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Life Science Journal 2012;9(4) http://www.lifesciencesite.com
3504
The Effect of Chemotherapy on Quality Of Life of Colorectal Cancer Patients before and 21 Days after the First
Chemotherapeutic Sessions
Omibrahem A. Elsaie, Hend M. Elazazy and Seham A. Abdelhaie
Medical Surgical Nursing Department, Faculty of Nursing, Tanta University
hend.elazazy@yahoo.com
Abstract: Colorectal cancer and its treatment may cause adverse effects to the social function, including work and
productive life, relationship with the family, partners and friends, and other interests and social activities, the disease
and treatment impact to patients' well-being and functional results is a topic of growing interest for the colorectal cancer
researches. Although improvements in treatment regimens have beneficially impacted the prognosis of colorectal
cancer, several quality of life issues result from potential side effects of such aggressive treatment. This study aimed to
assess the effect of chemotherapy on quality of life for colorectal cancer patients before the beginning and 21 days after
the first session of chemotherapy. The study was carried out in outpatient of the Cancer Institute. The sample consists
of 80 patients diagnosed as colorectal cancer, postoperatively and undergoing chemotherapy. The European
Organization for Research and Treatment of Cancer-Quality of life Core-30 (EORTC QLQ-C30) questionnaire was
used to assess patient’s quality of life. Data were collected over a period of seven months started from September 2009
to March 2010. The results revealed that all symptoms dimensions except fatigue, and functional dimensions related to
physical, role, and cognitive functioning as well as overall functioning was significantly decreased post the
chemotherapeutic session. Conclusion and recommendation explained that; for the improvement of quality of life,
patients with colorectal cancer undergoing chemotherapy should be included in program to help them find out adopt,
and deal with function and symptoms complication of chemotherapy.
[Omibrahem A. Elsaie, Hend M. Elazazy and Seham A. Abdelhaie. The Effect of Chemotherapy on Quality Of Life
of Colorectal Cancer Patients before and 21 Days after the First Chemotherapeutic Sessions. Life Sci J
2012;9(4):3504-3514]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 519
Key words: Quality of Life; Chemotherapy; Colorectal Cancer.
1. Introduction
Cancer is a disease that affects people in the whole
world and may bring some impacts to patients and
families' lives in different ways, since the diagnosis
acknowledgement until the treatment choice, its
process, and the rehabilitation. Colorectal cancer, the
third leading cause of cancer death worldwide,
represents 10% of cancer diagnoses and deaths (1).More
than 800,000 new cases are diagnosed annually,
including 300,000 in the U.S. and Europe alone (2).
Estimated new cases of colorectal cancer in United
States in 2012 are 103.170 while deaths are 51.690 (3).In
Egypt, colorectal cancer is the 7th most common cancer
with reported incidence of 1/100.000 cases (4). An
increasingly important issue in oncology is to evaluate
quality of life in cancer patients (5). The cancer-specific
quality of life is related to all stages of the disease (6,7).
In fact, for all types of cancer patients general quality of
life instruments can be used to assess the overall impact
of patients’ health status on their quality of life (8).
Health-related quality of life (HRQOL) is an
important outcome of cancer therapy, currently; quality
of life has been introduced as an endpoint for treatment
comparisons on many cancer types, particularly in
advanced stages(9). Quality of life also, as an early
indicator of disease progression could help the
physician on daily practice to closely monitor the
patients (1 0).In addition, quality of life may be
considered to be the effect of an illness and its treatment
as perceived by patients and is modified by factors such
as impairments, functional stress, perceptions and social
opportunities (1 1, 12). According to the World Health
Organization (WHO), quality of life is defined as
individual perception of life, values, objectives,
standards, and interests in the framework of culture.
Quality of life is increasingly being used as a primary
outcome measure in studies to evaluate the
effectiveness of treatment(13-16).Colorectal cancer and its
treatment may cause adverse effects to the social
function, including work and productive life,
relationship with the family, partners and friends, and
other interests and social activities (17).
Physical and emotional integrity alterations, such
as discomfort, pain, disfigurement, dependence and
self-esteem loss are reported by patients who realize
deep changes to their quality of life in a short-term (18).
The disease and treatment impact to patients' well-being
and functional results is a topic of growing interest for
the colorectal cancer researches. The main problems
facing long-term cancer survivors are related to
social/emotional support, health habits, spiritual/
philosophical view of life, and body image concerns (17).
Recently, several studies have been developed in order
to assess such alterations in individuals' lives through
the Quality of Life (QOL) and Health Related Quality
of Life (HRQL) Assessments (17-19).Accurate assessment
Life Science Journal 2012;9(4) http://www.lifesciencesite.com
3505
of health-related quality of life in patients with
advanced colorectal cancer is essential to improve our
understanding of how cancer and chemotherapy
influence patients' life and to adapt treatment strategies
(20). A range of factors influence health-related quality
of life assessments, and they may vary according to
each study, however, health-related quality of life may
be considered having a great mental, physical and social
function level, as well as real life position (social role),
which includes relationships, health perception,
abilities, satisfaction with life and well-being. They may
also include assessments of the patients' satisfaction
level regarding the treatment, results, health state, and
future perspectives (21).
Currently, there are several therapeutic modalities
for cancer treatment, such as: surgery (curative,
palliative) chemotherapy, and radiation therapy, which
may be used isolated or associated, and an increasing
number of researches assesses the quality of life of
colorectal cancer patients going through different
treatment types(18,22,23). When assessing the value of a
particular treatment, it is important to consider the
impact it may have on the quality of life of those being
treated. This is particularly so for cancer patients, whose
life expectancy may be short (24).The relationship
between colorectal cancer risk and physical activity and
dietary habits has been well-established, but less is
known about the relationship between these behaviours
and quality of life post-diagnosis. Moreover, it is
unknown whether this relationship is consistent across
cancer stage or treatment setting (25). Although
improvements in treatment regimens have beneficially
impacted the prognosis of colorectal cancer, several
quality of life issues result from potential side effects of
such aggressive treatment. Consequently, shifting part
of our focus in research and program development to
address issues of quality of life and survivorship has
become essential (26, 27). Moreover, quality of life
measurements are considered essential to assess the
impact caused by the treatment to patients' lives.
Nurses, in their decision and actions, can influence
their patient's quality of life. In addition, quality of life
certainly has relevance of nursing; often patients consult
nurse regarding how to obtain the best possible quality
of life for themselves or for their family members.
Moreover, quality of life is an important indicator of the
success of nursing, medical, or health care intervention.
Therefore, improving the health related quality of life
for colorectal patients should be an interdisciplinary
goal of physician, nurses; patients care technician,
social worker and dietitians (28). Focusing nursing
intervention on decreasing chemotherapy treatment
symptoms, or to improve the patient ability to deal with
them, improving functional abilities, decreasing
limitation and identifying issues that affect general
health perception could increase a patient's overall
health related quality of life(29).Because nurses and other
health professionals are interested in the influence that
health and illness have on quality of life, the evaluation
of the positiveness or negativeness of attributes that
characterize one's quality of life appears to be of
pertinent value(30).
Aim of the study:
The study aim to assess quality of life, to
identify the domains affected in colorectal cancer
patients undergoing chemotherapeutic treatment and to
examine the relationship between socio-demographic
characteristics and quality of life and correlate them
with the quality of life domains.
Research hypothesis:
1. Colorectal patients undergoing chemotherapy; will
have higher scores of quality of life and global
health status before chemotherapy than 21 days
after.
2. Colorectal patients undergoing chemotherapy will
have higher level of symptom or problems 21 days
after first chemotherapeutic session than before.
2. Materials and Method:
Design:
The study was quasi experimental design.
Setting:
The study was carried out on outpatient of Cancer
Institute affiliated to Ministry of Health. Tanta City.
Subjects:
A convenience sample of 80 patients diagnosed
with colorectal cancer, post operatively, who attended
the outpatient clinic for follow up and prior to the
beginning of the first chemotherapeutic session.
Inclusion criteria:
Subjects were selected according to the following
criteria: Adult, 18 years or older, both sex with
colorectal cancer diagnosis, post operatively, for
chemotherapy treatment, free from other chronic
diseases, willing and able to communicate verbally and
nonverbally, and have stable vital signs.
Exclusion criteria:
Subjects were excluded from the study if they had
chronic disease such as renal failure, heart failure,
diabetes mellitus, or hepatic failure, and if they had
other types of cancer.
Tool of the study:
Quality of life interview questionnaire: It consists two
parts:
Part one:
Related to patient's socio-demographic data which
includes; age, sex, marital status, level of education,
occupation and place of residence.
Part two:
This part was adapted to asses quality of life of
colorectal patients using the quality of life
questionnaire-C30 QLQ-C30 (Version 3.0) with
functional/ symptom scale indicated (31 ). QLQ-C30 has
been found to be a valid, reliable and useful research
tool for Egyptian culture, it is a health related quality of
Life Science Journal 2012;9(4) http://www.lifesciencesite.com
3506
life questionnaire validated specifically for cancer
patients by the European Organization for research and
treatment of cancer (EORTC). Its quality of life model
is multi-dimensional and European Organization for
research and treatment of cancer group defines it
according to the central elements of the functional
status, cancer and treatment specific symptoms,
psychological distress, social interaction, financial
impact, perceived health status and overall quality of
life. It is comprised of both multi item scale and single
item measures. These include 30 questions which cover
five functional scales: physical, emotional, cognitive,
social, and role functioning, a global health or overall
quality of life, three symptom scales in order to measure
fatigue, pain, nausea and vomiting, and five single items
to assess symptoms such as: dyspnea, insomnia,
appetite loss, constipation, diarrhea; and one single item
which assesses financial difficulties. Each of the multi-
item scales includes a different set of items, no item
occurs in more than one scale.
Scoring system:
QLQ-C30 generates scores in the functional and
symptoms scales. The principles of the scoring these
scales is done as follow:
1. Estimating the average of the items that contribute
to the scale; this is the raw score.
2. Using of the linear transformation to standardize
the row score, each score is transformed in a scale
from 0 to 100. According to EORTC guidelines, a
high scale score represents a higher response level,
thus a high score for a functional scale represents a
high or healthy level of functioning, and high
score for the global health status represents a high
QOL, but a high score for a symptom scale items
represents a high level of symptom or problems.
Method:
1. An official Permission to carry out the study was
obtained from the responsible authorities.
2. Patient's written consent to participate in the study
was obtained.
3. Patient's confidentiality was ascertained.
4. The original English language copy of EORTC scale
was adoptive and modified by the researchers; it was
tested for validity and applicability, necessary
modifications were done.
5. The reliability of the interview questionnaire has
been acceptable and was tested by using Cronbuch's
Alpha test and it was greater than .70.
6. Patient who fulfilled the inclusion criteria was
selected, and the purpose of the study was explained
to each patient.
7. The interview questionnaire was conducted
individually by the researchers for data collection
twice:
Post operative and prior to the beginning of the
first chemotherapeutic session.
21 days after the first chemotherapeutic
session.
8. The interview questionnaire lasts for 20-30 minutes
with little clarification to some patient if needed.
Statistical analysis:
For categorical data the number and percentage
were calculated. For calculating the difference in
frequency of functions and symptoms before and after
chemotherapy median, Interquartile range, mean rank
and Wilcoxon signed rank test were used. The
differences between median values were calculated for
each dimension and the effect of different variables on
this mean difference was tested using median,
Interquartile range, mean rank, Mann- Whitney and
Kruskal-Wallis Test. The level of significance was
adopted at p ≤ 0.05.
3. Results:
The subjects comprised of 80 patients attending
outpatient clinic, Tanta Cancer Institute, with age
ranged from 41-76 years. As for sex, more than half of
the subjects were female (57.5%), and majority of them
(92.5%) were married, while (40%) of them were
housewives and illiterate, and only (12.5%) and (10%)
of them were retired and have university level of
education respectively. Regarding to place of residence,
about three quarters of the subjects (72.5%) were from
rural area.
Table (1): Total score of QOL items for
colorectal cancer patient pre and 21 days post
chemotherapy. In this table, it can be seen that the
highest score of functioning dimensions before
chemotherapy was related to role and cognitive
functioning with a medium of 100.00 each and
Interquartile range of 50.00, 20.00 respectively. The
table also showed that functional dimension of QOL
related to physical, role, and cognitive functioning as
well as overall functioning was significantly decreased
post chemotherapy with p value = 0.00 each, a negative
rank of 40.64, 27.50, 42.15, 40.96 and positive rank of
13.50, 0.00, 21.5, 12.5 respectively. This table also
shows that global health status was decreased post
chemotherapy with a median of 66.67 and 50 and
Interquartile range of 50.0, 33.33 before and after the
chemotherapy respectively, although the decrease was
not significantly with p = 0.135.
Concerning symptom dimension of QOL of
colorectal cancer patients, the same table revealed that
there was a significant increase in symptom dimension
21 days after the chemotherapy as related to pain,
nausea and vomiting, diarrhea and constipation,
dyspnea, insomnia, and anorexia and overall symptom
with a median of 40.00, 0.00, 16.67, 57.97, and 57.02
respectively pre chemotherapy and 60.00, 66.67, 50.00,
72.46, 96.49 respectively post chemotherapy ,negative
rank of 16.50, 0.00, 19.00, 26.89, and 6.00 respectively
Life Science Journal 2012;9(4) http://www.lifesciencesite.com
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and a positive rank of 37.28, 38.50, 40.79, 40.59, and
42.32 respectively with p value = 0.00 each.
Table (2): Correlation between function,
symptom, and global dimensions of QOL of
colorectal cancer patients. It is obvious that no
significant correlation was found between function,
symptom, or global dimensions of QOL of colorectal
cancer patient since p value = 0.474, 0.836 and 0.638
respectively.
Table (3): Correlation between QOL items of
colorectal cancer patients and their age pre and 21
days post chemotherapy. This table illustrate that, the
only significant correlation of QOL items was found
between role functioning and nausea and vomiting with
patient age pre the first chemotherapeutic session with P
= 0.031 and 0.047, respectively.
Table (4): Correlation between QOL items of
colorectal cancer patients and their place of
residence pre and 21 days post chemotherapy. From
this table, it can be concluded that the only significant
correlation was found between role functioning of QOL
and patients from rural area pre chemotherapy with a
median of 100.00, interquartile range of 25.00, a mean
rank of 21.91 with p= 0.00.
Table (5): Correlation between QOL items of
colorectal cancer patients and their gender pre and
21 days post chemotherapy. The table illustrated that,
there was a significant correlation was found between
female patients and physical function of QOL items pre
chemotherapy with a mean rank of 44.67with p= 0.052,
and global health status with a mean rank 46.11, 22.89
pre and post chemotherapy respectively with p= 0.010.
For male patient the significant correlation was found
between cognitive functioning and diarrhea and
constipation pre and post chemotherapy with mean rank
of 45.79, 48.15 in the pre and 21.12, 21.21in the post
chemotherapy respectively with p = 0.053 and 0.007,
respectively.
Table (6): Correlation between QOL items of
colorectal cancer patients and their occupation pre
and 21 days post chemotherapy. This table
demonstrated that the there was a significant
correlations were found between patient occupation
and; role, emotional and cognitive functioning of QOL
with p= 0.007, 0.022 and 0.002 respectively. In addition
the same table shows that there was significant
correlation was found between patient occupation and
nausea and vomiting and diarrhea and constipation with
p= 0.028 and 0.001, respectively.
Table (7): Correlation between QOL items of
colorectal cancer patients and their level of
education pre and 21 days post chemotherapy. In this
table, the only significant correlation was found
between physical functioning and patients education pre
chemotherapy with a median of 60, 80, 60, 30 and
Interquartile range of; 20,60, 20, 35 for illiterate, read
and write, diploma and university level of education
respectively with p = 0.001.
Table (1): Total score of QOL items for colorectal cancer patient pre and 21 days post first chemotherapeutic sessions
QOL Items
Pre Post Mean Rank (Post - Pre) Wilcoxon Signed
Ranks Test
Median Interquartile
Range Median Interquartile
Range
Negative
Ranks
Positive
Ranks Z P-value
Function dimensions
1.Physical 60.00 35.00 20.00 20.00 40.643 13.500 -7.248 0.000
2.Role 100.00 50.00 50.00 50.00 27.500 0.000 -6.804 0.000
3.Emotional 12.50 25.00 12.50 25.00 21.700 19.300 -0.340 0.734
4.Social 0.00 29.17 0.00 33.34 28.083 28.813 -1.023 0.306
5.Cognitive 100.00 20.00 60.00 35.00 42.147 21.500 -6.755 0.00 0
Overall functions -23.46 21.22 -50.46 23.15 40.959 12.500 -7.437 0.000
Symptom dimensions
1.Fatigue 85.84 39.34 92.99 39.34 35.429 33.850 -1.113 0.266
2.Pain 40.00 40.00 60.00 20.00 16.500 37.278 -5.897 0.000
3.Nausea& vomiting 0.00 29.17 66.67 33.33 0.000 38.500 -7.602 0.000
4.Diarrhea& constipation 16.67 33.33 50.00 0.00 19.000 40.794 -6.875 0.000
5.Dyspnea, insomnia& anorexia 57.97 28.98 72.46 28.98 26.885 40.591 -3.200 0.001
Overall symptoms 57.02 15.36 96.49 20.84 6.000 42.316 -7.667 0.000
Global health status 66.67 50.00 50.00 33.33 39.935 38.875 -1.496 0.135
Table (2): Correlation between quality of life dimensions of colorectal cancer patients pre and 21 days post first
chemotherapeutic sessions
Correlations
Function dimensions
Symptom dimens
ions
Symptom
dimensions
r
0.117
p
-
value
0.474
Global
Health
r
-
0.034
-
0.077
p
-
value
0.836
0.638
Life Science Journal 2012;9(4) http://www.lifesciencesite.com
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Table (3) Correlation between quality of life dimensions of colorectal cancer patients and their age pre and 21 days
post first chemotherapeutic sessions
QOL dimension
Age
Pre Post
r P-value r P-value
Function dimension
1.Physical 0.091 0.420 -0.04 0.78
2.Role -0.241 0.031 -0.18 0.28
3.Emotional -0.118 0.296 -0.11 0.50
4.Social
-
0.110
0.331
0.01
0.94
5.Cognitive 0.034 0.762 -0.04 0.81
Ov
erall functions
-
0.134
0.237
-
0.16
0.33
Symptom dimension
1.Pain -0.012 0.916 0.05 0.76
2.Fatigue -0.127 0.260 -0.09 0.57
3.Nausea and vomiting 0.222 0.047 -0.08 0.60
4.Constipation and diarrhea
0.026
0.817
0.05
0.77
5.Dyspnea, insomnia& anorexia
-
0.0
03
0.981
-
0.12
0.47
Overall symptoms
0.026
0.819
-
0.07
0.65
Global health status
-
0.193
0.087
0.29
0.06
Table (4): Correlation between quality of life dimensions of colorectal cancer patients and their place of residence pre
and 21 days post first chemotherapeutic sessions
Mann-Whitney Test
(P-value)
Mean
rank
Post
Mean
rank
Pre
Residence
QOL Items
post pre
Interquartile
Range
Median
Interquartile
Range
Median
0.99 0.947
40.397 20.00 20.00
20.48
30.00 60.00 Rural
Function dimensions
1.Physical 40.773 20.00 20.00
20.55
40.00 60.00 Urban
0.18 0.000
45.810 100.00 50.00
21.91
25.00 100.00 Rural
2.Role 26.500 50.00 0.00
16.77
50.00 50.00 Urban
0.24 0.291
38.845 25.00 12.50
19.19
31.25 12.50 Rural
3.Emotional 44.864 37.50 25.00
23.95
25.00 12.50 Urban
0.31 0.823
40.155 33.33 0.00
19.36
33.33 0.00 Rural
4.Social 41.409 33.33 16.67
23.50
16.67 0.00 Urban
0.69 0.757
40.052 30.00 60.00
20.93
20.00 100.00 Rural
5.Cognitive 41.682 60.00 60.00
19.36
40.00 100.00 Urban
0.56 0.646
41.224 23.15 -54.32
19.84
30.86 -23.46 Rural
Overall functions 38.591 23.15 -38.89
22.23
15.43 -23.46 Urban
0.90 0.228
38.603 35.77 85.84
20.36
42.92 85.84 Rural
Symptom dimensions
1.Fatigue 45.500 42.92 100.14
20.86
28.61 100.14 Urban
0.19 0.260
38.776 20.00 60.00
19.07
40.00 40.00 Rural
2.Pain 45.045 40.00 80.00
24.27
60.00 40.00 Urban
0.71 0.321
39.259 33.33 66.67
20.91
16.67 0.00 Rural
3.Nausea& vomiting 43.773 33.33 66.67
19.41
33.33 0.00 Urban
0.59 0.681
39.879 0.00 50.00
20.97
33.33 16.67 Rural
4.Diarrhea&
constipation 42.136 0.00 50.00
19.27
33.33 16.67 Urban
0.54 0.560
39.603 14.49 72.46
21.17
28.99 57.97 Rural
5.Dyspnea,
insomnia& anorexia 42.864 43.48 57.97
18.73
14.49 57.97 Urban
0.94 0.264
38.741 19.74 96.49
20.59
15.35 57.02 Rural
Overall symptoms 45.136 26.32 96.49
20.27
13.16 57.02 Urban
0.33 1.000
40.500 16.67 50.00
19.43
50.00 66.67 Rural
Global health status 40.500 66.67 50.00 23.32 50.00 50.00 Urban
Life Science Journal 2012;9(4) http://www.lifesciencesite.com
3509
Table (5): Correlation between quality of life dimensions of colorectal cancer patients and their gender pre and 21 days
post first chemotherapeutic session.
Mann-Whitney
Test (P-value)
Mean
rank
Post
Mean
rank
Pre
Sex
QOL Items
p z
Interquartile
Rang
Median
Interquartile
Range
Median
0.052 -1.939
23.21 20.00 40.00 34.853 40.000 60.000 Male
Function dimensions
1.Physical 18.5 20.00 20.00 44.674 20.000 80.000 Female
0.945
-0.069
23.09 100.00 50.00 40.324 50.000 100.000 Male
2.Role 18.59 0.00 50.00 40.630 50.000 100.000 Female
0.177
-1.351
20.65 31.25 12.50 44.500 43.750 12.500 Male
3.Emotional 20.39 12.5 25.00 37.543 25.000 12.500 Female
0.169
-1.375
22.35 33.33 0.00 44.500 33.333 0.000 Male
4.Social
19.13 0.00 50.00 37.543 16.667 0.000 Female
0.053
-1.936
21.12 30.00 60.00 45.794 20.000 100.000 Male
5.Cognitive 20.04 60.00 40.00 36.587 40.000 80.000 Female
0.124
-1.539
24.65 19.29 -38.89 45.088 19.29 0 -23.457 Male
Overall functions
17.43 -54.32 15.43 37.109 30.864 -23.457 Female
0.322
-0.990
22.24 42.92 100.14 43.441 35.765 85.837 Male
Symptom dimensions
1.Fatigue 19.22 85..84 28.61 38.326 42.918 85.837 Female
0.625
-0.488
21.03 30.00 60.00 41.912 40.000 40.000 Male
2.Pain
20.11 60.00 20.00 39.457 40.000 40.000 Female
0.086
-1.718
21.56 41.67 66.67 36.441 0.000 0.000 Male
3.Nausea& vomiting 19.72 66.67 33033 43.50 0 33.333 0.000 Female
0.007
-2.685
21.21 0.00 50.00 48.147 25.000 16.667 Male
4.Diarrhea& constipation
19.98 50.00 0.00 34.848 16.667 0.000 Female
0.301
-1.034
15.68 28.99 57.97 43.500 28.986 57.971 Male
5.Dyspnea, insomnia&
anorexia 24.07 72.46 28.99 38.283 28.986 57.971 Female
0.205
-1.267
20.79 26.32 96.49 44.265 17.544 57.018 Male
Overall symptoms 20.28 96.49 17.54 37.717 13.158 57.018 Female
0.010
-2.571
17.26 16.67 50.00 32.912 50.000 33.333 Male
Global health status 22.89 50.00 33.33 46.109 33.333 66.667 Female
Table (6): Correlation between quality of life dimensions of colorectal cancer patients and their occupation pre and 21
days post chemotherapeutic session.
QOL Items
Occupation Kruskal-Wallis Test
Housewife Farmer Employee Free work Retired X2 P-value
Function dimension
1.Physical
Pre Median 80 60 60 60 2.12
0.206
IQR 60 40 20 55
Post Median 20 20 20 40 40
IQR 20 20 20 30 30
2.Role Pre Median 75 50 100 100 10.47
0.007
IQR 50 50 37.5 75
Post Median 0 0 50 75 0
IQR 50 50 50 50 50
3.Emotional Pre Median 12.5 12.5 12.5 37.5 0 2.30
0.022
IQR 39.563 39.929 36.375 65 31.3
Post Median 12.5 0 18.75 25 0
IQR 25 25 43.75 28.13 31 .25
4.Social Pre Median -8.333 0 8.333 -8.333 0 1.20
0.463
IQR 16.667 16.667 29.167 29.167 25
Post Median 0 0 0 -8.33 33.33
IQR 33.33 33.33 33.33 29.17 75
5.Cognitive Pre Median 80 90 100 10 0 1.85
0.002
IQR 40 35 45 30
Post Median 60 60 60 40 60
IQR 35 20 30 45 40
Overall functions
Pre Median -23.457 -23.457 -23.457 -15.741 -31.173 1.75
0.151
IQR 28.935 23.148 21.219 28.935 27.006
Post Median -54.32 -46.60 -46.60 -42.75 -62.04
IQR 15.43 46.30 28.94 25.08 50.15
Symptom dimensions
1.Fatigue
Pre Median 78.684 85.837 85.837 78.684 71.531 6.65
0.569
IQR 50.072 42.918 21.459 42.918 50.072
Post Median 85.84 85.84 107.30 85.84 100.14
IQR 28.61 71.53 39.43 71.53 50.07
2.pain
Pre Median 40 20 40 50 40 0.67
0.503
IQR 60 40 30 50 20
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Post Median 70 60 60 70 60
IQR 20 40 50 35 60
3.Nausea& vomiting Pre Median 0 0 0 33.333 4.05
0.028
IQR 33.333 16.667 25 33.333
Post Median 66.67 66.67 83.33 75 83.33
IQR 33.33 33.33 45.83 29.17 41.67
4.Diarrhea& constipation
Pre Median 0 33.333 25 16.667 0 4.84
0.001
IQR 16.667 16.667 45.833 25 50
Post Median 50 50 50 41.67 50
IQR 0 0 0 29.17 25
5.Dyspnea, insomnia& anorexia Pre Median 57.971 57.971 57.971 65.217 57.971 7.57
0.306
IQR 21.739 43.478 28.986 25.362 36.232
Post Median 72.46 57.97 72.46 43.48 57.97
IQR 10.87 28.99 28.99 32.61 57.97
Overall symptoms
Pre Median 57.018 57.018 63.596 65.789 57.018 7.20
0.531
IQR 20.833 17.544 13.158 27.412 4.386
Post Median 94.30 83.33 100.88 85.53 96.49
IQR 19.74 21.93 18.64 35.09 37.28
Global health status Pre Median 66.667 33.333 66.667 50 50 2.08
0.068
IQR 33.333 16.667 33.333 66.667 66.667
Post Median 50 50 50 41.67 50
IQR 33.33 16.67 16.67 41.67 41.67
Table (7): Correlation between quality of life dimensions of colorectal cancer patients and their education pre and 21
days post first chemotherapeutic session.
QOL Items Education Kruskal-Wallis Test
Ill. R&W Dip. Univ. X
2
P-value
Function dimensions
1.Physical
Pre Median 60 80 60 30 16.979 0.001
IQR 20 60 20 35
Post Median 30.00 20.00 20.00 30.00 0.12 0.99
IQR 20.00 20.00 20.00 50.00
2.Role
Pre Median 100 50 100 100 2.887 0.409
IQR 50 50 50 37.5
Post Median 50.00 0.00 50.00 50.00 1.86 0.60
IQR 100.00 50.00 50.00 100.00
3.Emotional Pre Median 6.25 12.5 12.5 18.75 5.32 0.15
IQR 46.875 37.5 25 21.875
Post Median 12.50 25.00 0.00 18.75 3.99 0.26
IQR 25.00 37.50 25.00 12.50
4. Social Pre Median 0 0 -16.667 0 3.459 0.326
IQR 33.333 16.667 33.3 33 25
Post Median 0.00 0.00 0.00 -8.33 1.03 0.80
IQR 33.33 50.00 50.00 29.17
5. Cognitive Pre Median 90 80 100 100 2.794 0.425
IQR 35 40 20 30
Post Median 60.00 40.00 60.00 60.00 3.22 0.36
IQR 20.00 40.00 10.00 40.00
Overall function Pre Median -23.457 -15.741 -31.173 -31.173 4.471 0.215
IQR 19.29 15.432 38.58 21.219
Post Median -50.46 -46.60 -54.32 -46.60 0.22 0.97
IQR 23.15 23.15 30.86 44.37
Symptom dimensions
1.Fatigu
Pre Median 71.531 100.143 85.837 78.684 5.129 0.163
IQR 25.036 57.225 21.4 59 53.648
Post Median 100.14 85.84 71.53 85.84 7.38 0.06
IQR 39.34 28.61 50.07 71.53
2.Pain
Pre Median 40 40 20 50 3.726 0.293
IQR 35 60 50 35
Post Median 70.00 60.00 60.00 70.00 0.55 0.91
IQR 40.00 20.00 30.00 35.00
3.Nausea& vomiting
Pre Median 0 0 0 16.667 6.02 0.111
IQR 33.333 0 25 33.333
Post Median 66.67 66.67 83.33 66.67 1.24 0.74
IQR 29.17 33.33 41.67 37.50
4.Diarrhea& constipation Pre Median 16.66 7 16.667 0 8.333 1.526 0.676
IQR 50 16.667 33.333 29.167
Post Median 50.00 50.00 50.00 50.00 5.90 0.12
IQR 0.00 0.00 33.33 25.00
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3511
5.Dyspnea, insomnia& anorexia
Pre Median 57.971 57.97 1 57.971 65.217 3.795 0.284
IQR 28.986 0 36.232 47.101
Post Median 72.46 72.46 72.46 65.22 0.56 0.91
IQR 39.86 28.99 21.74 36.23
Overall symptom
Pre Median 57.018 57.01 8 57.018 67.982 2.236 0.525
IQR 8.772 30.702 8.772 26.316
Post Median 96.49 92.11 96.49 85.53 3.78 0.29
IQR 21.93 21.93 21.93 43.86
Global health status Pre Median 58.333 50 66.667 75 0.804 0.849
IQR 50 66.667 41.667 54.167
Post Median 50.00 50.00 50.00 33.33 3.40 0.33
IQR 29.17 33.33 25.00 25.00
0.000
5.000
10.000
15.000
20.000
25.000
30.000
35.000
40.000
45.000
F1 F2 F3 F4 F5 F S1 S2 S3 S4 S5 S G
Negative
Ranks
Figure (1) Quality of life dimensions of patients with colorectal cancer before and 21 days after the first
chemotherapeutic sessions
4. Discussion:
Quality of life is an important issue for patients
with colorectal cancer; accurate assessment of health
related quality of life in patients with colorectal
cancer is essential to improve our understanding of
how cancer and chemotherapy influence patients, life
and to adopt treatment strategies. The results of the
present study proved that; for functional dimensions
of QOL, physical, role, and cognitive functioning as
well as overall functioning was significantly
decreased post the chemotherapeutic session and the
decreased wasn't significantly as related to emotional
and social functioning, regarding symptoms
dimension of QOL; the result of the present study
also proved that; all symptoms dimensions was
significantly decreased post the chemotherapeutic
session except fatigue and the global health status
wasn't significantly decreased after chemotherapy,
this result in accordance with Turgay et al (2008) (32)
who mentioned that all of the post chemotherapy
mean scores from the quality of life instrument were
statistically significant lower at day of 21 except for
the cognitive functioning subscale and added that
overall, initial chemotherapy was found to have a
significantly negative effect on the quality of life of
cancer patients, the result also in agreement with
Hurny et al (1996) (33) who proved that
chemotherapy had an measurable adverse effect on
QOL in women with node positive operable breast
cancer, also Pagano et al (2008) (34) added that
chemotherapy is a treatment known to have a
significant impact on QOL, moreover, Arndt et al
(2005) (18) stated that there was statistically differences
with cognitive function, pain, and appetite loss and
the global health status was considered satisfactory. In
contrast of the present study, Conroy (2003) (20)
stated that more than half of the patients treated with
palliative chemotherapy have an improvement or at
least preservation of their health related quality of
life, also Bouvier (2008) (35) mentioned that patient
receiving adjuvant chemotherapy for colon cancer
actually had better physical functioning than patient
not receiving adjuvant chemotherapy, in addition,
Tsunoda et al (2009) (36) added that overall health
related QOL didn't deteriorate during adjuvant
chemotherapy with colorectal cancer despite the
effect from surgical damage. Also the result of the
present study was disagreed with Dehkordi et al
Life Science Journal 2012;9(4) http://www.lifesciencesite.com
3512
(2009) (37) who stated that chemotherapy can lead to
better sleep pattern in cancer patients and Chen et al
(2008) (38) who found that QOL in lung cancer
patients during the chemotherapy has been improved
slightly over the baseline values, and Heras (2009)
(39) who mentioned that fatigue intensity increased
gradually during chemotherapy, also Barras et al
(2001) (40)contradict this result and added that there
was no differences between groups in quality of life
at the initial assessment or once the treatment was
completed and insomnia was the symptom with the
highest impact on the quality of life.
According to the world health organization,
QOL is defined as individual perception of life,
values, objectives, standard, and interests in the
framework of culture (23), the result of the present
study shows that QOL domains which affected
significantly by patient' age were related to; role
functioning and nausea and vomiting, and also there
was correlation between role functioning of QOL
and patients from rural area which may be attributed
by the fact that patient from rural area encountered
travel related difficulties and transportation financial
burden particularly during treatment as outpatients
which may affect their role functioning, this result
is in constant with Kafa (2010) (41) who found that
there is a statistical significant correlation between
age and psychological dimension of quality of life,
in addition, Kamal (2008) (42) stated that the
residency doesn't correlate with the indicies of
quality of life and Nicolussi et al (2009) (43) found no
correlation between QOL and age, gender, social
status, marriage and job, moreover, Dehkordi et al
(2009) (37) who mentioned that there was no
correlation between QOL and variables such as age,
sex, marital status duration of disease, economic
condition and occupational function, also the result
of the present study is in disagreement with Mokabel
(1997) (44), Bouvier et al (2008) (35) who indicated
that there was a weak correlation between age and
quality of life domain.
The result of the present study illustrated
that there was a significant correlation between
female patient and physical and global health status
where these domains are most affected and for male
patient the significant correlation was found between
cognitive functioning and diarrhea and constipation,
this may be attributed to the fact that women are
physically weaker than men and they are more
affected by the dramatic effect of surgery as well as
the side effect of the chemotherapy, these result is in
agreement with Schmidt (2005) (45) who reported
that global health status and physical functioning
were significantly worse for women than for men
also Kafa (2010) (41) found a statistical significant
differences between sex and total score of physical
functioning and psychological status. In addition
Nicolussi et al (2009) (43) supported this result and
added that lower QOL scores were observed among
women specifically related to pain, insomnia, fatigue,
constipation and appetite loss while men have
reported better score in the emotional and cognitive
function scale than women, on the other hand the
result of the present study was in disagreement with
Dehkordi et al (2009) (37), Nicolussi et al (2009) (43)
who proved no correlation between QOL and gender.
In relation to occupation, the result of the
this study showed that; occupation affects greatly and
significantly role, emotional, and cognitive
functioning post chemotherapy which may be
explained by the fact that due to their disease and its
treatment, patients are at leave from the work, away
from home and family responsibilities which may
affect their role, cognitive and emotional status, the
result of the present study also showed that, for
symptom dimensions of QOL, nausea and vomiting,
diarrhea and constipation are most affected symptoms
by occupation post the chemotherapy which may be
explained that these symptoms are the most common
adverse effect of chemotherapy. The result of the
present study is in disagreement with Uwer et al
(2011) (46) who found that there was no correlation
between QOL and the type of job, and with Kamal
(2008) (42) who stated that occupation as a patients'
variable, hadn't correlate with the patients QOL.
In relation to level of education, the present
study revealed that; only correlation was found
between physical functioning and patients level of
education, this result is in accordance with Kamal
(2008) (42) who stated that level of education is not
correlate with indices of QOL, and Uwer et al (2011)
(46) and Dehkordi et al (2009) (37) who mentioned that
no correlation was found between QOL and patients'
educational level, in contrast to the finding of the
present study, Nicolussi et al (2009) (43) mentioned
that concerning educational level, patients who had
completed superior education reported having more
social difficulties of QOL.
Conclusion and recommendations
Conclusion: Based on the findings of the study, it
can be concluded that:
Most function dimensions of QOL for colorectal
cancer patient significantly decreased post the
first chemotherapeutic session.
All symptom dimensions except fatigue and
overall symptoms have been increased post the
first chemotherapeutic session.
No significant correlation was found between
function, symptom, or global dimensions of
QOL of colorectal cancer patient
Role function affected by patients from rural
area, female patients affected more than males as
Life Science Journal 2012;9(4) http://www.lifesciencesite.com
3513
related to physical function and global health
status.
Recommendations: based on the findings of
this study, it can be recommended that:
Nursing stuff should be encouraged to
attend up to date scientific conferences and
workshops related to improving QOL of
cancer patients undergoing chemotherapy.
Patients with colorectal cancer for
chemotherapy should be included in
program to help them find out and adopt
with function and symptoms complication
of chemotherapy.
Using of different strategies to improve the
patient ability to deal with function and
symptoms complication of chemotherapy.
Integrate the quality of life of patient with
chronic illness and cancer in nursing
curriculum for under and postgraduate
students.
Nursing curriculum should be directed
towards the importance of nurse's role in
different stages of cancer including
diagnosis, treatment and rehabilitation.
(2) Recommendations for future studies:
Further research is needed in this area for
nursing staff to provide more
comprehensive evaluation of quality of life
for patients with cancer, patients who are
receiving other complementary therapy for
cancer treatment, and patient with non-
operable cancer types.
Development of strategy to help patients'
improvement of their quality of life.
Corresponding author
Hend M. Elazazy
Medical Surgical Nursing Department, Faculty of
Nursing, Tanta University
hend.elazazy@yahoo.com
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