Psychological distress, quality of life, coping and adjustment: a comparison of Oshiwambo-speaking and Sesotho-speaking patients with breast and/or cervical cancer

[摘要] English: Psycho-oncology emerged as a formal discipline in the mid-1970s. Much progress hasbeen made in both research and clinical practice, specifically in developed countries.Psycho-oncological research in developing countries, including Africa, remains scant.Cancer has been viewed as a disease of the western world. However, it is estimated thatby the year 2020 cancer incidence in developing countries will surpass that of thedeveloped countries. Given this reality and the high mortality from cancer in Africa, thedevelopment and progression of psycho-oncology on the continent is essential to providea basis for research and clinical practice. Against this background, this exploratory andcomparative study aimed to investigate psychosocial aspects of cancer patients in twosouthern African countries.The major objective of the current study was five-fold. Firstly, to provide an overview ofpsycho-oncology research in Africa, with a brief historical perspective of internationalpsycho-oncology. Secondly, the study explored the presence of psychological morbidityin Oshiwambo-speaking Namibian and Sesotho-speaking South African cancer patients.Additionally, the feasibility of the use of a single-item visual analogue screeninginstrument of psychological distress was explored. Thirdly, the study explored quality oflife (QoL) of cancer patients in these two groups. The association of QoL andpsychological distress was also explored. Fourthly, the study explored perceived selfefficacyfor coping with cancer in these two countries. Fifthly, adjustment to cancer wasexplored. By its nature of being a comparative study, Oshiwambo-speaking Namibianand Sesotho-speaking South African patients were compared with regards topsychological morbidity, QoL, self-efficacy for coping and adjustment to cancer. TheDistress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), 26-itemWorld Health Organization Quality of Life measure (WHOQOL-Bref), Cancer BehaviorInventory (CBI) and Mental Adjustment to Cancer (MAC) scale were used. The sampleconsisted of 103 Namibian and 126 South African patients with a histologicallyconfirmeddiagnosis of breast or cervical cancer.Results suggest that a DT cut-off of 3 is the ideal cut-off score for both groups. Usingthis DT cut-off, approximately half of the patients in both countries reached the case criteria for psychological distress, while a third were identified as distressed on theHADS. About a third scored above the HADS anxiety cut-off. Approximately 30%South African and 20% Namibian patients met the depression case-criteria. With regardsto QoL, Namibian and South African patients in this study appeared to have comparableQoL on most domains. However, Namibian patients appeared to fare better on thepsychological domain. Psychological distress, anxiety and depression correlatednegatively with all facets of QoL.Results suggest overall high self-efficacy for coping with cancer for the entire studysample, and the Namibian group obtaining significantly higher scores. Self-efficacycorrelated negatively with psychological morbidity and positively with QoL for bothgroups of patients. Correlations with psychological morbidity were stronger for SouthAfrica, and comparable for QoL. Namibian and South African patients reportedcomparable and probably high levels of hopelessness/helplessness responses to adiagnosis of cancer. Fighting spirit correlated negatively with psychological morbidityfor both groups, however the magnitude of the correlations were statistically different.Helplessness/hopelessness correlated positively with psychological morbidity. Anxiouspreoccupation, fatalism and avoidance responses yielded mixed and conflicting results forthis study. QoL and self-efficacy correlated positively with a fighting spirit response.This study highlights the presence of psychological morbidity among cancer patients insouthern Africa, and supports international research. It further highlights relationshipsbetween psychological distress, QoL, self-efficacy for coping and adjustment to cancer.The results could have implications with regard to clinical practice within Namibian andSouth African oncology settings. However, psychological interventions must take intoaccount geo-socio-cultural differences of cancer patients in the various African oncologysettings. Further research in African psycho-oncology research is recommended.

[发布机构] University of the Free State