Quality of life for Palestinian patients with cancer in the absence of a palliative-care service: a triangulated study

Abstract

<h3>Background</h3> Cancer is a devastating illness that can deplete the resources of both the individual and the community. In the occupied Palestinian territory (oPt), it is the second leading cause of death (12%). Most cases are diagnosed at a late stage and patients are given little pain control and palliative care. In this study, we aimed to assess the determinants of quality of life (QoL) scores, and the symptoms in patients with cancer. <h3>Methods</h3> The study was done in the three main hospitals—Beit Jala Governmental Hospital, Watani Governmental Hospital, and Augusta Victoria Hospital—for cancer care in the West Bank, oPt, between May 1, to July 31, 2012. Patients (aged 18–90 years) with cancer who were attending the hospitals for treatment and follow-up were selected by convenient sampling and had qualitative in-depth interviews guided with five open-ended questions that were reviewed and validated by a palliative care doctor, a palliative care nurse, an oncologist, a social worker, and a researcher, and completed the cross-sectional quantitative European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30; scale 0–100). We did several statistical tests (<i>t</i>, ANOVA, χ², multiple linear regression analysis) using IBM-SPSS (version 19.0.0). We obtained written informed consent from all participants and interviewees, and study approval from the faculty board at the School of Public Health, Al-Quds University, East Jerusalem, West Bank, and the Helsinki Committee, Gaza Strip, oPt. <h3>Findings</h3> Ten patients completed the qualitative in-depth interviews and 323 (92%) of 350 completed the cross-sectional quantitative questionnaire EORTC QLQ-C30. In the qualitative interviews, respondents expressed several needs: financial aid, pain management, properly equipped health-care facilities in their vicinity, availability of medication, eradication of stigma, improved communication by the health-care team with the patient and psychosocial support, home nursing care, and palliative care. In the regression analysis, predictors of poor-health-related QoL (defined as <50; mean score 41·8) were advanced stage of cancer (β=−0·3; p<0·0001), poor economical situation (income <2000 NIS; β=0·19; p=0·001), low educational level (<10 years; β=0·12; p=0·04), and longer than 6 months of treatment (β=−0·11; p=0·04). The QoL domains with poor scores were physical (mean score 48·5), role (48·8), emotional (46·0), and social functioning (50·0), whereas the scores were worse for financial difficulties (64·6) and symptoms (fatigue [66·6], pain [63·0], and insomnia [56·4]). All these results were worse than were those for patients with cancer in Kuwait, Turkey, and the UK. <h3>Interpretation</h3> Palestinian patients with cancer encounter many difficulties in terms of their QoL. Palliative care for these patients should be integrated into the health-care system to improve their QoL. We recommend that policy makers integrate special services, such as palliative care, into the health-care system in the oPt to improve QoL and reduce suffering of these patients. <h3>Funding</h3> None.