Effect of Chemotherapy on the Distress and Quality of Life of Cancer Patients.

Introduction: The deteriorating effects of chemotherapy on cancer patients are well documented, as is the need and impact of psychosocial interventions in improving quality of life (QOL). In India, cancer centres have a very high patient load and providing quality treatment and achieving good survival is still the first priority. Published studies from India on QOL in cancer patients are far and few, current ongoing studies are even fewer. The present study is on effect of chemotherapy on QOL, and prevalence of psychological morbidity in the Indian context.

Patients and Methods: The study sample consisted of 117 cancer patients undergoing chemotherapy with curative intent as single modality or as part of the multi modality regimen. Nearly 30% of the sample had lymphoproliferative disease, 17% had haematological malignancies, 45% had solid tumours, and the rest had multiple myeloma. The assessments were carried out using the Distress Inventory for cancer version 2 (DIC V2), Functional Assessment of Cancer Therapy-General (FACT-G), and the Hospital Anxiety and Depression scales (HADS).

Results: Older patients (>=47 years) had significantly greater spiritual distress, and difficulties in activities of daily living, but had better emotional well being compared to younger patients (<47 years). Patients from lower income strata had significantly greater distress levels and poorer QOL than those in the upper income category. Those with advanced disease had significantly poorer scores on most of the QOL subscales. More than 20% of the patients were found to have significant psychological morbidity ranging from mood disturbances (12%), to anxiety (3%) and depression (5%). Though chemotherapy did not significantly influence anxiety and depression, it was noted that male patients had significantly higher depression rates than females.

Conclusions: The study was intended to measure the existence of psychological morbidity within the cancer patients. Older patients, those from lower incomes groups, and those with advanced disease had significantly greater levels of distress and significantly poorer QOL scores. Depression rates were significantly higher in male patients than in female patients. This shows the need to have psychiatric assessment and intervention among patients undergoing cancer chemotherapy.