Factors Influencing Health-Related Quality of Life After Gastrectomy for Cancer: Case Study of the University Teaching Hospital of Kigali (CHUK)

Abstract

Background: Gastric Cancer is the fourth most common cancer type and the second leading cause of cancer death worldwide. A good assessment of the health-related quality of life (QoL) in patients with gastric Cancer is vital to clinical practice to inform decision-makers on appropriate care. This knowledge aids patients, their families and treating doctors to address those factors that can be modifiable. Objectives: This study aims to assess factors influencing health-related Quality of life post gastrectomy for cancer patients in Kigali University Teaching Hospital (KUTH).

Methods: A prospective cross-sectional study of 71 patients operated for gastric adenocarcinoma from January 2017 to October 2022. Data Collection was done from February 2022 to October 2022, and the data was collected using a questionnaire including an instrument for assessing the quality of life, demographics and clinical information. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of life (EORTC QLQ-C30 STO22) site specific for gastric Cancer comprising 52 questions. Collected data have been entered in Epidata version 3.1 and then exported to STATA MP 13 for analysis.

Results: In this study, the majority of respondents are male, at 57.75%. The median age of the study participants was 63 years ranging from 22 to 82 years of age. The mean body mass index (BMI) is 20.7 ± 2.9. 70.42% are married. Only four participants (5.63%) attended university, 31% attended secondary school, and 49% attended primary school. Of the participants, 33.8% are classified in the third category of UBUDEHE, 49.3% in the second category and 16.9 % in the first category. All the tumours are gastric adenocarcinoma. Of the total participants (5.63%), 61.9% were in stage III, 22.5% in stage II and 15.5% in stage I. Forty-three per cent of the tumours were well differentiated, 38% with moderate differentiation and 18.3% with poor differentiation. Sixty-two per cent of the tumours were classified as Intestinal type by Lauren classification, 18.3% classified as diffuse type, and 19.7% as mixed. Fifty per cent of the participants underwent open partial gastrectomy, 36.6% underwent open near total gastrectomy and 12.68% underwent open total gastrectomy. Compared to the Dutch reference population most gastrectomy patients at CHUK have a slightly good score in Global HRQOL 70.4 vs 74, a good cognitive functioning at 90.14 (SD=14.52) and the lowest mean functioning score is in emotional functioning at 72.88 (SD=15.66). In general symptoms scales, the highest scores were found in financial difficulties scales. Factors associated with Poor global health status. Tumour differentiation and Lauren class of the tumour were found to be the accurate predictors of the global Quality of life (p=0.048) Conclusion: Patients who have undergone gastrectomy have a slight reduction in their global health-related quality of life. Most patients regain a good functional score. Most gastric cancer patients present at a late stage. Tumour differentiation and Lauren class are predictors of global Quality of life.