Quality of life and psychological distress in newly diagnosed treatment‑naïve cancer patients and their determinants at a Tertiary Hospital in Ethiopia
The substantial burden of psychosocial vulnerability among newly diagnosed cancer patients is highlighted, with more than half experiencing moderate-to-severe psychological distress, and the urgent need to integrate psychosocial care with physical health care in oncology is underscored.
Abstract
Newly diagnosed cancer patients often experiencing significant psychological disruption and a decline in quality of life (QoL), which may lead to interruptions in treatment. Nevertheless, the psychosocial status of these patient remains inadequately understood in resource-limited settings. Therefore, the present study aimed to evaluate psychosocial vulnerability, specifically psychological distress and QoL among newly diagnosed, treatment naïve patients, as well as the factors associated with these outcomes. A cross-sectional study was conducted among 231 newly diagnosed cancer patients between June and December 2024 at the oncology Department of Jimma University Medical Center (JUMC). Psychological distress and QoL were assessed using the National Comprehensive Cancer Network (NCCN) distress thermometer (DT, version 1.2024) and the EORTC QLQ-C30, respectively. Data were analyzed using SPSS version 26. Multivariable logistic regression analysis was performed, and the strength of associations between dependent and independent variables was expressed as adjusted odds ratio (AORs) with 95% confidence intervals (CIs). Statistical significance was set at p-value < 0.05. More than half of the patients (51.95%: 95%CI 46%, 59%) experienced moderate-to-severe psychological distress. Higher odds of distress were observed among rural residents (AOR: 2.45), patients with co-morbidities (AOR: 3.59), those reporting low social support (AOR: 6.09), individuals with advanced-stage disease (AOR: 4.82), patients receiving palliative treatment intent (AOR: 2.32), those with ECOG performance status ≥ 2 (AOR: 4.15), and malnourished patients (AOR: 5.68). Notably, perceived low social support, advanced disease stage and malnutrition were common factors associated with both psychological distress and lower QoL scores. This study highlights the substantial burden of psychosocial vulnerability among newly diagnosed cancer patients, with more than half experiencing moderate-to-severe psychological distress. Significant differences in mean QoL scores were observed between early-and advanced-stage patients. Advanced stage disease, malnutrition, and low perceived social support were consistently associated with lower QoL scores. These findings underscore the urgent need to integrate psychosocial care with physical health care in oncology, particularly to address unrecognized psychosocial challenges in resource limited settings.
Background Enhancing quality of life (QoL) is the primary aim of palliative care and a key endpoint in oncology research. Objective This study aimed to assess the QoL and its association with anxiety, depression, and clinical factors among patients with metastatic cancer attending oncology centers in Northwest Ethiopia. Design A cross-sectional study was conducted among 290 cancer patients with metastasis who were receiving treatment at oncologic centers in Northwest Ethiopia from August to October 2023. Methods Study participants were enrolled using the consecutive sampling method. QoL was measured using the World Health Organization Quality of Life Scale – Brief Version (WHOQOL-BREF). Multiple linear regression analysis was used to identify the determinants of QoL. Variables with a P-value < 0.05 at a 95% confidence interval were considered statistically significant. Results In this study, the mean scores for physical health, psychological health, social relationships, environmental health, and overall QoL were 26.74±10.09, 30.46±12.03, 34.48±13.97, 37.64±14.06, and 31.17±6.51, respectively. The overall QoL had a negative significant association with poor performance status (β = -2.52; 95% CI: -4.35, -0.69), presence of comorbidity (β = -2.46; 95% CI: -4.03, -0.90), depression (β = -3.17; 95% CI: -4.76, -1.59), anxiety (β = -1.99; 95% CI: -3.38, -0.47), and poor social support (β = -2.52; 95% CI: -4.43, -0.61). Conclusion The physical health domain of QoL had the lowest mean score. Poor performance status, the presence of comorbidity, depression, anxiety, and poor social support were the determinants of overall QoL. Hence, it is essential to focus on treatments that enhance physical health, improve poor performance status, manage comorbidities, alleviate depression and anxiety, and strengthen social support.
Fasil Bayafers Tamene, Tirsit Kestela Zeleke, Endalamaw Aschale Mihiretie et al.· Palliative Care and Social P...· 0 citations
BACKGROUND
In Sub-Saharan Africa, new diagnosed cancer cases surpassed 800,000 in 2020. However, the impact of pre-treatment nutritional status on treatment-related and psychosocial outcomes remains inadequately understood, particularly in resource-limited settings.
OBJECTIVE
This study aimed to assess the effect of pre-treatment nutritional status on cancer treatment-related and psychosocial outcomes among newly diagnosed cancer patients at Jimma University Medical Center (JUMC).
METHODS
A prospective study was conducted among 231 new cancer patients at the oncology department of JUMC between 2024 and 2025. Psychosocial outcomes were assessed using the World Health organization QoL short version and the National Comprehensive Cancer Network distress thermometer version 1.2024. Chemotherapy-related toxicity was measured using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events short-form tool. Data management and analysis were performed using R statistical software. Independent variables with a p-value < 0.05 were considered significantly associated with outcome variables.
RESULTS
Pre-treatment nutritional status was significantly associated with differences in physical and psychological quality of life (QoL) following chemotherapy. Compared with well-nourished patients, malnourished patients had lower scores in the physical-domain (β=-4.88), psychological-domain (β=-5.80), and over-all QoL (β=-5.10). Malnourished patients prior to chemotherapy were more than three times more likely to experience psychological distress (AOR= 3.29) and had nearly twice the hazard of developing chemotherapy-related toxicity (AHR= 1.97) compared with well-nourished patients.
CONCLUSIONS
Patients who were malnourished at baseline consistently exhibited poorer physical and psychological domains QoL, greater psychological distress, and an increased risk of chemotherapy-related toxicity. These findings underscore the importance of early nutritional assessment and timely intervention as integral components of comprehensive cancer care, particularly in resource-limited settings where vulnerabilities to malnutrition and psychosocial distress are most pronounced.
A. D. Dubiwak, Mulualem Tadesse, T. Belachew et al.· Complementary Therapies in M...· 0 citations
Recent evidence has revealed that non-CNS cancer patients experience pre-treatment cognitive complaints with a negative impact on their quality of life (QOL). Despite this knowledge, there is a lack of studies in resource-constrained settings that investigate cognitive complaints before treatment and their association with QOL among diverse non-CNS cancers. Therefore, this study aimed to investigate the relationship between cognitive difficulties and quality of life among newly diagnosed non-CNS cancer patients in an African context. A purposive sample of 50 non-CNS cancer patients aged 18 years and above were recruited into a cross-sectional study before oncology treatment at a tertiary hospital in Gauteng. The patients were assessed for subjective cognitive functioning using the perceived cognitive impairment, comments from others, and quality of life subscales of the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog) version 3. Spearman correlational analyses and t-test were performed to examine associations and differences. We observed a significant and moderate positive association between perceived cognitive impairment (PCI) and comments from others about cognition (Oth) (rs(46)= 0.460, p < .001) and between PCI and quality of life (QOL) (rs(44) = 0.554, p < .001). No significant association was found between Oth and QOL rs(46) = 0.172, p = 0.242. The findings revealed an association between perceived cognitive impairment (PCI) and quality of life among non-CNS cancer patients before treatment. The results highlight the need for cognitive and quality of life screening before treatment and implementation of early interventions to prevent deterioration and to improve health outcomes.
T. Motsamai, A. Lentoor· Discover Public Health· 0 citations
Background and Objectives: Anxiety and depression are among the most common psychological symptoms in patients with cancer and are associated with morbidity and impaired health-related quality of life (HRQoL), independent of the cancer stage. This study aimed to determine the prevalence of clinically significant anxiety and depression among adult oncology patients in Iraq and quantify the independent contribution of these symptoms to HRQoL. Materials and Methods: A cross-sectional study was conducted between 1 November and 15 December 2024, at the National Oncology Hospital in Najaf, Iraq. A total of 200 adult oncology patients were enrolled using consecutive sampling. Symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), and HRQoL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G). Descriptive statistics were used to summarize sample characteristics. Group comparisons were performed using Pearson’s chi-square test, the Fisher–Freeman–Halton exact test with Monte Carlo estimation, and one-way ANOVA, as appropriate. Associations among continuous variables were assessed using Pearson’s correlation and multiple linear regression. Statistical significance was set at p < 0.05. Results: The mean age (SD) was 52.2 (12.0) years, and 64.0% of the participants were male. Severe anxiety and severe depression were observed in 41.0% and 34.0% of the participants, respectively. Anxiety severity was significantly associated with age, sex, marital status, and treatment modality (all p < 0.01) and was significantly higher in females (58.3% vs. 31.2%) and unmarried patients. Depression severity was significantly associated with age (p = 0.005), sex (p < 0.001), and marital status (p < 0.001) but not with cancer stage (p = 0.223) or treatment modality (p = 0.530). The mean total FACT-G score was 58.2 (14.6), indicating low-to-moderate HRQoL. HADS-A and HADS-D were strongly intercorrelated (r = 0.741) and inversely correlated with FACT-G (r = −0.750 and r = −0.780, respectively; all p < 0.001). Multiple linear regression showed that higher HADS-A and HADS-D scores were independently associated with lower HRQoL, and the full seven-predictor model explained approximately 62% of the variance in FACT-G total scores (R2 = 0.62). Conclusions: Severe anxiety and severe depression were observed in 41.0% and 34.0% of participants, respectively. Higher anxiety and depression scores were independently associated with lower HRQoL.
A. Alkhaqani, Miklós Sugár, A. Jaber et al.· Medicina· 0 citations
This study aimed to assess chemotherapy-related symptom toxicities, nutritional status, psychological distress and palliative outcomes among adult cancer patients in a tertiary care centre in India.
This cross-sectional observational study selected 254 adult cancer patients undergoing chemotherapy at a tertiary care hospital. Eligible patients were selected for the study. Patients with histologically confirmed malignancies were enrolled, irrespective of cancer histology or prior chemotherapy cycles. Patients with diagnosed severe psychiatric disorders (e.g., schizophrenia, bipolar disorder or major depressive disorder affecting decision-making capacity), those receiving exclusive palliative care or those unwilling to provide informed consent were excluded. A face-to-face interview lasting 10–15 min was conducted after obtaining informed consent, using validated tools such as the National Cancer Institute -PRO-CTCAE
®
, full Mini-Nutritional Assessment (MNA), National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) and palliative outcome scale (POS) to assess chemotherapy-related toxicities, nutritional status, distress and palliative care needs. The data were analysed with Jamovi v2.6. Sociodemographic and clinical variables were documented. Descriptive statistics employed frequencies and percentages. Inferential analyses presented continuous data as mean ± standard deviation or medians (Shapiro–Wilk normality tested) and categorical data as proportions. Associations between age, body mass index (BMI), MNA, POS and distress were examined using non-parametric Spearman’s ρ correlations (
p
< 0.05 significance).
Among 254 chemotherapy patients (71.3% female; mean age 58.5 ± 12.5 years), breast cancer predominated (63%), with 83.9% below the poverty line and 83.1% having comorbidities (diabetes 42.2%, hypertension 36.5%). PRO-CTCAE
®
revealed moderate-severe toxicities: Alopecia (36.2%), decreased appetite (18.1%) and fatigue (17.3%). Distress affected 64.6% (DT ≥ 4). Significant malnutrition prevalence (57.1%) was observed, with 36.2% of patients additionally identified at malnutrition risk. Patients exhibited a moderate palliative care burden, with a Palliative Outcome Scale (POS) median score of 2 per item and a mean total score of 19.4 ± 4.7. Spearman’s ρ showed BMI-POS (ρ = −0.230,
p
< 0.001) and MNA-POS (ρ = −0.150,
p
= 0.017) were inversely correlated. There were no age associations (all
p
> 0.05).
Chemotherapy patients exhibited high malnutrition (57.1%), distress (64.6%) and toxicities (alopecia 36.2%). BMI and nutritional status showed weak inverse correlations with palliative burden (ρ = −0.230,
p
< 0.001; ρ = −0.150,
p
= 0.017). These validated tools (PRO-CTCAE
®
, MNA, DT, POS) reveal substantial unmet needs. The absence of multivariable analysis limits confounder adjustment. Targeted nutritional interventions, distress management and symptom control should be explored in future intervention studies to potentially improve quality of life in socioeconomically vulnerable Indian cohorts.
Arunachalam Ganeshan, V. G, T. Sriram et al.· Indian Journal of Palliative...· 0 citations
Radiotherapy is integral to cancer care, yet its impact on patient-reported symptoms and health-related quality of life (HRQoL) remains understudied. Objectives: To assess the severity of patient-reported symptoms and HRQoL during active radiotherapy and examine associations between specific symptoms and QoL domains among adult cancer patients. Methods: This cross-sectional analytical study was conducted from July 2024 to June 2025 at Bahawal Victoria Hospital, Bahawalpur. A total of 85 adult patients undergoing external beam radiotherapy (without concurrent chemotherapy) completed validated PRO instruments, the EORTC QLQ-C30 and site-specific modules (e.g., QLQ-H&N35, QLQ-CR29), and the PRO-CTCAE at mid-treatment. Data were analyzed using SPSS Version 23.0; Spearman correlation and multiple linear regression identified symptom QoL relationships. Results: Mean global QoL score was 58.4 ± 18.3. Fatigue (64.7 ± 24.1), pain (57.3 ± 26.8), and insomnia (52.9 ± 28.4) were the most severe symptoms. PRO-CTCAE revealed 71.8% reported moderate to severe fatigue. Fatigue (r = –0.52), pain (r = –0.48), and appetite loss (r = –0.41) strongly correlated with lower QoL (all p<0.001). Regression confirmed fatigue (β = –0.31), pain (β = –0.24), and palliative intent (β = –8.9) as independent predictors of reduced global QoL (adjusted R² = 0.486). Conclusions: Fatigue, pain, and treatment intent significantly impair QoL during radiotherapy. Routine PRO integration and context-adapted supportive care are urgently needed to preserve patient well-being in resource-limited oncology services.
A. Luqman, M. Hassan, Wajahat Hussain· Pakistan journal of health s...· 0 citations
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