Quality of Life Assessment and Pain Severity in Breast Cancer Patients Prior to Palliative Oncology Treatment in Indonesia: A Cross-Sectional Study

Figures & data

Figure 1 Flowchart of the study participants.

Table 1 Sociodemographic Characteristics of 160 Advanced Breast Cancer Patients

Characteristics	N (%) or Mean ± SD
Age (years)^a; range	50.2±8.3; 29–76
Body Mass Index, kg/m^2 a	25.9±4.7
Systolic Blood Pressure, mmHg^a	128.8±16.6
Diastolic Blood Pressure, mmHg^a	80.6±9.9
Pain severity (VAS)^a	2.1±2.4
Place of residence
Rural	44 (27.5)
Urban	116 (72.5)
Educational level
Low (never/primary/junior/senior high school)	115 (71.8)
High (vocational/under-/postgraduate degree)	45 (28.2)
Marital status
Single/separated/widow/widower	29 (18.1)
Married	131 (81.9)
Ethnic group
Javanese	58 (36.3)
Sundanese	47 (29.4)
Batak	5 (3.1)
Betawi	25 (15.6)
Minangkabau	6 (3.7)
Bantenese	1 (0.6)
Malay	7 (4.4)
Others	11 (6.9)
Religion
Islam	138 (86.2)
Protestant	14 (8.8)
Catholic	7 (4.4)
Buddhist	1 (0.6)
Karnofsky Performance Status, %^a	80.68±6.8
History of surgery
Yes	155 (96.9)
No	5 (3.1)
Did not know	0 (0.0)
History of radiation
Yes	60 (37.5)
No	97 (60.6)
Did not know	3 (1.9)
History of chemotherapy
Yes	101 (63.1)
No	55 (34.4)
Did not know	4 (2.5)
Metastasis status
Yes	33 (20.6)
No/did not know	127 (79.4)
Pain therapy
Yes	9 (5.6)
No/did not know	151 (94.4)

Note: ^aMean ± standard deviation.

Abbreviation: VAS, visual analogue scale.

Table 2 Mean Quality of Life, Functional Scale, and Symptom Scale Scores

EORTC QLQ-C15-PAL	Mean ± SD
Global quality of life (15)	78.02±15.34
Functional scales
Physical functioning (1–3)	89.88±12.32
Emotional functioning (13, 14)	81.29±20.67
Symptom scales
Fatigue (7, 11)	22.76±28.41
Nausea and vomiting (9)	4.27±15.21
Pain (5, 12)	24.01±27.47
Dyspnea (4)	3.33±11.79
Insomnia (6)	17.50±33.11
Appetite loss (8)	8.54±23.93
Constipation (10)	4.16±17.13

Abbreviations: EORTC QLQ-C15-PAL, the European Organization Research and Treatment for Cancer Quality of Life Questionnaire Core 15 items for palliative care; SD, standard deviation; VAS, visual analogue scale.

Table 3 Linear Regression Analyses of Associations for Quality of Life Score

EORTC QLQ-C15-PAL	Model 1		Model 2
	Effect Estimate (95% CI)	p-value	Effect Estimate (95% CI)	p-value
Functional scales
Physical functioning	0.30 (0.15 to 0.46)	0.0001	0.09 (−0.03 to 0.22)	0.15
Emotional functioning	0.40 (0.27 to 0.53)	<0.0001	0.25 (0.14 to 0.37)	<0.0001
Symptom scales
Fatigue	−0.43 (−0.56 to −0.30)	<0.0001	−0.21 (−0.33 to −0.09)	0.0006
Nausea and vomiting	−0.26 (−0.40 to −0.12)	0.0003	−0.08 (−0.21 to 0.04)	0.20
Pain	−0.33 (−0.46 to −0.19)	<0.0001	−0.13 (−0.25 to −0.01)	0.02
Dyspnea	−0.05 (−0.19 to 0.08)	0.42	–	–
Insomnia	−0.47 (−0.61 to −0.34)	<0.0001	−0.25 (−0.37 to −0.13)	<0.0001
Appetite loss	−0.34 (−0.49 to −0.20)	<0.0001	−0.13 (−0.25 to −0.008)	0.03
Constipation	−0.16 (−0.31 to −0.01)	0.02	−0.01 (−0.13 to 0.10)	0.81

Notes: Model 1 is age and Karnofsky Performance Status score adjusted; Model 2 is adjusted for variables from Model 1, in addition to the other domains from the EORTC QLQ-C15-PAL questionnaire; All reported effect estimates have been standardized. Statistical significance of bold values when p<0.05.

Abbreviation: EORTC QLQ-C15-PAL, the European Organization Research and Treatment for Cancer Quality of Life Questionnaire Core 15 items for palliative care.

Table 4 Linear Regression Analyses of Associations for Pain Severity (VAS)

Variables/ EORTC QLQ-C15-PAL	Model 1		Model 2
	Effect Estimate (95% CI)	p-value	Effect Estimate (95% CI)	p-value
Age	0.04 (−0.10 to 0.20)	0.53	–	–
KPS score	−0.39 (−0.54 to −0.25)	< 0.0001	−0.28 (−0.46 to −0.11)	0.001
Emotional functioning	−0.29 (−0.44 to −0.14)	0.0002	0.15 (−0.31 to 0.01)	0.06
Physical functioning	−0.25 (−0.40 to −0.09)	0.001	−0.003 (−0.17 to 0.17)	0.97
Constipation	0.14 (−0.006 to 0.30)	0.06	–	–
Appetite	0.07 (−0.08 to 0.23)	0.35	–	–
Insomnia	0.28 (0.13 to 0.43)	0.0002	0.06 (−0.11 to 0.24)	0.47
Nausea	0.03 (−0.11 to 0.19)	0.61	–	–
Dyspnea	0.06 (−0.09 to 0.21)	0.43	–	–
Fatigue	0.21 (0.06 to 0.36)	0.006	0.007 (−0.16 to 0.18)	0.93
Quality of life	−0.34 (−0.49 to −0.19)	< 0.0001	−0.08 (−0.30 to 0.13)	0.43

Notes: Model 1 designates the effect estimates from univariable analyses of the single domain variable, age and KPS; Model 2 was adjusted for all significant variables from Model 1; All reported effect estimates have been standardized. Statistical significance of bold values when p<0.05.

Abbreviations: CI, confidence interval; EORTC QLQ-C15-PAL, the European Organization Research and Treatment for Cancer Quality of Life Questionnaire Core 15 items for palliative care; KPS, Karnofsky Performance Status; VAS, visual analogue scale.