Efficiency of patients with carcinoma and acceptance of the disease

Introduction



Humans function in the following fields: physical, mental and spiritual.

These spheres overlap, so the appearance of cancer threatens the biological, psychological and social fields. Chronic disease, such as cancer, is a heavy burden for people, forcing them to change their lifestyle, plans and active, professional life. As a result of cancer and applicable treatment, the quality of life of the patient decreases, and the problems concern not only the patient but also his/her family [1–5].

Depending on the symptoms related to oncological treatment appearance, we could observe a vast impact on human functioning.

Severe pain, acute or chronic, causes with its duration a decrease the patient’s daily living activities up to a total lack of activity caused by the fear of pain [5–7].

In response to a physical disorder, negative emotional reactions may appear, such as anxiety, depression, anger or aggression, as a manifestation of mental disorders [8, 9]. Cancer involves a large number of stressful situations with elements of biological and psychological risks. The stress experienced by oncology patients, who have a chronic condition, can lead to the deterioration of the dynamics of life and fitness condition [9, 10]. Among the psychiatric disorders in the course of cancer, the most common are: maladaptive, depressive disorders, anxiety disorders and disturbances of consciousness.

Out of all these disorders the most common is depression. Currently, it is diagnosed in about 15–25% of patients with this disease. A number of factors contribute to its appearance, e.g. young age, female gender, poor financial situation, previous experience, physical exhaustion and physical symptoms that limit daily activities. The diagnosis is based on the so-called triad of depression (negative thoughts about yourself, negative thoughts about the surrounding situation and the future). In addition, in patients in the course of oncotherapy, the following symptoms are taken into consideration: depressed mood, feelings of helplessness and hopelessness, low self-esteem, feelings of worthlessness or guilt, inability to experience pleasure (anhedonia) and thoughts of suicide [11–14].

The appearance of carcinoma in human life affects the social functioning of the sufferer and of their family. This involves a significant reduction in professional activity because of the hospital treatment and consequent medication. A person afflicted with a disease has a sense of being dependent on other people, which can be a heavy burden to the sufferer as well as to their family [15, 16]. The problems of a spiritual nature relate to human spirituality. These are not only issues of faith in God and religion but also issues of philosophy, morals and morale. Having cancer raises questions about the meaning of life and the meaning of illness. Sufferers often try to resolve old conflicts and go through a process of self-examination of their life and experiences [2, 17, 18].

Patients are faced with the need to verify and re-evaluate their current values. Very often, human interests and values appear to be insufficient to fully eliminate this disease occurring in self-disability, injury, fear and loneliness. In these moments, religion and a spiritual relationship with God can give people hope and peace [9, 19]. The concept of “capacity” refers to the efficiency of human health, the overall health of a person. According to the literature, “the individual is efficient and physically fit when one has cardio-respiratory endurance, freshness of mind, reacts positively with others, has the desired level of fat, strength, flexibility and a healthy spine” [20]. Thus, the level of efficiency is expressed by the level of form that is conducive to the performance of tasks. Furthermore, efficiency is defined as the ability of the body to properly function [21]. However, the concept of self-efficiency is the body’s ability to take independent actions in the activities of daily living, actions aimed at satisfying the basic needs of everyday life. These include activities such as eating, moving around, following hygiene and satisfying physiological needs [70, 80]. In the wider context of human autonomy, it is defined as the self-protective act. Self-care is the ability to act independently, initiated in a conscious way, carried out in relation to other people and the surrounding environment. Self-protective activities are undertaken in order to preserve life, maintain or improve health, and to maintain internal balance and integration with the environment. Self-service and self-care include attention to quality of life [21–23]. Human capacity may be affected by problems and constraints caused by cancer. Limited efficiency in the course of disease is the result of physical realm disorders that have a negative impact on the mental or social spheres. There are many problems causing loss of function in cancer patients, and they include: general weakness of the body, depressed mood, anxiety, depression, reduction of physical activity, the need for specialised equipment or apparatus, pain prevention while conducting normal activities, malnutrition and sleep disorders [23, 24].

Observations of the efficiency of oncology patients is important for the therapeutic process because maintaining functional efficiency contributes to better adaptation to the disease [25–27].

Acceptance of the disease, which is associated with less severe adverse reactions and emotions connected with the disease, is an important part of the process of adapting to life with the disease. It is a process that occurs on two levels: the emotional level and the cognitive-behavioural therapy level. In addition, acceptance of illness is linked with the activities set to re-establish the well-being of the patient (the phoenix effect) and with a willingness to accept oneself as a patient [16, 28]. Acceptance of the disease increases the sense of security and reduces the severity of negative emotions and reactions associated with the disease, as well as the sense of discomfort. Studies show that the greater the degree of acceptance of the disease, the better the adaptation and less discomfort caused by the disease, the stress caused by the disease is lower and the sense of self-esteem is retained.



Aim of the research study



The following research problems have been established:

The main problem:

1. What is the relationship between the efficiency of patients with cancer and their acceptance of the disease?

Specific problems:

1. What is the relationship between the efficiency of patients with cancer in the performance of activities of daily living?

2. What is the influence of pain on activities in patients with cancer?

3. What is the influence of cancer on the mental functioning of the patients?

4. What is the degree of acceptance of the disease?

5. What is the relationship between the characteristics of the study group and functional efficiency, pain, depression and acceptance of the disease?



Material and methods



In this work we used the method of diagnostic survey, using the technique of a research-survey. As a research tool a questionnaire was used. The questionnaire was designed for a group of patients with cancer. It consisted of instructions explaining the purpose of research and personal specifications relating to shared demographic and social subjects. It also contained essential questions that concern everyday functioning [29]. This scale was developed and implemented by the mist and co-authors in the Upper Silesian Rehabilitation Centre in Repty. It is a universal tool and, although it was developed for the functional assessment of patients with damage to the nervous system, it is used for functional assessment of patients in the course of other diseases, including cancer. The Repty Functional Indicator does not address the issues of “social consciousness”, which include relations, memory and problem solving, because they belong to the realm of psychological and sociological tests and do not add up in scoring. Self-service, sphincter control, mobility, locomotion and communication are the evaluated issues.

The minimum number of scored points was 15 and the maximum was 105. The scale allowed the patient to be qualified for a specific category of disability, defining their independence in activities of daily living and any help required. The grading scale by Repta Functional Index is as follows:

• 105–75 points – full independence;

• 74–45 points – moderate dependence;

• 44–15 points – total independence.

The question sheet for the patient included questions on the implementation of activities of daily living. The test marked whether an action was performed alone, with the help of others or whether the patient was in fact dependent on the help of others. The questions related to activities such as self-service, sphincter control, mobility, locomotion and communication.

The assessment of pain intensity and its impact on daily activities was made using the Modified Sheet Pain Evaluation [30]. It is a verbal scale investigating whether and how pain affects the patient’s activity.

The degree of disease acceptance was made with the use of the abbreviated injury scale (AIS). The scale was proposed by Felton, and Hinrichsen Revensson of the Centre of Community Research and Action, Department of Psychology, New York University in 1984. It was transferred and adapted to Polish by Juczyński [31]. The AIS scale consists of eight statements that describe the negative consequences of ill-health in order to evaluate the limitations imposed by the disease, a lack of self-sufficiency, a sense of dependence on others and lowered self-esteem.

In each of these claims the patient defined his/her current state with a five-point scale, where 1 means to strongly agree and 5 means to strongly disagree. Score 1, strongly agree, expresses poor adaptation to the disease, while strong disagreement, score 5, constitutes acceptance of the disease. A general measure of the acceptance of the disease is given by the sum of all points, and the range of points is between 8 and 40.

Scoring for the AIS Scale:

8–14 points, low level of acceptance of the disease;

15–32 points, average level of acceptance of the disease;

33–40 points, high level of acceptance of the disease.

A low test result means not accepting the disease, not adapting to it and a sense of mental discomfort. A high score indicates acceptance of the condition, which is manifested by the absence of negative emotions associated with cancer.



Statistical analysis



The results of this study were subjected to descriptive and statistical analysis. The analysed data of quantitative variables were characterized by means and standard deviations. For the relation characteristics of the values, cardinality and interests were used, respectively. The results are shown in the form of tables and graphs. To assess the relationship or differences between the measurable data we used a homogeneity test or Pearson’s 2 test. Furthermore, in order to find the correlation between the analysed variables, parametric or nonparametric correlation tests were used. The statistical analysis was performed with Statistica 10.1 Software, Stat Soft Inc. All analyses were completed for CI (confidence interval) = 95%.



Results



Characteristics of the analyzed group



The study involved 137 patients with cancer, hospitalised in St. John‘s Cancer Centre in Lublin. The respondents represented a diverse group in terms of age, sex, place of residence, education, marital status, employment and the type of treatment and duration of the disease. Socio-demographic characteristic of the analysed group are included in Table 1.

The table shows that the average age of respondents was 56.2 years. More than half (65.69%) were women, while men accounted for 34.31%. With regard to place of residence, most of the respondents were from rural areas (36.50%), far fewer were from small towns (34.30%), and there maining respondents were residents of large cities (29.20%). The highest percentage (36.50%) of the study group consisted of patients with secondary and vocational education (18.96% of the respondents), 17.52% had a higher degree, 13.87% had basic education, and the smallest percentage were those with higher education (13.14%). In terms of marital status, the largest proportion of respondents were in a formal relationship 73.53%, divorced people represented 14.91%, while a single persons represented 9.56%. The smallest group consisted of patients remaining in informal relationships (2%). Another criterion for differentiating respondents was professional activity. The largest percentage of respondents (62.77%) were persons with disability or retirement benefit. A much smaller number of respondents indicated that they were currently employed but on sick leave (17.52%). A much smaller group consisted of people working, studying or learning (11.68%). It is notable that unemployed persons accounted for only 8.03% of respondents. The patients were also receiving different types of treatment. Almost half of the patients underwent chemotherapy 55.47% and slightly less had radiotherapy 44.53%. Disease duration was also varied. In more than half (56%) of the patients, disease duration did not exceed 5 years; 34% of the respondents had the disease from 5 to 10 years; while 9% said that their illness had lasted for more than 10 years. Mean disease duration was 2.6 years.



Our results



Assessment of functional capacity of patients with cancer based on the Repta Functional Index. To assess the functional capacity of patients in this study the Repta Functional Index was used. After collecting the questionnaires from respondents, analyses were carried out, and on the basis of the points attained therein, the level of functional capacity of patients are illustrated in detail in Table 2.

As can be seen, the vast majority of patients were independent in performing activities of daily living. Over 90% of respondents independently performed activities such as eating, taking care of body and mouth hygiene, bathing, dressing and using the toilet. Well over 90% of the patients satisfied their physiological needs alone, moving from bed to chair or wheelchair, entering the bath or shower. A similar proportion of patients walked alone to a wheelchair. Also, over 80% of respondents had no problems with understanding and speech.

Less than 5% of all the patients required assistance in performing activities of daily living. These patients required assistance especially in activities such as swimming (5.11%), using the toilet (5.84%) or entering the shower or bath (8.76%). These patients also needed help with walking or operating a wheelchair (7.30%). The highest percentage of patients needing help were those who needed help from others in walking up stairs (14.60%). 14.60% of the patients also had a problem understanding verbal commands and conducting conversations.

More than 1% were completely dependent somebody else. This relationship manifested in all activities of daily living: eating, hygiene activities, satisfying physiological needs, dressing, mobility and movement. A small percentage of respondents had serious problems communicating (0.73%).

Based on the points attained on the Repta Functional Index, the respondents were divided into three groups depending on their degree of independence. The classification is presented in Table 3. The table shows that almost all respondents (94.16%) independently performed activities of daily living. Only about 5% of the patients needed assistance in daily functioning, and patients depending on the help of others constituted a small percentage of the study group (1.46%). The average score obtained in this study was 98.83 points (min. 23, max. 105).



Evaluation of the impact of pain on the activity of the study group with the Modified Pain Questionnaire



In order to assess the impact of pain on patients undergoing active study the Modified Pain Questionnaire was used. This allowed you us to determine whether the pain experienced by the respondent interfered with their daily functioning.

The Table 4 below summarises the results of the evaluation sheet of the Modified Pain Questionnaire. The data contained in the table indicate that about 30% of the respondents declared no pain, approximately 22% of patients said that their pain could be taken lightly, and a similar sized group (21.17%) of respondents declared pain but with no impact on daily functioning. More than 13% of patients reported pain that interfered in everyday functioning, while 2.19% of patients said that pain interfered with the performance of activities of daily living. The presence of pain forcing respondents to lie down or take of analgesics occurred in approximately 10% of those surveyed.



The degree of acceptance of the disease



We analysed the relation between the level of acceptance of cancer patients and the age of the study population. In the analysed population, the relationship of the previously mentioned factors was not statistically significant (p = 0.141). Detailed information relating to this issue is listed in the Table 5.

The listed data indicate that in the group of respondents aged 20–59 years an average level of acceptance of the disease dominated (48%), similarly as in the group of patients aged 60–89 years (67.74%). There were significant differential stresses in the presentation of high acceptance of the disease. In the younger group (20–59 years) a high level of acceptance was declared by 41.33%, while in the group aged 60–89 years, only 8.06% of the respondents stated this. The difference was also for the low level of acceptance of the disease. The low level of acceptance of the disease was significant for patients aged 60–89 years (24.19%), and a significantly lower proportion of patients with low level of acceptance of the disease was seen in the group of 20–59-year-old (10.65%).



Conclusions



The majority of respondents were fully competent in the performance of activities of daily living. Only a few people needed help with everyday activities or were dependent on others. The majority of respondents did not feel pain, or felt the pain that could be taken lightly. Pain was an issue only for persons over 60 years of age, and this group had particular difficulty with daily functioning in terms of mobility and locomotion. The main condition caused by cancer in subjects was mild depression; several persons had moderate to severe depression. In the analysed group an average degree of acceptance of the disease was dominant. A small proportion was marked by a high level of acceptance, and only a few people showed a lack of acceptance of the disease. Use of self and acceptance of illness requiring assistance is at a medium level with dependents level of acceptance is low. Those most self show symptoms of mild depression. Moderate and severe levels of depression were significant for people who required help with daily functioning or were dependent on the assistance of others.



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Address for correspondence:



Marzena Kamińska MD

Chemotherapy Ward, St. John’s Cancer Centre

ul. Jaczewskiego 7, 20-090 Lublin, Poland

Phone: +48 607 234 462

E-mail: mkaminska0@vp.pl