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INTERNATIONAL JOURNAL Of ACADEMIC RESEARCH

Vol. 2. No. 4. July 2010

ATTITUDE OF PATIENTS TOWARD CANCER AND ITS TREATMENT


Dr. Fakhria Jaber Muhbies*, Dr. Nazar A. Sheren Al-Doski College of Nursing, Al-zaytoonha Univesity, Nursing department, University of Jerash (JORDAN) * Corresponding author: fakhria_muhbes@yahoo.com
ABSTRACT Cancer is considered the second leading cause of death in developed countries there were some 6.2 million cancer related deaths, accounting for 12% of all deaths globally. In the year 2002, ten millions new cases of cancer were diagnosed (5.3 million in men and 4.7 million in women (5). Patients perception toward this disease and preference concerning the types and aims of their treatment are vary they may loss hopes and become devastated and crippled or even dies earlier, if told about the diagnosis (13). However, Around one third of new cancers could be prevented through the modification of lifestyle factors (7) The study aimed to explore the attitude of (100 )patients with different types of cancer who were receiving therapy living in Iraq toward cancer and its treatment, The study was conducted in (4) teaching hospitals in Baghdad and interview technique was used for data collection. The study provides knowledge and understanding about cancer as disease based on attitude of the patients. The result reveals that, most of the sample refers the cause of their illness to stress and tension of previous year. They considered their illnesses are life threatened and there are no hopes for treatment and it is fatal, only (4%) of them believed that their disease is easily treated and they are not worried, and their information about cancer treatment were very poor. The study recommended that further study should be carried out related to issues, which have effect on patient with cancer and have an impact on the patient if told about their diagnosis, increase their knowledge about how cancer can affect relationship with partner, and find ways to help patients, through financial support Key words: Attitude, Cancer, Iraq 1. INTRODUCTION The word attitude can be defined as an internal state that affect on individual choice of action toward some objects, people and events. It represent an individual s degree of like or dislike for an item There are several factors affect individual attitude toward cancer including educational level, cultural, religious and health illness and beliefs which may be change through the tools of persuasion or by social influences (1) and (Wikipedia). The attitude we hold about a particular topic or subject will influence the way, which we behave towards its. Babor et al (2) and (Wikipedia Indicated that culture determines the different ways that patients understand cancer, the ways they explain it, and their attitudes towards it .In addition to cultural explanations of health and health behavior. These factors affect the patient's emotional response to the disease and health behaviors in terms of prevention and treatment (6). literatures showed that despite treatment, advanced cancer remain one of the most feared of all disease, the doctors may not know what to say or how to say it when they are about to inform the patient about their disease (14). Therefore, nurses should be very qualified and have high scientific background to play an effective role in supporting the patient and the family and take consideration the influence of attitude and beliefs in addition to the behavior during nursing intervention for patient with this disease (5). Importance of the study Understanding the attitude of patients with cancer has significant implications on nursing, which may have affect on caring of the patient. Moreover, nurses spending most of their time with the patients. Aim The study aimed to explore the attitude of 100 patients living in Iraq toward cancer and its treatment 2. METHODS Design of the study The investigators carried out a descriptive study from Feb. 2009 through mid of September 2009. A purposive sample of (100) patients with various types of cancer were selected.

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INTERNATIONAL JOURNAL Of ACADEMIC RESEARCH

Vol. 2. No. 4. July 2010

Data collection: Interview technique was used as method to gather data, the questionnaire were completed by the researcher and all the patients from (4) general Hospitals agreed to participate in this study. Tools A questionnaire format was constructed after reviewing the studies and literatures related to this study it content the data concerning socio-demographic characteristics of the patients, level of education and patients perception toward having cancer and toward treatment of cancer. In order to determine the reliability of the questionnaire test retest was done R=85 Results Table 1. Socio-demographic characteristic for sample Characteristics
Gender: Male Female Age: <30 years 30-39 years 40-49 years 50-59 years >60 years Marital status: Single Married Divorce Widow Level of education: Cannot read and write Read and write Secondary school High school Institute College Type of the cancer Breast cancer Leukemia Ca of the rectum Others

Frequency
25 75 6 13 35 33 13 60 23 7 10 25 20 20 18 12 5 45 38 15 2

percentage
25% 75% 6% 13% 35% 33% 12% 60% 23% 7% 10% 20% 25% 20% 18% 12% 5% 45% 38% 15% 2%

Table 2. Patients reasons to the causes of cancer Items


Psychological 1. too much stress or tension 2. fear and anxiety 3. missing member of the family 4. life events (fatigue and frustration )

No.
22 7 8 4

%
22% 7% 8% 4% 2% 5% 4%

Physical 1. have many children 2. taking drugs 3. low resistance Social 1. personal habit 2. poor hygiene 3. non health practice 4. smoking 5. alcohol drinking Environment 1. polluted water 2. environment pollution 3. contaminated food Dont know Total

2 5 4

4 2 4 4 4 8 9 6 7 100

4% 2% 4% 4% 4% 8% 9% 6% 7%

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Table 3. Patients perception or responses to their having cancer
Items Life threaten disease Can be easily treated Effect of emotional stress Long term disease Painful experience and suffering Guilt feeling from God Financial disturbance Total Patient responses 40 4 20 11 10 8 7 100

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% 40% 4% 20% 11% 10% 8% 7%

Table 4. Patients perception or responses to the treatment of cancer


Items Very important and have effect Moderate effect No or Poor effect Disfigurement Bad effect on health Dependency Financial difficulties Total Patient responses 10 10 20 35 10 5 10 100 % 10% 10% 20% 35% 10% 5% 10%

3. RESULTS AND DISCUSSION Regarding the demographic characteristics of the sample as shown in table (1) (75%) of the sample were female. (45%) of them were diagnosed with breast cancer. This can be attributed to the fact that breast cancer is one of the most frequent malignancies in women, and its incidence is increasing., no reduction in the mortality rate has resulted from advances in early diagnosis and new therapeutic modalities; therefore, new approaches to the understanding of this disease are required (2) Breast diseases such as breast cancer predominantly affect women this is because male breasts are more rudimentary than female breasts, making them more resistant to cancer (4). The majority of age group was ranged from (40-49) years old which represents (35%) all of them were Iraqi people, unmarried which represents (60%), and (25%) of the sample cannot read and write. However, (38%) of the sample patients complained from leukemia, there is strong and consistent evidence that a genetic component contributes to the etiology of chronic lymphocytic leukemia (CLL). A recent genomewide association study of CLL identified seven genetic variants that increased the risk of CLL within a European population (4), (15%) of the sample having carcinoma of the rectum. (8), and (2%) diagnosed with different types of cancer (lung, cervical cancer) The study revealed table (2) that most patients (22%) thought that the main causes of their cancer related to stressful situation and tension. While only (8%) of them believed, it was due to drinking alcohol or smoking. Previous study revealed that smoke exposure is estimated to account for 3,000 cancer deaths per year (4). NHMRC (7) stated that the risk of developing cancer also increases with the average amount of alcohol consumed (e.g. women who drink four standard drinks per day are more likely to develop breast cancer than those that drink one, two or three standard drinks(10) (7%) of the sample dont know the real causes of having cancer this can be attributed to fact that people find difficult to talk about what is happening to them and how they feel. In addition, having a serious illness can put a lot of pressure on their relationship with partner (3) Table (3) indicated that the majority of patient (40%) said that their illnesses are life threatened, there are no hopes for treatment, and it is fatal, However, only (4%) of the sample believed that their disease is easily treated and they were not worried this may be related to their believes that their illness can be easily treated and because the disease was in early stage (not advanced) and they had surgical treatment. Tong et al. (2007) (12) mentioned that during management of cancer, the health team ability to identify accurately patients attitude towards treatment is very important and critical. In this study (8%) of patients believed that they are feeling of "guilt" because of punishment from god or" Allah" to human being for their bad behaviors or works. Aljubran (2010) in his study mentioned that the nature of the disease cancer was and still is in many situations viewed as a death sentence and revealing the diagnosis to patient was considered cruel and inhuman(1). Moreover, (20%) of the sample believed that, their disease happened because of emotional stress. The diagnosis of cancer often means we experience a whole range of emotions. These may include shock, anxiety, sadness, relief, uncertainty and for some people, depression (11).

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INTERNATIONAL JOURNAL Of ACADEMIC RESEARCH

Vol. 2. No. 4. July 2010

Concerning table (4), it shows that Information about cancer treatment, including surgery, chemotherapy, radiation therapy were poor. The most frequent negative responses reported by patients were disfigurement, which represent (35%); most of those patients were having breast cancer. Surgical treatment will help psychological relief of patients and it may cause fewer side effects in this study (20%) of the sample reported a negative attitude toward the effect of treatment. Previous literature suggests that cancer patients were more likely to indicate support for cancer treatment than non-cancer patients, even when the treatment may not be curative and when the odds for cure are low (13). However Rohrer (2004) (9) suggested that daily contact with cancer patients may have positively influenced the attitude of individuals to high-risk cancer treatment, and when the patients are seriously ill and unable to make decisions on treatment. In addition, (10%) of the sample were concerned about financial difficultties as factors which may have affects on the program of the treatment. Financial issues can cause worry, when someone becomes ill, many Iraqi people find that a diagnosis of cancer affects their financial status and can cause various problems especially there are no system of insurance in Iraq and no health organizations available that can support or cover their costs of treatments (5). 4. CONCLUSION This study found that patients attitudes toward causes of cancer and its treatment were various. Most of the sample refers the causes of having cancer to tension and stress. The majority of them were female complained of breast cancer, some of the patients in this study they do not know the real causes of having cancer, which can be attributed to fact that people find difficult to talk about this fatal disease and they considered cancer as life threatened, and there are no hopes for treatment. Some of the patients in this study concerned about financial difficulties as factors that affect the program of the treatment In conclusion, patients expressed major differences in their perception of the different attitudes regarding the causes and treatment of their diseases 5. RECOMMENDATION The authors recommend paying considerable attention to the following issues: 1-More local research is required to study all public, patients, and physician s attitudes towards informing patients about their diagnoses of cancer 2-Increase knowledge about how cancer can affect relationship with partner. 3- Understand the most common reactions when informing patient about his diagnosis of cancer 4-Find ways to help patients, through governmental, private agencies or build up system of insurance in Iraq REFERENCES 1. Aljubran AH. The attitude towards disclosure of bad news to cancer patients in Saudi Arabia. Ann Saudi Med [serial online] 2010 [cited 2010 May 8]; 30:141-4. 2. Babor, T. Higgins-Biddle, J. Saunders, B. Montiero, M. The Alcohol Use Disorders Identification Test. 2nd ed. World Health Organization. 2001. [Cited 2010, March 3]. 3. BanJoni A. Jensen, and etc Tobacco Smoke Exposure in Nonsmoking Hospitality Workers before and after a State Smoking, Cancer Epidemiol Biomarkers Prev April 2010 19:1016-1021; Published Online First March 30, 2010; doi:10.1158/1055-9965.EPI-09-0969 4. Esther M. John, Jocelyn Koo, and Pamela L. Horn Lifetime Physical Activity and Risk of Endometrial Cancer -Ross Cancer Epidemiol Biomarkers Prev 1055-9965.EPI-09-1316; Published Online First April 20, 2010; 5. Mario Schootman, and etc Temporal Trends in Geographic Disparities in Small-Area Breast Cancer Incidence and Mortality, ,Cancer Epidemiol Biomarkers Prev April 2010 19:1122-1131; Published Online First March 30, 2010; doi:10.1158/1055-9965.EPI-09-0966 6. Melle M.Kearny N.Smith K.Management of cancer attitudes: a review European Journal of Oncology. 2009 .Vol.4, Issue 4 7. NHMRC. Australian alcohol guidelines: Health risks and benefits [online]. Commonwealth of Australia. 2001 [cited 30 July 2008 8. Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Canc. 2001; 37(Suppl 8): S4-66 9. Rohrer James E., Saeed Qassam, Saeed, S., Esler W. V., Beggs,D., Periman P.O., Hancock P. and Lim S.H., Attitude towards Cancer Treatment in Patients Attending a Community Cancer Center American Society of Hematology Annual Meeting Abstracts 2004 104: Abstract 3143 10. Russo and HRussoToward a physiological approach to breast cancer prevention. Cancer Epidemiol Biomarkers Prevention June 1994 3:353-364 11. Susan L. Slager, and etc, Genetic Susceptibility Variants for Chronic Lymphocytic Leukemia,Cancer Epidemiol Biomarkers Prev April 2010 19:1098-1102; Published Online First March 23, 2010; doi:10.1158/1055-9965.EPI-09-1217

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12. Tong Chu D Wekim-Sang, Pin kuo H.Ozacar R.Saljika F.Attitudes towards chemotherapy as assessed by patients versus physicians. International Journal of Lung Cancer and Other Thoracic Malignancy 2007 Vol.56, Issue 3 13. Voogt, E.Heide. Riejens, A.C. Leeuwen, A.F. Visser, C.C. Rijt, V. Vandermass Attitudes of patients with incurable Cancer toward Medical treatment in the last phase of life. Journal of clinical Oncology 2005 Vol. 23.No. 9 14. Younge D, Moreau P, Ezzat A, Gray A. Communicating with cancer patients in Saudi Arabia. Ann N Y Acad Sci 1997; 809:309-16. Web site: Attitude (psychology). From Wikipedia, the free encyclopedia. Available from: http://www.en.wikipedia.org/wiki/attitude_(psychology).

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