Cancer Treatment and Life Quality in Adult Patients Essay (Article)

Introduction

The purpose of this study was to critically evaluate a decade of quantitative quality-of-life (QOL) measurement in patients undergoing bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT) as performed in adult patients. The problem of this research is to examine cancer treatment in adult patients by assessing patients’ quality of life (QOL) through cancer patients.

Literature review

The researcher explained the therapy behind bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) as a type of cancer treatment that has greatly impacted cancer patients. It is considered to be an effective therapeutic treatment of hematological malignancies such as chronic myeloid and acute leukemia. Healthcare professionals find the treatment effect because of the significant mobility and mortality it has on the patients of BMT or PBSCT. Researchers have examined the QOL in BMT recipients that have been published for the last ten years. This article was published in the last ten years and does not critically evaluate the QOL measurement and the implication of the study results. The purpose of this literature review is to provide a critical evaluation of quantitative QOL measurement in adult cancer patients undergoing BMT or PBSCT. The study was also aimed at identifying potential measurement issues. The research does not include articles of the last five years in this review (Hacher, 2003, p. 1).

Current knowledge about QOL measurement is that it helps in assessing patients with cancer and provides data to clinicians that may be used to guide their treatment decisions. However, how to evaluate QOL measures has not been clearly understood by researchers, a controversy that has let us critically examine differences in conceptualizing QOL that has led to conflicting QOL outcomes thereby letting us compare different studies in our review (Hacher, 2003, p. 1).

The study framework implicitly expresses the therapy behind the BMT or PBSCT in adult cancer patients in the literature review by failing to explain how the therapy is administered and how the treatment impacts the patient’s health. They also lacked consensus remains regarding the definition of QOL because actually, the definition was not explicitly expressed in the literature review (King et al, 1997). The framework is based on substantive theory which defines technology, the BMT or PBSCT. The framework relates to the body of nursing because it helps them understand the clinical meaningfulness of changes in QOL (Hacher, 2003, p. 1).

The research objectives were aimed at:

1. Discussing how quantitative QOL measurement has been used for decades in adult patients undergoing BMT or PBSCT.
2. discussing nursing implications in discussing clinical changes since QOL was invented
3. Describe how different types of instruments vary in QOL measurement.

The variables in the study are independent, dependent and research variables.

1. Independent variable is the variable whose values determine the value of other variables.
2. dependent variable is a variable that is being measured. It is therefore affected by the outcomes.
3. Research variables are the variables manipulated to obtain results

The study, therefore, used conceptualization to a person’s normal standards in regard to QOL measurement. Conceptualization mainly determines the ability of a person to focus on the ability of a person’s contributions to society through involvement in social roles. QOL measurement is better when a person’s social roles are fulfilled. And the fulfillment depends on the congruence between desired (independent variable) and the achieved roles (dependent variable). A person is happy when his desired goals are achieved and sad when not achieved. Therefore QOL affects perspective on the range of affective states from depression to euphoria which are the results of the outcome (research variable).

Demographic variables were determined by the physical, psychological and social domains of the measurements to ensure a comprehensive approach to QOL.

The research design used quality of life, bone marrow transplantation and stem cell transplantation to such for literature subjects in MEDLINE and SINAHL databases. The measure used was Restrict to Focus to choose articles for QOL patients undergoing BMT or PBSCT. Subjects were assigned to two phases; phase one and phase two. Pilot studies were conducted by the researcher to assess the reliability and accuracy of the chosen research instruments. The single instrument for measuring QOL was examined to determine whether the tool provided domain scores, QOL scores or both of the scores (Hacher, 2003, p. 11).

Inclusion criteria in this review consisted of quantitative research articles that were published between January 1990 and January 2000 with studies of adults’ patients undergoing BMT or PBSCT and the exclusion criteria were meeting abstracts and unpublished studies in BMT or PBSCT. The method used to obtain the sample was the Restricted to Focus method. The sample size included 67 articles and 34 of them were excluded from the review since they did not meet the inclusion criteria. The reason for the exclusion was that some of the articles employed qualitative methodologies, others were not written in English, they examine pediatric patients and research comments were excluded. The 33 inclusion criteria articles examined two journals with the most recent reports for analysis (Hacher, 2003, p.11).

• the characteristics of the sample included examination of QOL with respect to PBSCT. Out of the studies reviewed, only three studies that accounted for 9% focused on QOL after PBSCT. Patients who were undergoing both types of transplants were included in the studies.
• The research included recent articles of attrition number (n=32) as a number of methodological characteristics. The majority of the studies of 88% examined the QOL in BMT patients and 9% focused on QOL after PBSCT.

The instruments strategy used in this review were questionnaires. The studies were categorized into two phases; Phase one and phase two. In determining the quality of life in Peripheral Blood Stem Cell Transplant and Bone Marrow Transplant, researcher Molassiotis & Morris (1999) used EORTC QOL-C30, BMT questionnaires, PAIS and HADS. These instruments used nominal measure since subjected were studied for a range of 13-92 months. Marks et al (1999) used MOS-SF36, SLDS and employment questionnaires with nominal measurement used numerical values of 42 months ranging 23-95 months. Hann et al (1999) used instruments POMS-F, FSI, STAI, CES-D used ordinal measurement since baseline was used just about the transplant was reinfused and towards the end of the treatment and Winner et al (1999) for Autologous BMT used nominal measurement where subjected were studies on a range of 13-64 months and used FLIC, SDS, sexual questionnaires as their research instruments (Hacher, 2003, p.5).

In another study of Quality of Life in Pheripheral Blood stem Cell Transplant and Bone Marrow Transplant Studies, researchers Zittoun et al (1999) used ordinal measurement where the treatment was performed on chemotherapy patients 10 days later and 10 days after time two. The instruments used were modified EORTC QOL core question, leukemia/ BMT module and HADS. McQuellon et al (1998) used a longitudinal study design with ordinal measurement of the time period of 100 days post-transplant and one year later transplant. The instruments used were FACT-BMT, POMS-TMDS, MOS-SSS, CES-D, PSR and interview questions. Researcher Kopp et al (1998) used a cross-section study design with ratio measurements where BMT patients of ration X=5.33 months for a period after one year ranging 1-11 months and one year after BMT:x=59.2 months ranging 12-30 months. These instruments were used to determine the measurement of QOL domains. The instruments used to measure emotional domains were EORTC, QLQ C30, FACT-BMT, MOS-SF-36, FLIC, CARES, SIP, COH QOL, BMT, SWED-QUAL, SLDS and for social economic status were FACT-BMT, SWED-QUALM QLI, COH QOL-BMT and FLIC. The purpose of these instruments was to measure QOL domains (Hacher, 2003, p.3).

The procedure for data collection was by use of questionnaires.

Research implications and findings were that QOL measurement is used in clinical studies will be able to bridge a gap between QOL researchers and oncology clinicians. This represents an important area for future growth. If supported by nursing research, the findings will be clinically meaningful to the patient since evidence-based practice improves the care of transplant patients (Hacher, 2003, p.15; Burns & Grove, 2009).

The study limitations identified in the research was that the sample size selected in the review was rather too small since the subjects were fewer than 100. Therefore, studies generated from the fewer sample may be not used as a general analysis for patients undergoing BMT or PBSCT. Also, the sample affected the ability of the researcher to find statistical significance from the findings that may be clinically meaningful. In the research design section, most of the studies used cross-sectional design either than longitudinal. Longitudinal would have been used because it carefully examines overall QOL and QOL domains over a long period of time in the same patients. This way, the measurement increases the confidence and reliability of study findings (Hacher, 2003, p. 12).

The researcher generalized the findings by concluding that BMT and PBSCT procedures and marrow ablative regimen result in toxicities, therefore the QOL measures provide a more complete evaluation of treatment outcomes. And because no gold standard existed in QOL measurement, it was important to understand the QOL instruments (Hacher, 2003, p. 16).

The implication of the research to nursing practice does not have that much of an effect since the instrument used, QOL does not exist in clinical practice. However, a list of QOL measurements has grown over the years and more clinical practices are using them (Garrat et al, 2002). The gold standard in QOL assessment in patients undergoing BMT or PBSCT does not exist the study, therefore, does not have any effect on their nursing practice (Hacher, 2003, p. 15).

Suggestions for further studies were warranted to review QOL in BMT and PBSCT in research findings in the context of normal life and satisfaction of conceptualizations.

The description of the study is not sufficiently clear because the QOL instrument is not used in the clinical arena. Therefore, the selection of criteria for choosing the instrument is not clear. Clinical practice requires a gold standard assessment for QOL for patient’s undergoing BMT or PBSCT while this measurement does not exist. A research environment requires a tool to provide a transplant technician with information that they may need to assess patients’ QOL which was not availed. Therefore, no QOL instrument provided satisfactory results to capture all the necessary QOL information needed for clinical practice (Hacher, 2003, p.15).

References

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