Factors associated with perceived quality of life among breast cancer patients during treatment at National Cancer Institute, Putrajaya, Malaysia

Breast cancer remains as the main cause of death among female worldwide. In light of its good prediction on survival of cancer, perceived quality of life (QoL) has been increasingly recognized as an important clinical outcome for oncology patients. This study aimed to determine the perceived QoL as well as its determinants among breast cancer patients during treatment. This was a cross sectional study. A total of 179 breast cancer patients in National Cancer Institute, Putrajaya were recruited via purposive sampling. A set of interviewer- administered questionnaire was used, including European Organization for Research and Treatment of Cancer-Quality of Life-Core 30 (EORTC-QLQ-C30), modified Medical Outcomes Study Social Support Survey and International Physical Activity Questionnaire-short form aimed to ascertain the perceived QoL (primary measure), functional health and medical symptoms, social support and physical activity level, respectively. Physical functioning was measured based on the total mean score of 5 items in EORTC-QLQ-C30. Nutritional assessments of weight, height, mid-upper arm circumference (MUAC), triceps skinfold thickness, handgrip strength and presence of edema were performed using standard techniques. Biochemical data on serum albumin, hemoglobin level and neutrophils count were retrieved from medical report as secondary data. Patients’ diet quality were evaluated using Healthy eating index-2015. Multiple linear regression was used to identify the factors contributing to perceived QoL. Respondents’ mean age and monthly income were 50.49 years and RM1962.83, respectively. A majority of the respondents was Malays (61.5%), married (68.6%), received secondary education (48.5%) and unemployed (60.9%). Slightly more than one-third of the respondents were diagnosed with cancer stage III, with mean duration of diagnosis at 8.77 months. The mean score of perceived QoL was 69.43, with approximately 47% of respondents had poor perception of QoL. Among the functional domains, respondents had the lowest score on emotional functioning. A substantial proportion of respondents experienced fatigue (94.1%), pain (60.4%), appetite loss (45.0%), insomnia (45.0%), financial difficulties (41.4%) and constipation (33.1%). Slightly more than one quarter of the respondents had poor social support while 62.7% of them were physically inactive. Approximately one in five had low corrected arm muscle area. More than 90% of the respondents had poor handgrip strength and poor diet quality. In terms of diet quality, the scoring of whole grains, dairy, fatty acids and refined grains were less satisfactory with scores less than half of the maximum score. For bivariate results, MUAC and handgrip strength were positively associated with perceived QoL while respondents with earlier cancer stage experienced poorer perception of QoL. In conclusion, breast cancer patients perceived their QoL as average during treatment, with emotional health was the most negatively affected. There were six factors associated with poor perception of QoL, which included early-stage cancer, lower handgrip strength and MUAC, better physical functioning, higher levels of fatigue and pain (R²=0.522; adjusted R²=0.457). To promote better QoL among breast cancer patients during treatment, appropriate strategies to improve MUAC and handgrip strength of the breast cancer patients are highly recommended.

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