Predicting Quality of Life in Taiwanese Women with Breast Cancer and the Role of Complementary and Alternative Medicine: A Mixed-Method Study

Abstract

Breast cancer is a common form of cancer in women. In Taiwan, breast cancer ranks as the second highest incidence of all cancers and is the fourth leading cause of cancer death for women. Being diagnosed and living with breast cancer involves a series of stressful life events that impact on many aspects of women’s quality of life (QOL). Consequently, many women with breast cancer have developed particular coping strategies and used complementary and alternative medicine (CAM) to enhance their QOL and well being. While research has shown that cultural and contextual factors affect QOL in women with breast cancer, it is unclear how well personal and environmental variables, specifically treatment-related stressors, coping, and CAM use, predict QOL in Taiwanese women with breast cancer. The overall purpose of this study was to identify the predictors of QOL and to explore the role of CAM use in Taiwanese women with breast cancer.

A mixed methods two-phased study was used. The study was underpinned by the pragmatist paradigm, and employed a sequenced combination of quantitative approach followed by qualitative inquiry. The complementarity approach was chosen to enhance, enrich and illustrate the results from one method with the results from the other method. Phase One used a predictive survey to identify the relationships between QOL and its hypothesised predictors in a convenience sample of outpatients from a large general hospital in eastern Taiwan. The survey data were collected by face-to-face interviews using structured instruments that comprised: a demographic profile sheet; and five scales, including symptom distress, anxiety and depression, internal health locus of control, use of coping strategies, and QOL; as well as number of individual items in relation to CAM use. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer (EORTC QLQ-C30) was used to measure the QOL. It is composed of five functioning scales, a single scale for global QOL, three symptom scales, and six individual symptom items. A number of multiple regression analyses were undertaken to identify the significant predictors of each of the EORTC QLQ-C30 scales.

A total of 240 women were invited to participate in study. The overall response rate was 81.7% (n = 196), which is considered statistically high. The majority of respondents were high school educated, married, Buddhists, not currently employed, and with a mean age of 53 years. The average time since diagnosis was 28 months. Most women were diagnosed with Stage II breast cancer, and had had a mastectomy with no recurrence of the disease. Approximately 74% of the women reported that they were CAM users before and/or after their diagnosis. The women’s perceived QOL was predicted by several independent variables. A combination of the independent predictive QOL variables explained 5.7% to 43.8% of the variance. In particular, symptom distress, anxiety and depression were the most influential variables in the prediction of QOL. Additionally, the use of coping strategies, such as planning coping, denial, humour, venting, and self-distraction, made statistically significant contributions to the prediction of various aspects of QOL.

Phase Two of the study used a qualitative exploratory design to describe the role of CAM use in the context of Taiwanese women’s health needs and perceived QOL, from the perspective of women with breast cancer. Various perceptions were integrated and further illustrated the women’s use of CAM. Three major domains were identified: women’s reasons for CAM use; influences on decision making regarding CAM; and effects of CAM use. Within these three domains, eight major categories emerged: dealing with emerging health problems through CAM use; regaining balance in life; fighting cancer to enhance health; family and friends’ influence; communication with health care professionals; beliefs about CAM; living a normal life through using CAM; and building strong social networks.

This study supports the stress and coping model proposed by Lazarus and Folkman, that indicated that people use particular coping strategies in response to the situation and context; and these, may affect their adaptation. The findings suggest that the use of certain coping strategies and CAM use may be integrated within the conventional biomedical treatments to help improve breast cancer patients’ well being. Understanding CAM use in women with breast cancer may inform clinical practice and assist health professionals to provide compassionate and comprehensive cancer care, and thus support women in making informed treatment decisions.