Volume 3, Number 14, December 2022

e-ISSN: 2797-6068 and p-ISSN: 2777-0915

 

 


THE ROLE OF SUPPORTIVE CARE TO OVERCOME DEPRESSION AND IMPROVE QUALITY OF LIFE IN PATIENTS WITH LUNG CANCER IN PULMONARY HOSPITAL

 

Udi Wahyudi1, Amid Salmid2, Subandi3, Achmad Hufad4, Viena R. Hasanah5, Dini Handayani6

1,2,3 Poltekkes Kemenkes, Bandung

4,5,6 Universitas Pendidikan Indonesia (UPI), Bandung

Email: [email protected], [email protected], [email protected], [email protected], [email protected]�

 

 

KEYWORDS

Supportive Care, Depression, Quality of life

ABSTRACT

Supportive care is an interprofessional collaborative care approach between health personnel, modified through affirmative therapy, psychotherapy, and zoning, to optimize health services for information needs, emotional, spiritual, social or physical during� diagnostic treatment or follow-up phase for patients with lung cancer. However, so far, hospital health personnel rarely use supportive care methods. Therefore, the aim of this study was to analyze the impact of implementing supportive care on depression and quality of life in lung cancer patients. The method used is a quasi-experimental design or pre-experimental design with a post-test approach of control group design. The sample size employed in this study was 44 respondents. The results showed that supportive care had a significant effect on depression and quality of life of lung cancer inpatients. A further recommendation from this study is that hospitals are expected to apply supportive care methods and carry out further research to develop innovative models of supportive care

 

INTRODUCTION

Lung cancer is one of the most common malignancies in the world and is a major cause of death. Lung cancer can have a serious impact on a person's quality of life, where patients often experience physical, psychosocial, spiritual suffering, and other problems. (Effendy et al., 2015) In one study, 39% of lung cancer patients who underwent active treatment experienced stress. psychosocial significance, while 79% of lung cancer patients who received palliative care and 17% of those without clinical evidence of disease experienced the same rate, 10%-20% of all oncology patients suffered from a major illness such as depression. (MI Fitch, 2008)). The results of other studies show that the majority (80%) of lung cancer patients are depressed. (Halim et al., 2020)

The emergence of depression problems in lung cancer patients is caused by fear of undergoing examinations, recurrence of the disease, and fear of death. (Smith et al., 2018). This can affect the quality of life, so it is necessary to carry out appropriate interventions that are collaborative interprofessional, such as supportive care innovations (Petrillo et al., 2021). �

Supportive care innovation is a health service that uses compartmentalization strategies, positive thinking (affirmations), or spirituality to meet physical, emotional, social, psychological, informational, spiritual and practical needs during the diagnostic, treatment, and follow-up phases (Petrillo et al., 2021). Supportive care can improve quality of life, autonomy and dignity and optimize health for cancer patients. (M. Fitch & Maamoun, 2016). From the results of research by E. Bandieri at. All, 2012 showed that the provision of supportive care in lung cancer patients can reduce the level of depression and improve the quality of life (Bandieri et al., 2012). Therefore,� it is necessary to carryout appropriate interventions that are collaborative interprofessional, such as supportive care.�

Theoretical Foundation

1. Lung Cancer

Lung cancer is all malignant tumors that mainly attack the lungs. Primary lung cancer is a malignant tumor originating from the lungs. According to the 1999 WHO classification, there are four types of primary malignant cells in the lungs i.e. small cell carcinoma, squamous or epidermoid cell carcinoma, adenocarcinoma and large cell carcinoma.

The etiology of lung cancer is unknown, but apart from other factors such as immunity and genetics, long-term exposure or inhalation of carcinogens is a major risk factor. Smoking is considered a major cause of lung cancer. Lombard and Doering (1928) reported that smokers had a higher incidence of lung cancer than nonsmokers. There is a relationship between the average number of cigarettes smoked per day and a high incidence of lung cancer. It is said that 1 in 9 heavy smokers will develop lung cancer. However, not all lung cancer patients are smokers. It is estimated that 25% of lung cancers in non-smokers originate from secondhand smoke. Several genes that play a role in lung cancer undergo changes/mutations, namely proto-oncogenes, tumor suppressor genes, and enzyme encoding genes (Provan, 2018). Many people with lung cancer have smoked, but some have never smoked at all (Alberg et al. , 2013)

Lung cancer is characterized by atypical symptoms and complaints, such as weight loss, loss of appetite, intermittent fever, paraneoplastic syndromes such as Cushing's syndrome, hypercalcemia, hypertrophic pulmonary osteoarthropathy, peripheral venous thrombosis, and signs of neurological syndrome. The problems faced by cancer patients are complex. Several risk factors predispose cancer patients to depression, one of which is chemotherapy (Wagland et al., 2016). While the other factors are related to medical factors (location and clinical course of the disease, type of treatment, presence of pain, drugs), psychological factors (coping abilities, developmental stages, previous emotional disorders) and social factors (availability of support, socioeconomic). (Halim et al., 2020)

2. Supportive care�

Quality of life is a major problem in lung cancer patients that needs special attention. This is caused by problems that are felt very heavy, both physical and psychological problems. The severity of the problem felt by lung cancer patients requires comprehensive care support i.e. the involvement of all professions or multidisciplinary which aims to meet the needs of lung cancer patients in the form of information, the need for support and palliative care. Multi-disciplines involved in cancer care include clinical nurse specialists, oncologists, palliative care specialists, nutritionists, and mental health practitioners. Before supportive care is given, it is necessary to carry out an assessment in the early and advanced phases.�

MASCC (The Multinational Society for Supportive Care of Cancer) in 1990 stated that the prevention and management of cancer side effects and their treatment is the most important thing in patients with lung cancer. From diagnosis to post-treatment care, the entire cancer experience includes supportive care management of physical and psychological symptoms and side effects. Improving recovery, secondary cancer prevention, survival, and end-of-life care are components of supportive care. Supportive care is care given to improve the quality of life of patients and their families. Supportive care is a holistic service that includes physical, social, cultural, emotional, nutritional, informational, psychological, spiritual needs, as well as the experiences of cancer patients (Hauora, 2010). There are three main components of supportive care, comfort care, palliative care and symptom management.�

Rosenbaum (2016) states that supportive care has 4 goals such as reducing morbidity and toxicity of disease and symptoms due to treatment, as well as improving physical and mental health in general, improving the quality of life of patients receiving treatment and maintaining a longer life i.e. by providing assistance with screening, testing, diagnosis, treatment, and additional programs related to ongoing disease and treatment, and helping to get better information about disease and symptoms in cancer patients undergoing treatment

 

RESEARCH METHOD

This research is a quantitative study using a quasi-experimental design or pre-experimental design with a control group post-test design approach, the design employed to find a causal relationship by adding a control group to the experimental group. In this study, all patients treated in Mawar inpatient room of RSPG Cisarua Bogor were selected as respondents through a predetermined sampling procedure. The sampling technique in this research is utilizing purposive sampling technique i.e. the sampling is not based on strata, groups or random, but based on certain considerations/objectives. The sample size used in this study was 44 respondents (Hadi, 2019). Based on this number, they were divided into two groups, 22 in the experimental group and 22 in the control group. The experimental group is the group that is given treatment or intervention in the form of supportive care. The control group is the group that received non-supportive care. The location of the research was carried out in a special inpatient room for lung cancer at RSPG Cisarua Bogor.

The data collection technique in this study used a tool consisting of the Supportive Care Needs Survey (SCNS From 34) format, which is a tool to measure the need for supportive care, the European Organization for Cancer Research and Treatment Core Quality of Life Questionnaire (EORTC QLQ) instrument. -C30). (Metelko et al., 1994), to measure quality of life and BDI-II (Beck Depression Inventory II) instrument to measure depression level of lung cancer patients (Wang & Gorenstein, 2013). During implementation, respondents in the experimental group treated with supportive care. In 1 session, each respondent has 1 hour. Meanwhile, respondents in� control group still received treatment in� form of non-supportive care (education).

Research data processing uses a computerized system, including the editing, coding, processing, and cleaning processes. While the data analysis includes univariate analysis and bivariate analysis. This univariate analysis was designed to obtain an overview of the frequency distribution of each study variable, including the independent variable (need for supportive care) and the dependent variable (depression and quality of life). If the total score is > 2, the need for supportive care is good, and if the total score is 2, the need for supportive care is poor. Meanwhile, the bivariate analysis used statistical independent sample t-test with a significance level of 95% or p < (0.05). The results of this analysis are used to determine whether supportive care impact on depression and quality of life of lung cancer patients in� inpatient unit of RSPG Cisarua Bogor.

 

RESULTS AND DISCUSSION

1. Characteristics of The Respondents

Characteristics of the respondents are presented according to the type of data such as numerical data and categorical data. Numerical data of age employed mean, median, standard deviation, and min max. Meanwhile, categorical data includes age, gender, education employed explanation of quantity/value, quantity and presentation.

Table 1

Characteristics of Respondents Based on Age at RSPG Cisarua Bogor, October 2019

(n=44)

Group Intervention (n=22)

Group Control (n=22)

 

Variabel

Mean

Median

SD

Min-Maks

Mean

Median

SD

Min-Maks

Age

56,52

60

12,177

25-77

53,86

54

14,42

20-70

 

 

 

 

 

 

 

 

 

 

Table 2

Characteristics of Respondents Based on Gender and Education at RSPG Cisarua Bogor, October 2019 (n=44)

Variable

Group Intervention (n=22)

Group Control (n=22)

Total

(%)

Total

(%)

Gender:

 

 

 

 

Male

15

58%

16

72,72%

Female

7

22%

6

27,27%

Total

22

100%

22

100%

Education

 

 

 

 

Elementary School

12

54%

8

36,36%

Junior High School

Senior High School

Higher Education

2

8

0

0,9%

36,36%

0

6

6

2

27,27%

27,27%

0,90%

Total

22

100%

22

100%

2. Description of Supportive Care

The assessment of supportive care needs employed the SCNS � SF 34 instrument (Supportive Care Needs Survey) from The Cancer Council New South Wales. The instrument consists of six domains i.e. physical, emotional, psychosocial, informational, spiritual, and practical. The total respondents based on the need for supportive care were 44 respondents, consisting of 22 respondents as controls and 22 respondents as experiments.

Table 3

Frequency Distribution of Respondents Based on Supportive Care in RSP. Goenawan Partowidigdo Cisarua - Bogor, October 2019 (n=44)

 

Group Intervention (n=22)

Group Control (n=22)

 

variabel

Mean

Median

SD

Min-Max

Mean

Median

SD

Min-Max

Physical

12,1

11

5,959

0 � 25

13,1

13

4,5294

7-25

Emosional

11,05

10

5,9336

0 - 25

23,75

21

10,04

12-45

Psychosocial

23,75

21

13,50

0 � 60

11,7

10

5,292

5-25

Informational

18,8

18

10,792

0 � 45

23,05

20

10,47541

4-45

Spiritual

3,6

4

2,348

0 � 10

4,9

4

2,71

2-10

 

Practice

2

2

1,337

0 � 5

2,8

2,5

1,4726

1-5

 

3. Overview of Depression Levels

Table 4

Frequency Distribution of Respondents Based on Depression Levels at RSP Goenawan Partowidigdo Cisarua - Bogor, October 2019

(n=44)

Variable

Catagory

Group Intervention (n=22)

Group Control (n=22)

Total

%

Total

%

�Level of Depresion

Normal

Mild

Moderate

Severe

2

9

8

3

 

0,9

40

36

13

 

3

11

1

7

13

47,8

0,45

31,8

4. Overview of Quality of Life�

Table 5

Distribution of Respondents Frequency Based on Quality of Life at RSP Goenawan Partowidigdo Cisarua - Bogor, October 2019 (n=44)

Variable

Catagory

Group Intervention (n=22)

Group Control (n=22)

Total

%

Total

%

Quality of Life�

Very bad

Bad

Moderate

Good

Very good

0

2

14

6

0

0

0,9

63,63

27

0

0

1

12

9

0

0

0,45

54

40,9

0

5. Differences Supportive Care on Depression

Table 6

Different Effects of Supportive Care on Depression at RSP Goenawan Partowidigdo Cisarua - Bogor, October 2019

(n=44)

Variabel

Mean

SD

SE

p-value

N

Depression

Pre Test

Post test

 

19,59

10,23

 

9,88

3,49

 

2.17

0,74

 

0.000

 

22

22

6. Different Effects of Providing Supportive Care on Quality of Life

Table 7

Differences in the Effect of Supportive Care on Quality of Life at RSP Goenawan Partowidigdo Cisarua - Bogor, October 2019

(n=44)

Variabel

Mean

SD

SE

p-value

N

Quality of Life Pre Test

Post test

 

52,09

61,41

 

14,02

7,77

 

2.99

1,66

 

0.002

 

22

22

7. Differences in the Effect of Education on Depression

Tabel 8

Differences in the Effect of Education on Depression at RSP Goenawan Partowidigdo Cisarua - Bogor, October 2019

(n=44)

Variable

Mean

SD

SE

p-value

N

Depression

Pre Test

Post test

 

20,77

21,09

 

13,25

12,57

 

13,25

12,57

 

0.184

 

22

22

 

�From the results of the statistical test it can be interpreted that the influence of the intervention group given supportive care and the control group being given education has a very significant difference in effect.� From the results of these statistical tests, it can be concluded that there is a difference and influence between the provision of supportive care and the provision of education to patients with lung cancer in Mawar inpatient room at RSP Goenawan Partowidigdo Cisarua Bogor.�

�Supportive care aims to improve the quality of life of patients with serious or life-threatening illnesses (National Cancer Institute, 2016). Supportive care focuses on the overall management of the physical, emotional, cultural, and spiritual needs of patients and family members. Supportive care does not hasten or delay death, but seeks to relieve suffering, control symptoms, and restore functional capacity (Schmid-B�chi et al., 2013)

The goal of supportive care is the early prevention or treatment of symptoms caused by the disease, including the side effects of treatment or treatment, and other problems related to the disease or its treatment, such as psychological, social, and psychiatric problems (National Cancer Institute, 2003). Ernest et al. al (2016) explains that the goals of supportive care programs for cancer patients are to improve the quality of life of cancer patients and their families, reduce mortality and disease poisoning due to side effects of treatment programs, and in general improve physical and mental health to improve quality of life. Cancer survivors use treatment plans to address specific cancer-related problems experienced by patients, their family members, and friends. Supportive care tells a lot about the unmet needs of people with cancer. Supportive care programs are considered to be able to improve the quality of life of cancer patients.

The results revealed that the highest average need for supportive care was information needs, followed by emotional needs. This is different from the research of Ker et al (2007) which suggests that cancer patients choose emotional needs as their highest needs, especially the need to overcome anxiety. However, another study by Kerr et al (2004) showed that for supportive care needs of cancer patients, information needs were the highest supportive care needs, followed by emotional needs. The average value of psychosocial needs reached 23.75%. Patients urgently need supportive care to reduce levels of depression and improve quality of life, in addition it can be used as an educational and informational forum and it is very effective in helping through the continuum of care. Providing adequate supportive care is important for peace of mind in cancer patients and helps patients control the situation, maintain optimism, and develop strategies that directly benefit the patient.

In terms of psychosocial needs, almost all patients need help to overcome their fears if cancer develops, more than half need help to overcome their fears, and if less, their physical needs are reduced. Meeting the need for supportive care represents two additional elements in implementing family-centered care, providing general and specific information, which can reduce depression rates in cancer patients and enable patients to be more comfortable doing their jobs. On the emotional side, to meet the need for supportive care, interventions can be designed through supportive group interventions.

 

CONCLUSION

The overall results of the study indicate that the provision of supportive care is very influential in reducing the level of depression and improving the quality of life of lung cancer patients at Goenawan Partowidigdo Cisarua Pulmonary Hospital, Bogor.

Disadvantages and Limitations of the Study

The limitations of this study are related to the time of the study and the condition of most of the patients who were not stable after chemotherapy, which affected the implementation of the intervention. In addition to the above factors, other limitations are related to the characteristics of respondents who are not homogeneous, such as duration of illness, frequency of chemotherapy, depression level, and quality of life before suffering from lung cancer. Moreover, the barriers of the study is related to the difficulty of accessing references of research journal on supportive care carried out in Indonesian hospitals.

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�Copyright holders:

Udi Wahyudi, Amid Salmid, Subandi, Achmad Hufad, Viena R. Hasanah, Dini Handayani (2022)

 

First publication right:

Devotion - Journal of Research and Community Service

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