IMPACT OF UNCERTAINTY, ANXIETY, AND DEPRESSION ON ONCOLOGY PATIENTS’ QUALITY OF LIFE: SOME EVIDENCE FROM BULGARIA AND ITALY
DOI:
https://doi.org/10.35774/jee2023.02.312Keywords:
Quality of life, cancer patients, Italy, Bulgaria, Tobit model.Abstract
The objective of the present paper is to assess health-related quality of life (HQOL) of oncological patients. The treatment of cancer and of other invalidating and chronic pathologies cannot neglect the patients’ personal dimensions, let alone the uncertainty surrounding therapies and their effectiveness. Simultaneous consideration of all these factors makes it possible to identify the patients’ needs concerning their hospital experience, together with self-perceived health status, and to isolate crucial factors that improve patients’ satisfaction. For this purpose, health related quality of life (HQOL) was measured through the Visual Analogue Scale (VAS) and the EuroQOL-5D questionnaire for the sample of 600 cancer patients who live in two countries (300 in Italy and 306 in Bulgaria). Another validated scale employed in the research explored uncertainty through the Mishel Uncertainty in Illness Scale – MUIS, while other aspects related to cancer were measured through a tool developed by the European Organization for Research and Treatment of Cancer (EORTC). In the estimated Tobit model, a dummy variable was included among the regressors to control for the place of residence. The econometric analysis highlighted the need to account for relational and uncertainty-in-illness factors in the management of oncological diseases. Since both national sub-groups were not representative of the whole sample, we re-ran the same analysis for colorectal cancer, i.e., the most frequent type of cancer in Italy and Bulgaria both. The results of this second model only partially confirmed the main regression results, while the national effect lost its statistical significance. This suggests that the nature of the face-to-face relationships and the type of cancer under consideration matter more than the national institutional setting in providing a person-centered care.
JEL: I10; I19; C24.
References
Badia, X., Monserrat, S., Roset, M., & Herdman, M. (1999). Feasibility, validity and test-retest reliability of scaling methods for health states: The visual analogue scale and the time trade-off. Quality of Life Research, 8(4), 303-310. https://doi.org/10.1023/A:1008952423122
Bottomley, A. (2002). The cancer patient and quality of life. The Oncologist, 7(2), 120-125. https://doi.org/10.1634/theoncologist.7-2-120
Brédart, A., Bottomley, A., Blazeby, J. M., Conroy, T., Coens, C., D’Haese, B., Chie, W. C., Hammerlid, E., Arraras, J. I., Efficace, F., Rodary, C., Schraub, S., Costantini, M., Costantini, A., Joly, F., Sezer, O., Razavi, D., Mehlitz, M., Bielska-Lasota. M., & Aaronson, N. K. (2005). An international prospective study of the EORTC cancer in-patient satisfaction with care measure (EORTC IN-PATSAT32). European Journal of Cancer, 41(14),2120-2131. https://doi.org/10.1016/j.ejca.2005.04.041
Coleman, M. P., Alexe, D. M., Albreht, T., & McKee, M. (eds.). (2008). Responding to the challenge of cancer in Europe. Institute of Public Health of the Republic of Slovenia. https://apps.who.int/iris/bitstream/handle/10665/107879/9789616659208-eng.pdf?sequence=4&isAllowed=y
Desai, A., & Gyawali, B. (2020). Financial toxicity of cancer treatment: Moving the discussion from acknowledgment of the problem to identifying solutions. eClinical Medicine, The Lancet Discovery Science, 20, 100269.https://doi.org/10.1016/j.eclinm.2020.100269
Djambazov, S. N., Giammanco M. D., & Gitto, L. (2019). Factors that predict overall patient satisfaction with oncology hospital care in Bulgaria. Value in Health Regional Issues, 19, 26-33. https://10.1016/j.vhri.2018.11.006
Djambazov, S. N., Giammanco, M. D., & Gitto, L. (2022), Econometric analysis of oncology patients’ Health-Related Quality of Life determinants in Bulgaria. Central European Journal of Public Health, 30(3), 160–165. https://doi.org/10.21101/cejph.a7095
Encheva-Malinova, M., Djambazov, S., Mitova, R., & Vekov, T. (2019). EuroQol5D assessed health-related quality of life in cancer patients vs. general population in Bulgaria. Value in Health, 22(Suppl 3), S526. https://doi.org/10.1016/j.jval.2019.09.655EORTC. (n.d.). Satisfaction with in-patient cancer care. https://qol.eortc.org/questionnaire/satisfaction-with-in-patient-cancer-care/
EQ-5D. (n.d.). Explaining the EQ-5D in about two-and-a-half-minutes [Video]. EuroQol Research Foundation. Retrieved December 31, 2020 from https://euroqol.org/eq-5d-instruments/
Giammanco, M. D. & Gitto, L. (2019). Patient satisfaction and uncertainty in illness in oncology: Which are the relevant aspects when planning a qualitatively adequate assistance? In A. Bianco, P. Conigliaro & M. Gnaldi (Eds.), Italian Studies on Quality of Life (Social Indicators Research Series,vol 77, pp. 349-360). Springer, Cham. https://doi.org/10.1007/978-3-030-06022-0_23
Husson, O., Mols, F., & van de Poll-Franse, L. V. (2011). The relation between information provision and health related quality of life, anxiety and depression among cancer survivors: A systematic review. Annals of Oncology, 22(4), 761–772. https://doi.org/10.1093/annonc/mdq413
International Atomic Energy Agency. (2011). Inequity in cancer care: A global perspective. IAEA Human Health Reports No.3. http://wwwpub.iaea.org/MTCD/publications/PDF/Pub1471_web.pdf
James, T. A., Wong, S. L., & Carp, N. Z. (2016), Quality in cancer care: A critical need for clinician engagement. American Journal of Medical Quality, 31(5), 389–391. https://doi.org/10.1177/1062860616639639
Mayo, M., Potugari, B., Bzeih, R., Scheidel, C., Carrera, C., & Shellenberger, R. A. (2021). Cancer screening during the COVID-19 pandemic: A systematic review and meta-analysis. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 5(6), 1109-1117. https://doi.org/10.1016/j.mayocpiqo.2021.10.003
Miles, A. (2015). From EBM to PCH: always predictable, now inexorable. Journal of Evaluation in Clinical Practice, 21(6), 983-987. https://doi.org/10.1111/jep.12525
Miles, A., & Asbridge, J. E. (2014). Clarifying the concepts, epistemology and lexicon of person-centeredness: an essential pre-requisite for the effective operationalization of PCH within modern healthcare systems. European Journal for Person Centered Healthcare, 2(1), 1-15. http://dx.doi.org/10.5750/ejpch.v2i1.857
Miles, A., & Asbridge, J. E. (2016). The chronic illness problem. The personcentered solution. European Journal for Person Centered Healthcare, 4(1), 1-5. http://dx.doi.org/10.5750/ejpch.v4i1.1206
Milosavljevic, T., Kostic-Milosavljevic, M., Jovanovic, I. & Krstic, M. (2010). Gastrointestinal and liver tumours and public health in Europe. European Review for Medical and Pharmacology Science, 14(4), 259-262. https://www.europeanreview.org/wp/wp-content/uploads/734.pdf
Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing Research, 30(5), 258-263. https://doi.org/10.1097/00006199-198109000-00002
Mishel, M. H. (1997). Uncertainty in acute illness. Annual Review of Nursing Research, 15(1), 57-80. https://doi.org/10.1891/0739-6686.15.1.57
Osoba, D. (1994). Lessons learned from measuring health-related quality of life in oncology. Journal of Clinical Oncology, 12(3), 608-616. https://doi.org/10.1200/JCO.1994.12.3.608
Parkin, D., & Devlin, N. (2006). Is there a case for using visual analogue scale valuations in cost-utility analysis? Health Economics, 15(7), 653-664.https://doi.org/10.1002/hec.1086
The Ministry of Health of Italy. (2023). National Oncology Plan: Planning document and guidelines for the prevention and fight against cancer 2023-2027 [in Italian]. https://www.salute.gov.it/imgs/C_17_pubblicazioni_3291_allegato.pdf
Riva, S., Bryce, J., De Lorenzo, F., Del Campo, L., Di Maio, M., Efficace, F., Frontini, L., Giannarelli, D., Gitto, L., Iannelli, E., Jommi, C., Montesarchio, V., Traclò, F., Vaccaro, C. M., Gallo, C., & Perrone, F. (2019). Development and validation of a patient-reported outcome tool to assess cancerrelated financial toxicity in Italy: A protocol. BMJ Open, 9(9), e031485. https://doi.org/10.1136/bmjopen-2019-031485
Sawka, C., Ross, J., Srigley, J., & Irish, J. (2012). The crucial role of clinician engagement in system-wide quality improvement: the Cancer Care Ontario experience. Healthcare Quarterly, 15(Special Issue), 38-41. https://doi.org/10.12927/hcq.2012.23157
Skarstein, J., Aass, N., Fosså, S. D., Skovlund, E., &Dahl, A.A. (2000). Anxiety and depression in cancer patients: Relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. Journal of Psychosomatic Research, 49(1), 27-34. https://doi.org/10.1016/s0022-3999(00)00080-5
StataCorp. (2007). Stata statistical software (Release 10). College Station, StataCorp LP. https://www.stata.com/stata10/Tobin, J. (1958). Estimation of relationships for limited dependent variables. Econometrica, 26(1), 24-36. https://doi.org/10.2307/1907382
Velikova, G., Stark, D., & Selby, P. (1999). Quality of life instruments in oncology. European Journal of Cancer, 35(11), 1571–1580. https://doi.org/10.1016/S0959-8049(99)00193-8
World Health Organization. (2020). Noncommunicable Diseases Progress Monitor 2020. https://www.who.int/publications/i/item/9789240000490
Received: March 29, 2023.
Reviewed: April 16, 2023.
Accepted: May 29, 2023.
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