 Were you limited in doing either your work or other daily activities?
7 Were you limited in pursuing your hobbies or other leisure time activities?
8 Were you short of breath?
9 Have you had pain?
10 Did you need to rest?
11 Have you had trouble sleeping?
12 Have you felt weak?
13 Have you lacked appetite?
14 Have you felt nauseated?
15 Have you vomited?
16 Have you been constipated?
17 Were you tired?
18 Have you had diarrhea?
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19 Did pain interfere with your daily activities?
20 Have you had difficulty in concentrating on things, like reading a
newspaper or watching television?
21 Did you feel tense?
22 Did you worry?
23 Did you feel irritable?
24 Did you feel depressed?
25 Have you had difficulty remembering things?
26 Has your physical condition or medical treatment interfered with your
family life?
27 Has your physical condition or medical treatment interfered with your
social activities?
28 Has your physical condition or medical treatment caused you financial
difficulties?
For the following questions please circle the number between 1 to 7 that best applies to you
29 How would you rate your overall physical condition during the past week?
1 2 3 4 5 6 7
Very poor Excellent
30 How would you rate your overall quality of life during the past week?
1 2 3 4 5 6 7
Very poor Excellent
Part V: Hospital Anxiety and Depression Scale (HADS)

D A D A
I feel tense or 'wound up': I feel as if I am slowed down:
3 Most of the time 3 Nearly all the time
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2 A lot of the time 2 Very often
1 From time to time, occasionally 1 Sometimes
0 Not at all 0 Not at all
I still enjoy the things I used to enjoy: I get a sort of frightened feeling like 'butterflies'
in the stomach:
0 Definitely as much 0 Not at all
1 Not quite so much 1 Occasionally
2 Only a little 2 Quite Often
3 Hardly at all 3 Very Often
I get a sort of frightened feeling as if

something awful is about to
happen: I have lost interest in my appearance:
3 Very definitely and quite badly 3 Definitely
2 Yes, but not too badly 2 I don't take as much care as I should
1 A little, but it doesn't worry me 1 I may not take quite as much care
0 Not at all 0 I take just as much care as ever
I can laugh and see the funny side I feel restless as I have to be on the
of things: move:
0 As much as I always could 3 Very much indeed
1 Not quite so much now 2 Quite a lot
2 Definitely not so much now 1 Not very much
3 Not at all 0 Not at all
Worrying thoughts go through my mind: I look forward with enjoyment to

things:
3 A great deal of the time 0 As much as I ever did
2 A lot of the time 1 Rather less than I used to
1 From time to time, but not too often 2 Definitely less than I used to
0 Only occasionally 3 Hardly at all
I feel cheerful: I get sudden feelings of panic:
3 Not at all 3 Very often indeed
2 Not often 2 Quite often
1 Sometimes 1 Not very often
53
0 Most of the time 0 Not at all
I can sit at ease and feel relaxed: I can enjoy a good book or radio or TV
program:
0 Definitely 0 Often
1 Usually 1 Sometimes
2 Not Often 2 Not often
3 Not at all 3 Very seldom
Total score: Depression (D) Anxiety (A)

0-7 = Normal
8-10 = Borderline abnormal (borderline case) 11-21 = Abnormal (case)
Annex 3: Amharic Version Questionnaire
ባህር ዳርዩንቨርስቲ ህክመናና ጤና ሳይንስ ኮሌጅ የማህበረሰብ ትምህርት ክፍል የተሳታፊዎች መረጃ ቅፅ
ጤና ይስጥልኝ፣ ስሜ …………. ይባላል የምስራዉ…………………..ነዉ. በባህርዳር ዩኒቨርሲቲ ህክምናና ጤና ሳይንስ

ኮሌጅ የጥናት ቡድን አባላት በተዘጋጀዉ ጥናት ላይ መረጃ ሰብሳቢ ሁኜ እየሰራሁ ነዉ.ይህን ጥናት በተመለከተ አጭር ቃለመጠይቅ
ከርስዎ ጋር ይኑረኛል፡፡ ከቃለ ምልልሱ በፊት ግን ስለዚህ ጥናት አላማ በአጭሩ እገልጽሎታለው፡፡ ይህ ጥናት በ ባ.ዩ ህክምናና ጤና
ሳይንስ ኮሌጅ የ ማስተርስ ፕሮግራም መመረቂያ ፅሁፍ ነዉ፡፡ የዚህ ጥናት አላማ በጥቁር አንበሳ ስፔሻላይዝድ ሆስፒታል ካንሰር
ላለባቸውና በኬሞ ቴራፒ ህክምና ላይ ላሎ ህመምተኞች በህይወት የመኖር ጣዕም ላይ የሚያተኩር ነው፡፡ እርሶም በዚህ ጥናት ላይ
እንዲሳተፉ ተጋብዘዋል፡፡አሁን የምናደርገው ቃለ ምልልስ ምክንያት ጊዜዎን ከመሻማት ውጪ በአካሉ ላይ የሚደረግ ምንም አይነት
የለም ፡፡
የዚህ ጥናት ጥቅም •
• ካንሰር ያለባቸውና ኬሞ ቴራፒ ህክምና ላይ ላሎ ህመምተኞች በህይወት የመኖር ጣዕም እዉቀት ይጨምራል፡፡
• የዚህ ጥናት ውጤት ሌሎች ጤናን በተመለከተ መተዳደሪያ ደንብ ለሚያወጡ ግለሰቦች አስተዳደሮች ጥናትን ለሚያከናውኑ
ግለሰቦች በ ካንሰር ለሚሰቃዩ ህሙማን መረጃ ይሰጣል፡፡ ይህ የሚሰጡን ግላዊ መረጃ ሚስጥራዊነቱ የተጠበቀ ነው ፡፡
54
ይህ መረጃ በኮምፒውተር በሚስጥር ከተመዘገበ በኃላ ስምዎት አይጠቀስም እናም በምንም አይነት መንገድ ሊታወቅ አይችልም፡፡
በኮምፒውተር ውስጥ ያለው መረጃ በሚስጥር ኮድ ታስሮ ይቀመጣል፡፡ ይህን መረጃ የሚሰጡን ያለምንም ግዴታ በሙሉ
ፍቃደኝነት ነው ከተጀመረ በኃላ በማንኛውም ግዜ ተሳትፎዎትን የማቁረጥ ሙሉ መብት ይኖሮዎታል፡፡
በጥናቱ ላይ ለመሳተፍ ፍቃደኛ ነዎት? 1. አዎ 2. አይደለውም አመሰግናለው!!
ፈቃደኝነትን የሚያረጋግጥ ቅፅ በመረጃ ሰብሳቢዋ መሰረት የተነገረኝን መረጃ በሙሉ ተረድቻለሁ፡፡ አናም በዚህ ቃለመጠይቅ ላይ
ለመሳተፍ ፈቃደኛ ነኝ፡፡ የምላሽ ሰጪ ፊርማ ............................................. ቀን………………………………. የጠያቂ
ፊርማ ……………………………………
55
1. ማንነትን የሚመለከት ጥያቄዎች
1፤ ዕድሜ ………………… 2፤ ፆታ ………………

3 ፡ ክብደት…………… ቁመት …………….
4፤ የትምህርት ደረጃ …………. ሀ/ አልተማርኩም ለ/ ማንብብ መፃፍ እችላላሁ ሐ/አንደኛ ደረጃ ያጠናከኩ መ/ ሁለተኛ ደረጃ
ያጠናከኩ ሠ/ ኮሌጅ እና ከዚያ በላይ ረ/ሌላ ካለ
5፤ ስራ ሀ/ የቤት እመቤት ለ/ የመንግስት ሠራተኛ ሐ/ መንግስታዊ ያልሆነ ድርጅት ሠራተኛ መ/ ግል ሠ/ሌላ (ይግለፁ)
6፤ ሀይማኖት………………. ሀ/ ኦርቶዶክስ ክርስቲያን ለ/ሙስሊም ሐ/ፖሮቴስታንት መ/ካቶሊክ ሠ/ ሌላ ካለ
7፤ የጋብቻ ሁኔታ ……………. ሀ/በትዳር ላይ ያሉ ለ/ ያላገባች ሐ/የፈታች መ/ሌላ ካለ
2. ማህበራዊ ና ኢኮኖሚያዊ ደረጃ መለኪያ (wealth index)
1 ቴሌቪዥን 1.አዎ2. የለም
2 ሬድዮ/ቴፕሬኮርደር 1.አዎ2.የለም
3 ሞባይልስልክ 1.አዎ2.የለም
4 ሞባይል /የገመድ ስልክ አለዎ 1.አዎ2.የለም
5 የኤሌትሪክምድጃ 1 አዎ2.የለም
6 ፍሪጅ 1.አዎ 2. የለም
7 ላውንደሪ(የልብስማጠብያ 1.አዎ 2. የለም
8 ሶፋ 1.አዎ 2. የለም
9 ሳይክል/ሞተርሳይክል 1.አዎ 2. የለም
10 መኪና 1.አዎ 2. የለም
2. የቤትሁኔታ
11 የመኖሪያ ቤት ባለቤትነት 1. የግል 2.የመንግስት 3 .ኪራይ 4.ሌላ ጥቀስ
12 ምንያህል ክላስ አላቹህ
13 ከ አንድ ቤት ምን ያህል ሰዉ ያድራል
14 የቤቱ የወለል ሁኔታ 1.ተፈጥራዊ ቁስ (ሣር) 2.ቆርቆሮ 3.ሸክላ 4.ሌላ ጥቀስ
56
1. ጭቃ 2. ጣውላ 3. የሲሚንቶ ወለል 4. ሴራሚክ 5.
15 የግድግዳ ሁኔታ
ምንጣፍ 6. ሌላ (ጥቅስ)
1. ውሀ ያለው ሽንት ቤት 2. ጉርጓድ መጸዳጃ ቤት 3.መጸዳጃ ቤት
16 ምንአይነትመጸዳጃቤትአላቹህ
የለም / በቁጥቋጦ / በሜዳ
ለቤተሰቡ የመጠጥ አገልግሎት
1.የቧንቧውሀ 2. የምንጭ ውሀ 3.የጉርጓድ ውሀ 4.
17 የሚውል ውሀ ዋና ምንጩ ምንድን
ኩሬ/ሀይቅ/ወንዝ/ 5. ቋሚ የሆነ ምንጭ የለም
ነው
የቤተሰቡ አባል ምን ያህል የእርሻ
18 1. የአከባቢዉ መለኪያ…………..ጋሻ 2.የእርሻመሬትየለኝ
መሬት አለዉ
ከተዘረዘሩት የእንስሳት መሃል
1. የወተት ላም፣ በሬ፣ኮርማ 2. ዶሮ 3. ፍየል 4. በግ 5.
19 የቤተሰቡ አባል ምን ያህል
ፈረስ፣አህያ፣በቅሎ 6. የንብቀፎ
አለው
3. የሕክምና መረጃ
11፤ የካንሰር ህመምዎ አይነት ምንድን ነዉ ? ሀ/ የጡት ለ/ የአንጀት ሐ/ የማህፀን በር መ/ የደም(Hematological) ካንሰር ሠ/ ሌላ
(ይግለፁ)
12፣ የካንሰር ህመም እንዳለብዎ ያወቁት መቸ ነዉ ያወቁት ……. ፣ ቀን……ወር……ዓመት…….
13፣ ካንሰር ህመሙ ስንተኛ ደረጃ ላይ ነው፣ ሀ/ Stage I ለ/ Stage II A ሐ/ Stage III መ/ Stage IV
14፤ አሁን ለስንተኛ ዙር ነው ይህን መድሀኒት የሚወስዱት ሀ/ለሁለተኛ ጊዜ ለ/ለሶስተኛ ጊዜ ሐ/ ለአራተኛ ጊዜ መ/ ለአምስተኘ ጊዜ
ሠ/ለስድስተኛ ጊዜ ረ/ ለሰባተኛ ጊዜ ሰ/ ለስምተኛ ጊዜ
15 ፤ ተጉዋዳኝ በሺታ ዐለብዎት ሀ/አዎ ለ/የለብኝም
16፤ ለ 15 ጥያቄ መልስዎ አዎ ከሆነ ህመምዎ ምንድን ነዉ ሀ/የደም ግፊት ለ/የስኳረ በሺታ ሐ/የልብ በሺታ መ/ሌላ
17፤ የስራ ተግባር እና የእንቅስቃሴ አፈፃፀም ሁኔታ

0. ሙሉ በሙሉ ንቁ እና ከበድ ያለ ስራ ወይም እንቅስቃሴ ለመስራት ችግር የለለበት
1. መንቀሳቀስ እና ቀለል ያለ ስራ መስራት የሚችል
2. መንቀሳቀስ የሚችል ግን ማንኛዉንም የስራ እንቅስቃሴ ማከናወን የማይችል
3. ከ 50% በላይ የስራ ሰዐት በአልጋ ወይም ወንበርላ ይ የሚያሳልፍ
4. ሙሉ በሙሉ በአልጋ ወይም ወንበር ላይ የሚያሳልፍ
57
QLQ C- 30 በጭራሽ በት በ በ
ንሹ መ ብ
ጠ ዛ
ኑ ት
3.1 ከባድ ስራ ወይም እንቅስቃሴ ለመስራት ችግር አለብዎ 1 2 3 4

(ለምሳሌ፤ዘንቢል ለመሽከም)
3.2 ረጅም የእግር ጉዞ ለማድረግ ችግር አለብዎ 1 2 3 4
3.3 አጭር የእግር ጉዞ ለማድረግ ችግር አለብዎ(ከቤትዎ 1 2 3 4
ውጪ)
3.4 በህመምዎ የተነሳ በቀን አልጋ ላይ ወይም ወንበር ላይ 1 2 3 4
ሁነው ረዘም ላለ ሰዓት ያሳልፍሉ?
3.5 የዕለት ተዕለት እንቅስቃሴዎን ለማከናውን ረዳት ወይም 1 2 3 4
አጋዥ ይፈልጋሉ ?ለምሳሌ መመገብ መልበስ
3.6 ስራዎትን ወይም የዕለት ተዕለት እንቅስቃሴዎን 1 2 3 4
ለማከናወወን አግድዎት ነበር
3.7 በትርፍ ጊዜ የሚከናወን ስራ ወይንም ዝነንባሌዎን 1 2 3 4
ለማሳካት ወይም ሌሎች የመዝናኛ ጊዜዎች ለማሳለፍ
አግዶዎታለ?
3.8 ሲተነፍሱ ትንፋሽ ማጠር አጋትጥመዎት ነበር? 1 2 3 4
3.9 የህመም ስሜት ነበረብዎ? 1 2 3 4
3.1 ከወትሮዎ የተለየ ዕረፍት አስፈልጎዎት ነበር? 1 2 3 4
0
3.1 የእንቅልፍ ችግር ነበረብዎ? 1 2 3 4
1
3.1 አቅም ያንስዎት ነበር? 1 2 3 4
2
3.1 የምግብ ፍላጎትዎ ቀንሷል? 1 2 3 4
3
3.1 የማቅለሽለሽ ስሜት ነበረበዎ? 1 2 3 4
4
3.1 አስመልስዎት ነበር ? 1 2 3 4
5
3.1 የሰገራ ድርቀት ነበረብዎ ? 1 2 3 4
6
3.1 ተቅማጥ ነበረብዎ? 1 2 3 4
7
3.1 የድካም ስሜት ነበረብዎት ? 1 2 3 4
8
58
3.1 ህመሙ ዕለት ተዕለት እንቅስቃሴዎን ያውክብዎ ነበረ ? 1 2 3 4
9
3.2 አንዳንድ ነገሮች ትኩረት ስጥተው ለመስራት? 1 2 3 4
0 ያዉክዎት ነበር? (ለምሳሌ፤ ጋዜጣ ለማንበብ፤ ራዲዩ
በማዳመጥ )
3.2 የውጥረት ስሜት ነበረብዎ ? 1 2 3 4
1
3.2 የመጨነቅ ስሜት ነበረብዎ ? 1 2 3 4
2
3.2 የመነጫነጭ ስሜት ነበረብዎ? 1 2 3 4
3
3.2 የመደበር ስሜት ነበረብዎ ? 1 2 3 4
4
3.2 ነገሮችን የማስታወስ ችግር ነበረብዎ ? 1 2 3 4
5
3.2 የጤናዎ ሁኔታ ወይም የሚከታተሉት 1 2 3 4
6 ህክምና ኑሮ ላይ ያሳደረው ተፅዕኖ አለ
3.2 የጤናዎ ሁኔታ ወይም የሚከታተሉት ህክምና በማህበራዊ 1 2 3 4
7 ህይወትዎ፤ በሚያደርጉት እንቅስቃሴ ላይ ያሳደረው
ተፅእኖ አለው ?
3.2 የጤናዎ ሁኔታ ወይም የሚከታተሉት ህክምና ገንዘብ 1 2 3 4
8 እንዲያጥርዎ /እንደቸገርዎ አድርጓል ?
ባለፈው ሳምንት ውስጥ

3.29 ባለፈዉ ሳምንት በአጠቃላይ የጤንነት ሁኔታዎን እንዴት ይመዝኑታል?
በጣምመጥፎ እጅግ በጣምጥሩ
1 2 3 4 5 6 7
3.30 በአጠቃላይ ባለፈው ሳምንት የነበረዎን የኑሮ ሁኔታ ጥራት እንዴት ይመዝኑታል?
በጣምመጥፎ እጅግ በጣምጥሩ
1 2 3 4 5 6 7
59
የጭንቀት እና ቁዘማ(ሀዘን) መገምገሚያ መጠይቅ
D A D A
1. የመጨነቅ ወይም የመወጠር ስሜት ምን 8. ስራዎትን ሲያከናዉኑ ምን ያህል የዘገዩ ይመስልዎታል

ያህል ይሰማዎታል
3 በጣም ብዙ ጊዜ 3 እጅግ በጣም ጊዜ
2 ብዙ ጊዜ 2 በጣም ብዙ ጊዜ
1 አልፎ አልፎ 1 አልፎ አልፎ
0 ምንም አይሰማኝም 0 ምንም አልቀነሰም
2. ቀደም ሲል ያስደስትዎ የነበሩ ነገሮችአሁን 9. ሆድ አከባቢ የሚሰማ የመደንገጥ ወይም የመሸበር ስሜት
ምን ያህል ያስደስትወታል ይሰማዎታል
0 አሁንም እንደድሮዉ ያስደስተኛል 0 ምንም ኤሰማኝም
1 ከድሮዉ ትንሽ ቀንሷል 1 አልፎ አልፎ

2 በጥቂቱ ያስደስቱኛል 2 ብዙ ጊዜ
3 ጭራሽ አያስደስቱኝም 3 በጣም ጊዜ
3. አንድ መጥፎ ነገር ሊጋጥምዎ የተቃረበ 10. ለ አለባበስዎ ትኩረት መስጠት አቁመዋል
የሚመስል የፍርሃት ስሜት ይሰማዎታል
3 እጅግ በጣም ይሰማኛል 3 አዎን ምንም ትኩረት እየሰጠሁ አይደለም
2 በጣም ይሰማኛል 2 የምፈልገዉን ያህል ትኩረት እየሰጠሁ አይደለም
1 በጥቂቱ ይሰማኛል 1 ድሮ ከምሰጠዉ ትኩረት በጥቂቱ ያነሰ ትኩረትን እሰጣለሁ
0 ምንምአይሰማኛል 0 ሁሌ የምሰጠዉን ትኩረት እሰጣለሁ
4. መሳቅ እና የነገሮችን አስቂኝ ጎን ማየት 11. አንድ ቦታ መሄድ ያለብዎ ይመስል ተረጋግቶ መቀመጥ
ይቸግርዎታል
ይችላሉ
0 አብዛኛዉን ጊዜ እችላለሁ 3 በጣም ብዙ ጊዜ ይቸግረኛል
1 እንደድሮዉ ባይሆንም እችላለሁ 2 ብዙ ጊዜ ይቸግረኛል
2 በጥቂቱ እችላለሁ 1 ብዙም አይቸግረኝም
3 ምንም አልችልም 0 ምንም አይቸግረኝም
60
5. ጭንቀትን የሚያጭሩ ሀሳቦች በአእምሮ 12. መጪ ነገሮችን በደስታ ይጠብቃሉ
ምን ያህል ጊዜ ያመላልሳሉ
3 በጣም ብዙ ጊዜ 0 ሁሌም በተለመደዉ ወይም በድሮዉ መጠን እጠብቃለሁ
2 ብዙ ጊዜ 1 ከድሮዉ ወይም ከተለመደዉ በጥቂቱ ባነሰ መጠን

እጠብቃለሁ
1 አልፎ አልፎ 2 ከድሮዉ ወይም ከተለመደዉ ባነሰ መጠን እጠብቃለሁ
0 አንዳንዴ ብቻ 3 ምንም በደስታ አልጠብቅም
6. ደስተኛ ነዎት 13. በድንገት የመደንገጥ ወይም የመሸበር ስሜት ይሰማዎታል
3 ምንም ደስተኛ አይደለሁም 3 በጣም ብዙ ጊዜ ይሰማኛል
2 ብዙ ጊዜ ደስተኛ አይደለሁም 2 ብዙ ጊዜ ይሰማኛል
1 ብዙም ባይሆን ደስተኛ ነኝ 1 አልፎ አልፎ ይሰማኛል

0 አብዛኛዉን ጊዜ ደስተኛ ነኝ 0 ምንም አይሰማኝም
7. ተረጋግተዉ መቀመጥ እና ዘና ማለት 14. በሬዲዮ ወይም በቴሌቪዥን ፕሮግራሞች ራስዎን

ይችላሉ ያስደስታሉ
0 ሁሌም እችላለሁ 0 አዎን ብዙ ጊዜ
1 አብዛኛዉን ጊዜእችላለሁ 1 ብዙም ባይሆን አዎ
2 ብዙዉን ጊልችልም 2 አልፎ አልፎ
3 ምንም አልችልም 3 በጣም አልፎ አልፎ
Total score: Depression_____________ Anxiety_________
61
Annex 4: Scoring items
Analysis category Scale Number Item range Question numbers analyzed

scale of items together
Global health status / QoL
Global health QOL 2 6 29, 30
status/QOL
Functional scales
Physical functioning PF 5 3 1 to 5
Role functioning RF 2 3 6,7
Emotional functioning EF 4 3 21,24
Cognitive functioning CF 2 3 20,25
Social functioning SF 3 3 26,27
Symptom scales/ item
Fatigue FA 3 3 10,12and 18
Nausea and vomiting NV 2 3 14,15
Pain PA 2 3 9,19
Dyspnea DY 1 3 8
Insomnia SL 1 3 11
Appetite loss AP 1 3 13
Constipation CO 1 3 16
Diarrhea DI 1 3 17,
Financial difficulties FI 1 3 28
62
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2
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Quality of Life and Associated Factors

QUALITY OF LIFE AND ASSOCIATED FACTORS AMONG ADULT

BY: AHMED NURU (BSC)

QUALITY OF LIFE AND ASSOCIATED FACTORS AMONG ADULT CANCER

Advisors: Mr. Sitotaw Kerie (Assistant professor)

A THESIS SUBMITTED TO THE DEPARTMENT OF ADULT HEALTH

Ahmed Nuru Muhamed (Bsc) ______________ _____________

Name of the candidate Date Signature

BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

Approval of Thesis Report

Advisor’s name Signature Date

1. Mr. Sitotaw Kerie (Bsc, Msc, Assistant Professor) ____________ __________

BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

We hereby certify that we have examined this dissertation/thesis entitled “Quality of

_____________________ ________________ _____________

External examiner’s name Signature Date

_____________________ ________________ _____________

Internal examiner’s name Signature Date

_____________________ ________________ _____________

Chair person’s name Signature Date

ACRONYMS AND ABBREVIATIONS ..................................................................................iv

TABLE OF CONTENT ..............................................................................................................v

LIST OF TABLES ................................................................................................................... viii

LIST OF ANNEXES ..................................................................................................................x

1.1 Background of the Study ....................................................................................................... 1

1.2 Statement of the problem ...................................................................................................... 3

1.3 Significance of the study ....................................................................................................... 4

2.1. Quality of life of patients with cancer ................................................................................. 5

2.2. The symptoms experienced by cancer patients undergoing chemotherapy ........................ 6

2.3 Factors Associated with Quality of life ................................................................................ 8

2.3.1 Sociodemographic characteristics ...................................................................................... 8

2.3.2 Psychological Factors ......................................................................................................... 9

2.3.3 Clinical characteristics and QoL ..................................................................................... 10

2. 4 CONCEPTUAL FRAMEWORK ..................................................................................... 12

3.1 General objective................................................................................................................. 13

3.2 Specific Objectives ......................................................................................................... 13

4.1. Study area and period ........................................................................................................ 14

4.3. Population ......................................................................................................................... 15

4.3.1 Source Population ............................................................................................................ 15

4.3.2 Study population .............................................................................................................. 15

4.4. Inclusion and Exclusion criteria ........................................................................................ 15

4.4.1 Inclusion criteria:.............................................................................................................. 15

4.4.2 Exclusion Criteria:............................................................................................................ 15

4.5 Study Variables .................................................................................................................. 15

4.5.1 Dependent variables ......................................................................................................... 15

4.5.2 Independent variables ....................................................................................................... 15

4.6. Operational definition: ...................................................................................................... 16

4.7. Sample size determination ................................................................................................ 16

4.8. Sampling technique and Sampling Procedures ................................................................. 18

4.9. Data collection ................................................................................................................. 18

4.9.1 Data collection tool: ........................................................................................................ 18

Ahmed Nuru Muhamed (Bsc) __ _

1. Mr. Sitotaw Kerie (Bsc, Msc, Assistant Professor) __

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a GI Cancer, Colorectal, Gastric, Esophageal cancer c Asthma, HIV/AIDS