Quality of Life and Functional Status in Advanced Cancer Patients and its Association with Caregiver Burden: A Cross-sectional Study

Introduction: The incidence of cancer is likely to increase from 1.46 million in 2022 to 1.57 million in 2025 in India. Majority of the cancer patients are diagnosed at the locally advanced stage. Symptoms experienced by patients are multi-dimensional and not only impacts patients’ Quality of Life (QoL) and function but also increase caregiver burden. There is scarcity of evidence encompassing the intricate relationship between QoL, Functional status, symptoms and its association with caregivers’ burden. Aim: To assess the symptom burden, performance status and QoL among patients suffering from advanced malignancy and its correlation with caregivers’ burden. Materials and Methods: The present cross-sectional survey was conducted at Cancer Centre of Shree Krishna Hospital, a rural Tertiary Care Teaching Hospital between December 2018 and August 2020. All or simultaneous non-oncological critical illness were excluded. Detailed history and primary oncological diagnosis with staging were noted. Questionnaires viz. Edmonton symptom assessment system, EORTC QLQC30, Karnosfky Performance status, Zarit Burden Interview (ZBI) and Caregivers Strain Index (CSI) were administered by the investigator. Descriptive statistics, Analysis of Variance and correlation coefficient were employed to explore participant’s profile and association of patient characteristics with QoL and caregivers’ burden as well as their interactions. STATA (14.1) was used for the analysis. A p-value of less than 0.05 was considered statistically significant. Results: Out of 138 eligible patients, 125 (90.6%) participated. Majority of the participants were from age group 41-60 {72 (57.6%)}, had stage 4 disease {93 (74.4%)} and suffered from Head and Neck or breast cancer {71 (56.8%)}. The mean (SD) QoL summary score was significantly higher in patients experiencing up to 3 symptoms as compared to those experiencing 4 or more {82.29 (10.49) vs. 65.41 (11.50), p<0.001**}. The domains, global health status and financial difficulties and symptoms viz. fatigue, appetite loss and pain hampered the QoL. The mean (SD) Caregivers Strain Index (CSI), Zarit score and QoL summary score were 5.49 (3.00), 27.63 (12.75) and 77.1 (13.3), respectively. The CSI and Zarit score correlated significantly {r=0.69, p<0.001**}. The CSI score showed significant negative correlation with Quality-oflife summary score {r=-0.29, p=0.01*}. Conclusion: Despite advanced cancer staging, most patients remained functionally independent. QoL in advanced cancer patients was found inversely related with symptom burden and early palliative care may reduce caregiver burden.