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Symptom Burden and Functional Dependencies Among Cancer Patients in Botswana Suggest a Need for Palliative Care
Mark Lazenby1, Miriam Sebego, Norman Carl Swart
1Author Affiliations: Yale University School of Nursing, West Haven, Connecticut (Dr Lazenby and Mss Lopez and Peterson); University of Botswana School of Nursing, Gaborone, Botswana (Dr Sebego and Mr Swart); Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Mr Swart); MD Anderson Cancer Center, University of Texas, Houston (Ms Lopez); Park Nicollet Methodist Hospice, Park Nicollet Health Services HealthPartners Health System, Minneapolis, Minnesota (Ms Peterson).
Background:
Palliative care and cancer nursing in sub-Saharan Africa is hampered by inadequate clinical resources and evidence base but is central to symptom management amid the growing cancer burden.
Objective:
The aim of this study is to describe symptom burden and functional dependencies of cancer patients in Botswana using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) and Enforced Social Dependency Scale (ESDS).
Methods:
A cross-sectional multisite study was conducted in Gaborone, Botswana, from June to August 2013 using MSAS-SF, ESDS, and Eastern Cooperative Oncology Group (ECOG) performance status at 1 time point. Descriptive statistics, tests of association, correlation, and scale validity were used.
Results:
Among the 100 cancer patients, 65 were women, 21 were inpatients, 48 were human immunodeficiency virus-positive, 23 had gynecological malignancies, 34 had stage 4 disease, and 54 received chemotherapy only. Sixty-four reported pain; 54, neuropathies; 51, weight loss; and 51, hunger. Most distressing symptoms were weight loss, body image, skin changes, and pain. Recreational/social role was most affected by cancer. Cronbach's α for both the MSAS-SF and ESDS was .91. Variations in means for MSAS-SF and ESDS were associated with ECOG grade 2 (P < .05); the ECOG moderately correlated (0.35) with MSAS-SF (P < .01). No associations with human immunodeficiency virus status were found.
Conclusions:
Patients reported distressing levels of cancer pain, weight loss, hunger, and dependency in recreational/social activities. The Setswana translations of the MSAS-SF and ESDS were found reliable to assess cancer patients' symptoms and function.
Implications For Practice:
Nurses trained in palliative care are needed to meet cancer patients' pain and symptom management care needs.
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