- In this cross-sectional study in Bangladesh, 202 patients receiving chemotherapy for ovarian cancer completed the EORTC Quality of Life (QOL) Group C30 questionnaire and the ovarian cancer–specific EORTC QOL OV-28 questionnaire
- The average score for global health status was 55.7
- Global health status correlated moderately well with impairment on all function scales (physical, role, cognitive, social and emotional function)
- Many symptoms and other burdens were negatively associated with QOL, particularly fatigue (r = -0.60), pain (r = -0.58) and financial difficulties (r = -0.46)
- 60% of all patients complained of vaginal dryness, and only 51% of patients reported being sexually active; 70% of that subgroup said they were not enjoying sexual activity and were not interested in sex
It's known from studies in high-income countries that the toxicities of chemotherapy for ovarian cancer can have a substantial negative impact on a patient's quality-of-life (QOL). However, even though the incidence of gynecologic cancers is rising in low-income countries, little research has examined how treatment there influences QOL.
Annekathryn Goodman, MD, MPH, a gynecologic oncologist and co-director of Global OB/GYN at Massachusetts General Hospital, and colleagues report in the Journal of Cancer Therapy that in Bangladesh, overall health-related QOL is low among patients who are receiving chemotherapy for ovarian cancer.
The cross-sectional study was conducted at the National Institute of Cancer Research and Hospital (NICRH) in Bangladesh. 202 patients were enrolled between January and December 2019 who received chemotherapy for ovarian cancer. Terminally ill patients and patients with dual malignancy were excluded. The average patient age was 48 and 86% had stage III or IV cancer.
Patients completed the validated Bangla version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Group C30 questionnaire and the ovarian cancer–specific EORTC QOL OV-28 questionnaire.
Global Health Status
The average global health status score, based on scores of both overall health status and overall QOL, was 55.7. 50% of scores fell between 34 and 66.
The average function scores were:
- Physical function: 56.7
- Role function: 53.7
- Cognitive function: 77.2
- Social function: 44.8
- Emotional function: 50.2
Symptom Scale/Single Items
The highest scores (highest level of burden) were for:
- Hair loss: 91.4
- Upset due to hair loss: 52.8
- Financial difficulties: 49.5
60% of all patients complained of vaginal dryness. Only 51% of patients reported being sexually active, and 70% of that subgroup said they were not enjoying sexual activity and were not interested in sex. Sexual problems were associated with stress and reduction in relationship satisfaction and were correlated with higher levels of depression.
Global health status correlated moderately well with all function scales, with R-values as follows (P<0.05 for all):
- Physical: 0.62
- Role: 0.52
- Social: 0.44
- Cognitive: 0.52
- Emotional: 0.45
Many symptoms/single items also correlated moderately well with global health status, with R-values as follows (P<0.05 for all):
- Fatigue: −0.60
- Pain: −0.58
- Financial difficulties: −0.46
- Upset due to loss of hair: −0.45
- Loss of appetite: −0.44
- Insomnia: −0.40
- Dyspnea: −0.38
- Heartburn: −0.37
Opportunities to Improve Care
Almost 59% of patients in this cohort were in the lowest income group, those earning ≤4,920 Bangladesh taka ($58 USD) per month or less. NICRH is government-funded and provides almost all chemotherapy drugs and antiemetics at no charge, and 98% of study subjects were outpatients. Even so, they had to pay for growth factors ($24/dose), blood transfusions ($2.50/set) and laboratory testing ($7–$8). Therefore they had a substantial financial burden.
Clinicians in low-income countries—and any low-income region worldwide—need to consider not only the type of interventions needed to enhance QOL but also the setting. Strategies to minimize physical symptoms, psychological impairment and sexual dysfunction may be most helpful for patients with financial hardships if they can be integrated into primary care facilities.
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